Monday, September 17, 2007

harvest

organ transplant is a noble and wonderful endeavour. however before the transplant comes the harvest.

one experience that will stick with me for many a year (ever), which scored very high on my weird sh!tometer, happened when i was a very junior registrar.
she was about 16 years old. except for the massive head trauma there was nothing wrong with her. in fact when i became involved, the neurosergeons had already declared her brain dead. the transplant coordinators had done the ground work with her parents, getting consent to harvest the organs. (i never envied their job. can you imagine having to get consent as fast as possible when the people you need consent from have just had their world turned upside down? sort of 'sorry about your loss but can we have her kidneys?') all we had to do was operate to get the kidneys. we had to time it in conjunction with the heart transplant team which was flying up from cape town (the only place where the state still does heart transplants. why, you ask? i don't know).

as soon as we heard they had landed we started the operation. we got the kidneys as close as we could to out without compromising the heart. instead of waiting, we opened the chest so the thorax team would have less to do when they arrived. then we waited.

the thorax surgeon finally arrived. he walked in, glanced into the open thorax, glibly said in an almost inaudible voice, "too small." and walked out. we were left wondering if we had heard right. he had just flown 1500km (a whole bunch of miles) only to turn around and fly back with nothing. i couldn't help thinking he could at least have said hello to us. but i think that may have been beneath him. (looking back it seems a strange thought to have)

the surgeon then quickly carried out the final steps to remove the kidneys.

meanwhile, the transplant coordinator immediately told us to take the heart anyway because the valves could be harvested even if the heart itself was too small. my senior volunteered me. i was young and keen. she assured me it was easy. just cut the large vessels off as far away from the heart as possible so as not to dammage the valves. sounded easy enough.

the surgeon left. the anaesthetic machine was turned off, creating an eerie quiet instead of the reassuring beeping noise of the monitors. i could still see the heart beating though. it seemed wrong to cut it out, but i grabbed the scissors and went to work.

moments later, the heart was loose. it's not too difficult to remove a heart when the outcome is predetermined. i lifted it out. then the weird set in. the heart was young and strong. while i held it in my hand it was still beating. two things went through my head simultaneously. the first was a flashback to the movie raiders of the lost ark when the priest ripps the heart out of his victim for him to see just before he dies.

the second was much more intense. there i stood with a human heart, still beating in my hand. yes my head knew she was brain dead and had been so for some time. but somehow my emotions (i was going to say heart, but...) didn't seem to be agreeing with my head. i felt awful. up until then it had all been business. get the organs and get a good night's sleep. somehow after standing with that girl's heart beating in my hand i felt for her. i felt for her parents. i felt the tragedy of the whole situation. i was touched.

i passed the heart to the transplant coordinator. she left. i was now alone with the shell of the dead girl in theater. my job was to close what we had opened. but because she was dead, there was no anaesthetist and no sister. just me and my thoughts of intimacy with this poor girl who i did not know. i cried as i placed the stitches.

i did not get that good night's sleep.

11 comments:

Chrysalis Angel said...

You can't help but think of the fine balance that is life and death. I felt for the girl, the parents and you. It's so sad, when they haven't even had the chance yet to truly experience living.

rlbates said...

When I was a gen surg resident, we had to obtain the consent from the family. Some were easier than others (depended on the rapport you had built up with the family) though never easy.

And I know what you felt closing...

mkeamy said...

it's better to have company for these moments, I think. I try to hang around (when I can) to make sure everyone is ok (which none of us ever are, I guess, anyway). Wait till you have your own child the age of the donor...

Nice post. colleague

Roer said...

OMW that's horrible and sad. Maybe (all) dr's become like the thorax surgeon in your 'story' as to protect themselves from the pain. Everyone deals with the emotions involved differently I suppose. I doubt I'd be able to do this job. It's truly a calling.

Sid Schwab said...

Sewing up, you become aware that there's no beeping of a heart monitor. That's a very loud silence.

Bongi said...

roer, dit hoef nie so te wees nie. nie almal van ons nie. ek hoop om my mensikheid en hoflikheid altyd te behou.

sid, the silence is eery to say the least.

mkeamy, thanks.

make mine trauma said...

bongi, do I comment or not? I have such strong feelings regarding this topic. A brave and selfless decision for the families and renewed hope for a stranger and family. Do I tarnish the (percieved) sanctity of it all?

I know the sadness and the tears you felt.

mmt

Greg P said...

I remember as an intern many years ago, before the advent of open heart surgery, before balloon pumps, of going to a code on a patient in the CCU.
CPR was surprisingly effective, to the point that chest compression would give him an excellent circulation, manifested by the patient complaining about the CPR, yelling out with the shocks, yet his heart failed to respond to anything -- no rhythm could be established.
In the end, when we ran out of options, we had to simply stop CPR.

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S said...

They say that the only function of all the organs in the body is to keep the brain alive and healthy. It is so sad that this person had to be brain dead with a beating heart. Some how feels unacceptable. It is easy to believe, someone is dead when there is no heart beat compared to accepting brain death. The fact that you were holding a beating heart keeps coming back to my thoughts for the last two days. i am finding it difficult to forget. i don't know what you went through after that incident. Nice post. - smalltowndoc.wordpress.com

Anonymous said...

Now I'm crying. I'm a Dad and I have a this rebellious, rambunctious, defiant, in-total-self-destruct-mode teenaged daughter of 15 going on 40 who has forgotten everything I ever knew and then some. Sometimes I could quite happily throttle her but an article like this makes you think about how precious and so fragile their lives are. I love her so much, I'd be destroyed if anything had to happen to her.