Authors: Kellee Slater
performs all types of abdominal surgery and is a member of the liver transplant team at Brisbane's Princess Alexandria Hospital. She lives in Brisbane with her husband and four children and this is her first book.
HOW TO DO A LIVER TRANSPLANT
Stories from my surgical life
A NewSouth book
University of New South Wales Press Ltd
University of New South Wales
Sydney NSW 2052
Â© Kellee Slater 2013
First published 2013
This book is copyright. Apart from any fair dealing for the purpose of private study, research, criticism or review, as permitted under the Copyright Act, no part of this book may be reproduced by any process without written permission. Inquiries should be addressed to the publisher.
National Library of Australia Cataloguing-in-Publication entry
Author: Slater, Kellee
Title: How to do a liver transplant: stories from my surgical life/Kellee Slater.
Subjects: Slater, Kellee â Anecdotes.
Liver â Transplantation â Australia â Anecdotes.
Surgeons â Australia â Anecdotes.
Transplantation of organs, tissues, etc. â Australia â Anecdotes.
Donation of organs, tissues, etc. â Australia.
Dewey Number: 617.556
Shutterstock: Plain Picture
Like everyone, there are some days when I don't want to do my job any more. These are the days when I have to tell four people in a row that they have cancer. Then there are the times when I have worked all night and feel like my eyes will bleed if I don't close them soon. I want to give it all up when I haven't seen my husband for three days.
But all of this pain is balanced out by the days when I get to do a liver transplant. This is the one operation that keeps me coming back for more â those six hours or so when I am totally focused on the task of taking the old liver out and putting the new one in. When you say it like that, it seems so simple, but it has taken me hundreds of hours to learn how to do it and I just love it.
This is the story of my life and how I came to be a doctor, a surgeon â and a mother.
I was born to be a general surgeon
realised that I was going to be a surgeon pretty early on by figuring out what I
like about medicine. Take phlegm, for example. Some patients think there is nothing I'd like more than to inspect a giant lugie they have coughed up and spat into a cup. They are just so wrong. Then there are feet â if you show me any problem concerning the foot, you will be sure to see me using mine to run in the opposite direction. This phobia stems from two of
most ghastly things I have ever seen.
As a medical student, I travelled to India to work in a community hospital to experience health care in a
developing country. It was the height of summer and the temperature was a sticky 40 degrees. My next patient was a young man with diabetes, who entered the room on crutches, dragging his foot behind him. The foot was swaddled in a filthy bandage and he hobbled in leaving a trail of pus in his wake. The smell was bad, even from some distance away. I thought the dressing was black with dirt but, as he came closer, I was horrified to see that the colour was from hundreds of flies. As I crouched down, shooed the flies away and gingerly unwound the stinking layers of gauze, I held my breath to avoid inhaling the smell. As I unwrapped the last few strips, I felt something soft come away and fall into the palm of my hand. I closed my eyes for a moment, not wanting to acknowledge what I suspected had happened. As I opened them again and looked down, nestled there in the bandage were all of his toes. I instantly recoiled and the toes fell, making a soft plopping sound as they hit the ground. This poor boy's gangrene was so advanced that his toes had amputated themselves. I promptly vomited on the floor, right next to the toes.
The second time I vomited in front of a patient was back in Australia, and again it involved feet. When I was a very junior doctor hoping for a career in surgery, one of my jobs was to work in vascular surgery. This specialty involves unclogging blood vessels that have been damaged by years of smoking or diabetes. I was in a vascular clinic that looked after patients with nasty ulcers on their
legs and feet, and I was confronted with a lady who had a similar dressing to the one I had seen in India. Suffering post-traumatic stress from my previous experience, I unwound the bandage with significant trepidation. The dressing came off, this time with toes intact. I let out a sigh of relief. Feeling slightly more adventurous, I moved in for a closer inspection and I could see a deep, crevasselike ulcer between two toes. Very professionally, I pulled the toes apart to inspect the fissure. At that moment a fat and juicy maggot wriggled out of the wound, like a worm out of its burrow. Again my reaction was to turn around and throw up, this time into the sink. The unwitting patient looked more than a little alarmed and asked me if everything was all right. So as not to upset her, I told her that I had food poisoning.
