On May 8, 2013, a woman named Karen Irwin posted a picture of her kidney on Facebook.
Not an X-ray. Not an MRI. Not a drawing, not a painting, not an artist's conception. Her actual, honest-to-God organ; a photograph snapped by an attending nurse in the OR while Irwin's kidney was, in Karen's words, "between gigs."
I commented on the photograph: "The top part looks like bacon. The rest looks like British food."
Actually, that was just me trying, and failing, to be comical. The top part did look like bacon. The rest looked like a boneless chicken breast - complete with rib meat - that had been left on the cutting board a little too long. Kinda ... pinkish/bluish/weirdish.
By the way, before you judge, I wasn't the only one who chimed in with a Hannibal Lecter-esque "human-organ-as-food" gag. A lot of Karen's friends, it turns out, are equally morbid.
They were also equally touched by what that photo meant.
Karen Irwin's kidney has come unstuck in Karen Irwin.
It's now stuck in the dude she's dating.
The naming of the kidneys
I went to see Karen in the hospital, two days after the surgery, two days after she'd donated one of her kidneys - the one she'd named Stacey - to her boyfriend. She sat upright, stoned but alert, all the monitors and tubes and appliances and accessories attached to her that one comes to expect to be burdened with when one is wearing one of those ridiculous medical gowns. The room was a flurry. Friends dropped in. Family. She had a visit from an advisor/advocate person whose functions included making sure that no one was holding Karen's dog or kid or grandma or family heirlooms hostage in some kind of extortion-for-organ plot.
Her pupils were huge.
"What are you on?" I asked her.
"Right now ... I just switched over to Percocet."
Before we talked motive, before we talked process, before we talked about the recipient and Karen's relationship to said recipient - I had to hear about the naming of the organ. Some of us name our external parts on occasion - ahem - but you don't find too many folks walking around with nametags emblazoned with things like "HELLO! My liver's name is Floyd!"
Plus, it was all over social media. I mean all over. My news feed had become Stacebook.
Karen explained why her kidneys both received a moniker: "The left one was Dolores and the right one's Stacey. Stacey was supposed to stay - that's why her name was Stacey - and Dolores was gonna be the one that went on a suicide mission to live with Randy."
Once more, for the sake of clarity: Stacey is - sorry, was - Karen's right kidney. Dolores is her left. Randy Julian is her boyfriend.
Karen named Stacey after consulting with medical professionals. But she still didn't think Stacey would actually stay. "From the minute I started thinking about donating my kidney a couple years ago - prior to even meeting this recipient - I had envisioned my right one. In my dreams - I was always holding the right side of my abdomen ... " She trailed off a little.
Percocet. Karen Irwin usually finishes her sentences with an unmistakable bang.
The doctors, the advisors, everybody with IU Health informed Karen that the left kidney was usually the one that, well, left. Karen insisted she thought the right one was going to exit. A CAT scan revealed that Dolores was 208 grams and Stacey was 203 grams. They were roughly the same weight. A toss-up, size-wise. However, because of the length of the surrounding vessels, the left was usually the best candidate for a transplant. But Dolores - although she left lived on the left - had a spare artery, something that complicated the process of attaching the organ to its new host.
Now it was up to the attendant physicians to hammer it out among themselves. Whose job was going to be more difficult - the take-it-out doc or the put-it-in doc? Karen, not the sort who'd let some guy in a lab coat make decisions about Karen's bod without Karen's input, informed everybody that, "If it's all the same to you people, I'd just as soon get rid of Stacey. That's who I said goodbye to a long time ago."
So Stacey became the one getting a travel agent.
"Which is a great relief. Because once you've said goodbye to a kidney, you really don't want to keep that one."
The kidney transplant procedure takes about two to three hours. Recovery time is patientdependent but most patients (recipients) are feeling fairly good by two to three weeks. Donor recovery time is a bit different but again patient-dependent. We suggest that donors stay off work for six weeks (although they have usually recovered much sooner.) Complications are discussed with the potential donor prior to the procedure and are consistent with any other laparoscopic procedure. - Dr. Tim Taber, medical director for the kidney transplant program at IU Health University Hospital.
