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Parts Is Parts

Michael 5 Comments

I haven’t written much recently because I haven’t had much to say lately. At least not in mixed company.

Actually I’ve had a lot of doctor appointments, tests, and a even a procedure done in the past couple weeks and I’ve been tired! Today I was at the dentist’s office sitting in another one of those waiting rooms with one other gentleman sitting across the way. You know how some people will go to extremes not to speak with another person in a small space, even so far as to not even make eye contact? This guy was not one of them! He would probably start a conversation with the driver of the car in the neighboring lane at a red light. I wasn’t sure if he intended on speaking with me or just talked all the time, but with an occasional “uh huh” or “umm” and a “oh yeah” or two he kept up enough conversation for the both of us. It was almost like being married again. (I’m sorry ladies, I just couldn’t resist.) (Yes, maybe that is one of the reasons.) One thing he brought up in his remarks is how as we age we pick up more spare parts as he pointed to various body parts.

It’s not something we might think about and if we do that we’d admit to ourselves, but it is quite true. Even at my tender age I have a variety of pieces that are not original equipment. And they don’t all have to be as dramatic as replacements of major internal organs. Or even minor internal organs. I would wager almost everybody reading this is helped along in some daily activity with something that was not there on Day One.

Those spare parts could be something obvious and visible like a pair of glasses or a hearing aid. It might be something not quite so obvious but still visible if you look hard enough like a dental crown or implant. If you’re looking that hard it should be at a person you know pretty well, certainly better than a random waiting room partner. You also shouldn’t stare at somebody with a larger spare part such as a prosthetic limb.

SparePartsSome spare parts are less obvious and often invisible. Artificial lenses often reside in post cataract surgery eyes correcting clearer but weaker vision; pacemakers and implanted defibrillators keep weak hearts working stronger. A friend’s father was an early recipient of an early implanted defibrillator. It worked dandily, even way back then. Except whenever someone triggered the garage door opener they also triggered a mild shock to his heart. They fixed that by replacing the opener. Easier than replacing the father. And some spare parts are outright replacements like a swapped out heart, lung, pancreas, liver, even a kidney.

Spare parts. They may not add up to what became the 1970s version of the Six Million Dollar Man, but to the person with a new heart or not blurred vision they are priceless.

Hurry Up and Wait

Michael 3 Comments

It is annual exam time and I’ve been spending a lot of time in doctors’ offices this week. A fixture of doctors’ offices is the waiting room. Some waiting rooms are actually nice pleasant places to be that make lasting impressions on the patients there. I recall from my youth the dentist who had fish tanks, aquaria even, with sunken pirate ships, treasure chests, and probably fish but as a six year old boy I mostly remember the pirate stuff. Some waiting rooms are actually one eyebrow raising (which I have never been able to master) like the gastroenterologist’s office who had an aviary, a bird cage even, where several colorful birds and pages noting why they were actually beneficial in a doctor’s office and probably plaques to identify the birds but as a sixty year old waiting for a colonoscopy I mostly remember just that there were birds. But mostly doctor’s office waiting rooms are sort of bland with sort of cheap furniture with sort of old magazines with small screen TVs hanging in an upper corner of the room sort of over there by the sliding glass window that somebody opens at irregular intervals to check in new arrivals, copy insurance cards, and distribute privacy notices. To me waiting rooms seem almost oxymoronic. Not much waiting goes on in them, and except for the one with the birds, most don’t have much room. The real waiting goes on in “the other room.” The exam room. The surgery in 18th century colonial speak. Back there.

We all know the drill. The office nurse sticks his or her head out into the waiting room, calls out a first name hoping there is only one Augustine (thank you HIPPA), leads Mr. X down the hall to the scale, then places him into “the other room.” There things start optimistically. A blood pressure is taken, the little finger thingie that measures oxygen in your blood is put on your finger, maybe some questions about changes in meds or general health are asked and answered, notes are made on the computer, a smile is flashed, the line “The doctor will be right in” is sing songed your way (sing sang?), and the door is pulled shut behind her. Or him. And now we wait. There are never any old magazines in the little room. Maybe you brought your phone or tablet and still have enough battery power to play a game or thirteen. But you don’t because you know you’ll be moving up to level 57 when the knock on the door comes.

