I spent my last 3 weeks of surgery on 2 different transplant services. The first week I was on the renal transplant service. I didn’t get to see a kidney transplant, but I saw a number of fascinating operations (even got to close incisions on a few, with some improvement from my time at the VA) and interacted with a few patients that have stayed on my mind since then. In one of our courses, we discuss at length the importance of continuity of care; we were even encouraged to make a “panel” on the electronic medical record of patients whom we’ve seen or interacted with so that we can follow their course of care throughout the hospital. There’s one patient, a little girl, whom I met on the renal service and want to follow for a while.
My last two weeks were on the hepatobiliary service, also known as the “liver transplant” service. I spent a little time doing non-medical “scut” work such as pulling out drains and lines, a little time helping with elective cases in the OR, and some time shadowing residents and attendings in clinic, but the meat of this rotation is the liver transplants. They can happen at pretty much any time, mid-day or mid-night, and involve two main parts: 1) procurement/recovery of the liver and sometimes other organs from a donor who has been declared brain-dead, and 2) replacement of the recipient’s liver with the donor’s liver, which occurs soon after the first part. The process can take a REALLY long time–especially if the donor is not already in the area, in which case the team might fly there. I was involved in four transplants over 2 weeks–2 of which were back-to-back. Thankfully there were other students on the service with me, so one person wasn’t expected to do both legs of each transplant–although one leg is pretty exhausting as it is!
For the first procurement I went on, we flew in a private jet to get a liver in North Carolina; I also got to ride in the back of an ambulance on our way to and from the hospital. The donor operation itself was very bloody and very fast-paced; the surgeons are trying to free the organs they need as quickly and efficiently as possible, but they also have to take care to preserve the connecting vessels so that they may be used in the recipient. This gets tricky if there are multiple teams trying to procure multiple organs, because sometimes 2 teams have to negotiate for sufficient lengths of the same vessels; for example, a heart surgeon needs the inferior vena cava, but if the liver is being procured as well, that surgeon also needs enough of the IVC to reconnect it in the recipient.
The second procurement I went on occurred at Vanderbilt. Our team procured the liver and kidneys from the donor, while a different surgeon flew in to procure the lungs. While helping the visiting surgeon, I got to hold the aorta while blood was still pulsing through it, and I later got to cut pieces of the spleen for Donor Services. Since both the chest and abdomen were open for this case, I was able to see more anatomy than I remember having learned in class my first year. The case was long, and the attendings pimped me to the point of exhaustion (mine, not theirs), but it was definitely worth it.
The two recipient operations I scrubbed in for were also fast-paced due to concerns with time under anesthesia and the time that the donor organ spends outside of a human body, but to me they felt a bit less frantic than the procurements. The staff played music in the OR and frequently commented about how exciting it was that another transplant was happening, especially during the 1500th liver transplant. Being part of this experience was so rewarding; seeing the liver darken in color as blood began to flow through it again at the end of the case made me smile.
All in all, my three weeks on transplant were some of the most tiring in my life. There were plenty of nights when I woke up in bed, hoping I hadn’t missed an important text, plenty of early mornings after too little sleep and too much activity the day before. After all of this, I’m still pretty sure that I’m not going to be a surgeon. But I have loads of respect for anyone who goes that route.