I'll Sleep When I'm Dead?

So yesterday (actually today AM) I went on my first organ procurement. Back in the olden days, before I was in medical school, it was called organ harvesting, but apparently that is too scary-sounding and un-PC now, because obviously, taking the viscera out of a [clinically] dead person is not scary at all, it is merely the fact that someone decided to call it ‘harvesting’ that makes it scary.

Anyway. So last night around 6:30pm the resident notified me that there was a transplant ‘happening’ in about an hour, and did I want to go see it, and if so I should just wait for a page from a dude named David. No details about where or why or how. It was all very Skull-and-Crossbones and shrouded in mystery and hush-hush and I-could-tell-you-but-I’d-have-to-kill-you.

Not really, I just forgot to ask her where and why because I was all excited about the thought of seeing a solid-organ transplant.

Did I want to go see it? Uh YEEEEAH… (Yes, I said it Valley-girl style. Very professional.) You take THIS guy’s liver and put it into this OTHER guy, and presto! It’s like this guy is TOTALLY INSIDE this other guy! (Without being gay porn.) I mean, if transplantation isn’t the pinnacle of modern medicine, I don’t know what is. (Besides Fentanyl lollipops, of course.)

I got the page from David about 20 minutes later. (Once again: Doctors and drug dealers, the only professionals who use pagers in the 21st century.) He told me that instead of seeing the transplant (i.e., watching the recipient receive the donor’s organ), I would be going to the procurement (i.e., watching the donor organs get taken out), and it would be happening in an hour. AWWWWW SHEEEEEIT!! (That was supposed to be an ecstatic AWWWWW SHEEEEIT, am I really this lucky? not a OH NO AWWWWWW SHEEEEEIT, I just stepped in doggy doo. Subtle differences. Try to keep up.) I was super crazy excited because the other people in my class who went on procurements got to go in the helicopter or the ambulance to hospitals far away in order to get the organs. One guy even went to New Jersey, on a private plane, to procure some stuff. Haha, can you imagine going to work thinking it’s going to be just a regular boring day and then your boss says ‘By the way, you’re flying to New Jersey and back today’? Talk about mixed feelings—I mean, it’s a private plane (sweet!) but it’s NEW JERSEY (ew.) (Sorry if you like Jersey). Also, unrelated, but this guy is kind of weird (like most medical students are, myself being no exception); once he introduced me to somebody as ‘his white friend’. And he wasn’t joking. Just in case you forgot if I’m white or not: Here (I am the one who is not white.

Anyway. I got a cup of coffee because I knew the procurement would probably be 4-6 hours and it would probably not start until 9 or 10pm (because it was scheduled for 7:30pm, which in hospital time means either 5:17pm or 11pm or 9am the next Tuesday). I also ate some Pizza Hut because my fellow on-call students ordered Pizza Hut. I hadn’t had Pizza Hut since my childhood, I think. At my school they had this thing called BookIt! (with the exclamation mark as part of the name; it’s not that I am really excited about BookIt!) where if you read a book and wrote a book report, you got a free personal pan pizza at Pizza Hut. If you think about it, maybe Pizza Hut is to blame for the epidemic of childhood obesity because (1) not only did they reward kids for sitting on their asses (because who reads while NOT sitting on their ass), but (2) they did it by feeding them pizzas. Now all we have are a bunch of fat yet well-read kids. Great.

Anyway, I digress. (Not that THAT’S anything new. I mean, I should really just go ahead and renamed this journal Anyway, I Digress, by Rachel J Kwon. And the domain name would be anywayidigressbyracheljkwon.com. And everyone would stop reading.)

I am trying to make a post without using swear words because if I am to be a kiddie doctor I can’t be saying ‘fuck’ all the time.

Where was I? Oh yeah, coffee and Pizza Hut. It’s true that doctors eat awesomely healthy diets and always get eight hours of sleep a night and exercise regularly. IF BY TRUE YOU MEAN FALSE, you opposite-loving fucker. (Oops. Minus 1.)

So I was totally wired and ready to gets me some liverkidneypancreas. Then the transplant guy paged me and said that it wasn’t going until midnight, and I should take a nap before then. Well, great. Thanks for telling me that before I gave myself a caffeine bolus. So I sat in the call room and wrote some postcards to people. (If you receive a postcard from me about Pizza Hut and liver transplants, that’s why. Unless you know somebody else who ate Pizza Hut before doing a liver transplant. Shit, I’ve said Pizza Hut like seventeen times already. They should be paying me for this shit.)