DoctorSignSo I play a different game while I wait in “the other room.” Guess The Footsteps. For example, if I know somebody ahead of me went in with a walker and I hear the slide of it I might figure that person is on the way out so then from recalling how many patients went in between him and me I can guess if I have enough time to finish that crossword puzzle. If I hear two sets of footsteps that’s the nurse and new patient coming in so that doesn’t help with figuring out how much longer it will be. A single set needs evaluating before I can determine its significance. A slightly hesitant pace might be a patient leaving making certain to take no wrong turns. (I’ve noticed that although you are always escorted to the exam room it’s about a 50/50 chance somebody will accompany you out. And yes I have gotten lost along the way.) (Sigh.) A fast pace barely heard through the closed door is the nurse returning to the waiting room to bring back another patient. A fast pace clearly heard approaching and receding is the office person who handles the billing and probably the only staff member other than the doctor not in scrubs and tennis shoes. A purposeful step that pauses outside your door with an accompanying rustle of paper is the doctor arriving at the wrong door and putting your chart back in the holder mounted on the wall next to the door. And somehow with all that marching up and down the hall, when the doctor does knock once and open the door to finally get on with the main event, I never hear those steps.

So that’s how I spend my time waiting. It might not be all that much fun but I got a whole blog post out of it! I wonder if this was how Milton and Bradley got started.

Happy Holidays

Michael 3 Comments

Happy Easter Monday the day after Easter to Roman Catholics and most Christians, Holy Monday the second day after Lazarus Saturday and day after Palm Sunday to Orthodox Catholics and many Eastern Rite Christians, Chag Sameach as we are at the Fourth Day of Passover or Pesach to the Jew Communities, an early Ramadan to Muslims whose holy month starts in just under two weeks on May 5, a late New Year which was April 19 to Theravada Buddhists, and again a late Hanuman Jayanti celebrating the birth of Hanuman one of the prominent heroes of the Indian super epic Ramayana also on April 19 per the Hindu calendar. My apologies to all if I got any dates, names, or reasons wrong or I missed anybody completely.

I bring this up because it’s worth bringing up. All diverse peoples all taking time out from a hectic time of year, just as seasons are changing and schools are ending and graduates are starting new lives and gardens and yards are being tended for the first time in a while and probably bunches of other stuff that you’re doing and I hadn’t written down. These aren’t new celebrations. None of these were thought up by a greeting card company or a marketing firm. Frankly, if you are celebrating one of these you probably aren’t paying much attention to any of the others. Yet together, within a 2 week period almost all of the world will be celebrating as they have been celebrating for millennia. And they will be, and I dare say most of us will be, celebrating religion.

For all that the world has given us it is our religions that live on. They are our collective identities. The sources differ, the customs differ, the names differ, but the reason is one. To each of us there is a path, a way, a trek through ourselves to a greater end. Don’t talk about politics or religion at the dinner table we are cautioned. Politics yes, never talk about politics. Blech! But religion. I’m not so sure about that. I think if we saw beyond our own and looked not at how others celebrate we would find what we celebrate is quite well known to each of us and we might find that each of us is reflecting in and perhaps even a part of the one across the heretofore forbidden common table.

I use the word celebrate very specifically. Not that we worship or to whom we pray or what we venerate. We celebrate. Our religions offer us community, stability, an anchor that contributes to our sense of purpose and fulfillment, to our well-being, and to our need to belong and to share. Religion makes us who we are. And it makes us happy.

I think some of that happiness is defined by religion itself. If you think narrowly that happiness is defined by possessions, religion won’t make a difference to you. But to those of you who include things like friendship, accomplishment, guidance, peace, and comfort in the Top Five Ways to become Happy, religion has those. It doesn’t hand them out. You aren’t baptized and immediately become the ultimate guide to peace and tranquility. There is work involved on your part. But it opens the path and begins the build up of happiness. Religion provides the structure to achieve the goal.

