Being a transplant coordinator, you are constantly assisting patients on their spiritual, emotional and physical journeys. You ride the emotional rollercoaster with the patient to the transplant center, only to learn that the organ is not viable. What prepares the case manager for a conversation with a preemptive kidney transplant candidate now starting dialysis?
“Well, Kathy, it is time. Life is over as I knew it.” Those words come across the phone like a huge weight that lands heavily. Jim had already been disappointed in December 2005, when he worked through the feelings of even considering taking a kidney from one of his daughters. However, neither daughter could donate due to medical conditions of her own. What do you say? “Well, Jim, you are a father of three, a supportive husband, an engineer, and now, you have dialysis on your agenda?” Of course not!
Being a managed care transplant coordinator, I am a telephonic case manager. Jim and I had been in touch since he listed for kidney transplant in August 2004. Christmas 2005 was sad because he learned neither daughter could donate. Two months later, the world collapsed onto his shoulders. He had to start dialysis — end of life as he knew it! Since 2004, we had been talking about dialysis and monitoring his creatinine. Coping with lifestyle changes was a part of the care plan. Jim had verbalized his feelings. The fistula had been placed and maturing. I thought we were on track!
A telephonic case manager relies on clinical documentation to be her eyes, but relies heavily on her ears when assessing a patient. “What am I going to do?” he repeated. Then it hits me out of nowhere. I had been a hemodialysis nurse for years. Why did I not think of this earlier? I refer to my notes. He appears to qualify. But it is risky to mention since he has dealt with so much. Then the words come out, “Has your nephrologist mentioned peritoneal dialysis?” Jim replies, “He may have mentioned it. Why?” After discussing it in detail, he calls his nephrologist to arrange a meeting.
Weeks later, Jim calls me. He is going to have a peritoneal dialysis catheter placed. Weeks later, he calls me again. “You changed my life. I am working and doing my dialysis at night on a cyclic machine in my own home. I cannot thank you enough.”
In August 2006, I came into work to receive a voicemail that said, “Kathy, I wanted to call you first. My wife and I are on our way to the transplant center to get a kidney.”
Jim did great through the transplant! Christmas 2006, I got another voicemail. “Merry Christmas, Kathy. I will always remember how you changed my life. You are my hero! Do you know how good milk tastes?” Jim had not been able to have his drink of choice for years. I raised my morning cup of coffee and said to myself, “Cheers!”
