Brothers for life

When Jeff Skinner needed a kidney transplant to stay alive, his brother David was there for him

When Jeff Skinner needed a kidney transplant to stay alive, his brother David was there for him
Read more

What your kidneys do

Signs of kidney disease

Preventing kidney disease

About the Manitoba Renal Program

Dialysis treatment defined

Transplanting a kidney

About Transplant Manitoba

Winnipeg Health Region
Wave, March / April 2010

The acting students are rolling through their lines when teacher Jeff Skinner stops them cold.

"I can see we're a little rusty," barks Jeff, a cherubic man in his mid-50s. "Your characters aren't believable. Come on, let's get body, thoughts and words all together."

The students give it another go, hoping to pass muster and coax a compliment from the taskmaster at the head of the class. It won't be an easy thing to do. Even Jeff acknowledges he is feeling more obnoxious than usual as he promises to make the lives of his would-be actors "a living hell!" But the students don't mind. They're just happy to see him. After all, it was only a few months ago that they learned their beloved mentor might not be standing before them on this January evening. In fact, there was a good chance he might not be standing anywhere.

That's because last fall Jeff was suffering from chronic kidney disease, a condition that left him in need of daily dialysis treatment simply to stay alive. The prognosis was not good - without a kidney transplant, most people with chronic kidney disease eventually die from complications such as cardiovascular disease. Fortunately, Jeff was able to get a transplant, thanks to his brother, David Skinner, who became a living kidney donor. Now, in early January, just six weeks after the transplant operation, Jeff is up and around, teaching acting classes and tending to business at Two Lagoons, a film production company he founded with Kent Ulrich in 2008.

It's a dramatic turnaround for Jeff, and one that is not lost on his students.

"He used to have yellow pasty cheeks," says one during a break in the class. "Tonight he has rosy little cheeks and bright eyes," she adds.

"His voice is strong, no coughing," offers another.

"Before, we watched him deteriorate before our eyes - as though someone pulled a plug. He was fuzzy-brained and couldn't concentrate. Now he looks and acts 15 years younger."

Yes, to paraphrase a famous line from an old movie, Jeff Skinner is back, and he has a story to tell. It's a tale of how one man stepped out from the shadows of a potentially fatal disease to find comfort in friends, family and work. It's also a story of how health-care providers - nurses, doctors, technicians and others - worked together to help Jeff along on his journey. But, ultimately, this story is about brothers - two men never all that close as kids (they were born eight years apart) - but who are now true brothers for life.

Chronic Kidney Disease

Kidneys are arguably the most under-appreciated of the human organs. And yet without these two organs on either side of our abdomen, each the size of a fist and shaped like a bean, we would have no means of removing waste and toxins from our body. In other words, without them, we would be dead.

Like many people, Jeff knew a bit about kidneys and their importance to the body's overall function when he walked into his doctor's office 12 years ago, in 1998. His mother, Evelyn Skinner, now 88 years old, lost a kidney when she was 40 because of arterial problems; and her mother, Jeff's maternal grandmother, had one removed because of kidney stones.

At the time, Jeff had been passing kidney stones - a relatively common condition that occurs when the urine has, for example, too much calcium or uric acid - so he was expecting to hear that he would have to undergo some kind of treatment or take some steps to deal with the problem. What he did not expect to hear was that he had a more serious kidney problem. Further exploration revealed many cysts on both kidneys (unlike a few cysts that are most often found in people over 50 years of age and not considered serious).

The diagnosis was polycystic kidney disease. The prognosis? Bleak. Over time, as the cysts multiplied, the kidneys would enlarge and cease to function.

With that diagnosis, Jeff joined a growing number of Manitobans who have some form of kidney disease. In fact, Manitoba has the highest rate of chronic kidney disease in Canada, according to the Manitoba Renal Program. Each year, more than 275 Manitobans start chronic dialysis treatment to stay alive, according to program officials. Most of these cases - as many as 60 per cent - are caused by diabetes. Cystic diseases, like the kind that struck Jeff, account for less than five per cent of cases. Based on world-wide population studies, it is estimated that as many as 100,000 Manitobans may be affected by chronic kidney disease in different stages.