Somebody out there may be saying “Religion! Bah, humbug! All religion is good for is to strike fear of an unforgiving god in an unsophisticated person and ask for money.” I say those are they who have not experienced faith and are among the ones whose top ways to become happy are get money, get power, and get laid. And that’s fine if that’s what they want to believe. Just don’t tell me my way is wrong. And don’t be offended now when I see so many others celebrating and I wish the world collectively …

“Happy Holidays!”

Coexist

Letting the EGGS out of the Basket

Michael Leave a comment

For the most part American marketing and merchandising has made a mockery of holidays. Thanksgiving takes a back seat to Black Friday. Washington’s Birthday isn’t even called that so the Presidents Day car sales can be stretched over weeks rather than a single weekend. Halloween, St. Patrick’s Day and Cinco de Mayo vie with New Year’s Eve for most traffic accident honors. Flag Day is forgotten. Memorial Day and Veterans Day would be forgotten but for gratuitous Facebook posts. New Year’s Day is really Mattress Sale Day. The Fourth of July is as much about back to school sales as celebrating the winning of the freedoms that allow free markets and the free speech to promote them. And Christmas, Christmas is the poster child holiday for Freedom of Religion protesters and rejoinders. Yet for the same most parts, Easter has been left pretty much alone.

Maybe even crass marketers saw reason to shy away from the holiest of Christian holy days. Other religious groups have had similar high holy days spared the merchandising of their sacred events. There have always been Easter sales but not outright assaults on religious sensibilities. The quiet 1990s marketing of dresses and suits was not much different than the diffident 1940s Easter bonnets sales. They were almost presented as a service. “You have something special to do; we have something special for you to wear.”

We even made it partway into the 21st century not desecrating Easter. Much. But I fear that time is over. Over the past few days I’ve seen television commercials, opened hard copy and email promotions, heard radio advertisements, and even saw on-line banner ads touting EGGS-cellent opportunities, EGGS-traspecial specials, an EGGS-travaganza of savings, and EGGS-tra Savings on all your needs. Isn’t that clever the way they made all those cute little references to EGGS. And just in time for Easter because of course, EGGS were the main course at the Last Supper. But just in case you missed it, all those references to EGGS were just like that, in all caps, E-G-G-S. One stood out in its subtlety.

HOP on over for a BASKET of savings.
You won’t have to HUNT for the best deal
At our new and pre-owned
Springtime EGGStravaganza of Savings!

(Note how they used Springtime instead of Easter so it has universal appeal.)

eggsSo far I have resisted the urge to save hundreds, even thousands during this EGGS-tra special buying time of year. I’ll spend my special time in church rather than at the car lot. I just hope like the how the commercials for tax preparations all disappear in April 16 and how political ads vanish the first Wednesday after the first Tuesday after the first Monday of November, all the EGGS will find their way back into the basket next Monday. Until then, it’s really going to be EGGS-asperating.

 

 

No Business Like Shoe Business

Michael 2 Comments

Have you ever had a day when to want to say something but are sure it will unwarrantedly ruffle someone’s feathers? You don’t mean to. You really just have a thought you want to express but, particularly in the now when every thought, let alone action, regardless of intent is either forgiven or vilified depending on the political affiliation (real or perceived) of the thinker and/or actor, you hesitate. So I’ve been very concerned about bringing this up but I just can’t hold it back any longer. Where the hell are all the brown shoelaces?

I don’t need new shoelaces right now but there is a pair (are a pair?) (no, is a pair) fraying and will surely and shortly break. I’d like to be proactive and have the replacement on hand if not actually on shoe before that happens but I can’t find laces for brown dress shoes. White for athletic shows yes. Hundreds of any length and thickness imaginable. Thick black laces in lengths clearly for boots most probably fitted with steel toes are everywhere. Those rawhide looking things for hiking shoes hang on racks by the score of scores. Some places seem to begrudgingly devote a hook, maybe two, to black laces appropriate for dress shoes, but brown…um, nope. Not out there.

