How Death Becomes Life

Since I began taking care of sick people, I have noticed that one of the hardest things about getting sick, really sick, is that you are separated from the people you love. Even when families are dedicated to the patient, illness separates the well from the sick. The sick suffer alone, they undergo procedures and surgeries alone, and in the end, they die alone. Transplant is different. Transplant is all about having someone else join you in your illness. It may be in the form of an organ from a recently deceased donor, selfless gift given by someone who has never met you, or a kidney or liver from a relative, friend, or acquaintance. In every case, someone is saying, in effect, ‘Let me join you in your recovery, your suffering, your fear of the unknown, your desire to become healthy, to get your life back. Let me bear some of your risk with you.’

The thing that blows me away about Tito’s case is how close I came to giving up on him. I remembered the thoughts that went through my head in the OR:

I can’t save him.

He doesn’t have a chance.

It would be better for his family if we called it and moved on.

They could grieve and then go on with their lives.

But then something changed my mind. I attribute it mostly to Orinda’s expression of her trust in me. This is the crux of being a surgeon: Patients and their families trust you to do the best thing for them, for their loved ones. They take you at your word. You bring people to the OR, you open up their bellies or their chests, their heads, their limbs, you put their lives into your hands, and your judgment becomes everything. This is both the beauty and the challenge of surgery. This is why we train so hard and help one another and push ourselves to be perfect even when we can’t be. This is why surgery can be so wonderful, but also so humbling. It is also why we need to call for help, own our mistakes, always try to be better.

These organs we transplant the livers, the kidneys, the hearts – they are the ultimate gift, the gift of life, the last thing the dead can bestow upon the living. We, as surgeons, simply transfer them from one person to another. We are the stewards, and it is our job to make sure the gift is given. Yet I am blown away by how hard we need to fight for it sometimes, how often we must remind ourselves about the pioneers in transplant: They never gave up. It would never have crossed their minds.

One piece of advice I’ve always liked is that every surgeon needs to have a metaphorical ‘box’ into which he places all his complications. He should be able to access that box each time he sees the patients with complications and their families, and when he presents a case at an M and M [morbidity and mortality] conference. At the same time, a surgeon should be able to close that box and put it away when he goes home to his family. Those who fail to maintain access to the box become cavalier and lose their compassion. Conversely, those who don’t have a box can struggle to keep their sanity, can’t stop thinking about all the bad things that may have happened or they may have caused, even after hours. Such surgeons often leave the profession entirely, or never really get started once they finish their training. Others limit themselves to small procedures, and call partners in to help at the slightest turn of a hair. Whatever the right strategy, we surgeons have to find a way to live with complications, to learn from them, to help patients get through whatever we may have caused or at least been a part of, and to move on.