Donor: Victor Stone. Auto accident victim, father, ALS diagnosed
Recipient: Michael, oldest brother and legal guardian of 3 siblings.
Medical Dilemma: The right to end life support or to refuse treatment and the effects on the donor, the recipient and the physician
Michael is trying his best McG impersonation as he plays with his younger siblings. (I totally think this would have been Steve if his entire world hadn’t been thrown into oblivion) While playing in the dusty, dirty leaf pile Michael starts gasping for breath (I am too…I got all itchy and SOB just watching it..such an adventurer I am! Lol)
Kuol puts his VAD to the limit as he starts scooting all over the hospital in what looks like a few job duties they’ve given him. Hey, healthcare isn’t free, y’all! Andy warns him that he may be feeling better but the VAD isn’t a miracle device. Kuol scoffs and heads off to flirt with the nurses.
Spongebob is setting up a banquet for Recipents to meet their Donor families. He meets Barbara Harris, a heart recipient from Texas and she wants to get her BBQ on!
Victor is in his car and has run his scooter batter down (No, an ACTUAL scooter this time) and phones his daughter to tell her she was right. (can he be my dad??) A spool of wire falls off a construction truck in front of him because apparently you don’t have to have those things tied down in Pittsburgh. It causes Victor to crash and in the hospital we learn he has ALS and his rib injuries are bad news for someone with his disease. Dr. Jordan and Reed ask Andy to come in and assess the situation.
Back at the banquet set up Barbara is trying to make nice with Dr. Foster telling her that her father, old Dr. Foster, personally gave her attention before her transplant and how that made her feel very special. Miranda understandably, not only doesn’t give a rat’s ass, I think she’d like to punch Barbara if only that was acceptable. Maybe she does it with her mind because soon Barbara collapses during the set up.
Dr. Lee goes in to visit Michael and questions him on the 50-60 visits he’s had to the ER in the past year. We find out that Michael is the legal guardian of his 3 younger siblings. His parents are deceased and he didn’t have insurance so his lungs have deteriorated. When he finally got disability, it was basically too late. (don’t even get me started…..) He signs out AMA (against medical advice) so that his siblings aren’t sent to separate foster homes.
Victor’s daughter arrives at the hospital and Victor proclaims the ALS is winning, she’ll have none of it!
Barbara and Dr. Foster are trying to figure out why she collapsed. She only has one thing on her mind and that’s to get better to see her donor’s family tomorrow.
Victor and Kuol. *sigh*
During his rounds, Kuol wanders into Victor’s room to offer him something to read. With near child like innocence, he asks Victor “what happened to you?” He starts to tell him about his ALS but it doesn’t click with Kuol until he calls it Lou Gehrig’s Disease…OH! “The greatest Yankee!” then they do a lot of baseball talk which is all blah blah to me as I hate baseball. Lol. But Kuol’s impression of Lou’s final speech where he proclaims himself “The Luckiest Man”. When Victor asks why Kuol is here, he tells him of his need for a heart transplant from the Great Dr. Yablonski and Victor proclaims how sad it is because Kuol is so young. Andy you better get back in here quick because these two are about to steal the “ESS’s favorite bromance” award away from you and Kuol.
Dr. Lee gets test results back on Micheal and they’re not good. He needs a lung transplant…yesterday. However Michael still isn’t ok with staying because of his responsibilities. They can’t even list him with UNOS until he gets admitted, which Micheal won’t do. Against his better judgement, Dr. Lee agrees to write him a few prescriptions and let him leave with the promise to return as he gets better. Dr. Lee tells Micheal the final truth. “You’ll be no good to them if you die.”
In Victor’s room Andy is explaining to him and his daughter that they’ve discovered there is tear in the pericardium and the heart muscle is wedged into it. It won’t heal on it’s own, but with surgery and a little time, he can get Victor back to where he was prior to the accident. Any day, every day isn’t easy when you have ALS, having major surgery is a huge decision with far greater implications than for a normal healthy person. Victor says he’s not sure he wants to do it. He has 2 choices, “Fight this or die.” At the request of his daughter, Victor agrees to the surgery though you can tell he doesn’t really want to.
