human

though this is not technically about Africa, I have to blog about the experience I had on Tuesday.

My 2nd day of transplant service, and I get to go on an organ procurement with one of the transplant surgeons and my intern. First of all, I was asked about 7:45 if I wanted to go, and oh by the way we need to leave at 8:00. So my intern and I drive at lightning speed to the airport (really -- we were going 90-100mph the whole way), and we hop on a little Cessna to fly 2 hours to where the donor is. The weather in Indy at that time was quite terrible (as it continues to be), so the takeoff was very rough in our teeny little plane. The weather at our destination was not that much better either, and by the time we took our rollicking ambulance ride from the airport to the hospital, I was feeling quite green.

The real spectacle, though was the procurement itself. And I don't mean spectacle in a bad way -- it was just...wow. To start off with, the incision went from neck to groin, as well as 2 cross-wise abdominal incisions so everything would be exposed completely. Gross anatomy this was SO not. Everything looks so much different -- much more /real/ in a live patient as opposed to a cadaver. We were there to get liver, kidneys, and pancreas, and there was a local doc there to get the heart. Since our team brought 3 people and he didn't have anyone with him, I got to 2nd assist with the removal of the heart. I helped remove a heart. A beating heart. I still don't think I have fully processed that fact. To make a long story short, some unexpected things occurred with the procurement, the aorta was punctured and the donor patient had a lot of bleeding. As it turned out, after the kidneys came out it was deemed that they were not usable due to their prolonged lack of blood flow. This was of course quite disappointing, but we were still able to leave with a liver for a patient, and the pancreas went to research. We got the heart out too, which was quickly rushed off to a locally waiting patient.

I was excited to be able to go, to experience something that aside from these 6 weeks I'll never get to experience again. But, I was also surprised at how sad it made me feel. Primarily because this patient represents a whole life lived, a whole family now with one less member, a wife and kids grappling with a mountain of grief. I think a lot of it also had to do with the fact that this was a quote-unquote living donor (that is, he was brain dead, but physiologically all of his other organs functioned), and so in the beginning when we opened him up it seemed just like countless other surgeries I've scrubbed on. But to see his heart still beating, and then us working hard to get it out -- that was a large concept to try and grasp. Medically, this man was dead. He had no brain function and would never again have life as we understand it. That being said, why is it that it wasn't until we took the heart out that I really thought of him as being dead? Was it the fact that we were responsible for his physiologic death? Or maybe because a small part of everyone wants to hope that brain dead patients will make a miraculous recovery? Though in his case this wouldn't have been true -- I understand why it's hard for families to let go of such patients; because they look well aside from persistent unconciousness. After his organs were out (lungs were also removed for research purposes), the intern and I helped the IOPO staff stitch him back together. I was just struck at that moment how much it seemed like we had left a formerly living, human person in utter desolation. Other than stomach and small intestine, his formerly functional body had been reduced to an empty shell of bone, muscle and fat. It was so striking.

But overall, it was quite awe-inspiring. I don't want to talk anyone out of organ donation or in anyway detract from the completely selfless gift that this man made. Even though it was (and is) so hard to move on from the image of taking out his beating heart, after it was all over and we were back on the plane, I couldn't stop thinking to myself that I helped save someone's life today. Somewhere, right now, a wife, husband, son, or daughter is recovering from receiving a brand new heart. This patient and his/her family has no doubt gone through many, many ups and downs on the road that had lead them to the point of needing a new organ. And now, today, they are experiencing a hope and joy that they likely haven't felt in a long time.

Experiences like this really make you contemplate the Big Questions -- the meaning of life and all that. What is it to be alive, anyway? It's clearly not just the physiologic, native functioning of our many organs. If that were the case, our donor patient could have 'lived' for many more years. Conversely, it's not simply brain function -- your brain can work perfectly and you'll still die when your heart gives out. No, there must be something more than that; something more that makes us truly ALIVE and gives us our humanity. Many people, myself included, believe that this is what defines the soul of a person. And I also believe that the soul is the part of the person that goes on existing after the physical body has died.

As obvious as it sounds, the experience was difficult because I am still a living, breathing person. It is impossible for me to fathom losing any part of the body that I have lived in for 25 years. I still cling to 'the things that are seen.' This man though, our donor patient; he understood that after his physical death, he had absolutely no need for his liver, kidneys, and even his heart. His time had come to move beyond the things of this world into 'the things that are unseen.' In the end, it wasn't the surgery team that saved 2 lives that day, it was the patient. He took what would have been 3 deaths and saved the lives of 2 others -- 2 strangers nonetheless. What an amazing legacy for him to leave with his own passing from this world.

off to a roaring start

with this blog, eh?

I really will be trying to post more often now, for a few reasons
1. ONLY 5 WEEKS LEFT OF BEING AN MSIII!!!
2. I finally was able to recover the password to this blog, which was quite the feat in that I created it 3 months ago, forgot what email I signed up with, and forgot my user name as well.
3. Hopefully I'll be buying my plane tickets toward the end of this month

4. Most importantly: this article about Joe Mamlin was in yesterday's Star. Sure, spending 61 days in a 3rd world country makes me feel anxious at best and terrified at worst, but when I think about the work that Dr. Mamlin has done, I can't /help/ but be excited. In his short lifetime, he has transformed a country and given hope to thousands, probably millions. I am going to be a part of something that has changed the world. Something that will continue to change the world, as Dr. Mamlin's multi-disciplinary approach to fighting HIV/AIDS spreads to other countries in Africa, and more partnerships between American & African institutions are formed.

Joe & Sarah Ellen have created a legacy, a legacy that will last for many years regardless of whether or not he wins the Nobel Peace Prize. Though I personally think he should. (And it would be really cool, seeing as I've had dinner with the Mamlins). But mostly because he seriously deserves it.