Wednesday 12 April 2017


At The Institute, we are required to keep class attendance records for all our students, as if they were in primary school. Never happened when I was in college! As voting-age adults, it was assumed that we had the maturity to achieve an effective work-life balance.   It usually worked out. A palomino partied so hard in his first year in Law School that he flunked his Summer exams but knuckled down over the summer to pass the Autumn repeats. He went on to a stellar career in commercial law, easing the sale of airports and power-plants, and retired on his money at the age of 50. The policy at The Institute is driven by a pro-active sense of care. Twice each year we hold progression meetings to check on all our students, flag those who are not doing well and try to get them back on track. If they haven't attended class, haven't got a sick-note and aren't known to have trouble at home then they get a stern talking-to and that works more often than you'd expect.  Without that meeting you don't know if they are missing because they hate you or hate the subject or are just party-animals.

ANNyway, I get presented with a lot of sick-notes and leave-of-absence dockets [teaching sporty people you expect them to bunk off playing soccer for The Institute occasionally]. With that evidence I can pro-rate their marks and ask them to catch up as best they can. I make a point of never looking at the detail, or even the date because it's really none of my business whether they had pneumonia or a case of the pox. And I usually give the docket straight back to the student so that they can present it in the other relevant classes. In early March, one of my students handed me a sheet to explain her two week absence. I handed it back, but she said keep it I have more, so I tucked it into the class envelope and rushed to my next class. A few weeks later, I found a folded sheet in my heap of papers, opened it up to see where I should file it and saw it was from the Blood Transfusion Board asking for leave-of-absence for that student because she had volunteered to be a >!bone-marrow donor!< Blimey! I said, that's a woman who deserves doffed hats from the rest of us. Bone marrow transplants are one line of attack on leukaemia and other cancers: you kill all the stem cells in the patient so they cannot continue to propagate defective blood cells (horrible aggressive radiation therapy will do there) and then take in fresh haematopoietic stem cells with the bone marrow donation. Getting the bone marrow out is grossly invasive: the harvesters have to drive a huge needle into your hip bone to suck out your precious bodily fluids. There is a small but detectable risk of something going wrong on the sterility front and the donor getting an infection. All-in-all, it is not something lightly undertaken.  At least with bone marrow, there is a a natural rate of turn-over and after several weeks (barring infection) you are back to the status quo ante. If you live in Ireland, you may now wish to sign up with the bone marrow donor registry. I can't, I'm too old. In contrast to the story below, bone-marrow donors and recipients are, by EU law, kept strictly separate and anonymous after the procedure.

It's not the same with a kidney. Most of us are born with two and they work away for 100 years.  But a number of babies are born each year with only one kidney or with one so diminutive as to be useless. Then again, if you have diabetes, you can put so much stress on your kidneys that they pack up.  I wrote about kidney exchange and kidney rings in January.  In the news this week including the Irish Mirror, are Ruth Smith and Noel Howard whose lives sharing a GP practice in Galway became more interleaved last year because he donated a kidney to her when she started on dialysis. They were both married (to other people!) with three kids and kidney donation (even if you, as most of us, have one spare) is not without risk.  He was determined to make the donation because his brother in law had died of cystic fibrosis after no donor could be found for lung transplant.  On the wireless at the end of last week, the two doctors were interviewed about the process. I turns out the old clapped-out kidneys are left in place because removing them is awkward and the new kidney is plumbed in using another artery and vein and then just rests in the abdominal cavity pumping and filtering away. Like a lot of medical interventions, dialysis is a blunt instrument compared to a working kidney and QALYs go way up if you can make the switch.

1 comment:

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