Some food for thought next time you’re enjoying a pee:
J, RN writes:

Ever ponder the miracle of urine? I mean, really ponder, with utter amazement, the beauty of producing waste? I know, as medical personnel, we tend to get overly excited about bodily functions. But, never before have I ever been so fascinated by a living body to produce something as mundane as urine.

Now, needing to pee is both a blessing and a curse for most of us. A curse as we run from activity to activity without a spare moment to relieve ourselves. That constant tick-tick-ticking of an untapped bladder can drive a person near-insane with the NEED TO PEE. And, upon the moment of actually being able to release that urine, we become one with the universe and thank our lucky stars for the immense joy we feel with the act of voiding.

But what if you couldn’t do that? Not, perhaps, due to a screaming bout of cystitis. Rather, in a renal failure sort of way. Your kidneys shut down and you no longer micturate. The only balance you have in your life is measured by a formula given by a doctor to a dialysis nurse. One liter off. Two liters off. Three. Whatever is called for by the nephrologist.

And then, let’s jump forward a bit and say you’re a candidate for transplant. Suddenly, you’ve been given hope that a kidney will appear and your life will be “normal” again.

Anticipation and disappointment are your constant companions. “Today will be THE DAY,” you wake up thinking. The day ends without a new kidney and you fall asleep thinking with the hopes that dawn will bring you salvation from endless needles, dialysate, heparin flushes, and visits to one doctor after another.

Finally the day arrives. You get your kidney! At long last, you will control your life again. Except that you have to get through the first 48 hours post-op.
Forget sleep during those two days: blood pressure checks every 15 minutes. Then every hour. Then every two. The foley isn’t sitting in your urethra right. It’s pulling and hurting and that damn nurse insists on fiddling with it every two minutes. “Perhaps if we set it here…”

Then, your new kidney does the most incredible thing. It’s actually filtering your blood, removing wastes, and MIRACLE OF ALL MIRACLES, you begin to produce urine.

Everyone on the floor gathers around to measure the amount, color, and specific gravity of the product of your….well….loins.

“It’s too bloody,” claims one.

“No,” says another. “That’s what we expected.”

Yet another medical professional jumps in with an opinion. “Perhaps we should give it some time and see what happens next. Just check every fifteen minutes for the next two hours and let me know what happens.”

Whatever you produce is subject to as much intense scrutiny as the first time. Every two hours, the same people utter the same things.

It’s a waiting game. All you want to do is sleep. All they want you to do is pee. Thankfully, that foley means you all get what you want. Sort of. The constant parade of healthcare providers through your room awakens you. And, really, they can’t wait a full fifteen minutes to check. They’re obsessed with your ability to filter.

Eventually, Someone In Charge will determine that you aren’t producing enough of your precious fluids and order 120mg of Lasix. That’s followed by 12mg of Bumex. Water and juices are set in front of you and you’re encouraged to drink up, “it’s good for you!”

At some point, it’s decided that you’re either in ATN (acute tubular necrosis) or that your transplant has taken. If the transplant has taken, everyone’s happy, but still they watch you like a hawk. Ever vigilant is the staff’s motto. However, if it’s decided that you’re in ATN, that’s when they pump you full of fun diuretics.

For the nurses, monitoring the patient’s urine output becomes a game of sorts. We stand there, watching and waiting. Measuring and recording every drop. Is it enough? Has the patient met the goals for output? When given diuretics, has the patient maintained adequate systolic blood pressures? Have we given appropriate/adequate urine replacement IV fluids? Why is this patient not resting better? Those are just a few of the questions we ask as we assess the fresh kidney.

I’m still new enough to transplants that I get excited over the fact that a patient has gone from the anuric state to one of actual production. I am amazed by the technology and medical advances that allow someone else’s kidney to be placed into my patient, blood vessels connected, and filtration to occur.

I watch as the foley tubing fills with urine. I manipulate the tubing to facilitate more drainage. I’m mesmerized by every drop. The entire process fills me with wonder that modern medicine can do this.

Not every transplant goes smoothly. Sometimes we wait weeks or months to see the kind of results that some of my patients are lucky enough to experience right away. Either way, the fact that we can change a person’s life so drastically is something that never ceases to amaze me - just like the urine my patients suddenly produce.