Paper:   Chicago Sun-Times
Title:   Running for lives
Author:   BOB KURSON
Date:   October 17, 1999
Section:   LI
Page:   41

Running For Lives

Susanna is 10 years old, so she knows some things.She knows that pierced ears, the Backstreet Boys and dolphins are cool. Like most good soccer goalies, she doesn't commit to the shot too early.

She also knows she's going to die this month. She needs a liver, and she's turning yellow and dying without one. So the Wisconsin fifth-grader asks her mom whether she'll live long enough to get married and train dolphins. She also wonders, like many kids her age, about death. Will it hurt? Will there be sounds? Will I be lonely?

Someone, please, her family prays, give Susanna a liver.

Hundreds of miles away in a Chicago suburb, a librarian named Charlotte sprays her hair and adjusts her skirt and gets ready for work. Charlotte works with kids, her dream since childhood. She kisses her husband goodbye, sees her own child off to school, then drives to the library.

There, Charlotte feels a little dizzy: It looks like there are eight coat hangers in the closet, not the usual four. She jokes to a friend that it sounds crazy but she thinks she's seeing double, kind of early for a woman of only 42, don't you think?

Ten minutes later, Charlotte is on her way to the emergency room. A few hours later, she's brain dead. No warning, no symptoms, no planning. A brain aneurysm.

Doctors tell her husband she won't recover.

Once he absorbs the enormity of the moment, he is asked, delicately, if Charlotte might donate her organs. His head is spinning, but he knows this much_Charlotte insisted that she be an organ donor.

"It was her demand, not a request," her husband says. "And she loved children, and there are sick children out there."

Maybe, he thinks, a child will get her liver or her kidneys. Just don't mutilate her, he asks. Take the organs.

Moments after Charlotte's husband signs an organ transplant consent form, a beeper chirps at the Oak Park home of a former accountant. The woman who answers owns no medical license, has passed no tests, has never enrolled in an anatomy course. But Susanna's life is now in her hands. Angie Cassman, 40, along with partner Angel Rivera, 32, are transplant coordinators at Chicago's Children's Memorial Hospital.

World-famous surgeons seek their advice. Pilots rely on them. Families endure because of them. Approaching 2000, science still hasn't invented a computer that can do what Cassman and Rivera do, because science still can't build into machines compassion and a burning obsession to keep kids alive.

"Angel and Angie important?" asks Riccardo Superina, director of the Siragusa Transplantation Center at Children's Memorial Hospital. "We couldn't do it without them."

Children's Memorial Hospital is one of 10 organ transplant centers in Illinois and one of about 200 in the country. There are perhaps 400 people in the United States who do what Cassman and Rivera do. It is a job of staggering ethical responsibility and one which requires a savantlike talent for complex organization under pressure. Cassman and Rivera don't get second chances. When their pagers ring, a child is about to live or die.

Cassman calls the number on her pager. It is the donor hospital. They describe Charlotte_her height, weight, medical history, cause of death.

Cassman asks technical questions, uses lots of words ending in "-ology" and "-osis." Then, without consulting a doctor, without making a single telephone call to ask anyone's advice or permission, she makes a pronouncement_"The liver sounds healthy. We'll take it."

Cassman phones Rivera. He's on call, so it's now his case. It's 11:30 p.m. and Rivera is sleeping. But he has trained himself to hear detail even while his brain untangles from its dreams. He absorbs 90 seconds of information from Cassman, then lurches out of bed.

The next few minutes are a blur of phone calls. Rivera phones Susanna's parents in Wisconsin_"We've got a liver. Get Susanna dressed and to Children's immediately. Try to be there by 3."

She's been waiting for more than a year.

He calls Superina with the liver details, then suggests to the surgeon, "Get some sleep. I won't wake you unless the liver looks bad when it comes out. We'll be back from the donor hospital at around 7 a.m." He calls a team of procurement surgeons_the doctors who will extract the organs_and tells them, "Meet me at the Children's emergency room at 1:30 a.m." And he calls AeroCare, the company that provides high-speed ambulances, helicopters and Learjets to transplant coordinators at a moment's notice. "Tonight we'll need the car since we're going local, and we'll need to go hot," Rivera says, meaning he'll need lights and sirens.

