Thursday, July 10, 2008

The dawn that wasn't - Part 4

An important part of a transplant is the post surgery medication. This involves a set of medicines including immunosuppresants and steroids. Basically these medicines prevent rejection of the new organ by the body.

Cyclosporin is the most commonly used immunosuppresant. Unfortunately, in Hemolytic Uremic Syndrome (HUS), cyclosporin is suspected to cause recurrence of the disease in the transplanted kidney. Well, no one can say for sure. But there have been studies that have found a link between cyclosporin and recurrent HUS. Again, there have been studies that demonstrated that there was no link.

So, its extremely important to get the choice of immunosuppression right. I did a lot of looking up on the internet and took printouts of all the articles to Dr. Shastry.

After a few days, I went to him to discuss this. He asked me what I thought we should use. I was a little surprised. When your doctor wants to know what you think on such an important decision, it could mean that he wants to involve you in this. It could also mean something else - he does not know. And that can be a heck of a lot worrying.

Anyway, we decided that we would use cyclosporin. Because of inconclusive evidence to suggest the contrary. I was a part of that decision.

My mother and I got admitted to Kamineni Hospital a day before the surgery was scheduled.

I had dialysis that day. I was thinking happily that that was my last dialysis. I would never have to undergo the pain of the 2 thick needles in my left arm.

My doctor thought I would have a sleepless night and gave me some sedatives. I slept quite well.

Finally, the morning of the transplant came.

I was wheeled into an Operation Theater, my mother into the adjoining one.

The two main surgeons (a husband and wife pair) started working on us. Before the surgery, a ventilator was put through my mouth to ensure proper breathing since I was given general anesthesia. Within a few hours, my mother's kidney was transplanted to me. No, mine were not removed. This is a popular misconception. Almost always, during a transplant, a third kidney is put into the recipient and it is not a replacement. Almost instantaneously, urine is produced to signal functioning of the new kidney.

When the surgery was complete, I was moved to a transplant care unit. There, the doctors suddenly realized that I was not recovering from anesthesia. There was panic all round and the anesthetist was summoned urgently. They tried a cocktail of drugs to get me out of the peaceful slumber I slid into. Since this could potentially cause cardiac issues, a senior cardiologist and a group of other specialist were called in.

Seeing all this commotion, my family was terrified. The entire pantheon of different religions was invoked. Mantras were chanted incessantly. About a month back, I myself had seen another transplant recipient go into this stage of 'not recovering from anesthesia'. I had seen the group of doctors lean over his body trying hard to get him back. They did not succeed.

I was luckier. Within an hour or so, I came out of my stupor. Still unconscious but stable.

Part 5

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