How did you spend your evening?

Me?

Well, I had a pretty run of the mill evening. I spent my night arranging a brain harvest. Sounds like fun stuff, no?

I’m on call tonight. Why does the odd stuff happen when I’m on call?

I had a patient who had a diagnosis of Huntington’s Chorea - a pretty severe and debilitating - and eventually fatal, neurological disease. Prior to her debilitation - she had pre-arranged to donate her brain to the Brain Tissue Research Center at the Harvard Medical College. No big deal, right? Seems like it should be a breeze?

We had detailed instructions on what to do in the event of her death. I had to pack her head in ice immediately upon pronouncement. Then needed to make sure that her body was placed in refrigeration within 6 hours of her death.

So far, so good, right? Wrong.

This woman had made these arrangements a year and a half ago. To night, that hospital informed me that they do not have a Pathologist able to perform the tissue harvest because they canceled their brain and spinal cord harvesting program a year ago due to the cost of the program.

Ok. So now what?

I called the county Coroner who really was of no help at all. Although, he did offer to transport her body to the county morgue to place her in refrigeration while we worked at finding a facility and Pathologist willing to do the harvest within the next 48 hours.

Whew. Ok.

I called Harvard Medical College and explained the situation to the Neurologist who is on call. His name is Lewis and he is a very nice and very very helpful man. He told me that he was going to try and find a pathologist to fly in and perform the harvest - - however, he did not know how long that was going to take. I could get a call from him at 3 am telling me where to transport the body.

Ok - I really don’t want to sit on call all night long waiting for some pathologist to be flown in at a moments notice — I really, really want to get this squared away sometime before midnight.

So I kept digging and I pressed Lewis from Harvard for more ideas.

He suggested that I give the University of Wisconsin- Madison a call. “Place a call to their Pathology Department and see if they have someone that can do this harvest tonight or tomorrow.”

Sounds good!

I call. They direct me to their website that gives me ABSOLUTELY NO information at all! I call back - I get an answering service that tells me to call back Monday morning during business hours.

No good.

I called Bob, the county Coroner back - asked him if he had any ideas. He gave me some smart ass comment about taking a chain saw to the woman’s head — packing it in ice and Fed. Ex’ing it to Boston.

Ha. Still no good - and no help. We’re all getting a bit punchy at this point — I’m 5 hours into this thing and still no solution.

The whole time, I’m in contact with the family who are distressing over this because this was Carol’s wish - - the minute she was diagnosed with Huntington’s - she made explicit arrangements and was absolutely adamant about donating her brain to Harvard. The daughter starts to cry because she can’t imagine how her mother’s spirit must be feeling at this point.

I want to help. Quite honestly - we dropped the ball on this one. The arrangements were made a year and a half ago. When we knew that her death was imminent - we really should have confirmed the arrangements by calling the hospital. We would have found out that they don’t do it anymore — then we could have called Harvard for further instruction. Plus - if we would have alerted Harvard when we knew her death would be within twenty four hours — they would have pre-arranged a Pathologist to be on call for us at a moments notice. But we didn’t. And now there is the extra burden to the family because in order to transport her mother’s body to any University - well, there would be cost involved.

I called my Administrator and explained the situation - - explained that I thought we dropped the ball on this one and gave her my opinion that we should foot the bill for the transportation of the body to wherever it needed to go for brain harvesting.

She said “Ok” - - I think, at 10:30 at night, she didn’t want to get into a kafuffle with me or the family.

Ok - we’re getting somewhere now. I call the family, and they are at least satisfied with the fact that they will not have to incur any cost.

Now - where was I? Oh…..

I called Dr. Tom - our Medical Director. I ran this whole situation past him and asked for his advice. He informed me that, unless things had changed, he didn’t have knowledge that the University of Wisconsin - Madison was equipped to perform brain or spinal cord harvesting.

Great! Now what? The Coroner’s suggestion of the chain saw and block of ice was looking kind of reasonable to me at this point!

Dr. Tom said that maybe Dr. Lewis from Harvard really meant the Medical College of Wisconsin? Which is in Milwaukee - not Madison. Dr. Tom said that he knows they have a Neuro-Anatomy Department specifically geared toward brain/spinal cord harvesting. He suggested I call Dr. Harvard back and get clarification.

I did. He gave it. I’m on a roll - - 6 hours into it.

I call Dr. Tom back and tell him that I think the call that needs to be placed to the Neurology resident on call with the Medical College probably would be a call best places Doctor-to-Doctor - and asked him if it I would be terribly taking advantage of him by asking him to place the call?? (please? please?)

He agreed. (Yay!)

Now I’m sitting here waiting to hear back from Dr. Tom that the pathologist at the Medical College is ok with performing the harvest tonight - or sometime within the next 36 hours. Then I need to put that Pathologist in contact with the Neurologist from Harvard. Then I need to call the Coroner and arrange for transportation of the body to the Medical College. Then I need to call the family and explain this whole sordid ordeal — then maybe I can go to bed.

Unless I get another phone call on another patient - - then it’s off to work I go again! IlovemyjobIlovemyjobIlovemyjobIlovemyjob!