That was not the end of my torture with legs and feet in that vascular term. As I was the most junior member of the team, my main job during that six months was to amputate more than 40 rotten legs belonging to crumbly old smokers whose âbest by' dates had well and truly expired. The unfortunate victim of a surgical amputation is usually subjected to a local anaesthetic (they are often too sick to go to sleep) so they can frequently hear everything that is going on, including their leg bone being sawn through. One patient, who suffered from dementia, even yelled out distressingly, âDon't take my leg!' as I took my big knife to their skin, muscle and tendons.
I would use a serrated wire with little handles on either end and place it under the bone. I then stood on a box to get enough purchase and ran that wire back and forth just like a competition woodchopper. The friction produced by the wire burned through the bone and broke it in two with a grisly snap. There are no words to describe how horrible it was to do this. To me, surgery is about repair, not destruction, and even though removing that leg meant saving their life, it was a pretty difficult thing to do. Once the leg was separated, I would pick it up and have to feel its dead weight before tossing it into a big trash can at the end of the bed. The sound that a leg made when it hit the bucket was so disturbing that I would have to turn the music in the theatre up loud so I couldn't hear it. Those legs would appear in my dreams at night, dancing through my subconscious, trying to kick me in the arse as punishment for cutting them off. No, no â a life as a foot doctor just wasn't for me.
I believe that I was born to be a general surgeon. Yes, I admit it, I have always loved to squeeze pimples, pick scabs, release pus and generally unclog things. When you break it down, this is what a general surgeon does, so it is definitely the right job for me. I can happily work away in someone's abdomen all day long and not give it a moment's thought. If I couldn't be a general surgeon, there would be no point in my being a doctor at all. I love the diagnosis, the physical steps of the operations and caring for the patients after
their surgery. It is the only thing I have ever been interested in. One of the real joys of surgery is that almost every day I'll encounter something I have never seen before, and even after all these years I am constantly surprised as interesting problems walk through my door. My heartbeat quickens when I make a rare diagnosis or do a difficult operation. I dream about the surgery at night. Being a general surgeon is a lot like waking up on Christmas morning, anticipating with excitement what gifts will be underneath the tree. Diagnosing a patient's problem is just like shaking the presents to figure out what's inside, and getting to operate is like tearing the paper off to find out if my deduction was right.
General surgeons get to fix people (for the most part) with terrible, life-threatening problems. These patients come in broken and, I hope, after I have operated, they leave the hospital just a little bit better than they were before. Unbelievably, this idea that surgery makes people better didn't really crystallise with me until recently when I had to have a procedure myself. My primary focus, just as it is when I operate, was on all the things that could go wrong. I'm sure that this is not what the average patient is thinking when they go off to sleep, but I do. I was pleasantly surprised when things went really well and my problem was successfully fixed, making my life much better.
I worry a lot, but this may not be a bad thing. It keeps me sharp. I have an intuition about when things might
be going wrong. I am regularly known to call the ward in the middle of the night to check on someone I am concerned about. The nurses think I'm crazy, but knowing everything is all right for now is the only thing that will allow me to sleep sometimes. My mind is always âon' and I wonder if I will burn out one day. Being a general surgeon is all about predicting what could happen to a patient and how I will fix it if it does. During surgery, this is what is running through my mind. I have to have eyes everywhere. I need to see when the assistant is pulling on something too hard and is about to snap it. I have to ask for an instrument that may not be in the room well before I might need it in an emergency. Before I start a liver transplant, I need to make sure that the cooler with the liver in it has arrived. A general surgeon needs to be in control of everything and totally focused on the job all the time.
It is not all toil, though. There are the funny situations and stories that patients bring into my life â both intentionally and by complete accident. This is what makes my job really fun. Like the patient who brought a fish tank complete with filter into the hospital for a one-night stay to help them relax, or the lady who thought it was outrageous that the hospital could not supply her with an organic peach when she was hungry late at night. I am privileged to get an intimate glimpse into the many quirky things that people get up to and the offbeat way some of them choose to live. It can sometimes be hard to keep a straight face
but of course I try my best always to be professional. I see the lighter side of most things and you will have to excuse some of the black humour in this book; it is my coping mechanism, I suppose.
There are a lot of grim moments in general surgery, what with all the cancer and dying. Some days I cry and some days I don't want to get out of bed because I know I will have to tell a patient that their life is going to end. There are also the less-than-glamorous aspects of the job, but I can easily put up with them because the rest of general surgery is just so darn interesting. Take dead gut, for example.