David Clark is a nurse anesthetist at Montgomery County Memorial Hospital in Red Oak. He recently had a kidney transplant. In honor of April being Donate Life Month, he decided to tell his story. Here it is in his own words.
I found out when I was 17. It was just a fluke, really. I was in a high school health class that visited the local hospital for a day. They sent me to watch some ultrasound procedures in X-ray, but that particular time they had no patients so they used me to perform an ultrasound. The tech said, “Let’s look at your kidneys. Everybody likes seeing kidneys.”
Well, not very many people had kidneys like mine. Mine were full of cysts. It kind of freaked out the tech, but polycystic kidney disease (PKD) runs in my family so I was not shocked. My mom, my aunt, and both of my sisters had it, as well as countless past relatives that I never knew.
Being so young, I failed to fully realize the seriousness of this discovery. I told my mom about it and all she said was, “Don’t tell anyone about it or you won’t be able to get life or health insurance.” You see, one of my sisters also found out at a young age during a scheduled test so it was in her permanent health record. She never could get private health or life insurance unless she participated in a group plan, so I kept it secret. I told no one. I think for a while I even convinced myself that my kidneys were just fine. They weren’t.
Polycystic kidney disease is the most frequently inherited disease in the United States. More than 600,000 people in the U.S. have it, and more than 12 million suffer worldwide.
PKD causes the formation of cysts in the kidney that grow over time. These cysts grow and push normal tissue out of the way and slowly affect the function of the kidney. Kidneys can grow to be the size of footballs and weigh up to 20 pounds. Mine were almost the size of a football.
Since the kidney is over-engineered, it takes a long time to see any changes, but inevitably, kidney failure is the end result. There is no cure. Options are dying, dialysis or a kidney transplant.
If you have never heard of PKD, you are not alone. We are pretty quiet about it. It’s not a glorious disease, and patients have a reputation of being difficult. We get cranky and itchy and have leg cramps. We are generally short-tempered. These are generalizations, of course. Some get along pretty well (like me) and some are completely disabled by their symptoms.
About 16 years ago, I had a bad kidney stone attack that landed me in the hospital and led to a three-hour surgery to remove the three stones. Needless to say that the cat was out of the bag. My polycystic kidney disease was in the open. I decided to start seeing a nephrologist to monitor my condition. For 15 years, I did just that.
In 2015, notable changes started. My kidneys had reached a point where they could not keep up as much and lab values began to rise. As my levels continued to rise, the symptoms of kidney failure began to get worse; itching that would not go away, being tired all the time no matter how much sleep I got, irritability, and frequent nausea with eating.
In January of 2016, my levels reached the point where I qualified to be put on the kidney donor list. This meant a complete two-day workup, about a gallon of blood draws, and counseling. Once I was approved and put on the donor kidney waiting list, I was told that the average wait time for my blood type was 18 months unless the perfect kidney presented. I was to remain within a two-hour radius of Omaha and to avoid getting sick. A donor could be found at any time and I would have to drop whatever I was doing a report to the hospital.
Average wait time of 18 months – I didn’t think my native kidney would keep working well enough to keep me from needing dialysis for that long!
Why is the wait so long? There is a lack of kidney donors. There are more needs than can be filled in a timely fashion.
In the early morning of last Aug. 11, I got a call from the Nebraska Medicine Transplant Office. They had a kidney for me. I had only been on the list for four months. I definitely was not expecting a call this soon. I was speechless.
Several things went through my mind – first, disbelief, then panic, then excitement. My wife and I had to make several quick phone calls to family and work (I was on call at the time), pack up some things, and then drive quickly to Nebraska Medicine to check in. That day was a whirlwind of activity with final tests, visits with all the staff that would take care of me, and family coming in.
After waiting 20 hours I was finally taken in for my transplant. For me, the next thing I knew was waking up and in a little pain. It was all over. Just like that I had a new kidney! My doctor said everything went great and that the kidney was already working hard. What a special thing that was to hear.
I later learned that I received what amounted to the perfect kidney and that is why I was moved to the head of the line. My doctor said that even a family member donor would probably not have been as good of a match as the one that I received.
Now for the hard part of the story.
In my case I received a donor (cadaver) kidney meaning someone had to die first before the kidney was made available. Someone died for me to live. I am grateful for the gift and blessings I received that day but somewhere out there was a family grieving at their loss. For a long time I took that very hard and would get emotional just thinking about it.
