Don’t get me wrong, I like The Boss. “I’m on fire” may be one of my favorite songs, but that night Bruce Springsteen’s voice filled the operating room like a Mongolian throat singer's fills a yurt. We were eight hours into what would likely be a fourteen hour surgery and nothing but E-Street Radio played the entire time. And as exhausting as Bruce’s voice had become, something amazing was happening here.
I used to say that ironically when I worked at Columbia University. “Amazing things are happening here.” A large banner spanned the sky bridge between the towers of their hospital, an arrogant proclamation of exceptionalism that I had come to expect and love in New York and that hospital in particular.
But tonight something amazing truly was happening a thousand miles from that banner. Not litigation, not a dinner full of CEOs, not a charity event for clean water in sub-Saharan Africa. Tonight, a 40 year old woman was receiving a new small intestine from a 12 year old child. Optical loops, Debake forceps, an ice machine, organ bag, argon laser, and some of the most advanced medical equipment in the world were present in the room along with two of the handful of surgeons proficient in the procedure. In the age of laparoscopic cholecystectomies, appendectomies and monotonous surgical care, these surgeons were facing the verge of the unknown with new techniques, medications and devices. Where other physicians settled, they forged ahead, insistent on finding an answer. I was in awe.
I had seen bowel transplants before in my previous job; but never so close and never from start to finish. Never had I appreciated how knotted and congested the abdominal cavity had become in patients with multiple abdominal surgeries; never had I appreciated the process of “back- tabling” the bowel such that the vascularity was completely preserved and patent; never had I appreciated the delicacies of creating the anastomosis between the donor superior mesenteric artery and the recipient’s abdominal aorta.
I left the OR at 4am that night grateful to the staff for letting me travel to see this entire process, for allowing me to see the anatomy, and for teaching me.
A week later I was on a private jet to a procurement. A 10 year old girl had fallen and was brain dead. Her family had decided to donate her organs. She was a healthy Asian girl who out of poor luck, fate, cruelty or divine will had been taken from her family all too early. We lined up outside the operating room along with all of the other transplant teams. There was a team for her heart, one for her lungs, one for her kidneys, one for her liver, and then us. Five of the best surgeons in the world and their chosen apprentices and students, all waiting for our patient; it was reminiscent of my time as a coxswain on a college rowing team lining up at the starting line. Exciting, daunting, stimulating. I was gassy, sweaty and star struck by the talent around me.
The patient was brought back and half an hour later every team was in their respective location, ready to start the case. Everyone would examine and prep their organ. The lungs would go first, followed by the heart, then the visceral organs and kidneys last. Her body was opened. Her exposed heart was seen beating, her lungs breathing with mechanical assistance, then her intestines, liver and kidneys. Everything was exposed, everything was moving. Few medical students have the opportunity to see such pristine anatomy all functioning in vivo. Hours later, we had what we came for and were on our way out. The girl was dead, her intestines in a cooler, her heart already in another body, her lungs on an airplane to another state. Life was being shipped across the country like the operating room was an Amazon.com warehouse.
With our precious commodity in hand, we left the OR for our ambulance to the airport. I grabbed my backpack from the linoleum behind the nurses’ station and zig-zagged through the maze of a hospital, trying my best to keep up with the other two on my team; but, I, in true medical student fashion, got lost. I hustled down this hall and that. Much of any hospital can look the same, making navigation all that much harder. Halls spun; I ran into dead ends, doubled back and tripled forward. Every room and hall mirrored the one I had just passed until I passed the family waiting room. That’s when the corner of my eye caught a tearful Asian family, huddled together. I paused long enough to catch a woman’s face; a face so torn that it could only be that of a grieving mother. I didn’t stop for more than a second before forging ahead to find the other two, but her face burned into my retinas like a projector left on for too long. Black hair framed her frail face that was exhausted from crying. Her lower eyelids weighed heavy with tears and her lips were pursed as her husband attempted to console her. Two children sat by them, neither of them older than eight and both either stoic or too exhausted to grieve anymore.
I repressed the image until our mission was accomplished and our arduous surgeries complete, but as soon as I allowed the thought to creep back into my consciousness I was overwhelmed by the fact that all of this was made possible by the death of this girl. As grandiose as the egos of physicians and surgeons may be, the transplantation process humbles them. The surgeon’s knots were perfect, his technique divine and his knowledge of the procedure unmatched by nearly any human alive or dead; and as incredible as that all may be, none of it comes close to the awe-inspiring act of donation. Amazing things did happen that day, just as they have in every transplant that I have been in. A 10 year old girl died and was reborn. Amazing things happened.