Rivera kisses his sleeping wife and kids goodbye, then pulls on a sweat shirt and jeans.

"What we're going to see tonight will be very sad," he says, "A lot of my job is sad. But hopefully, tonight we'll see someone else's death become life for a very sweet little girl. If that weren't a possibility, I couldn't do what I do. I couldn't see what I see."

By day, the basement of Children's hums with the activity of nurses and doctors ordering cafeteria spaghetti and trading operating-room war stories. But at 1 a.m., when Rivera arrives, it is silent, a maze of slumbering hallways. Rivera upsets this calm. Dressed in aqua scrubs and armed with an Igloo cooler, 10 pounds of ice, and a fistful of syringes, scissors and tiny serum vials, he is a blue blur of obsessed intention.

"We've got five minutes before we roll," Rivera announces, his thoughts running together. "It'll take us about 45 minutes to get to the hospital_and Susanna is just such a nice kid. I'm so praying that this goes well for her and since the donor is an adult we'll have to trim down the liver once we get back and I'm sure this is enough ice."

Five minutes later, the AeroCare driver pulls up in a custom Chevy Suburban and hands out Dunkin' Donuts and coffee to Rivera and his three bleary-eyed surgeons. He checks his collection of laminated area hospital maps, memorizes the route, then flips on the lights and sirens and gets the vehicle up to 60 mph on Halsted, speeding to reach a dead person, all to save Susanna's life.

Often, several transplant teams show up for a procurement. Northwestern might take the heart, University of Chicago the kidneys, Children's the liver. Tonight, Rivera says, his will be the only team. As a favor to another hospital's team, which is exhausted after three consecutive extractions, he has agreed to pull the heart valves and kidneys for them.

The Suburban screeches into the emergency-room entrance at the hospital, and Rivera and his surgeons_who had been talking Bears football on the way_turn instantly serious and make a beeline for the operating room. While the surgeons scrub, Rivera asks a face-masked nurse to show him "the important stuff." She hands him three documents.

"I need to see consent by the family, proof of brain death and the donor's blood type," Rivera says. "If there's a question on any of it, my team doesn't set foot in the room."

Satisfied with the documents, Rivera begins mixing medicines outside the operating room, sucking various potions into ominously tall syringes to form what he calls "my cocktails." These are the medicines that Rivera will flush into the organs once they are removed from Charlotte. Yes, Rivera says, he is the one who flushes the organs, manipulates them, judges them, clips them with scissors if need be. Like Cassman, he has no license, no degree.

A minute later, Charlotte is wheeled into the operating room on a stretcher. She looks to be asleep and content, her chest rising and falling with metronome consistency. Her hand, which has slipped from beneath the white sheet that covers her body, rests on one of the stretcher's stainless steel rails, as if she's holding on. The team enters the operating room.

Burnout rate for transplant coordinators runs about 18 months. The job requires a coordinator to be on call 24 hours a day every other week, and that can stress a family. But Cassman says the burnout more likely results because coordinators invest themselves so personally in their work.

"We get to know the sick kid," Cassman says. "We play with them, hug them. They draw us pictures. And we become, at least for a time, part of their family. And as much as it kills you, some of these children die. You might be the most polished professional in the world. But you never get used to seeing a child die."

Cassman also sees tragedy on the other end. Often, the donors from whom she procures organs are themselves children and young adults, and many have died unexpectedly. Cassman has taken organs from teenage suicides, child abuse victims, kids riding their bikes who didn't look both ways.

"There was a mother who was carrying her baby," Cassman recalls. "She fell down the stairs and it broke the baby's neck. I'm a mother. In the operating room, taking that baby's organs, I can't help but see my own baby."

Cassman survives_even thrives_by focusing on results.

"You're giving life," she says. "In a way, it's the most beautiful experience, even while you're standing over a dead child. You're looking at the worst kind of tragedy, yes. But you're there so that another child can be given life. That never stops being awesome."

For two hours, the surgeons work on Charlotte while Rivera prepares sterilized tables of instruments, bowls and bags to hold the organs. During this time, Rivera has played a Beatles CD ("keeps things loose in here"), given his opinion to the surgeons ("That spot on the lower right of the liver does not trouble me at all") and kept up constant phone contact with Children's ("Everything's on schedule. We'll stop the heart around 5 a.m., which means we'll be leaving by 6.").