So serious is the problem, that the Winnipeg Health Region and the Manitoba Renal Program have launched a campaign to raise awareness about the issue. Dr. Mauro Verrelli, Medical Director of the Manitoba Renal Program, says other measures are also being considered to help stem the rise in chronic kidney disease cases. They include using new tests to screen for early signs of kidney disease, more education and support for family doctors, and making more of an effort to identify higher risk patients for testing, especially those in remote Aboriginal communities in northern Manitoba.

But no matter how one develops chronic kidney disease, it can take a toll. Says one medical specialist, "Losing kidney function affects how your hair grows to how your toenails grow and everything in between." Another, a nurse working in a dialysis clinic, states: "We look at people and know their lives will never be the same again."

It took Jeff some time to absorb the importance of what he was being told. The news came as a shock and left him feeling helpless. Like many people in his situation, he asked the obvious questions: How could this happen to me? Why has my body betrayed me?

Within days, however, Jeff regained his composure. Kidney disease was just another thing to deal with, and Jeff resolved to deal with it.

The Black Sheep

Jeff Skinner is, in a manner of speaking, the black sheep of his family.

These are, after all, the Skinners of hot dog and hockey fame. Jeff's grandfather, Jim Skinner, Sr., not only founded the first Skinner's drive-in at Lockport in 1929, but also helped establish the Manitoba Junior Hockey League. And, as owner of the Selkirk Arena, he was instrumental in developing the Selkirk Steelers senior hockey club as the farm team for the Detroit Red Wings.

Jim had three sons, Jim Jr., Gordon, and Morden (Ducky). Jim Jr., perhaps the best known, held various positions with the Red Wings for 30 years, including coaching the team to the Stanley Cup in the 50s. He and "Ducky," also a professional hockey player, are in various Hockey Halls of Fame. Jeff's father, Gordon, ran the family business until it was sold in 1973.

Gordon and Evelyn had two sons: David was born in 1947 and Jeff was born eight years later, in 1955. Both boys grew up working long hours in the family business, but as they matured, each chose careers far removed from the food and beverage industry. David planned to be a lawyer, while Jeff had developed a talent and passion for the creative arts.

"Dad offered the business to us," says Jeff, "and I couldn't have asked for a better education. I learned money and people skills. But my life is all about what I do and I knew I wanted something different."

Instead of hockey, Jeff Skinner played piano; instead of golf, his passion was voice and trumpet. From grade school through university, Jeff studied with some of Winnipeg's finest music teachers. And it paid off: his raw talent has been honed into an impressive instrument. From starring in high school musicals to performing at Rainbow Stage to singing at numerous public events, Jeff has over the years appeared in 50 musical and theatrical productions and in over 500 musical stage appearances, along with about 40 roles in TV shows and movies.

In the 1970s, there was, of course, the requisite pilgrimage to Toronto to "make it big." He had a few minor stage successes, but overall, "I found I couldn't wait by the phone for it to ring. I wanted to create my own work."

Returning to Winnipeg, he began a career in marketing - first with Stage West and then with the Winnipeg Sun.

From 1982 to 1987, he and three friends formed the Argyles, a show band that had a strong local following, performing at the Rorie Street Marble Club, the Norwood Hotel, and at various events. The group's success expanded as Entertainment Ambassadors for Expo '86 in Vancouver - opening for big acts like the Neville Brothers and Tower of Power, and sharing the stage with the Nylons.

Eventually, though, Jeff left the group and evolved into an events planner. Through his own company, Theatricom, he served as Festival Co-ordinator for the 1991 Grey Cup, and created and produced the Festival of Lights Parade for the 1998 Grey Cup. In 1998, he joined the team at The Forks where he worked for seven years. "We did 200 events a year," he recalls. "I created Dancing Under the Canopy and the original Christmas at The Forks."

And on top of all that, there was community involvement.