I think it started with Casual Friday. I never understood that. Why should somebody making an appointment with a banker, broker, car dealer, or human resource manager on the last day of the week be made to feel like the appointment maker has already started on his or her weekend? Why do Tuesday appointments get treated more formally than those who scheduled on Friday? I guess others felt the same way because it seems there is no more Casual Friday. It is now Casual Week. (I think I also once mentioned an off shoot of this. That is, why everybody who has anything remotely to do with medicine now feels the need to wear scrubs. If I hit the next billion dollar Power Ball jackpot and feel the urge to endow a hospital nephrology department, I do not want to meet with an administrator in a Looney Tunes scrub top to discuss my multimillion dollar gift. Just putting that out there.) Anyway, that’s how it all started – when men shed their suits and ties.

Women can be just as casual but a woman knows there are times when “dress” means more than the garment. And still have them in their closets. The garments that is. (That are?) I am certain if women’s dress shoes required laces there would be sufficient stock from which to choose.

BrownShoesI guess we men just lost our will to dress up. And stores responded. The Men’s Department yielded space to The Active Male, Sports and Leisure, and You’re Only as Young as You Feel departments. And the space they gave up used to be occupied by shoelaces for dress shoes. Even brown. Well I want it back! I want that space that used to hold tie bars and pocket squares. I want a belt that isn’t reversible. I want shoes that need polishing. And I want brown shoelaces!

I sincerely apologize for feathers that have been ruffled and trust this won’t result in some social media frenzy. But one last thing … if you should happen to have knowledge of brown shoelaces appropriate for a men’s dress shoe with 4 eyelets please email me their location. I will not share your information.

Thank you

 

Just a Number

Michael 2 Comments

Welcome to Major League Baseball 2019. Today is opening day. I remember way back when I was a kid, a youngen, a tyke, a small fry even, on opening day we would sneak our transistor radios into school with our earphones surreptitiously threaded up our short sleeves so the teacher would not know we were listening to the game instead of conjugating irregular verbs. Like she really wasn’t going to notice that hunk of plastic on the desk. But we were young and stupid. Much like the players we cheered on. Oh, not the stupid part. Young. They were young, just like us. Younger than I ever, even to this day, realized.

BaseballOf the four major American sports, baseball has often been maligned as the old man sport. It’s slow, it’s boring, nothing happens for long stretches, anybody can play baseball. Eh, probably that last part is true. It does not take much to play baseball. A bat, a ball, a glove, and an open field and you have the minimum requirements for the game. But it’s not an old man’s sport. No, not at all. You see, also of the four major American sports, baseball is the only one opening this year’s season with nobody playing who was playing MLB baseball in the 20th century. Nobody taking the field today was there on opening day in 19-anything. No one. Not one. Nary a soul.

That’s only been 19 years. That’s one less than 20. For some of the younger folks reading those words 20 years could be a large percentage of their lives and might still seem like a long time. But looked at from a regular job perspective, twenty years doesn’t even get you a commemorative watch. Apparently for Major League Baseball, less than twenty years gets you retirement. Even for a government job you need to put in the “whole twenty” to cash in on a cushy pension.

Only 19 years. If a player started his major league career at the seemingly ancient age for a rookie of 25, he is among those sitting in lap of retirement luxury and not yet 45 years old. I had dreams of retiring at 55. I figured if that was old enough for the government to say I could start drawing from my IRA without penalty, and considering “retirement” is right there in the name of the account, then it must be the perfect age to target for retirement. Of course I knew I would more likely work until I hit 75. But 45. Forty-five! Wow.

I’m old enough not to be impressed by terribly much but that report really floored me. I’ve watched hockey players playing the game for over 20 years still this year. There is considerably more physical contact in hockey than baseball. Football and basketball both still have players who were wearing the uniforms from way back in the last century. Nobody ever called either of those an old man’s sport. Of any of them I’d not have pegged baseball as the first sport to lose everybody from the pre-2000 days.

As “they” might say, time marches on. It just doesn’t circle the bases.