In December I received a special holiday surprise – a couple of letters from the mother and aunt of my kidney donor. I found out who my donor was. When I say I found out who she was, I don’t just mean her name. I mean I “found out” who she was. What I learned that day was that there is a higher power out there and He works in very mysterious ways.
This person was not only a match to me physically, but we were also a match in our personal lives. Personality, interests, temperament – all were a good match. This person had been involved in a car accident 10 years ago that almost claimed her life. She survived, but that accident changed her.
That was when she made the decision to become an organ donor. She also informed her family and they supported her decision. I say this because until I read that letter, I was feeling guilty. I am still emotional about the whole thing but not guilty anymore. Her family is grateful that her death was not the end of her story. A part of her is living in so many other people. Her mother expressed thankfulness that I was blessed with this gift of life. My donor’s nickname was “Ladybug” and out of tribute to her I have named my new kidney “Ladybug.”
My life has been changed by the gift of a kidney donor. As a result of my experience, most of my wife’s family has decided to become organ donors. I hope and pray that more people hear stories that impact the way that they feel about organ donation. There is so much need out there.
(From time to time, the blog features recipients of the IHA Iowa Hospital Heroes Award. These outstanding hospital employees come from across the state and work at hospitals of every size. They exemplify the courage, caring and community focus that are the hallmarks of the hospital mission in Iowa.)
Talk about General Surgeon Dr. Timothy Breon at Mahaska Health Partnership (MHP) in Oskaloosa and people will smile… and often chuckle! It doesn’t matter what department staff work in, he makes an uplifting impression throughout the organization. (For a “dose” of Dr. Breon’s good humor, watch this video of him learning he will receive the Iowa Hospital Heroes Award.)
Dr. Breon truly is an excellent surgeon, but also a very selfless person. He swells with a wonderful sense of humor; he supports community fundraisers not just financially, but with his time and talents; he’s an educator at heart and a very good speaker; he puts his patients first and will often pray with them; he’s a family man who is immensely proud of his five children.
There is not one specific reason that makes Dr. Breon a Hospital Hero, but a thousand that span more than 14 years since he first came to MHP.
It wasn’t difficult to compile examples of the many lives he’s touched; a few phone calls resulted in a flood of personal accounts. One grateful family shared, “Dr. Breon had my brother-in-law scheduled for a Lap Nissen surgery. When the labs came back before surgery, it wasn’t good. He told us the results and talked to us about seeing a hematologist for the possibility of leukemia. We were in Des Moines for the consult very quickly, thanks to Dr. Breon. He also came to the house to explain to our family what it all meant and what the treatment plan was going to be. He would also frequently check on my brother-in-law throughout his rounds of chemo. My family will never forget his compassion and caring.”
The personal connections Dr. Breon makes with patients, the visits to a patient’s home or even showing up on his tractor in a snowstorm to pick up a stranded colleague are examples of his natural way of making health care personal.
MHP is a better health care organization thanks to Dr. Breon’s support and involvement. The hospital staff are inspired by it; administration and our board count on it and our patients and community see and feel it. We are thankful and proud now that the entire State of Iowa has the chance to know our Hero!
Something was clearly wrong with Craig Morgan. Those closest to him could sense it. He wasn’t himself. He seemed tired and confused.
Craig, unfortunately, couldn’t really explain what he was going through. A resident of Friendship Ark Homes (FAH) in Ames, Craig is an adult with intellectual disabilities. While his communication skills are limited, he’s an endearing guy, agreeable almost to a fault. His response to any question is often, “Yeah,” accompanied by a big smile.
His well-being depends on those who know him best being able to read his moods and actions, and, by doing so, help others provide Craig what he needs.
“Craig is eager to please. He’ll always say ‘yes’ and can feign understanding whether he has it or not,” says Andy Nichols, a supervisor at FAH who has known Craig for years. “That’s a big part of working with Craig in the community – helping him understand and helping others understand him.” This was vitally important when Craig was brought to McFarland Clinic and then to Mary Greeley in early August.
“His spirits were fine,” says Nichols. “He was a little more confused than normal and over the weekend had become very weak and tired. We thought he might have pneumonia.”
From McFarland, Craig was sent to Mary Greeley’s emergency department for immediate tests. It wasn’t pneumonia. Craig had experienced a heart attack.
Diagnosis and Big Decisions
Craig was admitted to Mary Greeley’s intensive cardiac care unit (ICCU). The next day, he underwent an angiogram performed at Mary Greeley’s cardiac catheterization lab by Iowa Heart
cardiologist Dr. Ravinder Kumar.