"My family believed in community service," he says. "And that's why I volunteered to be the Marketing Chair for the United Way Fundraising Campaign for five years and Vice-President of the Rainbow Society. I also sit on the board of the Burton Cummings Theatre. At three points in my life, I had to pull out because I was spending up to 80 per cent of my time in volunteer work."

What's remarkable about Jeff is not only his prodigious work history, but also the fact that, alongside his public accomplishments, he was battling many a private health crisis.

His mother, Evelyn Skinner, with whom he shares the family home, suffers greatly because of Jeff's medical history. "I keep thinking, 'What did I do wrong?' I had one kid who's always been healthy and one who has been falling apart."

Evelyn says her son's health problems started at the age of one. "I saw one leg longer than the other. His pediatrician always questioned if it was polio. He had a terrible fever and was in hospital for several weeks. It was a terrible time," she recalls.

The next blow came when Jeff was 21. After a few years working at minimum-wage jobs, he was deeply immersed in theatre studies at the University of Winnipeg.

"Suddenly, I began to have severe headaches," says Jeff. "I didn't sleep for a month. My family was helpless." It was eventually determined that Jeff had an aneurysm in his brain and had to undergo surgery to remove it.

Nine years later, at age 30, Jeff was diagnosed with testicular cancer. He underwent surgery and radiation for seven weeks, and the cancer disappeared.

Another decade, another crisis. In 1997, at 42, Jeff had the first of several operations to repair multiple aneurysms in his left leg. He has an arteriovenous malformation, a condition described as an abnormal connection between the arteries and veins. It's a lifelong condition, which means Jeff will face more procedures as he ages.

Despite everything, Jeff is able to put a positive spin on these experiences: "There is an upside to all this. Every time you go through a medical crisis, you learn more about yourself."

Still, nothing prepared Jeff for chronic kidney disease. "Everything else I had could be fixed. This can't."

Not that he didn't try.

The Journey Begins

Chronic kidney disease can be a very slow-developing condition. At the time of his diagnosis, Jeff was not required to do anything. But his doctor told him what to expect: over time, his kidneys would start to fail and he would eventually need dialysis and a kidney transplant.

Doctors couldn't tell Jeff precisely when all this would happen as even a family history of polycystic kidneys was absent. This condition which is very often transmitted genetically, can have a relative predictive pattern of disease progression. Without a reference point, Jeff was entering unfamiliar medical terrain.

Nonetheless, and despite past medical problems, Jeff believed he was basically pretty healthy. He was a non-smoker, rarely drank, and was careful to take vitamins daily. In short, he hoped his generally healthy lifestyle would slow down the deterioration of his kidneys, maybe even halt it altogether.

Once the diagnosis was in, Jeff started attending the renal clinic at Health Sciences Centre where his condition could be monitored. As expected, the disease gained ground as the years went by. But even as his creatinine levels started to rise (creatinine levels measure the kidneys' ability to excrete waste), Jeff got on with his life. "When you are self-employed, what choice do you have? You just get on with life," he says.

In 2003, renting studio space on Albert Street, Jeff went out on a long entrepreneurial limb and opened the Actors' Training Centre of Manitoba, where he hoped to develop a pool of film actors who could plug into the local movie industry. A few years later, he ran into Kent Ulrich, who was in the business of financing films. The two men formed a partnership called Two Lagoons Entertainment Inc.

Jeff threw himself into the project with his new partner, working long days reading scripts, teaching, and producing feature films. They even built a western movie set on a parcel of land near Tyndall. At the same time, however, he was entering a different phase of his illness. His body was starting to shut down. "I couldn't walk four steps, my lungs were full of fluid, and I had severe sleep apnea," he says.

It was now clear that dialysis would be needed if Jeff was to stay alive, but even so, he resisted. Dialysis treatment can be psychologically intimidating for people with chronic kidney disease, in part because it signals that the patient is in end-stage renal failure. That is to say, their kidneys are no longer functioning at an acceptable level and they need the help of a machine to clean their blood.

"No one wants tubes hanging out of their stomach," Jeff says, trying to explain his reluctance. "So you try to hold off. But I knew I was miserable not on dialysis."