 

Yes, No, Maybe

Michael 2 Comments

I’m a sucker for a good survey. Not the ones people with clipboards try to take at the mall while intercepting you rushing out of Spencer’s attempting to make it to Macy’s before the rest of the family realizes you’re missing. Not the ones that pop up at the bottom of otherwise legitimate online news articles implying (inferring?) you can turn your free time into earnings time. I mean real surveys by real polling outlets for genuine marketing, opinion, or news pieces.

Some years ago I shifted all my verbal correspondence to my mobile number and did away with the landline phone. I was all about eliminating unnecessary or duplicate services and as I was more likely to carry a cell phone around with me than I was a corded (or even cordless) device tied to a hard connection in the wall, the cell won. Unfortunately for as cutting edge as we want to believe our smart phones are and how sophisticated we talk ourselves into believing the service providers may be, they still haven’t figured out how to handle Caller ID. Or for all I know they have and haven’t yet figured out how to charge for such an archaic concept, or the government has decided it is in our best interest not to know who is on the other end of the call, or it is in their best interest not to get into a perceived battle over privacy issues some nut might claim. As a result I don’t answer a call unless it is someone in my contact list or is a number I recognize. As a further result I no longer get to enjoy participating in one of the few random phone surveys that still might come my way.

Now I do belong to a few opinion panels and occasionally get to answer a poll or do a survey on line. I also will answer surveys published by those I follow on social media if the topic interests me and I keep an eye out for new invitations from new or established pollsters. It’s all in fun for me. I haven’t filled any free time with “earnings time” and the most I’ve ever gotten from answering a survey was a $15 gift card.

I like surveys. And I think I like giving people a piece of my mind, but then that’s what this blog is for. And now you know we’ve gotten to the meat of the story, the heart of the topic, the reason for being here you and I. Who is getting a piece of my mind today?

You may not recognize it from my writing but I try to keep myself on the right side of the grammar and usage police. Some time ago I taught a few classes at a university. At that time there was a rather decent size to-do brewing over perceived favoritism demonstrated by the grading of essay type questions on tests and we were encouraged to administer multiple choice tests and to use machine gradable answer cards. (This was in the 90s. Now personally I think somebody had purchased a bunch of these cards for a dying technology and that somebody saw their budget approval rights in jeopardy if said cards did not find their way off the storeroom shelves. Just thinking out loud.) Anyway, I became the Mad Professor of Multiple Choices. Every question not only had three seemingly logical answer choices (a, b, and c) but also multiples of those choices (a and b, a and c, b and c) and total inclusion (all of the above) or exclusion (none of the above). I was always careful to arrange the answers so “all of the above” came before “none of the above” so I could not get drawn into the argument “but Perfessor Evil Tester, how can ‘all of the above’ be right if it includes something that might be right and ‘none of the above’ sayin’ that none of them is right ’cause there ain’t no way nothing can be right and not right at the same time.” I knew my tests, and my test takers! If you consider that a multiple choice test is just a big survey you could say now I know my surveys also.

So, to make a long story short (and aren’t you glad you’re not getting the long version?), I had to scratch my head when this little gem popped up in my Facebook feed, although it was Facebook.

Survey

Hmm. Did you watch TV last night? Yes, No, Not Sure. Not Sure? Really? You can’t tell if you were watching TV? Not “Both yes and no depending on when last night.” Not even to old “Prefer not to answer.” Nope, they really asked “Not Sure.” How are you not sure? Wait, I have it. You were watching a television network broadcasted show via a streaming service on your handheld mobile device. That makes sense. Yeah. Probably an offspring of the “Hey Perfessor” guy.

Oh, just so you know, somewhere in this country the “Hey Perfessor” guy is part of somebody’s health care team. Let’s just say I “prefer not to answer.”

Too Often In a Blue Moon

Michael Leave a comment

Did you see the “Super Worm Equinox Moon” last night? I saw a moon. It was a nice moon. Big, bright, beautiful in a moonly sort of way. Didn’t see no worms though. I don’t want to get into a “remember when” thing here but…remember when the moon was just the moon. Sometimes it was full. Sometimes you looked up. Sometimes you didn’t. Sometimes you went ahh. The moon was just “The Moon.”

