How to Do a Liver Transplant (11 page)

We spent that first week touring Target, Wal-Mart and various garage sales to source the very best budget furniture we could find. Before long we were watching our tiny TV on $5 lawn chairs and the day I would start as a liver transplant Fellow drew closer. Even though I was always
anxious before starting any new job, this time I was more nervous than I could ever remember. Would I be good enough? This was the big league.

You want me to start at
what
time?

I
wanted to make a good impression on my first day on the job in Denver, so I arrived at 7 am. I was used to starting work around 7.30 in Australia, so I thought that showing up half an hour early would be a pretty safe bet and would let everyone know that I was keen. I nervously approached Dr Kam's secretary and told her who I was and what I was there for. She didn't seem to know much about me, mainly I think because she didn't understand my very broad Australian accent. I repeated myself, this time in my best American drawl, and what had been lost in translation finally became clear. She informed me
that everyone was in surgery, that I was late, and I should get down to the operating room – or OR – as soon as possible. They had already been transplanting for an hour. She went on to to tell me that the junior doctors' work day usually began somewhere in the vicinity of 5.30 am. Did I hear her correctly, 5.30 am? Wow, that just didn't seem right. My heart sank, maybe this job wouldn't be so enjoyable after all. I was ushered down to the OR to find Dr Tom Bak plugging a liver into a patient, accompanied by his favourite music – Canadian rock group Rush – playing from speakers mounted at the end of the operating table. After two years I would eventually become familiar with all the songs in their catalogue. Dr Bak did not look up from his work and without any ado told me to ‘scrub in'. I had begun my job with no fanfare.

After my morning in the OR, I finally had time to sit down and talk with Dr Kam properly for the first time. On first meeting, he was abrupt, imposing and bore more than a passing resemblance to Marlon Brando (a picture of whom hangs behind his desk). What I quickly realised was that behind the gruff exterior there was a heart of gold and one of the kindest people I had ever met. Dr Kam was renowned for his superb surgical skills, and his blistering but side-splittingly funny remarks. ‘Yous guys suck' was a particular favourite that I like to borrow now and then when I playfully reprimand
my
junior staff. Operating with Dr Kam was just as daunting as it was with Professor Strong.
He expected perfection and in transplant, this is not unreasonable. Dr Kam wanted every movement to be precise and done exactly as he liked it. When I operated with him, every time I moved, he would say the word ‘careful' at least one hundred times. ‘I am being careful,' I often thought. Just not enough for his liking, I realised. I clearly improved over time and the ‘carefuls' became a little less frequent. It was my aim to get through a case with less than ten of them being said.

In America, everything that I knew about work was different, even the language. I misguidedly thought that we would all understand each other when it came to medical matters. It was all done in English, right? How wrong I was. Temperature was in Fahrenheit, many of the blood tests had different reference ranges, and drugs I would previously prescribe in my sleep all had different names. Even the local bacteria were foreign to me and required a whole different set of antibiotics to treat them. The nurses would call me and tell me that someone's blood sugar level was 70 and I would have no idea what that meant. I would make small talk on the phone whilst I hurriedly looked up the answer in a book. I was grateful for my devotion to TV shows like
ER
for teaching me the names of drugs like Versed and Demerol. I was supposed to be in charge of the residents and suddenly I felt like an intern again. I tried my best not to let my lack of knowledge show, but I'm sure they were on to me and wondered if I would survive the
year. I bought lots of medical students' textbooks in that first month and did a fast refresher. It seemed I was a pretty good actor and before long the words ‘Run in the Neosynephrine stat' or ‘Order a CBC and Chem7' rolled off my tongue like I had been saying these phrases my whole life. After a few months no one seemed to be talking about the new ‘Ostralian' girl any more.

