Date: July 6, 2008
About: Nicole Goldenstein - Class of 2003
Sisters selflessness gives gift of life to brother needing kidney transplant
Nicole Goldenstein stands in the doorway of her hospital room, an IV stand by her side. The comfortable brown sweatpants and white T-shirt she donned the day before have been replaced by a drab, oversized hospital gown.
Her eyes look sleepy. It is, after all, just a few minutes past 5 a.m., and she didn't get much shut-eye overnight.
About a dozen family members and friends have taken over the hallway outside of her room. Few others are stirring and little can be heard other than the quiet buzz of their conversations.
About 20 minutes later, the group gathers in a circle around Nicole to pray that God's "angels will be around her."
Nicole's mother, Angela Goldenstein, gives her a hug, and her fianc & eacute;, Adam Utterback, reassures her with a gentle touch and tender kisses.
Despite the support, she's anxious.
"This is nerve-wracking," the 23-year-old Liberty woman says, eager to get her surgery under way.
Another 20 minutes pass. Finally, two hospital workers -- perky for that time of day -- come to wheel her down the hall and into a large elevator. A little more than two hours later, Nicole's surgery begins with a small incision.
An hour later, surgeons remove the gift of life.
That gift -- Nicole's left kidney -- is then given to her 25-year-old brother, Joey Goldenstein of Camp Point, who had been battling kidney disease since the sixth grade. In July, he was told he had just 9 percent kidney function and started dialysis.
Joey, a husband and father of two young children, needed a transplant to survive.
"I have a child of my own. I can't imagine him growing up without me," Nicole said when talking earlier about her decision to donate her kidney.
It's now three months after the transplant and despite some minor complications after her surgery, Nicole has no regrets.
"Seeing him play with his kids, knowing he'll have more time with his kids, giving him a better quality of life ... it was really definitely worth it," she said. "He's smiling more. He's happy."
'I'm just ready for it to be over and done with'
The transplant took place Thursday, March 6, by Washington University transplant surgeons at Barnes-Jewish Hospital in St. Louis. Barnes-Jewish Hospital has one of the largest and most experienced kidney transplant teams in the country.
Nicole arrived at the hospital on Wednesday morning for preliminary exams, including a chest X-ray and EKG. She had 14 tubes of blood drawn for lab tests. By mid-afternoon, nurses began to try to get an IV started so they could begin giving her fluids at 6 p.m.
It wasn't an easy task.
"Just relax," a nurse said as she tried to insert the IV for the third time. Nicole looked at Adam with a smile, which quickly turned to a grimace. She closed her eyes, obviously in pain, but she remained calm.
"Owww," she screamed, her face cringing.
The nurses would have to try again later.
Nicole clutched a stuffed animal that Adam had given her and sat up to drink a Dr. Pepper. The day was getting long and Nicole was getting anxious, as was Adam.
"I probably won't sleep a whole lot," he said, even though he worked eight 10-hour days before coming to the hospital to be with Nicole. "As long as everything goes OK, it will be OK."
Earlier in the day, Nicole filled out forms naming Adam as her health care power of attorney and her mother as her secondary power of attorney. She spent some time with Joey, Joey's wife, Nik, and their two children, T.J. and Isabella.
Joey did not feel comfortable speaking to a reporter about the transplant.
"I think he's anxious about the surgery. He's got a lot more to think about than I do," Nicole said.
The hardest thing for her, and Adam, was the waiting.
"I'm just ready for it to be done and over with," Adam said.
In late afternoon, a surgeon and anesthesiologist visited Nicole's room separately to see if she had any questions about the procedure. Then she got a visit from her dad, Donald, who had her 2 1/2-year-old son, Tyson, in tow.
"Mommy's going to miss you tomorrow," Nicole told Tyson, who wanted to see his mom's "owies" and kiss her left arm.
'All right ... show time'
Nicole got a little sleep overnight, but 5 a.m. came early. About 40 minutes later, they wheeled her to a pre-op area, and she was joined by Adam and her mom.
Nicole answered questions from health-care workers to ensure she was the right patient, that it was a kidney donation procedure and that the incision would be made on the left side. She also filled out paperwork.
Adam gave her the occasional kiss.
"It's very, very important to have him around when I need him," Nicole said. "I need someone to lean on."
At about 6:20 a.m., a nurse told Nicole that she would be in the operating room with her and explained what would be happening. At 7, an anesthesiology resident asked if she had any questions. The anesthesiologist followed a few minutes later and at 7:15 declared, "All right, show time."
Nicole was wheeled into the operating room, while Adam and Angela were escorted to a comfortable waiting area where the rest of the family and friends had gathered.