In the meantime I saw a pediatric patient in the ER for whom surgery was consulted for a ‘bug bite’. It was actually her diabetic mother’s insulin needle that she had accidentally inoculated herself with, and had been buried deep into her arm. That was a surprise on the x-ray. Not as big a surprise as the guy who had abdominal pain and, on pelvic x-ray, was found to have the outline of Aunt Jemima in his rectum. I am allowed to share this anecdote because it does not violate the Health Insurance Portability and Accountability Act, since I have changed minor identifying details of the anecdote. (It was actually Mrs Butterworth.)

Around 11:30pm I ate some trail mix and washed my face (not at the same time) because I was hungry and my face was dirty, respectively. (I had to add ‘respectively’ there in case you thought I washed my face because I was hungry and ate trail mix because my face was dirty. Which I have done before; it is not quite as satiating.) I was about to go down to the meeting place for the transplant team (surgery is such a jock specialty; it’s all about TEAMS and TEAMWORK and BEING A TEAM PLAYER and JOCKSTRAPS and WAIT SCRATCH THAT LAST ONE and WAIT MAYBE NOT, MAYBE I’M DOING IT WRONG AND THE KEY TO SUCCESS IS IN FACT TO WEAR A JOCKSTRAP IN THE OPERATING ROOM and OH NOES HERE I GO AGAIN) when broheim paged me again saying that the procurement was now going down at 2:30am. Motherfucker! I should have taken the nap when I had the chance. So I downed a couple of shots of espresso so I could stay awake longer, and, completely paradoxically, passed out for two hours. (I have no idea how that happened.)

So then I met the team and we went (via ambulance) to the hospital where the donor was waiting. Unfortunately (or fortunately), it was literally ten minutes from the hospital where we were at. So no helicopter or private plane. Just a van marked ‘ambulance’ with a big trunk, and a guy named Mike. It wasn’t as sketchy as it sounds. He was actually a very nice driver and spent the whole ride talking about Seabiscuit. The movie, the book, the horse, the legend. (In that order.)

The donor was a 20-something male who aspirated on his dinner, went into cardiac arrest, was brought to the hospital and was pronounced brain-dead at 1:50pm yesterday. His sister signed the form for his liver, kidneys and pancreas to be donated.

Interestingly, his last name was the same as the first name of the man who is, at this moment, receiving his liver. Don’t you tell me the universe doesn’t come full circle.

I felt bad for whining that I hadn’t gotten to nap before the procurement. Who the hell cares if the medical student is sleepy?

The actual procurement (operation) was just like every other operation. We prepped the patient in a sterile fashion. We scrubbed in. We did a time-out. The only difference was that the incision was huge (neck to pubic bone) and there was a tacit understanding that we were not operating to save this man’s life, but to save four others (with a liver, a kidney, another kidney, and a pancreas/spleen). I sort of have mixed feelings about the CONCEPT of organ transplants (in general, from a cost-benefit standpoint, I think the success rate is too low to make it worth recommending for everyone with organ failure), and the things we have to do to prevent rejection (aw bro she totally dissed you! Wait no, immune rejection) are almost as bad as organ failure anyway, BUT if my dad was dying of liver cancer and some other younger healthier person happened to die and donate a liver so MY loved one could have a CHANCE at MAYBE living another year or so, I would jump at that chance no matter how small or cost-ineffective it was. You can’t measure a single human life in terms of healthcare dollars saved or spent. (Actually, you probably can, but then you’ll just be THAT asshole.)

I wondered what this donor’s life was like. Usually before I scrub in on a case, I go to the pre-operative holding area and say hi to the patient and find out why they are having an operation and who is waiting for them in the waiting room and how they are feeling and all that. But this guy was dead before the ship even sank.

At the risk of sounding insensitive, this procurement was an incredibly valuable experience for me because I got to do a lot of things I had only practiced on orange peels or dummies before, since we didn’t necessarily have to worry about cosmesis (other than to the extent that obviously he was still a person and absolutely deserved to be treated with dignity just as every patient is despite his braindead status and inevitable impending death). At one point one of the nurses commented, ‘It’s so sad, he’s so young’ and I almost wanted to cry because it WAS so sad and he WAS so young, but before I could react, the surgery fellow replied, ‘Yes, but he’s doing a great thing for these other people’. That is what I like about the surgeon mentality. They may appear (and/or actually BE) arrogant and abrasive and unemotional, but they literally do deal with life and death, more than other doctors, I think, and they tend to have that very practical view of things and they get things done that other people can’t.

It’s true. It’s sad that he had to die. It’s sad that people benefit from his death and that his body was ‘practiced’ on by some bumbling med student who didn’t even know how to hold the cautery device. But you can also look at the other side, that it is wonderful that he did not die and disappear and just END, he gave other people a chance to live, in an extremely tangible and measurable way, and he gave me the opportunity to learn about humanity and mortality and dignity and respect (and yes, running sutures and electrocautery with a Bovie and knot-tying and anatomic variants in the gastrointestinal tract and all that other stuff that is individually not as important) in such a way that I will never forget.

