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By David Drake, DO, DFAPA 

It was a little more than a month ago when I sat down and wrote a letter to my family and friends. I told them I would be undergoing surgery the following week. I asked them to keep me and my wife Claire and the surgeons in their thoughts and prayers.

I wasn't sick, and I didn't have any significant health issues. This was purely elective surgery — and, in some respects, even unnecessary. But I had decided to serve as a humanitarian kidney donor — giving my left kidney to someone I had never met!

How did this come about? Several years ago, I began reading about folks donating kidneys — it was in Reader's Digest or who knows where. These were living donors giving a kidney, probably to family members. Then in January 2013, The Des Moines Register featured an article on multiple people — donors and recipients — who were part of paired organ transplant exchanges. Ten people were shown as part of the giving and receiving process.

The need for kidneys in Iowa is significant. There are somewhere around 600 folks on a waiting list for a kidney. In many cases the donation of a kidney is life saving — or at least life changing — because it allows a person to get off dialysis if the donated kidney functions for them.

As I approached turning 62 in March, I began to realize that with good luck, good genes and taking care of myself, at best a third of my life remained. I took this to heart and began to wonder about what kind of contributions I wanted to make in my remaining years.

Somehow the idea of becoming a live humanitarian kidney donor began to strike my interest. I called  my doctor to let him know of my initial curiosity. I was referred to the transplant team at Mercy Medical Center in Des Moines, and that began a process lasting some four months of extensive tests.

The thought process in donating to a stranger can be complex. Somehow the idea of humanitarian kidney donation hooked me. We can be hooked by something, in addition to the contributions we already make. An awareness of the coming end of our lives can perhaps bring these opportunities into clearer focus and awareness.

If you don't have doubts at the beginning of the screening/evaluation process you probably will along the way. And my surgeon warned me about the mass effect that accumulates as the prospective donor moves forward.

The several months of screenings — medical, social, psychological — began to take a toll and made me question whether I was really up to this. Is this something I really felt moved to pursue? In my case, because my father had suffered a severe stroke at 76, I was referred for an extensive heart evaluation — including treadmill stress test, EKG, cardiologist consultation and a heart echocardiogram.

Since the surgery on July 8, I have met the recipient of my kidney and his wife. They are from an adjacent state. He was diagnosed with severe kidney disease and had been on dialysis for the past two years. But the dialysis ended as a result of receiving my left kidney.

Our hospital rooms were two rooms apart. When I went out into the hallway for a brief walk the morning after the surgery, his wife recognized me and stood there with tears in her eyes, shaking her head. "I can't believe you did this," she said. She gave me a very warm hug. Her husband and I spoke several times during my brief stay. He plans to go back to driving a truck. She plans to focus more on her own career.

In less than two weeks post-surgery, I have been able to return to work full-time. But my work entails mostly listening and talking from a comfortable chair. It would be very different for someone in more physical work.

The donation of a kidney can save a life — and certainly enhance a life. Donating a kidney changes the life of the donor, as well as the recipient, forever. I can believe that.



 Iowa Psychiatric Society
Behavioral Health Clinic Workshop
Friday, October 10, 2014
Des Moines, Iowa
IPS & University of Iowa Department of
Psychiatry Fall Conference
Friday, October 17, 2014
Iowa City, Iowa


By Michael Blackmore, MD


It’s something that I would not say to a patient.  It’s something that I would not admit to myself except after the fact.  Even then I’d hesitate to say it to a colleague.  The concept first occurred to me  a few years into practicing.  The term “terminal depression” did not come to me until years later.


My early experience with the concept was a middle-aged woman, Sherry, who was referred to me by a therapist.  The therapist had worked with her for at least a decade.  Sherry had previously been prescribed many psychiatric medications by a number of doctors, she told me that all the medications had been mostly unsuccessful.  I began to work with the medications that had shown her brief promise.  I had her try some simple combinations and augmentation.  I believed she did not abuse substances.


Her therapist was very experienced, patient and talented.  What we noticed most regarding Sherry was her pattern of being defeated.  She had been defeated by her job, her family, her marriage and her children.  Her one area of conquest was over her caregivers.  We failed her constantly and consistently. She did not have a church, a group of neighbors or any other support group. Efforts to help her establish these were not successful.


After two years of working with her, I met with the patient and therapist.  I asked the patient if I had been of any benefit to her over the two years.  She said I hadn’t.  I told her that I would be willing to keep working with her or that she might try another doctor.  We could give her help finding another doctor.  She wanted to continue to work with her long-time therapist.  She chose to work with another doctor.


I changed offices after a few years but kept in touch with her therapist.  Some years on I learned that the Sherry had asphyxiated herself in a garage.  I was saddened but not surprised.  The therapist told me that her mood never rose above her low baseline.  A few months prior to her death difficult life- circumstances sent her lower and into paranoia.  She refused ECT.


We’ve all had many patient’s with features like this.  It wasn’t until a neighbor of twenty years killed himself that I embraced terminal depression as a term that might help his wife, Ann.  I was not the doctor, I was a friend.  My wife was supportive of my idea and we acted together.  Our neighbor’s therapist was supportive too.  Ann’s life had been a tortured one for more than twenty years while her husband struggled to deny his illness and resist his treatment.  She had wrestled a suicide gun out of his hands several times.

Over the next six months Ann was willing to accept that her husband died of a terminal illness, that she was not to blame and that she would go on energetically with her life.  She worked frequently and closely with her therapist.  Ann is talented and persevering.  She soon accomplished a life change that is heartening and remarkable.


I won’t use the term “terminal depression” often but I found one situation where it appeared to be  helpful.

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Quick Guide for ICD-10 and DSM 5 Codes

As you may know, beginning October 1, 2014, the US will be transitioning to the ICD-10-CM system of medical codes. In anticipation of this change, DSM-5 includes both ICD-9-CM and ICD-10-CM codes. However, questions from clinicians have arisen about the nature and purpose of the codes in DSM-5 and how they should be used in light of the impending adoption of ICD-10-CM.

In order to ensure clinicians are fully aware of the issues surrounding the transition, the APA has developed a fact sheet HEREto serve as a “quick guide for clinicians” in understanding the relationship between DSM and ICD. 

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