By June 2008, Jeff was ready to take the next step on his journey and begin dialysis treatment. The only question was whether he would undergo hemodialysis or peritoneal dialysis.

The former involves having a patient attend one of the city's four dialysis units, which are operated by the Manitoba Renal Program and funded by the Winnipeg Health Region. Once there, the patient is hooked up to a machine that cleans his or her blood outside the body.

Peritoneal dialysis, meanwhile, is a less invasive process in which blood is cleaned by placing a catheter tube in the patient's abdomen, which is then used to insert dialysis solution. The solution draws the toxins from the blood and is then drained out of the body.

Jeff chose peritoneal dialysis because it allowed him to carry out the treatments at home, something that he thought would allow him greater freedom. Because it is a self-administered program, there is a one to two-week training program to learn all the intricacies of the process. Jeff picked up the skills in five days.

Living with Kidney Disease

It's a drizzly day in mid-August 2009 and Evelyn Skinner is sitting in her living room, which is decorated in her favourite colours of soft blues and peach. The Skinners have lived in this comfortable 1-1/2-storey home in Silver Heights since it was built in 1952. The family has strong roots in this small, tight-knit community. This is where, from birth, Jeff grew up, went to school and formed lifelong friendships.

For years, after he graduated from university, Jeff lived away from home, but on his deathbed, his father asked that he come back to share the family home with his mother. And he did, purchasing the family home so that his mother could continue living where she was most comfortable. They have an ideal set-up. Evelyn Skinner has her own self-contained apartment upstairs; Jeff lives in the lower portion of the house. The living arrangements work well.

Evelyn, perhaps more than anyone else, understands what Jeff has been going through all these years as he struggles to overcome kidney disease. She was here when he came home with the diagnosis, and she was here when the dialysis equipment arrived 10 years later in 2008. She says her son has had difficulty coming to terms with dialysis.

"Normally Jeff is a kind and obliging person," says Evelyn, "but since he's been on dialysis, it's all changed. Every day, I can hear him swearing at the dialysis machine. He is angry - very verbal - very loud - at the least little thing," she says.

Jeff acknowledges that his relationship with the dialysis machine is a complicated one. "As soon as I was on dialysis, I felt better," he says. Nonetheless, he admits that he does lose his cool on occasion. "I do it here (get angry) because I can't release (my frustration) around anyone else. I tell her (my mother) not to take it personally," he says. He says socializing, and more importantly - teaching - is difficult. "What energy am I putting out? How am I affecting others? How am I controlling my manners?"

He says his anger comes from feelings of isolation. "I feel like the kid standing on the outside looking in," he explains. "The last two years of my life should have been the most exciting with our movie company, but I've had to stay in the background and watch others play. I had to fire myself more than once because I was incapable of doing the work. Thank goodness for Kent; he kept everything going."

Verrelli says Jeff is not alone in his feelings about dialysis. "Most patients have to come to terms with the fact that this transition is unfortunately necessary, and getting over the hump is often very difficult for patients," he says. "But when a patient eventually starts dialysis and feels much better, he or she then understands how sick they really were."

In order to dialyze at home, Jeff had to make some changes to the house. On this visit, one can see that a main-floor guest room has been converted into a medical storage area. Heavy cardboard boxes - 60 delivered each month - are stacked floor to ceiling. Each box contains heavy five-litre plastic bags of a fluid called dialysate. Under the window, more medical supplies are neatly arranged on a long white rectangular table: bandages, a bag of heparin capsules, a blood pressure cuff and monitor, a gallon of distilled water and saline cleanser, and a bag of syringes. Other boxes contain lengths of clear plastic tubing.

Next door, on an oversized table next to his bed, sits a large white machine, known as a cycler. It looks very much like an oversized infant scale. The bags of dialysate are kept warm on the top of the machine, which automatically controls how much fluid flows through the tubes into Jeff's lower abdomen. The waste fluid is then drained by another length of tube into the toilet about 20 feet away. Jeff undergoes dialysis overnight. The equipment takes at least 1/2 hour to hook up in the evening and another 1/2 hour to take apart in the morning. All products used are thrown away daily. "One of my biggest costs is in garbage bags," says Jeff.

