- Email: [email protected]
A Signature
IN A FEW WORDS
A Signature
I
Am J Kidney Dis. 2014;64(3):xvii-xviii
LVAD supporting her own failing heart. All of these people will probably live much longer and better than they would have without a transplant—and it is wonderful. But, it is fundamentally horrifying to think of a 4-year-old boy’s parent signing near the large “X.” How do you decide which parent signs? Did mom sign, because dad couldn’t hold the pen even though he said he wanted to sign? Or, maybe, dad was in Afghanistan. Or, maybe there was no dad. Was the donor’s wife’s signature shaky because she was crying, or was she standing in a dim hospital hallway and writing up against a concrete wall? The donor’s daughter has a beautiful, fluid signature. Did her mother always tell her that she wanted to be an organ donor if “something happens,” so she signed with the confidence of knowing that she is helping fulfill her mother’s wishes—or did she just get good grades in penmanship? Did his sister sign because mom was dead? Did she have to sign because, at age 43, he and his partner—despite the fact that the state did not recognize their longterm relationship—never thought to set up a medical power of attorney? Did the donor’s father sign with a pen from his wife’s purse— the nice one that their daughter got for high school graduation, but left at home when she went off to college—or did he sign it with a discarded drug rep pen left at the nurses’ station by an exhausted intern? The coordinators from the organ procurement organization spend a lot of time with the family. They don’t have to speculate about the story behind the signature. They were there; they saw the signature occur. Sometimes, the coordinator will tell us the story behind the donor or the family, and that signature at the bottom of the xvii
IN A FEW WORDS
t is part of the preoperative routine before every organ recovery. First, we check the brain death note, then check the blood type, and finally the signature on the consent. It has to be there for us to proceed. Somewhere nearby, the form will indicate if the person who signed the form was the donor’s husband or wife, sibling, child, or parent. The signature is sometimes written boldly, with the stress of the decision already behind the signer. More often, the handwriting is not so steady. We learn to write our name very early. Usually, it’s one of the first things we learn to write. We print it at the top of homework when we’re young. We sign things continually as we get older, from checks and legal documents to letters and birthday cards. For the most part, people only glance at the signature. The quick question is answered: “Oh, Aunt Taffy sent me a Halloween card.” We spend more time thinking about the thought behind the letter, or implications of the document. This approach is as it should be: we think of the kindness behind the holiday card, rather than what type of envelope the missive of kindness came in. The signature on the organ donor consent looks the same as the one on all the birthday cards and letters, but it is also different—in both beautiful and terrible ways. The signature is part and parcel of the story. It is a discrete moment when the finality of the patient’s death is acknowledged, but with a glimmer of hope that something good can come out of the tragedy that has occurred. The decision has been made: “We will try to help someone else at a time when we cannot be helped anymore.” The signature brings a new liver to a dying young wife, a kidney to a father of three and grandfather of a few more, and a heart to a 5-year-old girl with an
Kenneth J. Woodside
consent. Other times, they don’t share the story— but the signature and the story are still there. How do the coordinators handle that, day in and day out? Organ recipients are grateful. Sometimes, they will write letters to their donors. Sometimes, they may get letters back. These letters usually are exchanged anonymously, through the organ procurement organization. However, they never get to see that singular and most important signature—the one that means so much to both the recipient and the signer, but in such different ways. The organ recovery team looks at that signature for them. Sometimes, we just check the signature to make sure it’s there. But, at other times, we absorb the full impact of what that signature means. When that happens,
maybe we just quietly stare off into space for a bit, or maybe we hug our kids a bit tighter than usual when we get home the next day. Probably, we won’t show it much on the outside. But, no matter what, we look at that signature—every single time. Kenneth J. Woodside, MD Cleveland, Ohio Dr Woodside is an Associate Professor of Surgery at the Division of Transplant Surgery, Department of Surgery, Case Western Reserve University & University Hospitals Case Medical Center. Address for correspondence: [email protected] Ó 2014 by the National Kidney Foundation, Inc. 0272-6386/$36.00 http://dx.doi.org/10.1053/j.ajkd.2014.05.003
CALL FOR SUBMISSIONS IN A FEW WORDS
“A doctor, like a writer, must have a voice of his own, something that conveys the timbre, the rhythm, the diction, and the music of his humanity, that compensates us for all the speechless machines.”—Anatole Broyard, Intoxicated by My Illness In this space, we hope to give voice to the personal experiences and stories that define kidney disease. We will accept for review nonfiction, narrative submissions up to 1,600 words, regarding the personal, ethical, or policy implications of any aspect of kidney disease in adults and children (acute kidney injury, chronic kidney disease, dialysis, transplantation, ethics, health policy, genetics, etc). Footnotes or references are discouraged. Any submission which refers to real patients must be either unidentifiable or approved by the patient(s) described. Submissions from physicians, allied health professionals, patients, or family members are welcome. Items for consideration should be submitted via e-mail at [email protected]. Questions or requests for assistance may also be directed to the editorial office staff at this address.