One working kidney too many
Maybe you've seen Karen in a Fringe play. Maybe it was Assholes & Aureoles (with Diane Kondrat and help from Eric Pfeffinger). Maybe you've seen her Janis Joplin tribute show, A Piece of Her Heart, which returns for a run at The Cabaret at the Columbia Club July 26 and 27. (Don't worry - Karen will be all healed up by then. Not to mention 203 grams lighter.)
Maybe you've caught "Karen-oke." Maybe you've seen her other work. Maybe you've met her.
If you know Karen personally, or if you're familiar with her stage chops and/or her attitude, then it's probably not a big stunner that Karen simply decided one day that she had one working kidney too many when a lot of other folks were walking around with one working kidney too few. Once someone with Karen's personality type decides that the donation of an organ is Something That Should Be Accomplished, there ain't much that'll stop said task.
So - it's not a surprise that Karen wanted to do something like donate a kidney. But where does that come from? What's the impetus for the idea itself? What's the trigger?
What makes somebody decide to be an organ donor?
"I honestly don't know." She's searching for words, suddenly. These aren't the meds talking. This is a rarity: Karen Irwin, momentarily unable to express herself.
Turns out there's more than one reason. She's having trouble prioritizing.
REASON 1: She was purging. Unloading. Getting rid of stuff. She quit drinking. Didn't need it. That wasn't challenging enough. So she quit smoking. OK, now what? Sold everything she felt she didn't need. More satisfaction. Less consumption. Less stuff.
REASON 2: She'd been on the bone-marrow donor list since she was 17. And nobody wanted her bone marrow.
"And frankly, that's a little insulting. What is wrong with my bone marrow?"
Surely, somebody would want a healthy kidney, right? Right?
REASON 3: Karen's dad has been on the lung transplant list. As a recipient, since they don't let you give those away. (He's got a fresh one now.) Note: Karen didn't cite that as a reason. That's just me, playing armchair shrink.
REASON 4: Karen's not going to have children. However: something can be taken out of her that will provide life.
But we'll get back to that.
Randy's kidneys ate themselves
While Karen was purging, she also became a server. She "ran away to Zionsville." In the midst of sorting out what she still needed to get rid of, she now had an answer for those who queried:
"So, Karen, what are you doing these days?"
"Well, I'm thinking about getting rid of a kidney."
This was not to elicit shock, mind you. That's honestly not the way Karen's brain works, believe it or not. Irwin is part anthropologist. She wants to see what happens when The Answer They Didn't Expect lands on The Unsuspecting Ear. If it shocks, so be it, if it saddens, so be it, if it amuses, win-win.
Karen didn't like the responses she was getting. A lot of times the comeback was, "What if you NEED it?" That horrified her.
I pointed out that it seemed a logical response: if one goes to hell, you've got a backup.
Irwin shook her head. "The disease that Randy got - his kidneys ate themselves." They were both working - kind of. They were both doing the same thing at the same time. And they were both dying.
About 10 years ago, I was diagnosed with a thing that hardly anybody can pronounce, a thing called glomerulosclerosis - which is a scarring of the filter sacs in the kidney. You've got about a million of them per kidney, and you need about a million total to live a normal life - which is why you can get away with living with one kidney. I ended up on a very harsh steroid therapy for a year - and we thought we had it under control. There's two forms of the disease. ... If you have the fast acting one, then the steroid therapy almost always cools it down. ... If you have the slow acting one, you're inevitably going to end up on dialysis - and with a transplant. - Randy, recipient of Stacey
203 grams of tissue
As Karen and I were talking, there was a gent in another wing of the fourth floor of University Hospital, a guy who'd just received 203 grams of tissue that had come unstuck from Karen Irwin.
Again, his name's Randy, and he and Karen are now connected in ways most couples aren't.
OK - so how did the donor and recipient get to be linked - romantically ... and renal-ly?
"I went online," Karen explained, "and I started feeling real judge-y: 'I want someone to do something GOOD with my kidney'." Karen wanted her kidney to have a good home - and then realized that was a horrible place to start. "As soon as I started having those judgments, I realized I didn't want to be the person who made this decision." Karen decided to be an "altruistic" donor: a live donor who just wants to give an organ to the next needy human who's a match.
About 40 percent of IU Health's kidney transplants involve living donors. We have about one or two non-directed altruistic donors annually. The relationship of the donor to the potential recipient has been changing with the advent of paired donation. Specifically, more donors are not related to the recipient than in the past. - Dr. Taber