Lydia's Top Tips - December 2003
I'd like to share something very interesting with you. Every now and then, I see a presentation that incorporates so many of my secrets and special techniques that I use it to illustrate how powerful a presentation can be. If you have participated in one of our 'Dynamic Presentations' workshops, you will recognise many of these. If you haven't, see how many techniques you can spot.
I should also mention that this is long and very moving speech, so bear that in mind if you are feeling emotional today.
Dr. Moritsugu's Lecture
American Trauma Society 28th National Trauma Conference
21 May 2001 Arlington, VA, USA
Good morning!
One of life's joys is to discover relationships which you never realized existed, but were there all the time.
Sometimes we are just blind to the fact, or we are just not looking in the right places.
And the awareness of that relationship is triggered by an otherwise totally unexpected, totally unrelated, totally serendipitous event or interchange.
That is what happened a few weeks ago, and why, to a certain extent, I am here today.
I was in Nevada a few months ago, speaking to a group of emergency room nurses. One of the other speakers was a senior member from this organization. A few weeks later, she and a few others from your leadership came to meet with me to discuss the American Trauma Society, and your Second Trauma Program.
And in the midst of that discussion, a new relationship was discovered, between what you are doing through your Second Trauma initiative, and what I have been involved with over the past eight years. And each of us has been pursuing our interests with a passion.
Your letter inviting me to be your Stone Lecturer this morning was very open ended. It stated that I should feel free to speak on anything I wanted.
And, in fact, that happenstance interchange a few weeks ago, defined for me how I wanted to use my time with you today, and what message I wanted to bring to you.
I respect what you do every day as trauma professionals, in your efforts to save and repair victims of trauma.
And hearing about your initiative, Second Trauma, focusing on helping families and loved ones of those victims to cope and heal as well, I respect your perspectives on who the victims of trauma are - all the victims, not just those coming to the emergency rooms physically broken, but those accompanying these injured victims as well, those who need your assistance also, but perhaps in a different way.
Let me shift to a unique and specific disorder.
Consider a disorder by which over 76,000 individuals are afflicted right now, and the number and rate of those afflicted continues to rise.
Consider a disorder from which sixteen people die, every day. That's about one every hour and a half.
Consider a disorder for which there is no cost to those who are committed to its elimination.
Consider a disorder which continues to exist, simply because not enough people are willing to do something about it.
Consider a disorder which has a solution.
Consider a disorder that does not need to be.
That disorder is organ and tissue transplantation, and organ and tissue donation.
Today, over 76,000 individuals are on the national list, waiting for a solid organ for transplantation, in order to save their lives and to improve the quality of their lives. This list swells by over 3,000 more individuals every month, and that rate of increase rises, every month.
And there are thousands more, waiting for bone marrow, cornea, skin, and other tissue.
Last year, only 21,000 individuals were fortunate enough to receive an organ transplant; only 1 in 3 who are waiting. Every day, over 16 people die, waiting for a solid organ transplant, waiting for the donation of an organ to transplant, which does not come in time.
And the only reason these people are waiting, the only reason these people are dying, is because not enough of us have considered becoming organ and tissue donors, not enough of us have made the decision to donate, not enough of us have communicated to our loved ones and next of kin what our wishes are.
There are not enough families who have known what their loved ones wanted on their deaths, and hence, these families were unable to carry out the final wishes of their loved ones, to be organ and tissue donors.
This is a public health issue, an issue that affects all of us.
And as I heard about your second trauma program, I realized how intertwined these two issues are.
Organ donation and transplantation are messages of hope, because transplantation is the end-of-the-line option available to people who have exhausted other ways to save their lives.
In our great nation, we have brought organ transplantation out of the experimental, into the community standard, with people living fruitful, productive lives for years, if not decades.
The one thing we lack is a sufficient number of organs to transplant, and that is dependent on a sufficient number of people, individuals generous enough to consider becoming organ and tissue donors, without whom nothing can happen.
Science and the medical profession continue to improve outcomes, with increasing survival post transplant. But until science comes up with other options, individual organ donation will continue to be the rate-limiting factor.
Last weekend in Chicago, I had the privilege of attending an evening symposium entitled "Paths of Discovery." After dinner, eight of the giants in the history of organ and tissue transplantation reflected on their contributions to this field. I had the privilege of reflecting on their reflections.
And I could not help but comment on how far we have come in this life-saving procedure over just the past few decades. But I also had to wonder how much farther we had to go, before we found the permanent solution to this issue, whether it would be through new science, through improved medical capabilities and advanced surgical techniques, through elimination of the underlying causes leading to the need for transplantation through prevention, through xenotransplantation, through breakthrough pharmaceuticals.