Simply viewing the equipment and supplies is exhausting; a life dependent on it is overwhelming. "Man, oh man - it's amazing what those little 10 cm things called kidneys can do, when you consider what I have to do to create a poor facsimile," he says.

Visiting the Clinic

Decked out in a red T-shirt, sunglasses perched on his head, Jeff Skinner looks bright and chipper as he makes his way to the dialysis clinic at Seven Oaks General Hospital on this late August day.

Located behind the hospital's Emergency entrance, the clinic is a lowlying oasis of pleasing red brick and landscaped grounds. It's obviously been designed to meet human needs, from the ample, inexpensive parking nearby to the restful décor inside.

Jeff has now been dialyzing at home for more than a year, but he still must make the trek to a renal clinic for a monthly checkup, just to make sure things are as they should be. He picked this clinic for his visits because of Dr. Sean Armstrong, his nephrologist and the Medical Director of the Seven Oaks Renal Program.

Jeff first met Armstrong at the St. Boniface renal clinic when he was struggling with the whole idea of dialysis. He felt an immediate connection with the tall, good-humoured kidney specialist. What he appreciated most was that Armstrong didn't try to force him into a decision. "He has respect for the patient," Skinner says. "He knows where we are emotionally."

When Armstrong moved over to Seven Oaks, Jeff quickly followed.

Interestingly, Jeff looks forward to these visits, his quick wit and people skills on full display. The staff reciprocates with equally warm quips and comments.

"Hey, Jeff! Any new projects you can tell us about?" calls out one staffer. "Still making movies?"

The feeling of relaxed bonhomie extends into the examination room where all conversations concentrate on a printout of Skinner's blood work and blood pressure numbers.

Dialysis doesn't take away the problems of chronic kidney disease, it holds them at bay. Monitoring a patient with kidney disease is a meticulous process. Each element in the body - creatinine, sodium, calcium, potassium, phosphate, cholesterol, hemoglobin, urea reduction ratio - is carefully calculated to measure how the kidneys are working and if dialysis is flushing enough toxins from the system. The work is carried out by a team of specialists: One after another, first a nurse, then a dietitian, then a pharmacist, then the doctor, they go over every detail of Skinner's monthly tests. To keep his body in balance, Jeff takes daily medications and vitamins; he's also supposed to adhere to a phosphate-free diet as well as limit his fluid intake to one litre a day. He attempts to follow the food and fluid regimen, but it's tough.

Despite his calm exterior, he's always concerned about what the blood work shows: "Sometimes I feel as though I got sick because I failed. If my blood work numbers are off, I have failed."

He's hesitant to share these feelings with the medical team. And he remembers his feeling of complete elation a couple of months ago when Armstrong told him, "You know what? You're still the healthiest person in my practice."

Today, after all observations have been carefully notated in a five-inch-thick dark green binder, labelled "Jeff Skinner" - Armstrong enters the room to review the whole picture. The discussion is serious: Jeff has already increased his dialysis up to fourteen hours a day and still his body is a mass of symptoms. He complains, especially about the numbness in his hands, the sensitivity of nerve endings throughout his body, which feels like a million needles, his restless leg syndrome at night, flaky skin, sores that don't heal, and burst blood vessels that turn his eyes into a vision of hot pink and red. He's still fatigued, has shortness of breath and has developed a cough.

It's obvious that peritoneal dialysis isn't going to be a long-term solution. Armstrong looks at the creatinine levels and confirms what Jeff already knows: He is on the brink of needing to undergo hemodialysis, which some patients require when their residual kidney function drops to almost nothing.

Fortunately, Jeff is also on the brink of something else: receiving a kidney from a live donor. It's just a matter of arranging a date for the transplant operation.

Armstrong, with true emotion, says, "I'm glad you're getting a transplant." And as he leaves the room, he tells Jeff that he is going to call the Health Sciences Centre "to see if we can push things along."

