So Shall Ye Reap

** Names and details have been changed to protect patient confidentiality, privacy, and dignity **

It is autumn in rural America. The green-hued sweet gums, oaks, and sycamore trees now boast their orange and yellow palates. The fields of corn which bore ears for the farmers markets and lifestock feed are actively plowed to the ground. Combines rest in the expanses after a hard day's work. Advertisements for fresh apples and pumpkins litter the roadway. It was harvest time. I drove to the hospital, surrounded by the changing fall landscape. Like the combine, I too was headed for a harvest.

To say that I met Kevin would be a misstatement. I became aquainted with Kevin in his ICU bed. He was a young white male, half a century younger than his hospital neigbors. He was intubated and unresponsive, with a central line sprouting from his neck, and an IV in his forearm. I examined him daily, noting his absent reflexes and fixed pupils. The ICU team evaluated him on daily rounds, noting any minute changes in his care. Kevin was not getting any better. He had multiple organ failure, and received multiple rounds of CPR over the past week. The treatment options for acute medicine had been exhausted. We placed a consult to the neurologist to test his brain function.

Kevin didn't blink when a cotton swab was placed on his eyes. He didn't turn when ice water was dropped into his ear. Hedidn't flinch when a reflex hammer was tapped on his tendons. Kevin was brain dead. His family was notified, and plans to withdraw care were determined. But there was a caveat; Kevin was an organ donor. His heart and kidneys had been damaged, but his eyes, liver, and lungs could be of use. We began giving IV fluids and monitoring his blood pressure more stringently, as to preserve the organs for donation. Surgical transplant teams were notified, and made plans to fly in for retrieval.

Since organ donation "harvests" take place at night, I was asked to attend. I had cared for Kevin for several days, and knew his histoy well.I arrived at Kevins hospital bed as the helicopter was landing 6 floors above. His family surrounded the bed. I noticed that he had been clean-shaven with the slight aroma of cologne on his bedsheets. He remained unresponsive as the family said their goodbyes, and whispered to him. The team slowly trailed into the room. Nurses, respiratory therapists, OR technicians, and myself were present as "farmhands", preparing and assisting in the process.I heard the screams and wails of his family behind us as we wheeled his bed towards the elevators.

The "harvest" went quickly. Teams from large institutions came in to retrieve the organs needed for their patients. Kevin remained sedated as the surgical specialists worked on various parts of his body, lowering his body temperature with ice to ensure that the organ was preserved for transport. They made the process as quick and as dignified as possible. The organs were packaged and placed in coolers, and rushed to the awaiting helicopter. I held his discordant, weak heart while his lungs were removed, and watched the contractions slow to a halt. Kevin's incisions were then sown together, and he was placed on a gurney.

Like Kevin, I too have elected to be an organ donor.This experience did not alter my decision-- I was comforted by the professionalism and dignity-preserving methods utilized by the transplant team.I was thankful for Kevin's decision to give life to strangers, to prolong the life of others, even in death.

At some point, I may find myself in an ICU hospital bed, awaiting "harvest".

As ye reap, so shall ye sow.