I quickly discovered that the early start times were no mistake and that everyone did indeed front up to work at ungodly hours, shaking the patients awake to ask them how they were feeling. ‘Tired, you idiot,' was the usual response as they cracked open one eye with disgust. This predawn medicine was a bit of a comedy because by ten in the morning we were usually being flooded with calls from the nursing staff; the patients had woken up properly by then and had had the time to consider what was really ailing them. I was used to working hard, but not quite this hard. As soon as I had assimilated enough to warrant a say in things, I rationalised these nocturnal ward rounds and persuaded everyone that a much better idea would be to all go around together at 6.30 and then head off for a team breakfast of burritos smothered with green chilli. We also came up with the brilliant team-building innovation of attaching cup holders to the chart trolley so we had somewhere to rest our supersized cups of coffee that were essential heart-starters at that hour of the morning.

There were many other differences. Scrubs are the
shapeless, pyjama-style shirts and pants that surgeons wear to avoid getting blood and guts on their clothes. In Australia I was used to wearing scrubs solely in the OR. It was forbidden to wear them on the wards or to clinics, so I was used to changing clothes several times a day. In the US, though, it was standard practice to wear scrubs everywhere: on rounds, in surgery, to restaurants and to the supermarket. You simply put them on in the morning and fell asleep in them at night. If I was going to see patients on the ward, a long white coat with my name embroidered on the pocket was worn over them in an attempt to make them look a little more professional. Surgical scrubs were obtained from a vending machine. Wearing scrubs full time was a revelation to me. When they got a bit smelly, I exchanged them for a fresh set from the vending machine. I didn't have to worry about buying nice work clothes and, best of all, there was no washing.

‘I love scrubs,' someone once said to me as they wiped their greasy chicken-stained fingers over them. ‘It's just like wearing a big napkin.'

Denverites are very kind and I quickly made friends. They seemed to be endlessly fascinated by Australians, especially the way we spoke. They made merciless fun of my accent and they loved the way I cursed when I got upset. The phrases ‘that just shits me to tears', ‘what a wanker' and ‘you're a complete tosser' particularly cracked them up. These insults didn't quite have the same impact when
delivered with an American accent. They couldn't figure out the appropriate context to use them in, either, yelling out across the crowded cafeteria: ‘Hey Slater, you wanker, can you bring me some ketchup?' It was in serious medical conversations, though, that my accent became a problem. During surgery I was often misunderstood when I asked for an artery clamp (said in Australian-speak as ‘artry') and when I said the word melaena (meaning a sticky black poo in Australia and a girl's name in the US) I was laughed off the ward round. I asked someone if I could nurse their baby and they nearly called child protection (to nurse a baby in the USA means to breastfeed it). Even my name was an issue. When I said it, what they heard was ‘Kellee Slider' and they would always ask me to repeat it. My accent was distracting and it detracted from patient care. Instead of listening to what I said, everyone would listen to the way I said it and I found myself misunderstood at every turn. I soon decided that I would try to speak with an American accent when I was not at home. I thought it sounded ridiculous, but because they were not used to hearing anything else, my colleagues didn't seem to notice. So I discarded the Australian habit of leaving letters out and pronounced absolutely every letter in each word and rolled my r's over like a local. Again I was thankful that my years spent sitting in front of American sitcoms were finally paying off. My darling husband, with his pronounced Aussie accent, had a great deal more trouble making himself understood.
He would take a pad and pencil with him and whenever he wanted to order dinner from a fast-food restaurant, he would write down ‘large pepperoni pizza' and push the note across the counter, pretending he had a sore throat.