And I reflected that until that time comes, we will still be dependent on the generosity of strangers, organ and tissue donors, to assure that this intervention is available.
About three months ago, when then Governor Tommy Thompson assumed his new position as Secretary of Health and Human Services, he stated that one of his first priorities would be to increase organ and tissue donation across the country.
And he has been true to his word, with the release of a multi-pronged initiative a month ago, an initiative to assure that as many people as possible are aware of their choice to donate, are aware of the positive outcomes of their actions, and are aware of how they can express their decision to others.
While we need to increase organ donor awareness on the part of individuals, we also need to increase the rates of family consent.
A recent HHS study examined families who had faced real-life decisions about donation. This study confirmed what we had suspected: many of these families were unprepared for this decision - a decision they had to make in a time of severe grief and, perhaps, unexpected crisis; only 43% had ever discussed donation with their loved ones; less than 25% knew if their loved ones carried a donor card; in addition, families who were undecided when asked, were only half as likely to consent as families who were initially inclined to donate; perhaps it is not surprising that less than half the families asked, actually consented to donate; the overwhelming majority - 95% - of he families indicated that knowing their loved ones' wishes, would have had a substantial influence on their final decisions.
This study and others, confirm that most Americans would consent to donation, if they knew that their loved ones had requested it.
Hence, the need to increase organ donor awareness, and to make certain that individuals discuss that decision with their families, "to share your life, and to share your decision."
But why do I bring this topic to your attention here today, you might ask. And well you might, because your association is made up of professionals dedicated to saving lives, fixing bodies broken through trauma.
One could question whether there might be a conflict of interest, a conflict of ethics, to encourage organ and tissue donation from those whom you have worked to hard to save, or at the very least, the perception that you might be torn between your attempts to save a life, and your efforts to increase organ and tissue donation.
In fact, this is one of the more difficult things for individuals involved in trauma care. Because you are trained to mend broken bodies and to save lives; and when a patient dies, it is too easy to construe that death as a failure.
It is not a failure, since as you well know, there are some injuries that cannot be fixed, there are some lives that cannot be saved, no matter what resources and talents are available.
It is when that event, when that death, occurs, that life can again be saved - through organ and tissue donation and transplantation.
But in order to drive home how much what you do every day can make that life or death difference, in first trauma, in second trauma, and what I will refer to as third trauma as well, let me try to personalize what you do, and put a human face to how you can make that difference.
Consider two scenarios.
You are driving back home from a day of sightseeing with visiting relatives, when your pager goes off. You call your office. Your assistant informs you that there has been a terrible auto accident involving your wife. You immediately head to the hospital.
A nurse ombudsman meets you as soon as you walk in to the Emergency Room and identify yourself to the clerk. She escorts you to a small, quiet, private room off to the side. The lighting is soft; the chairs are comfortable. Right now, you need both.
She informs you that your wife has been severely injured. There has been head trauma. The ER team is working on her, and surgery and neurosurgery are involved.
She offers you coffee, access to a phone, and invites you to remain in the room, assuring you that she will keep you informed. She returns periodically to advise you of what is happening. It is not good.
The trauma surgeon stops in. The team has stabilized vital functions, but there has been severe head trauma. The neurosurgeon is with your wife.
A chaplain arrives, and offers comfort.
The neurosurgeon enters, and describes what has happened. Your wife has sustained such severe head trauma, that while her heart is still beating, she has lost blood flow to the brain. She is dead. The ER staff is cleansing her, and you can see her very shortly.
The doctor remains to answer questions, then leaves you to your grief with your family, who has now gathered.
Shortly after, the nurse ombudsman returns again, and escorts you to the trauma room to see your wife, who has been cleaned from her injuries. It is a tragic moment.
As you are leaving her side, the neurosurgeon joins you, walks down the corridor with you, and gently raises the question of what you would like to do.
His question jogs your memory of an earlier discussion, years before, between you and your wife. You each had decided to be organ donors on your deaths, and had discussed this with each other.
What would you do now?
Consider a second scenario:
You are relaxing at home after dinner. The phone rings. It is a hospital.
Your 22 year old daughter has been struck by a car, and is med-evaced by helicopter to a nearby trauma center. She will arrive in about 20 minutes.
You drive as carefully as you can in your shock to the trauma center, about 15 minutes away.
You arrive at the ER, and go to the clerk's desk. Without looking up at you, she brusquely states that she has no information about any young woman arriving by helicopter.
Shortly after, an ER nurse comes out to inform you that a "Jane Doe" is arriving, but she does not know if it is your daughter. You have to insist on someplace quiet to wait; not the busy and noisy ER waiting room.
She offers the police squad room, where there are three office desks, office chairs, and a phone.
