<Reflections of a heart transplant surgeon> from NEJM..God, he's a doc I could hang with..in the moment of the experience of harvesting an organ from a youngster whose family and friends are in major grief to bringing the heart to a family for whom this is their last hope to give life to their loved one..this always gave me pause...and it was in all our faces when once(and only once in my career..thank God) we had the baby who was brain dead in one bedspace and the baby who was going to accept his liver several bedspaces away...
I'll shoot this guy an email to thank him for sharing..
Thoughts from the Transition Zone July 19, 2006
J. Terrance Davis, M.D.
I got the call earlier today. A teenager has been on life support at our hospital while awaiting a heart transplant. She was running out of time when we got the offer of a heart, and it was my job to recover the organ. Before I knew it, I was arriving at a suburban hospital 600 miles away, accompanied by my resident and a procurement technician. When we drove in, it seemed like any other emergency department at night.
But as we walked through the emergency room (ER), all grew quiet. There were eyes upon us, and as people stepped aside, I sensed their ambivalence at our arrival: "Something good will come of this. It's almost over. What a shame." In this small hospital, the tragedy of a young life lost in a motor-vehicle accident had permeated every department.
This is the donor zone. Teenagers stood in the hallways crying and comforting one another, medical teams had given their all but to no avail, and the family was trying to come to grips with the loss. It is a zone of intense sadness. Out of sight of all this, back in the operating room, a heart was beating in a body with no future.
The recovery was routine — and yet extraordinary. An army of coordinators had been on the telephone for hours to bring together people who could maximize the potential of orphaned organs in a body that was about to die. Working side by side, we and another team that was taking the liver and kidneys divided shared vessels in the middle. When we all were ready, I put the cold potassium solution into the heart, which immediately stopped beating and turned into a flaccid, pale, cold, apparently lifeless organ. I removed the heart from the body, realizing that this act completed the process of death and marked the beginning of a difficult time in the donor zone.
People here would go home grieving. But I had much to think about — no time to reflect. I thanked everyone, and we jumped into the waiting ambulance. The funeral procession for the donor was yet to come; this was a different sort of journey for a heart headed to a new home.
Soon, we will enter the recipient zone. It will be permeated by anticipation, excitement, and hope. As I walk through that ER, eyes will once again be on me, but the message they convey will be different: Good news! They're waiting for you!
There will be a sense of both pride and hope as I enter the operating room, where the transplantation surgeon will have placed the patient on the heart–lung machine. The equipment that has kept her alive for the past week will be in the hallway, being cleaned. Everyone will be focused on installing the new heart into a person who will now have a future. I will assist the surgeon in sewing in the organ. He will unclamp the aorta, fresh blood will run into the coronary arteries, and the gray tissue will turn pink. Will the heart start? Will it work? Within a minute or two, the muscle will jump to life and start beating.
Soon, the job of the 1250-lb heart–lung machine will be taken over by this little muscle. The surgeon will tell the anxious family that all is well so far. It will have been a good day in the recipient zone.
Of course, it won't be over yet in the intensive care unit — a good outcome is not guaranteed. Although the heart's recovery is likely, other organs have been damaged, and how the liver, kidneys, and brain will function has yet to be seen. Ultimate success will require meticulous attention to hundreds of details over the next weeks and months. And how will the whole patient herself fare? There will be much to think about and little time to reflect.
But at the moment, I am in the transition zone. I sit here, in a jet quietly cruising at 500 miles per hour, 40,000 ft above a sleeping country. It is the middle of the night. Unlike the other zones, this zone does not require me to do anything, to work out any details. I can now reflect.
This is a bizarre and surreal space. I envision the piece of flesh sterilely wrapped and packed in ice in the cooler at my feet. We are both in transition. I am in the middle of a major mood swing. I think of the intense sadness in the donor zone and the joy, anticipation, and hope in the recipient zone. The people in each zone are aware of and understand one another, but they are, quite rightly, concentrating on their respective jobs. All this activity requires speedy air travel, with pilots to transport the organ and us safely from zone to zone in a time frame that will allow the heart to recover without damage. The transition zone represents the interface of medical science, medical technology, aeronautical engineering, aviation, and medical professionalism.
I glance out the window at the dark, moonless night. The density of the stars in the sky and the lights on the ground below are about the same. In the absence of a horizon, the stars and the lights blend, and it looks as if we are suspended in space. From this strange perspective, it dawns on me that although I understand scientifically how each part of this process happens, the process as a whole still fills me with awe and wonder. The way it can change a life, a family, a community remains a mystery.
In the meantime, at the center of it all, in the transition zone, the pound of muscle lies cool, totally relaxed, between jobs. If I were wise, I would do the same.
Source Information
Dr. Davis is an emeritus professor of clinical surgery at the Ohio State University and a surgeon at the Heart Center, Columbus Children's Hospital — both in Columbus, Ohio. |