Songs were written about it, couples shared their first kiss under it, now and then a couple got engaged under it, probably some couples got pregnant under it, ghost stories were told in its light, and Halloweens were scarier when it was full that night. For over 4-1/2 billion years it has hung in the sky, orbiting the earth, reflecting sunlight at night so we don’t curse the darkness. And still today we look to it, we wish on it, we wonder how high it is, how far it is, how big it is. And still today we take it for granted.

The moon keeps our days at what we call days. Without the moon’s gravity pulling at the earth and slowing its rotation, a day would be about 6 hours. And you already think there aren’t enough hours in one! The moon power our tides so we don’t become a stagnant pool, keeps the earth’s rotational tilt so we don’t fall over, and keeps the planet spinning smoothly rather than wobbling its way through space.

With all the moon does for us does it not deserve some respect from us? Instead we treat it like an attraction at a carnival.

STEP RIGHT UP,
YES STEP RIGHT UP
AND SEE THE AMAZING,
THE STUPENDOUS,
THE UNBELIEVABLE,
THE ONE, THE ONLY,
THE SUPER WORM EQUINOX MOON!

Only twenty-five cents per person
have your tickets ready
please hold your own tickets
no readmissions
no exchanges
no refunds
this is a limited time offer.

They say, and I suppose they ought to know, this is the last supermoon for 2019. Apparently we’ve had our fill of micromoons for 2019 also. (Oh yes, that’s a thing too.) That means we can all go back to our porches and patios in the evening and listen to the crickets chirp and stare into the sky and not have to worry about whether we might feel foolish tomorrow at work (or worse on Facebook) when we say something like “Wasn’t the moon pretty last night?” and hear in reply “Pretty! Why that was best darned whiskey pourer blood pressure red possum longitudinal moon ever last night!”

Oh, and happy first full day of spring.

Supermoon

Day to Day

Michael 2 Comments

Shhh. Come closer. I have something to tell you. Today is Monday. That means you have the best chance of any day of the week to not be scammed. Good news, no? But don’t say anything lest the scammers find out you don’t fear them today and they start making Mondays their new Friday. Yeah, that’s the day you are most like to fall prey to the con.

Can you believe somebody actually gets paid to research this stuff? In some way it is interesting. There is a “best day” for just about anything you can imagine. The best day to shop at a thrift store is Monday. That’s what the experts say. The logic is that people have yard sales on the weekend and what isn’t sold often gets donated or consigned to thrift shops and second hand stores. How can you argue that? Except … those stores aren’t taking items in the back door and putting them directly on the sales floor. The have to be sorted, tidied, priced, then hung or displayed. Maybe Tuesday would be the better day. Or maybe it’s Friday so the store can make room for the wave of incoming merchandise next Monday.

How about the best time to post a photo on … wait, I’m sorry … the best time to post an image on Instagram? Yes, there are hundreds of experts who say without a doubt it is Wednesday, preferably at 2am or 5pm. Except for those experts who tell you the absolute best time to post is Thursday at 2pm. I might be more inclined to agree with the 2 in the afternoon people rather than the 2 in the morning people but that’s just because I believe the best time to sleep involves that coveted 2am hour. But then maybe I’d rather take heed of the experts who claim the best time is Monday at 8am. That would work especially well if I want to post photos, err, images of the stuff I’m picking up at the Goodwill store.

While you are out shopping and snapping pictures on Monday, mentally get your resume together because if you are thinking of applying for a job on line the best day is Tuesday, specifically at 11:30 in the morning. I’ve been looking for a little part time job to stave off the boredom of the lifestyle of the poor and unknown and now I know why I’m not getting any nibbles. In the true fashion of Willy Nilly, I have been applying whenever I see a job post that interests me.