After uncountable minutes, you sense the beat of helicopter blades, and step out to find out if this is your daughter. No one knows. Finally an ER physician responds and states that a young woman has arrived with little information. The ER team is working on her. You push your way in and determine that the patient is in fact your daughter. You retreat to the police squad room to leave the professionals to do their job - to try to save your loved one.
Your daughter has had severe head trauma. She is transported to the Intensive Care Unit.
You ask the ICU staff for access to a phone to call the rest of your family. The staff point you to the pay phone, in the middle of the busy hallway, next to the elevator. Of course, you don't have any change for the phone.
The staff are continuing to work on your daughter. After sitting in the large, open ICU visiting room, with the soap opera du jour blaring on the TV for everyone to hear and see, a clerk finally shows you to a small, quiet room off the ICU where you could wait.
The staff provide you access to your daughter, despite the limited visiting hours. Because of the trauma, her brain is swelling; there is little more the neurosurgeons can do. You wait, watching the intra-cranial pressure rise.
You have to request pastoral assistance. The staff state that it is after hours. Can't you wait till the next day? No, you insist! After a couple of hours, the on-call chaplain arrives.
The ICP has now risen to critical and terminal levels. Death is inevitable. Your daughter's mother arrives after an exhausting 16 hour flight. Less than two hours later, the neurosurgeon, in the middle of the ICU, informs her that it is time to declare your daughter dead. He tells her that he has been keeping her alive until she arrived.
Later, after a brain flow study is done, the neurosurgeon again approaches, obviously prepared to announce the results to you and the family in the middle of the ICU. You have to insist on moving to the small room for privacy. He impatiently informs you that your daughter's brain flow studies confirm her death.
When her mother asks him to show her the clinical signs of death at the bedside, he states that it is not necessary; the flow study confirms that she is dead.
Nevertheless, he trounces off, as if leading a pack of medical students and residents on rounds, and proceeds to conduct a bedside evaluation of brain function. It is consistent with brain death.
He seems irritated at this unnecessary interruption of his day, and leaves.
When the trauma fellow is called to provide the second finding of death, he states over the phone that it is not necessary; he doesn't need to see the patient, since he accepts the neurosurgeon's determination. He argues, "I'm too busy to talk with the family. I have trauma to take care of."
When he finally arrives in a flash of green scrubs and white lab coat, he repeats the neurological evaluation, with obvious annoyance. He has other trauma to take care of. He has lives to save. Your daughter is dead.
Early on, realizing that your daughter might be an organ donor, you had asked that your local OPO be called. They now approach.
What would you do now?
These two scenarios are great examples of first and second trauma.
These two scenarios, with some editorial license, actually happened. They happened to the same person. They both happened to me and to my family.
My wife and daughter died in separate auto accidents, four years apart.
I don't know how you see this, but in the first instance, we the family felt supported and comforted in our grief. And at the point of being asked whether we wanted to donate my wife's organs and tissue, we were inclined and ready to do so.
In the second instance, we had already had the experience of donating our loved one's organs once before. And we were favorably inclined.
But as our time in the hospital went on, and we interacted with staff, we became increasingly negative to the "system" and its "people" and the way they were treating us.
Perhaps it was us, who were getting more frustrated and angrier in our grief. But perhaps it was not; perhaps it was in fact the natural and normal attitudes and behavior of the staff and the rest of the institutional environment, probably unintentional and totally transparent, in their efforts to address the First Trauma.
And in the latter scenario, I would guess, were we not already so strongly predisposed, we would have had a choice reply in response to a request for organ donation.
We all know of these and other scenarios, those we have heard of, those we have actually seen, and perhaps those we may have even been active participants in.
These two scenarios are real. We all know that they happen every day.
And during the several days we spent in the ICU until my daughter died, we observed more of the same. Ours was not an isolated experience.
With all the effort we pour into raising organ donor awareness, it ultimately comes down to the moment of truth, the moment of decision, the moment when we approach the family to ask for organ donation.
And we can just about toss everything down the drain if we don't do a good job in this peri-donation environment, in better preparing the family for this moment, by treating them with dignity and respect. That is what your Second Trauma program is about.
And if, in the second case, we reacted with our emotions rather than with our heads, several people who could have been saved through the miracle of donation and transplantation would still be on that waiting list.
Or even worse, they would be dead, unsuccessfully having waited for that organ which never appeared.
My point is that, just as in your Second Trauma program, in your day to day efforts at saving lives, never forget that there are several patients, not only the ones lying in the emergency room or in the intensive care unit bed, but also those who are standing around that bed, the family. And that ALL the patients need care.
So that, if you cannot save the life of your patient, when you or the OPO approach the grieving survivors to ask for organ and tissue donation, they will be better prepared to consider saying "Yes," and in so doing, they and you can help save and improve the lives of so many others.