At just after 5, the surgeons stop Charlotte's heart. Then they furiously pile gallons of slushy ice_which Rivera had meticulously prepared and maintained_into her open torso to chill the organs.

"Look at the heart," Rivera says. "Even without blood, it's still trying to beat. It doesn't want to die."

What was, for two hours, very deliberate motion by the procurement team now turns urgent. They have only hours before the organs begin to deteriorate. The surgeons hand Rivera the liver, the kidneys, the heart, and he baby-steps them to his tables. There, he flushes the organs, replacing their blood with his preservative cocktails, then triple-bags and ties them. In a matter of minutes, he has cleaned and packed the organs in his cooler.

"From now on, this liver never leaves my sight," Rivera announces. He makes a final series of phone calls_to Children's to get the operating room ready for Susanna, to Superina to wake him up and tell him all looks good. He never stops staring at the cooler.

But no one leaves the operating room yet. Charlotte's body must be restored, sewn up so flawlessly, Rivera says, that not even the funeral home will know she donated her organs.

"She made this all possible. We only have a short drive to the hospital, so we don't budge from here until she's perfect," he says.

And no one budges until she is.

Cassman and Rivera don't disappear just because a transplant is complete. An earlier recipient, Dawna Celenza, will know this in a couple of years.

Dawna is just 2 years old, which might be why she doesn't recognize Cassman and Rivera when they show up at her west suburban home for family functions. But Dawna might be alive because of Cassman and Rivera, who helped coordinate a liver transplant for her a year ago.

"I do invite Angie and Angel to family events, of course," says Dawna's mother, Terri Celenza. "They've been part of our lives since this happened."

The Celenzas lived in Florida then. Once Dawna's condition became critical and she moved to the top of the recipient lists, Cassman kept the family constantly updated, helping them understand the process and even assisting in arranging travel.

"But she did more than that," Terri Celenza says. "She was an emotional rock, a pillar for us. She understood exactly what we were going through. She stayed with us in the waiting room, helped us register, introduced us to the doctors. And this is all while she's off duty, when she wasn't working, because Angel had flown out to Minnesota to get the liver."

The transplant proved successful. In a night of overwhelming emotions, a mother still sees Rivera and Cassman clear as day.

"I remember it like yesterday," Terri Celenza says. "Angel and Angie were so happy, genuinely happy, for the match. I was happy, too. But I couldn't get over knowing that there was another family out there who'd lost their baby. That another mother was suffering something I could never know. And I felt terrible.

"Angie and Angel_and I'll remember this forever_took my arms, looked right into my eyes, and said, `Terri, this is not a bad thing. It's a good thing. It's the best thing.' And I believed them."

The ride to Children's is at 70 mph along the left shoulder of a rush hour-choked Eisenhower Expy. The surgeons gobble McDonald's on the way; this might be their only chance to eat all day.

At Children's, Rivera rushes the liver into the operating room. Susanna is already on the table, Superina above her, just as Rivera had arranged. Rivera scribbles the donor's time of death onto a marker board so that everyone will know just how much time they have_livers last only 12 to 24 hours after donation. Rivera offers a few more observations to Superina ("No surgical damage to the liver") and then leaves the O.R.

Rivera is exhausted, but he's not finished yet. He works his way to the waiting room, where Susanna's mother is asleep on a couch, clutching Susanna's teddy bear. He crouches down and taps the mother on the shoulder.

"Oh, God, Angel, it's you," she says, struggling to sit up.

"We're back," Rivera whispers. "The liver looks very good. They're getting it ready for Susanna now. It's all good so far."

"Thank you," the mother says. "I'll never be able to thank you enough."

More than 10 hours later, Susanna leaves the operating room. She won't be entirely out of the woods for perhaps a year. But she's alive today, "doing great," her mother says, and if all goes well she'll lead a normal, happy life. Someday, Susanna might even call Cassman and Rivera to say thanks. When they get home from another helicopter flight with another child's heart or liver, they say, they'll call Susanna back and invite her to lunch.

The names of the organ donor, recipient and their families have been changed to protect their privacy.