Kumar discovered that all three of Craig’s major heart vessels were seriously blocked. He had suffered what’s called a NSTEMI (Non-ST elevation myocardial infarction). It is sometimes called a silent heart attack. Conversely, a STEMI (ST-elevation myocardial infarction) is an immediate emergency type of heart attack.
Heart bypass surgery was considered the best option, but Craig’s family and FAH caregivers felt that he wouldn’t be able to understand the recovery and rehabilitation requirements of such invasive surgery. Doing the surgery was as potentially dangerous for Craig as putting him through it.
A decision was made to monitor Craig’s condition, to treat it medically and not surgically. That decision was promptly reconsidered after Kumar visited Craig the next day in the ICCU.
“He was miserable,” says Kumar. “Just sitting up on the side of the bed would make him exhausted. There’s no way we wanted him going home feeling like this.”
Kumar spoke to a colleague, and Craig was transferred to Des Moines for a high-risk stenting procedure to open his blocked arteries, with the help of an Impella heart pump during the procedure. (Mary Greeley’s cardiac cath lab can perform stent procedures but does not have the Impella device.)
Carrie Adams, BSN, RN, clinical supervisor of Mary Greeley’s cardiac rehabilitation center, was surprised when she ran into her old high school friend Andy Nichols in the halls of the hospital that day in August.
“One of my guys had a heart attack,” Nichols told Adams.
A few weeks later, Adams met that guy. It was Craig, who had been referred to Cardiac Rehab after his surgery. In these cases, a patient is generally referred to the rehab service closest to their home.
When Adams received the referral details and realized who the patient was, she knew to call Andy. That local connection was important because Adams and Nichols had an instant trust. Their conversation was the beginning of a coordinated effort to help Craig.
It is not unusual for the cardiac rehab staff to make accommodations for patients, but because of his cognitive abilities, Craig posed a new kind of challenge.
“It’s pretty individual for everyone,” says Adams of the Cardiac Rehab program. “We’ve had competitive athletes and people who have never stepped on exercise equipment in their lives. You’ve got to make it work for all of them.”
Making it work for Craig was personally important to Adams, who has a close relationship with a nephew who has special needs.
Cardiac Rehab at Mary Greeley usually involves small classes of people going through a prescribed set of exercises while wearing heart monitors. Rehab can last several weeks. Could Craig handle this? Should he receive treatment on a one-on-one basis, or be part of a regular group? Would being in a group be too busy for him, too much stimulation?
Nichols assured Adams that Craig could handle it all.
“The goal is to progress the exercise without making it too difficult,” says Adams. “Craig does a lot of active outings and we wanted to make sure he could get back to doing those things without Friendship Ark staff having to constantly worry that they were pushing him too hard.”
It was decided that Craig would benefit from being part of a regular rehab class. A slightly shortened 12-session course of treatment was planned. Because he had had falls at home, it was also decided to limit Craig to seated equipment. FAH coordinators Cassie Shivers and Chelsea Apland attended classes with Craig. They provided encouragement and helped cardiac rehab staff work with Craig.
“We would ask him ‘Are you OK?’ ‘Is this too hard?’ ‘Is this really easy?’ ‘Does your chest hurt?’ ‘Is it hard to breathe?’ Yes or no questions for the most part,” Adams says. “We couldn’t have done it without his helpers.This really was a team effort, with our staff working closely with staff from Friendship Ark to make sure Craig got what he needed.”
Friendship Ark staff echoed those sentiments.
“In the 10 years I’ve been with Friendship Ark and working with Craig, this was the most exemplary health care experience he’s had,” says Nichols. “The cardiac rehab staff
paid very close attention to him and got more out of him than any medical professional ever has since I’ve known him.”
In October, Craig finished his therapy. “We wanted him to feel like part of the group, and he did,” says Adams. “Other patients would ask him how he was doing and they cheered when he graduated. I loved seeing that. It was really sweet.”
Craig is back home at Friendship Ark, keeping busy with regular outings, or crocheting and jigsaw puzzles. Did he enjoy his cardiac rehab experience? You already know that answer. It’s a big smile and, “Yeah.”
Helping others has always been a passion for Carroll native Jamie Waller. It’s why she pursued a career in nursing at Iowa Central Community College in Fort Dodge and it’s why she participated in a three-week mission trip to Tanzania in Africa following her freshman year of nursing school.