There are many stories about donation and transplantation. Each one is special; each one is different. But what is common to all is the uncommon human generosity of each.
So what is the real story behind the scenarios?
Eight years ago, my late wife, Donna Lee, died in a severe auto accident. We had talked long before about wanting to be organ donors when we died. I had the privilege of carrying out her wishes.
And eight years ago, because of the decision she had made: a police detective in Tampa, Florida, received a healthy heart, and a new lease on life for nearly seven years; a 35 year old diabetic hospital custodian in Washington, DC, received a pancreas and a kidney; a 12 year old boy who was on dialysis and failing in school received her other kidney. The last I heard, he was making straight As, and I understand was on his way to college; a retired schoolteacher in Pennsylvania received a fresh liver; and was able to spend Christmas again with her family. Although she did not survive long, she was able to enjoy a bit more of life, for herself and for others around her; a young retarded woman in Baltimore, MD, received one cornea; and the other cornea provided new vision to a 49 year old government worker.
Donna Lee was simply an ordinary person, who accomplished extraordinary things. Without her generosity, as well as those of so many other donors, this would never have been possible.
And we the family felt a sense of comfort in our grief, that out of our tragedy, some good would result.
But that is not the end of the story.
Four years ago, my younger daughter, Vikki Lianne, only 22 years old, was struck by an auto while crossing a street in Virginia.
She suffered massive brain injury, and died after three days. We believed she would have wanted to be an organ donor, and so we made those arrangements.
But candidly, we were hesitant, since we had never discussed this with each other. And how many of us have these kinds of discussions with our teenage offspring?
Later, my older daughter, Erika, said to me, "Dad, we did the right thing." Because after Donna Lee had died, my two daughters had had several discussions about their own lives.
And they noted how so many others had benefited from Donna's final gift, and how we, her family, had found such comfort in our loss.
And Vikki had stated that she too, wanted to be an organ donor. I cannot express to you how proud I am of my two daughters, for their maturity and their insight.
And they were both teenagers at that time. If our children can discuss these issues, why can't we do so as well.
And because of Vikki: a mother of five children from upstate New York received a heart and a new lease on life for herself and for her family; a widow with four children received her lung; a 59 year old man from Washington, DC, active with a local charity, received her liver; a widower with one daughter received one kidney; a married working father of several children received the other kidney; a 26 year old man in Florida received one cornea; and a 60 year old woman in Pennsylvania received the other.
I have been privileged to be part of THEIR decision, their generosity, their gift of life, their ultimate gesture of humanity, just as all donor families are part of the generosity of their loved ones.
Because of Donna Lee, because of Vikki Lianne, and because of so many other organ and tissue donors, many others have gained, from a renewed life, and an improved quality of life.
This is a HUMAN issue, with HUMAN impact.
But as you well know, organ and tissue donation and transplantation affect many more than just the donors and the recipients.
Each person whose life is improved, whose life is extended through transplantation, affects many others.
Like a pebble tossed into a pond, the ripples of life expand outward, affecting not just the donors and recipients, but families: mothers and fathers, brothers and sisters, sons and daughters, friends, colleagues, coworkers; and these in turn affect so many others, in ever expanding Circles of Life.
Donation and transplantation affect society, not just one person. We must make it happen! And you can help.
Consider the sixteen people who will die today, before you go to sleep; and the sixteen more who will die tomorrow, and each day, waiting for an organ that will never arrive in time.
Summary
Eight years ago, Donna Lee Moritsugu died, and became an organ and tissue donor. And it was the right thing to do.
Four years ago, Vikki Lianne Moritsugu died, and became an organ and tissue donor. And it was the right thing to do.
Every day, someone dies who could be an organ donor.
Through the kindness of strangers, organ and tissue donation is a message of hope, it is the promise of life.
As you speak of First Trauma, the impact of trauma on an individual patient; and your new program, Second Trauma, the impact of the shock of trauma on families and loved ones, I believe there is opportunity in what you are doing, to care for these individuals, whether the patient, or the family, to help address a Third Trauma, the loss of the opportunity to save other lives, through organ and tissue donation and transplantation.
And as you engage in your initiative under Second Trauma, a program of compassion and support for the families of trauma victims, I encourage you to embrace the prevention of that Third Trauma, a natural and logical outgrowth of what you want to do every day, to help people at every level.
When I began, I talked about the confluence of otherwise seemingly unrelated issues, resulting in new opportunities. This is one of those opportunities.
Through your efforts donation becomes possible, and transplantation becomes a reality.
Every one of us can help make a difference.
Intervene for the First Trauma. Care for the victims of the Second Trauma. And help others avoid the Third Trauma.
Help others Share life.
And THAT is the right thing to do.
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