After the organs were procured (it took about two hours; you can’t just cut that shit out and sew it into someone else, you have to preserve the vessels and all that stuff), the anesthesiologist turned off the ventilator and the heart machine and whatever else was keeping our man ‘alive’.

I put my hand over his heart because (1) it was right there and (2) I am extremely emo.

It beat in my hand for a good three to four minutes even though he was clinically dead.

It beat so strongly.

Of all the crazy experiences I have had in medical school (getting my face peed on, dissecting a cadaver, learning to do pelvic and rectal exams on volunteer teachers, etc), the act of literally holding a still-beating heart in my hand pretty much tops them all out of the water and takes to hits them out of the cake park. (Hey, remember when my tendency to make mixed metaphors exploded in your face?)

At the end, we sewed him up like we sew up everyone else. We cleaned him up like we clean up everyone else. We put a blanket over him like we put a blanket over everyone else. The only difference was after that we put a toe tag on him and put him in a body bag and onto a cold steel cart instead of a warm bed. We packed the organs and double- and triple- and quadruple-bagged them with multiple knots into a cooler that was bagged, boxed, and labeled. (Sounds excessive, but let’s be real, no one wants kidney juice all over their culottes.) (Note: I was not wearing, and have never worn, culottes.) (In fact, I did not even know that it was spelled ‘culottes’ until about seven seconds ago when I Googled it because ‘koolats’ didn’t seem quite right.) We carried the boxes out to the vanbulance. (Not gonna lie, I felt pretty fucking cool being the one carrying that box that said ‘LIVING ORGAN FOR DONATION’ or whatever and having people stare and move out of the way.)

It was so sunny outside. The operation plus pre-op and post-op stuff went from 3am to 9am. Mr Mike was sitting in the driver’s seat, reading Seabiscuit. He took us to McDonald’s and bought me a bacon egg and cheese sandwich and a large coffee. That was nice. And also brought me back to earth because I was totally overdramatizing the procurement in my head.

Today, even though I’d slept two hours of the past 24, I couldn’t make myself take a nap because it was too beautiful outside and I felt like I couldn’t let life pass me by anymore. However, since I am extremely sleep-deprived, I am somewhat delirious and am talking like a drunk person. I went to the coffee shop and pounded some espresso shots then went on a bike ride with my friend to visit my friend’s friend at a hospital on the north side of the city (a.k.a. far-ish). It was weird that it was only noon and I’d already been to three hospitals since midnight. It was also weird to go to the hospital as a visitor and not as hospital personnel. The nurses looked suspicious when I asked why the patient was intubated. (Maybe because I was wearing my extravagant unicorn t-shirt and not my white coat.) Then I stuffed my face with barbecue and custard and went home to pass out. I still can’t fall asleep even though it’s been 34/36 hours of awakeness. I never thought I could do it, not sleep for this long. But I never expected to have a reason to WANT to stay awake. I fucking love surgery. I don’t know if I want to do it for real; eight weeks might be enough, but I feel that it is making me a better person. Those surgeons push you hard, but they also push themselves just as hard. They yell at you, but it’s for a reason; today when we were clamping the aorta (=big mama artery of the body) of Mr Donor-Man, my hands were shaking as I tied the knot and the fellow yelled, ‘What are you doing?!’ And if it was four weeks ago, I would have cowered and said, ‘I don’t know’ and then bitched about the fact that I got yelled at. But today, I thought, ‘He is absolutely right. What AM I doing? If I don’t get this knot right, we’re gonna lose the aorta and these organs will die along with the patient and Mr Kxxxxx and Mrs Rxxxx [the recipients] are going to die. Get over yourself and fucking fix it.’ So I looked at him and said, ‘I’m having trouble stabilizing the knot because I’ve never worked with this kind of thread. Can you help me?’ Then he said it wasn’t my fault because the thread WAS weird, it was this weak-ass shit that came with the transplant kit, and also, he had just broken the thread on the first tie too, like five minutes ago, so I knew he wasn’t just being an asshole and trying to spare my feelings or something. That’s what I like about surgery. They tell you what you are doing wrong and they tell you how to fix it. I like the simplicity of that. Also, am I going to look back twenty years from now and say, did I really REFUSE to even consider pursuing a potentially fulfilling career JUST because I liked sleep that much?

While you ponder that… I’m going to go sleep.

Also, ponder the hilarity of this: The two rotations that I purposefully put at the end of my third year because I KNEW I would HATE them and NEVER go into either field, have ended up being my FAVORITE ones and the ONLY ones I am SERIOUSLY considering. Irony, thy name is Rachel!