When my alarm goes off at 9am in clinic and I pull out my bright green pill organizer, others around me start to do the same. “I’m glad she did that because it reminded me,” I hear one woman say as I leave the room to find a space where I feel safer taking off my mask for the five seconds I will breathe unfiltered air and drink sips of water.
Lung transplant clinic days begin when I take a seat in a line of patients waiting for the Pulmonary Function Lab to open at 7:30am. Next, we race to complete chest x-rays and blood work before we can get our name on the list to see a physician. Some days I spend five hours at the hospital leading up to a five-minute meeting with my doctor. This isn’t unique to transplant clinics. Hospice physician, Ira Byock, recalls his father saying twenty minutes into a wait at a cancer center, “They give you only six months to live, and then, little by little, they take it back from you.”
Masks make it easy to recognize my compatriots so I try to use time in waiting rooms to meet other transplant recipients. I carry business cards with a link to my blog to make it easier to stay in touch. I’ve met patients ten, fifteen, and even twenty years post-transplant, heard stories about overcoming rejection, and traveling internationally. Sometimes it’s just nice to not be the only person in the room taking Prednisolone, a drug that makes me pretty much constantly on edge, and that has lived up to my pharmacist’s initial advertisement: more side-effects than letters in its name.
The drug that kept me alive before my transplant was so uncommon I had to fly or drive long distances to find other patients (and doctors) who understood it. My mom and I attended a pulmonary hypertension (PH) Conference in 2000, a week after my diagnosis. A fire alarm went off in our hotel the first morning. Standing outside in our pajamas, we met other families attending Conference, who, unlike us, had thought to grab backup supplies for their pumps that, like mine, administered intravenous Flolan, a medication with a worrisome 6-minute half-life. Forever after, I had a dedicated “backup bag” that went everywhere I did. Biennial PH Conferences were one of few forums in which I met other patients and learned critical information, like how to conceal my pump under a dress. Now I have a built-in community I can recognize based on the time they have their labs drawn.
Barring a few exceptions, all transplant recipients take an immunosuppressant with the brand name Prograf (also known as Tacrolimus and formerly FK506) every twelve hours. Transplant teams have a target level for the Tacrolimus concentration in the blood based on type of organ transplant, time since transplant, and so on. You don’t want the level to be too low or you might reject your transplanted organ(s), but you don’t want it so high that you risk infection and toxicity. Since the level can fluctuate a lot while trying to find the right dose with a handful (literally) of other drugs, labs must be drawn frequently–twelve hours after the last dose and immediately before the next. For me, that means at 9am or 9pm.
Sometimes I’m just not in the mood to deal with needles in my veins right after breakfast. Luckily, a friend I met in a waiting room taught me the secret of the after-hours lab. When a father and son line up with me at 8:30pm, I’m certain they’re checking Prograf so I introduce myself and ask what the boy had transplanted. Forever a perfectionist, I have them check in ahead of me so I can wait to have my labs drawn a little closer to 9pm. Out in the hallway, I overhear the phlebotomist praising the boy’s bravery. I smile, transported to bittersweet childhood memories.
As a child with PH, phlebotomists told jokes in vain attempts to distract me from the needle piercing my skin, my parents had me squeeze their hands, and rewarded me with bags of chips after my blood was drawn. As an adult with a heart-lung transplant, I calmly pull down the arm rest, squeeze my fist, and take a deep breath. In a few moments hundreds of thousands of other transplant recipients will be silencing alarms and swallowing pills. I am not alone.
Originally published by Pulmonary Hypertension News.
Photos © Kathleen Sheffer Photography