xviii
Am J Kidney Dis. 2014;64(3):xvii-xviii
A Signature
I
Am J Kidney Dis. 2014;64(3):xvii-xviii
LVAD supporting her own failing heart. All of these people will probably live much longer and better than they would have without a transplant—and it is wonderful. But, it is fundamentally horrifying to think of a 4-year-old boy’s parent signing near the large “X.” How do you decide which parent signs? Did mom sign, because dad couldn’t hold the pen even though he said he wanted to sign? Or, maybe, dad was in Afghanistan. Or, maybe there was no dad. Was the donor’s wife’s signature shaky because she was crying, or was she standing in a dim hospital hallway and writing up against a concrete wall? The donor’s daughter has a beautiful, fluid signature. Did her mother always tell her that she wanted to be an organ donor if “something happens,” so she signed with the confidence of knowing that she is helping fulfill her mother’s wishes—or did she just get good grades in penmanship? Did his sister sign because mom was dead? Did she have to sign because, at age 43, he and his partner—despite the fact that the state did not recognize their longterm relationship—never thought to set up a medical power of attorney? Did the donor’s father sign with a pen from his wife’s purse— the nice one that their daughter got for high school graduation, but left at home when she went off to college—or did he sign it with a discarded drug rep pen left at the nurses’ station by an exhausted intern? The coordinators from the organ procurement organization spend a lot of time with the family. They don’t have to speculate about the story behind the signature. They were there; they saw the signature occur. Sometimes, the coordinator will tell us the story behind the donor or the family, and that signature at the bottom of the xvii
IN A FEW WORDS
t is part of the preoperative routine before every organ recovery. First, we check the brain death note, then check the blood type, and finally the signature on the consent. It has to be there for us to proceed. Somewhere nearby, the form will indicate if the person who signed the form was the donor’s husband or wife, sibling, child, or parent. The signature is sometimes written boldly, with the stress of the decision already behind the signer. More often, the handwriting is not so steady. We learn to write our name very early. Usually, it’s one of the first things we learn to write. We print it at the top of homework when we’re young. We sign things continually as we get older, from checks and legal documents to letters and birthday cards. For the most part, people only glance at the signature. The quick question is answered: “Oh, Aunt Taffy sent me a Halloween card.” We spend more time thinking about the thought behind the letter, or implications of the document. This approach is as it should be: we think of the kindness behind the holiday card, rather than what type of envelope the missive of kindness came in. The signature on the organ donor consent looks the same as the one on all the birthday cards and letters, but it is also different—in both beautiful and terrible ways. The signature is part and parcel of the story. It is a discrete moment when the finality of the patient’s death is acknowledged, but with a glimmer of hope that something good can come out of the tragedy that has occurred. The decision has been made: “We will try to help someone else at a time when we cannot be helped anymore.” The signature brings a new liver to a dying young wife, a kidney to a father of three and grandfather of a few more, and a heart to a 5-year-old girl with an
Kenneth J. Woodside
consent. Other times, they don’t share the story— but the signature and the story are still there. How do the coordinators handle that, day in and day out? Organ recipients are grateful. Sometimes, they will write letters to their donors. Sometimes, they may get letters back. These letters usually are exchanged anonymously, through the organ procurement organization. However, they never get to see that singular and most important signature—the one that means so much to both the recipient and the signer, but in such different ways. The organ recovery team looks at that signature for them. Sometimes, we just check the signature to make sure it’s there. But, at other times, we absorb the full impact of what that signature means. When that happens,
maybe we just quietly stare off into space for a bit, or maybe we hug our kids a bit tighter than usual when we get home the next day. Probably, we won’t show it much on the outside. But, no matter what, we look at that signature—every single time. Kenneth J. Woodside, MD Cleveland, Ohio Dr Woodside is an Associate Professor of Surgery at the Division of Transplant Surgery, Department of Surgery, Case Western Reserve University & University Hospitals Case Medical Center. Address for correspondence: [email protected] Ó 2014 by the National Kidney Foundation, Inc. 0272-6386/$36.00 http://dx.doi.org/10.1053/j.ajkd.2014.05.003
CALL FOR SUBMISSIONS IN A FEW WORDS
“A doctor, like a writer, must have a voice of his own, something that conveys the timbre, the rhythm, the diction, and the music of his humanity, that compensates us for all the speechless machines.”—Anatole Broyard, Intoxicated by My Illness In this space, we hope to give voice to the personal experiences and stories that define kidney disease. We will accept for review nonfiction, narrative submissions up to 1,600 words, regarding the personal, ethical, or policy implications of any aspect of kidney disease in adults and children (acute kidney injury, chronic kidney disease, dialysis, transplantation, ethics, health policy, genetics, etc). Footnotes or references are discouraged. Any submission which refers to real patients must be either unidentifiable or approved by the patient(s) described. Submissions from physicians, allied health professionals, patients, or family members are welcome. Items for consideration should be submitted via e-mail at [email protected]. Questions or requests for assistance may also be directed to the editorial office staff at this address.
xviii
Am J Kidney Dis. 2014;64(3):xvii-xviii