Time for a Transplant

Jeff Skinner is doubly blessed. Not only is he eligible for a kidney transplant, he's actually had offers from five live donors over the last 18 months. The first to step up was his brother, David, followed by good friend, local artist and Renaissance man, Nicholas Burns. Initially, Burns appeared to be a better match for Jeff, so he became the first candidate.

Previously, Burns had learned of a woman in Vancouver who had recovered nicely after donating a kidney, and because of deep personal reasons, felt that was something he would like to do. "So, when Jeff first told me of his kidney problems, I told him I wouldn't have any problem being a donor," says Burns. And once the decision was made, Burns began the live donor evaluation process.

Of course, donating an organ is not as simple as putting up your hand and volunteering. First, the potential donor has to go through a screening interview with a transplant co-ordinator, which leads to an information session with a transplant nephrologist. Next, there is a series of blood and tissue tests to check if the potential donor and recipient are compatible. If all matches up, the potential donor starts undergoing a never-ending series of blood tests and X-rays to rule out possible health risks, now and in the future. A psychiatrist is also involved to make sure the potential donor is giving for all the right reasons.

At the Health Sciences Centre, all the details of the process - right up to the moment of surgery - are taken care of by one of several renal transplant co-ordinators. It's a job that requires meticulous organization and supreme tact. Co-ordinators not only juggle a plethora of appointments and test results from both donor candidate and recipient, they also have to maintain a fine ethical balance that protects both the potential donor and the recipient. In other words, the co-ordinator can't share any information from one with the other.

Even though some patients may feel constrained by the high level of secrecy - the rules are in place for a reason. Donating a kidney is a monumental decision; full privacy means the potential donor can pull out at any time without feelings of guilt or recrimination. (Donors themselves can obviously share as much information as they want with recipients.)

Jeff's file was handled by transplant coordinator Jody Sawatzky. Despite working with live donors every day, Sawatzky says she still is awed by their generosity. "Donors make magic. I admire them so much," she says. "Their commitment has to be strong and enduring."

The donor evaluation process for Burns started well. Blood and tissue typing went better than expected. Burns got a "thumbs up" - he and Jeff were almost a perfect match. However, six months into the process - in October of 2008 - further tests showed Burns had an anomaly of veins on one side and a lobed kidney on the other. He was out of the running. "I told Jeff about it in person. I was very disappointed, crushed really. It was really tough to tell him, but Jeff being Jeff, tried to ease the loss."

Jeff's brother, David, then 61 years old, would become the next candidate.

David Skinner Steps Up

On a windy, cool day in early October 2009, David Skinner greets this visitor in the hushed reception area of Taylor Mc- Caffrey law offices, nine storeys above the corner of St. Mary Avenue and Kennedy Street. We walk up a few flights more to his office, which offers a panoramic view of downtown rooftops. David has a busy law practice, but he says his work is flexible, which has given him the time to be a live kidney donor.

In just seven weeks - on Thursday, Nov. 26 to be precise - David will undergo surgery to have his left kidney removed to be transplanted into his brother, Jeff.

David does not appear at all anxious about the upcoming operation, even though, according to his mother, he hasn't had a brush with anything surgical since he had his appendix out 35 years ago.

Like Nicholas Burns before him, David has undergone the battery of tests that every potential live kidney donor must endure. "I've just been going through the process," he says nonchalantly, before adding ruefully, "They have taken more blood than I thought I had blood."

He says he appreciated the privacy allowed the donor. "The live donor ultimately calls the shots on how to proceed, and if at any time the donor wants to quit, it's his call," he says. "It relieves a lot of pressure for the donor - there is not as much pressure to carry on if circumstances change."

He has also been reading up about other live donors and feels confident of the outcome. "I'm not overly concerned. Transplants have become common procedure. In fact, I've already booked my winter holidays."

Not a demonstrative man, he comments on how Jeff has slowed down, how he's more subdued, how he attempts to put on a brave front. He notes that because of the eight-year age gap, he and Jeff have not been as close as other brothers, but through this process, they are beginning to joke around a bit more.

David's cool demeanour belies the remarkably selfless act he is about to perform. Jeff, as a recipient, expresses deeper, more personal sentiments.