The incision from which Nicole's kidney would be removed was made at 7:55 a.m.
Dr. Surendra Shenoy, Nicole's transplant surgeon, was assisted by Dr. Jeremy Leidenfrost. They'd be removing the kidney through a procedure called the mini-nephrectomy, which Shenoy developed with colleague Dr. Martin Jendrisak at Barnes-Jewish in 2000.
It is the least invasive way to remove the kidney of a living donor.
'Everything went well'
The surgeons made a small incision, measuring about three inches or less, directly over the left kidney. This "keyhole incision" is the smallest opening through which a kidney can fit.
At 9:36 a.m., Nicole's kidney slipped through that incision and immediately was placed in a small, silver bowl -- which looked similar to a dog's water bowl. It was set in ice, and the surgeon handling Joey's operation, Dr. Jeffrey Lowell, walked into the room and began to flush it with a solution to keep the organ cool and to preserve it.
Shenoy explained that the icy slush in the bowl keeps the kidney cool on the outside, while the preservative solution flowing through the kidney cools it on the inside.
This allows the surgeons to keep the kidney for up to 24 hours before placing it in the recipient's body.
But Lowell took the kidney to the adjacent operating room within about six minutes. Eleven minutes after that, at 9:53 a.m., he began to put the kidney in place. It took a little more than an hour to finish the surgery.
Back in Nicole's operating room, her incision was closed at about 10:38 a.m., and as she began to wake up about eight minutes later, the anesthesiologist assured her that she was OK, that she just had surgery and was being taken to recovery.
"Try to take a nap. You'll be fine," he said.
"Everything went well," Shenoy told an observer. "There were no surprises."
A corner of a Barnes-Jewish Hospital waiting room was home all morning to family and friends of Nicole and Joey, including their parents, children, both grandmothers, their older brother Rob and one of his young children, close friends, church members, and their significant others -- Adam and Nik.
"We got updates whenever they did something," Nik said. "That was great, just to know everything's going all right."
She admitted, though, that the wait was "very stressful."
Once she learned that the operation was over, Nik was "very relieved, but anxious to see him. And I'm hungry. I haven't eaten all day."
Angela and Donald, even though they had two children under the knife at the same time, didn't seem stressed.
"I'm at peace about it," Angela said before the surgeries got started. Hours later when they received word from the doctors that both procedures went well, she just had one word to share: "Rejoice."
Their grandchildren kept themselves occupied in the waiting room with coloring books, trucks and other activities. At one point, Isabella was sound asleep under a row of chairs.
At noon, a message came for Adam. Nicole wanted to see him.
The agonizingly long morning was finally over.
'It's definitely worth it'
But a few rough days still lie ahead.
Nicole was released from Barnes two days after the transplant, on a Saturday. But because of complications related to the anesthesia and pain medication, she said, her intestines weren't working properly.
She went to the Blessing Hospital Emergency Center in Quincy on Sunday night, then was transported by ambulance back to Barnes on Monday. She was released again on Tuesday.
About a month after the surgery, she started feeling about "90 percent better."
She still couldn't lift certain things, but she finally could begin to hold her 25-pound son.
"I had Adam with me all the time," Nicole said of her recovery. "I had to drink a lot of fluids and eat stuff high in fiber because of the complications I did have. I was really tired, and lying down was difficult. I did a lot of sitting."
She walked regularly to keep her back muscles from getting tight.
"I played a lot of Yahtzee with my grandma," Nicole said. "She baby-sat me. You need to set up a good support system. Adam, my grandma and his Aunt Betty would come sit with me. You need a good support system so you don't do too much."
Still, she says, her temporary discomfort was worth it because she knows that her kidney is giving her brother more years, and better quality years, to spend with his family.
"You're down a little bit, but not that long," Nicole said. "It's definitely worth it. Joey's doing really, really good. He felt good right after the transplant. When you don't feel well for so long ... his color is better, he starts getting an appetite, he just starts feeling better."
Joey went back to work at Titan Wheel much sooner than expected, and he'll soon finish a truck driver training program at John Wood Community College.
Nicole says her experience at Barnes-Jewish Hospital was "wonderful" and she thanks all those who took care of her, especially Dr. Shenoy.
She encourages others to consider being a living kidney donor if someone is in need of a transplant.
"The biggest misconception is it's going to cost you money. The recipient's insurance covers all medical expenses. The only thing it costs you is a couple weeks off work," Nicole said.
But what about living the rest of her life with just one kidney?
"I know I'll be perfectly fine with one kidney," Nicole said. "It's not really that big of a deal."