After surgery Andy informs him that his heart is fine but they found a more serious injury. His diaphragm has a tear which is bad news for his ALS. It means he will eventually go into respiratory failure if he doesn’t go on a ventilator. Possibly permanently. Victor is distressed because it basically means the loss of his freedom. They will get him a chair for a little mobility but really, he will be dependent on someone else from now on. Ugh. This scene.
Dr. Lee gets a phone call that Michael has gone into respiratory failure. Rescue goes to pick him up but there are no kids to be found. We find that Micheal has to have the transplant, he’s no longer responding to treatment and the kids are in hiding because they’re afraid of being separated…when he dies. Dr. Lee gets a 2 wk med stay pass for the kids, if he can get them to come in.
Dr. Foster and Dr Jordan are trying to figure out why Barbara is still so sick. Poor thing, she is getting the work up!!
Kuol goes to visit Victor and check on him after his surgery (ILU Kuol) and Victor says the fat lady is about to sing. “What fat lady??” asks Kuol and seriously, I want to hug him. Victor goes on, “..the one who sings…when it’s over!” Kuol tells him it’s not over. They’re both fighters and have much left to fight for. When Victor asks him if he’s afraid of dying, Kuol tells him he was before but now he feels like if he got his new heart or if he died today, he would have lived a beautiful life. You have Kuol, yes you have. ❤
When Andy comes in to check on Victor, Victor asks if Andy believed in fate. Andy says no… “it all seems pretty random” to him. Victor says he didn’t either but now he believes that he survived his accident to be taken to Three Rivers to meet Kuol. Instead of the two choices he thought he had before, he now believes he has a third. He wishes to terminate life support and donate his heart to Kuol.
In this episode, every new scene is more powerful than the one before it…
Kuol is apparently told the news about Victor’s dying wish. He tells Andy, “in order for me to get a heart I knew someone had to die. I never expected someone would choose to on my behalf. I’m not even sure whether to be happy or sad. ” They’re not even sure it can be done, it has to go before the transplant board to be voted on. Kuol asks Andy how he feels about it. He wants Kuol to get a heart “more than you know” but he’s not sure this the way to do it. <- that’s the nice way to put it.
Once in the transplant committee meeting Andy is a lot more sure, proclaiming, “I AM 100% OPPOSED to letting someone commit suicide by doctor.” The argument goes like this:
- A patient has a right to refuse medical care
- Not if it means they will die (actually this is an incorrect statement)
- He has to be depressed to make this decision, he just fought through surgery
- The psych doctor says he completely understands his decision
- Dr. Andy believes they should revisit once he’s stabilized
- He may not survive to be stabilized
- UNOS says it’s the hospital decision
- Is this fair to other patients waiting on the list?
- UNOS says to treat it as a direct donation
- Kuol can be listed provisionally (for the direct donation)
- The Ethics Committee was torn but they voted to approve it
- Dr. Andy says they should be helping Victor fight death not vote it in
Dr. Jordan says opinions have already been formed and they will never all agree so she calls for a vote. Dr. Andy, Miranda and a few others are the only opposers. Victor will get her wish.
Pam talks to Victor and we find out he traveled a lot as his daughter was growing up and wasn’t a very good father but since his ALS diagnosis they’ve become closer. A young girl and her mother enter the room and ask about his liver. Miranda and Dr. Lee have a heated discussion about what is right and wrong ethically. Miranda sees it in black and white (shock) and Dr. Lee sees it as uncharted water..something to learn from. He wants to ask for his lungs for his 22 year old patient, Michael and he does.
Victor’s daughter returns and he informs her of his decision to terminate life support. He tells her he’s taking control back while he can and is donating his heart to a wonderful young man. She says she’s not going to let him commit suicide. Victor says something profound, “There’s a difference between committing suicide and choosing to die.” He tells he he wants to die with what dignity he has left. “Cookie….I’m ready.” But his daughter isn’t…
Andy and Dr. Jordan are discussing Victor. Andy reiterates he’s against it saying that they can only refuse care when there is “no hope for a reasonable life”, Dr. Jordan counters, “as judged by who? You? Are you playing God now?” Dr. Andy says he’s opened up a lot of chests and he’s never seen god, never seen the after life and until someone can convince him things are better on the other side, he’s not sending someone through the door and he refuses to do Kuol’s surgery if Victor is the donor. Dr.Jordan urges him to speak to Victor and then make his decision.