BracketDaysYou’ll notice nobody has yet tapped Wednesday as a best day. That’s because they know you’re going to be busy buying shoes. Oh yes, there is an expert who has determined the very best time to buy shoes is Wednesday in late afternoon. No reason was given for that particular day but it is said that is when the deals are and the afternoon is when your feet are at their biggest because you’ve been on them all day. No word about those who have desk jobs or work the night shift.

Obviously you can’t buy shows every Wednesday so on those when you are sitting around rather than standing about to get your feet in shape for that shoe shopping spree, feel free to post something on Twitter. Yep, Wednesday afternoon between 4 and 5 is the best time to be noticed and maybe even get retweeted. Yippee.

If you are wondering (and why wouldn’t you be?), I was not able to find a best day of the week to have a vasectomy. For once experts agree that elective surgery in general has less negative outcomes when performed on Monday or Tuesday. It is claimed that because the recovery for a vasectomy basically amounts to hanging out on the couch and doing nothing for a few days, more vasectomies are scheduled right before the NCAA basketball tournament than any other time. I’ve never been able to track that “fact” back far enough to disclaim it didn’t start with those who broadcast said tournament but just in case it is in fact a fact, and considering the tournament starts tomorrow, and if you are missing your male companion today, you might want to get an ice pack ready.

And they say that Monday is the day not to get conned!

A Worldbeater of a Story

Michael 8 Comments

Because it is World Kidney Day, and only because it’s World Kidney Day, I’m going to talk about kidneys and then I’ll give you a few weeks without having to hear about my internal organs.

WKD

Since our last kidney transplant report I have lost one potential donor to high blood pressure. That leaves one who has now completed the evaluation and one with one test remaining and then of course the final review. That might bring up a couple questions for you. If it doesn’t, don’t worry, I’ll ask them. Does it seem to be taking a really long time and is it unusual to have a donor disqualified after such a long time into the process?

Honestly it is taking a bit longer than the average for these people to get through the evaluation process although not really by too much. I suppose if all the stars lined up and there was no waiting for appointments and if you had the most flexible schedule in the world and could be accommodating to the scheduling whims of a dozen different hospital departments you could breeze through the process in a couple months. But if you’re thinking the process is

…Step 1 hold sign up at hockey game looking for kidney,
…Step 2 sort through the 99,000 volunteers and pick the one with the best looking teeth,
…Step 3 meet in pre-op the following morning and plan to share a pitcher of beer later that day,

ummmm, no.

Under the best of circumstances it takes weeks and weeks because the process is a few more than 3 steps. And potential donors can be eliminated at any step, including the last.

The process pretty much follows the decreasing chance of elimination. That is, the step that would rule out most people as a donor is first, the second most common disqualifier then next, and so on.

A medical and family history is the first step along with a discussion of what is required for the evaluation, surgery, and recovery for a potential donor. At the same time, lab studies are drawn. Blood and tissue type compatibility is a must. If the donor candidate does not match the transplant candidate there are no further steps. In the spirit of the upcoming baseball season that means one strike and you’re out. There are no further reviews and no reconsiderations. If lab tests note suggestions of compromised renal function, unbalanced electrolytes, or heretofore unknown conditions such as diabetes, a committee will review the results and determine if the donor candidate can continue, be referred for treatment then reevaluated, or referred for treatment but disqualified.

Next are the cardiac and pulmonary functions. Will the donor’s heart and lungs get through the surgery and will they be strong enough to continue serving the donor well with the support of one remaining kidney? These steps include chest x-ray, EKG, stress test, and 24 hour blood pressure monitoring. At this point an abnormal return in one exam might require additional testing while the donor continues, additional testing while the donor holds, or disqualification. For example a slightly elevated blood pressure could require a second 24 hour test but the donor can proceed. A severely elevated blood pressure would hold the donor and refer him or her for new, modified, or additional treatment. A 24 hour blood pressure that remains within normal limits only with the use of more than one antihypertensive drug disqualifies the donor. In my particular set of donors there is one who was allowed to proceed pending a repeat 24 hour study ordered and then held and referred to cardiology for further review.