For someone from tropical Queensland, simply getting to work in Colorado offered new and unexpected challenges. Pretty soon after arriving, Andrew managed to get a job entering data at a pharmaceutical company. This meant he needed to take our only car. Because we were close to broke and couldn't immediately afford a second one, I rode a bicycle the mile to work each day. With the early starts in the wintertime, it was dark and literally freezing cold. I would layer myself with thermal underwear under my bright green scrubs, add a ski jacket and wrap a scarf around my head so I could just see enough to ride. I would pedal as fast as I could down the freshly ploughed snowy streets and arrive at work just before I froze to death. If a patient was bleeding or unwell in the middle of the night, however, my trip in to the hospital would have to be faster than my bike could manage. With no undercover garage to park in, this meant digging the car out of the snowdrift that partially buried it every winter's night. I would start it up and hop about, freezing my ass off as I waited for the engine to warm up enough to be able to drive. I would then need to take a scraper to the windshield and chip the heat-softened ice off the glass. When someone was really sick and threatening to die, there was just no time
for this procedure and I would be forced to drive with my head thrust out the driver's side window to see where I was going. I had a really good story rehearsed for the police if they ever pulled me over.

Kellee, there is a donor

I
magine you are going about your day, picking up the kids from school, stacking the dishwasher or sitting at your desk at work. Suddenly, like a bolt from the blue, you experience a headache that is so blinding you would swear you had been trodden on by an elephant. You clutch your head, a dark curtain comes down over your eyes and you collapse on the floor. That terrible pain is the last thing you remember, ever. You are discovered lying there, barely alive, and they rush you to the hospital. You are put through a CT scan and the doctors discover what everyone has feared – your brain is swollen and bleeding, the result
of a weakness in a blood vessel, a ticking time bomb you've carried since birth and it has detonated today.

This is how many organ donors die and after this, I become involved in their stories. This kind of death will change the lives of many people.

During my time in Denver, my daily job was to remove organs from people who'd died. Donors are where junior transplant surgeons
really
learn to operate. We all have to do dozens of these cases to earn our stripes. Even though I had scrubbed-in to assist in many liver transplant operations by now, only after I had mastered donor surgery would I be allowed to place even one stitch in a liver transplant patient. In some countries, a junior surgeon will spend several years doing these types of jobs before they are finally considered worthy of being allowed to do a crucial part of the operation. I wanted to prove that I had what it took to be allowed to do a transplant and I resolved to keep doing donors until I fell down where I stood. Donor surgery is definitely a young person's game, because of the time of day that they are done, so as soon as the most junior person in the team is up to speed with the operation, the task immediately falls to them. In the States, that junior person was me, and within a month of arriving in Denver, my phone rang every third night and Dr Kam's thickly accented voice would tell me, ‘Kellee, there is a donor.'

There is a very visible side to transplants, with slick advertising campaigns depicting grateful recipients enjoying
their new lives. It is very important to constantly remind people about the benefits of organ donation. Thanks to these messages, organ donation and people's wishes are often freely discussed at dinner tables across the world. But what goes on in the actual donation operation remains a pretty mysterious thing. Many myths exist.

For the surgeon, a donor operation can be a really difficult task. When everyone else is sleeping, there are small groups of doctors and nurses hurtling around the countryside retrieving organs. Donation typically occurs in the middle of the night simply because that's when the OR is available and it allows the actual transplant to commence in office hours when everyone else is fresh. There is nothing comfortable about doing it, either physically or technically. The procedure takes a really long time and usually involves travelling in a tiny plane in all weather conditions. It must always be done perfectly. Even a small mistake could potentially cost the life of one of the four or five patients waiting to receive the organs.

‘Doing a donor', as we call it, is emotionally confronting for the whole surgical team. It takes a lot of resolve to cut open a dead person and take things out of them, albeit respectfully. Some cultures and religions still do not allow organ donation, and even in the West some people believe that organ retrieval from a corpse is an abhorrent concept. In our culture this seems to be largely due to a lack of education and the existence of vile stories about how donation
is performed. I take a fairly pragmatic view of the whole thing. People die – it is a fact of life. They get buried in the ground or disposed of in an incinerator. The physical person is gone but their spirit will always be remembered by those who loved them. What a marvellous thing it is to be able to use these spare parts that would otherwise be wasted and thereby allow someone else an opportunity to have a happy, healthy life. If you think about it in any other way, it just does your head in.