As Dr. Jordan goes to get Victor to sign his Procurement Authorization, his daughter comes rushing in and tears up the paper. She has an irrevocable medical proxy for end of life care. She won’t allow it.
Andy goes to speak with Victor and what follows is I think, one of the best emo scenes in the history of television. It’s so great I can barely even talk about it without just quoting it. Really, you should just go rewatch it. Victor is mad. He can’t drive, soon he won’t be able to talk or swallow. “But you can FEEL” says Dr. Andy. Oh Victor can feel alright, he feels MAD! He’s mad he has to die without dignity instead of having what he calls “the best possible death” which is to donate to others. This reaches Dr. Andy’s heart. How do we know? Alex brilliantly portrays it. with. his. face. and the moment he grabs Victor’s hand and sits on the bed and they just sit there, in quiet understanding. No words are needed, and just like every time I’ve watched this, I feel like I just got punched in the heart. I want to simultaneously cry and clap all at the same time. Brava boys. Brava.
Now Andy just has to convince Victor’s daughter and he does so by taking her into the Gala the hospital is putting on for the recipients to meet some of their donor’s families. Andy tells her that he’s transplanted a lot of these people, that people come to him begging to stay alive, no one ever comes to him asking to die. “But your father is at peace with it and I realized I was making it more about me than about him.” How tough it must be to let go of someone you love like that, especially a parent. This scene is just as heartbreaking but so important.
Dr. Lee tells Michael’s family that he has some lungs for their brother and the youngest excitedly proclaims, “that’s awesome!” only to be reminded of the cold hard fact by an older sibling, “someone has to die first” and Dr. Lee assures them that “it’s ok…he’s ready.” I’m sure they don’t fully understand but it looks good on TV.
Pam is prepping Kuol for his transplant and Dr. Andy walks in to proclaim that the Great Dr. Yablonski is available for the transplant if he wanted him as his surgeon again and I love Pam’s level of sarcasm. hehe. Her face turns to sadness quickly though as she takes Kuol’s temperature, shows it to Andy and then leaves. Oh crap, what now? Kuol is running a fever which means they can’t do the transplant because he will reject the heart. The worst news is that Kuol was only listed provisionally for this direct donation, without it he goes back to the beginning pretty much. I almost can’t even watch Kuol put on his happy face and proclaim his “day will come”. FML.
As Andy tells Victor that Kuol won’t receive his heart, they decide to list it with UNOS as there are plenty of people waiting for a heart. Victor tells Andy he’d be honored if he’d do his surgery and Andy does “that face” and does the comforting hand grabby thing and ESS breaks into tears for the 5,000th time. My one and only complaint with this episode is that the ending is a bit overly glossy, with them wheeling him down the hallway and everyone coming out to meet them and give their respects but at the same time it’s very powerful. How many recipients get to thank the actual donor and how many donors get to have a moment, albeit very brief to see the thankful faces of all the people he will save? He is indeed the luckiest man.
This episode is very personal to me. You see, Victor reminds me very much of my grandfather who after serving in the Army for 50+ yrs became a paraplegic and bed bound after a stroke. His mannerisms and even his voice was similar to Mandy’s portrayal of Victor. That airy sound your voice has when you struggle to breathe because your own muscles, even the ones that support your internal life support systems like your lungs are betraying you. I was very close with my grandfather, he was my hero. Watching him die was brutal. Knowing what I know now, could I have supported him ending his life support sooner? Damn. That’s still a hard one. I’m sure many of you have similar stories, unfortunately this isn’t a story that’s unique and rare. That’s why it was so important this story be told and shared. I wish everyone knew about this episode and everyone could watch it with an open mind and heart.
Blood donation One alternative to help those with blood loss is blood donation. One pint of blood, which takes about fifteen minutes to donate, can save three lives. And then you get a cookie! Visit America’s Blood Centers to find a donation center near you.
Bone Marrow From the website for the National Bone Marrow Donor Program. “For people with life-threatening blood cancers like leukemia and lymphoma or other diseases, a cure exists. Be The Matchconnects patients with their donor match for a life-saving marrow or umbilical cord blood transplant.” Imagine if your bone marrow could cure a child with leukemia! I encourage you to visit this website and register as a donor. This is a donation you make while still living and in the words of Rebecca from this episode, “if you save one life, you save the world.”