Next are renal function tests. You might think that if a person is considering donating a kidney the renal function tests would come sooner. People who know they have a renal impairment know not to begin the process. Nine out of 10 people with renal disease do not know it so why would this not be the first system reviewed?  Many of these people know they have a family history or it will be suggested by the earlier lab studies so they may not ever reach this step. A donor who does not initially pass the renal function tests will be reviewed by the transplant committee. Here they will be held until a determination is made that the test will be repeated, the results were expected because of other physical characteristics of the candidate, or the donor is disqualified. In my set of donor candidates, one was held for a repeat evaluation then further reviewed and determined to be allowed to proceed.

Then comes the psychological review. Usually. In some cases when a donor candidate has a history that includes psychological, emotional, or mental medical concerns with or without medication management, the psychological review may come after the initial history and lab studies. Most often it is held here when the potential donor is only two steps from being or not being further referred to as a candidate. In its simplest term, this is when it gets real. A candidate will either move on or withdraw.

To this point each step contains multiple tests any of which can hold or disqualify a candidate. After each test the transplant committee reviews the results and determines the next step: proceed, proceed but reschedule and repeat, hold and repeat, hold and review, or withdraw.

The penultimate step is an abdominal CT Scan. This step is the last physical exam for the donor candidate. This step explores the candidate’s kidneys and their physical appearance and position and is used to confirm the kidneys are normal in size and shape, which is the preferred kidney for harvest, and that all surrounding organs and tissue appear normal and regular. Here a donor will be approved for final review, held for further study due to an inconclusive finding regarding either or both kidneys, held and referred to appropriate specialist for inclusive finding regarding surrounding organs, or disqualified. Among my donor candidate pool, one was referred to a specialist when a nearby organ appeared other than normal.

At the final step the donor’s results and findings are reviewed by the transplant committee who will recommend the candidate to donor status or recommend withdrawal. In the case of multiple donor candidates specific for a single transplant candidate, a recommendation of one or more with consideration to potential acceptance and viability of the donated organ may be made.

HeartAndKidneySo now that it took you so long to read about the process you may better understand why it is taking so long to complete the process. Each of my donor candidates was stopped at some point in the evaluation. One proceeded all the way to the CT Scan when a shadow was noted on a neighboring organ. The transplant committee interrupted the process and referred her to a specialist who in turn determined the shadow was not clinically significant and recommended her to continue which the transplant committed approved. One was held at the renal function test when the IV mediated glomerular filtration rate returned a slightly elevated result. The committee referred the result to one of its own nephrologists who recalculated the result and determined due to her physical structure it was within normal limits for her height, weight, and age and recommended to continue. One potential donor returned elevated 24 hour blood pressure results. She was allowed to move on to the renal function tests but had to reschedule a repeat 24 hour blood pressure monitor. The second 24 hour blood pressure results also returned elevated and she was referred to her cardiologist. Pending his review and finding, even though by this time she had passed the renal function tests, she was held from further candidate progress. Ultimately her blood pressure could be maintained within the standards expected for a kidney donor only with the use of two medications thus she was removed from the candidate pool.

So now with one candidate at final review and one awaiting an upcoming CT Scan, you might be reading one of the last installments in my search for a kidney. And if that’s the case it means you might soon get to start on a new journey, one of a new transplant recipient.

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Transplant Journey Posts

First Steps (Feb. 15, 2018)
The Next Step (March 15, 2018)
The Journey Continues (April 16, 2018)
More Steps (May 31, 2018)
Step 4: The List (July 12, 2018)
Step 1 Again…The Donor Perspective (Sept 6, 2018)
And The Wait Goes On (Oct. 18, 2018)
Caution: Rough Road Ahead (Nov. 19, 2018)
And The Wait Goes On (Jan. 24, 2019)

Other Related Posts

Walk This Way…or That (March 9, 2017)
Looking Good (May 18, 2017)
Technical Resistance (May 25, 2017)
Those Who Should Know Better (July 24, 2017)
Cramming for Finals (May 3, 2018)
Make Mine Rare. Or Not (Feb. 28. 2019)