He believes it is "the deepest act of love." He suggests there should be a ritual attached to the process - perhaps an exchange of letters between brothers. As time passes, however, he realizes that while there will now be a deeper connection with his brother, emotions will not be expressed openly. That's just not David's style.

Meeting the Surgeon

By the first week of November 2009, Jeff and David are beginning to tick off their pre-surgery appointments. Today, they are meeting Dr. Josh Koulack, the surgeon who performs most of the kidney transplants in the province.

As arranged, Jeff and David meet at the yellow desk on the main floor of Health Sciences Centre, their attire as much a study in contrasts as their personalities. David is the more formal of the two, wearing a black shirt, jacket and trousers. Jeff, meanwhile, is wearing a green T-Shirt under a black fleece jacket. A nurse leads them to a small, bright clinic room where they await the surgeon.

The meeting with Koulack is brief, considering the importance of the procedure. After reviewing medical histories, Koulack first explains how he will remove the kidney, artery, vein and ureter from David's left side. Because of a stent implanted in Jeff's left leg, he will place the new organ on the right side of Jeff's abdomen.

The tricky part is attaching the ureter to the recipient's bladder: "We have to go through a muscle and because that can cause a clot, to be preventive, we put in a stent - like a little tunnel - from the new kidney to the bladder," explains Koulack. "Six weeks later, we remove the stent."

Surprisingly, as they sign the consent forms, David and Jeff have few questions. Later, walking out, David remarks dryly on Koulack's youthful appearance. "Do you think he is really old enough to do the surgery?" Joking aside, both men have full confidence in this surgeon. After all, he does up to 40 transplants a year. And, truth be told, at this stage the brothers just want to get on with it. (David's sense of humour never disappears: A few days later, during the day-long pre-admissions clinic, he remarks: "You know, ever since I saw Dr. Koulack, my left kidney has been hurting.")

It's Show Time

On Wednesday, Nov. 25, 2009, Jeff Skinner, his dialysis equipment loaded into a wheelchair, checks into the Health Sciences Centre and enters a room on ward GD-4, which he will share with his brother.

Dr. David Rush, a nephrologist and Medical Director of Transplant Manitoba, Adult Kidney Program, greets him warmly. "Soon you'll be in a pretty blue gown - and then I will check you over," says Rush. "And as luck would have it, I'm on call and will be your doctor this weekend," he adds.

The next day, on Nov. 26, David is admitted early in the morning, a couple of hours before surgery.

By all accounts, surgery on both donor and recipient went well. David had a remarkable recovery. He was up and about two days later and discharged on the third. Jeff, however, had a serious setback.

On the Saturday night following surgery, at 11 p.m., the new kidney shut down. Under the direction of Rush - who came in at 5 a.m. Sunday - Jeff was put through a barrage of tests and procedures, from irrigation to ultrasound to CT scans. There was even talk of removing the kidney. No one knew what had happened. Then - just as mysteriously - at 1 p.m. Sunday, the kidney started to flow by itself. A week later, he was allowed to go home.

Back to Work

Today, almost four months after surgery, David is doing well. He's back at work, revitalized from that long-awaited winter vacation. Jeff is also doing well, as evidenced by his desire to bring the best out of his students on this January evening.

But even as his charges run through their scripts one more time, Jeff knows his own story is not yet complete. He's still being monitored twice a week at the transplant clinic, and he's still adjusting to the daily regimen of anti-rejection drugs that he will take every 12 hours for the rest of his life.

Taking a moment to reflect on his journey, Jeff wastes few words on himself. Instead, he lavishes praise on the "phenomenal" medical team of doctors, nurses, and unit assistants that cared for him during his 13-day hospital stay. "I was trapped in my bed; I was at their mercy; yet they made me feel empowered," he says. "They allowed me a sense of control. I felt as though we were working together to get me better."

His praise extends to his present care at the transplant clinic where already everyone knows him by name. "It's all about helping me manage with respect and dignity," he says. "This is, after all, a lifelong relationship."

Dolores Haggarty is a Winnipeg writer.

Wave: March / April 2010

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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