“After going to Africa, I discovered that nursing was my true passion in life,” Waller said. “It confirmed my interest in serving others and solidified my decision to become a nurse.”
Today, Waller is a registered nurse and six-year veteran of St. Anthony Regional Hospital in Carroll. She works on the medical, surgical and pediatric floor and often serves the role as charge nurse. But her commitment to serving others extends beyond her daily shifts.
In November 2016, newlyweds Jamie and her husband, Cory, ventured to Haiti with Grace4Haiti, a medical mission group based in Omaha. The couple joined the team’s 15th trip with the purpose to work in a hospital setting, perform medical services, prepare patients for surgery, assist surgeons, and care for patients in a hospital.
“We saw many, many patients in the clinic every day and performed small procedures in the clinics if able,” Waller said. “I realized on this trip that we have many luxuries we take for granted here in the in U.S. – things as simple as running water and electricity in every health care facility, and features as complex as all of the technology and supplies we have available. It was an eye-opening experience.”
Yet, most memorable of all, Jamie recalls two premature infants the medical mission workers saved during their stay.
One afternoon several of the mission team members walked to the beach during a short break from the hospital. As they were walking back, additional group members met them with the urgent message that an abandoned, premature baby had just been dropped off at the hospital.
“Luckily, we had the biggest group at the hospital that week, because at the same time this baby was struggling to breathe, another mother was having a scheduled C-section,” Waller said. “Once we delivered the baby via C-section, we knew right away the baby was not 40 weeks along. We had to cardiopulmonary resuscitate the baby for a short while and perform other medical techniques for this child to survive.”
Within hours, the medical team had both babies stabilized and transferred them to a nearby hospital, a couple hours away. The infants were transported in the missionaries’ vans, because there is no organized ambulance service in Haiti.
“I truly felt the difference our team was making in that moment to help those babies,” Waller said. “We used the resources and skillsets we had available to provide great care. Had our team not been there, I don’t believe they would have lived.”
Waller is grateful for the support of St. Anthony, which provided supplies and a mission trip support fund to match her employee vacation hours.
“St. Anthony’s generous donations were an invaluable asset for our trip,” Waller said. “We used many supplies while there. Every little bit counts and each donation helps to lessen the burden of providing health care in Haiti. The vacation match program also helped my husband and me financially with the trip. It meant the world to us.”
Jamie encourages others to partake in the same types of endeavors. She and Cory are leading by example, returning to Haiti in April with the hopes of spending more time in orphanages to show their support of Haitian children and continuing the relationships they built in November.
“I felt God’s presence many times while there – whether it was getting to know the people around me or guiding my hands while working with patients,” Waller said. “I truly believe that everything happens for a reason. My husband and I went on this trip to serve God and show love to other parts of the world by hugging someone that needs a hug or providing life or death care to a newborn baby. I am incredibly blessed and grateful for the opportunity to help others.”
Iowa’s Certificate of Need (CON) regulations were first enacted in 1977 for the express purpose of providing for the orderly and economical development of health care services, thereby avoiding unnecessary duplication of services, controlling the growth of overall health care costs and ensuring the stability of community hospitals. Since that time, these regulations have been re-examined multiple times and each time the same conclusion was reached: Iowa needs Certificate of Need.
Now the Iowa Legislature is considering a bill that, if enacted, would repeal significant portions of the CON program, putting community-based health care at risk. Here are some of the reasons why Iowa hospitals are supporting CON:
CON ensures access to health care services
- CON repeal will reduce access by destabilizing local health care systems.
- Without CON, services that keep hospitals financially healthy will be stripped away by for-profit, out-of-state, investor-owned organizations that selectively perform services simply because those services are likely to create the most income.
- These niche providers would leave the financial burden on hospitals to provide 24/7/365 emergency care, to provide care for patients with complicated conditions and patients with Medicaid or no insurance.
CON supports rural communities
- States without CON have seen hospitals close, especially in rural areas.
- Rural Iowa is uniquely susceptible to losing essential health care services. CON criteria and safeguards ensure health care systems are financially stable and that health care options exist throughout all of Iowa.
- In many counties, rural hospitals are among the largest employers, bolstering Iowa’s rural economy, attracting and retaining young professionals and families and bringing high-quality jobs where they are most needed.
CON promotes quality health care services
- CON criteria ensure new facilities operate with patient volumes that are sufficient to provide high quality services.
- CON criteria ensure excess capacity does not lower volumes in a manner that compromises patient safety.
- CON criteria result in consideration of the quality services available in the community.