How to Do a Liver Transplant (17 page)

That's it, case done – new liver, new life. I take some time to have a final look around and make sure there is no more bleeding to stop. When everything seems calm, I wearily close the layers of the abdominal wall and skin over the patient's brand new organ. Only then do I lift my head and step back from the table. With a stiff neck and locked knees I stumble off to pee as my brain suddenly realises that I haven't attended to that for a while. The silence in the room gives way to happy chatter. We all know we have done a good thing that day.

Born in the USA

W
inter was nearly over in our second year in Denver when the city received a once-in-one-hundred-years blizzard. Eight feet of snow fell in one night. We woke to a winter wonderland of fresh powder right up to the rooftops. Cars left on the street had become white mounds, and there was no clear indication where the road was. The snow ploughs could not cope with clearing the highways, let alone suburban streets, so no one could get to work that week. The nurses who were already on shift that first night had to stay in the hospital for days until the roads were clear enough for them to travel home. I was the only one in the medical team
who lived close to the hospital, but even walking there over the mountains of snow seemed impossible. When I tried to step out the front door, I sank up to my waist in soft powder. There were fallen tree branches everywhere and power lines had been torn down by the sheer weight of the snow.

I was four months pregnant. Perhaps not thinking clearly, I had the brilliant idea of strapping on my skis and travelling cross-country to work. It took me a while to get there in my gestational state, breathing heavily in the mountain air. I shuffled rather than skied but I made it to the hospital to do the rounds and make sure the patients were safe. This embodied my attitude to my pregnancies: I just kept going.

I was 32 years old at this point and, after arriving in the States, I quite suddenly developed an overwhelming desire to start a family. Even though I had always wanted to have a baby one day, it had never really occurred to me to actively try. In fact, Andrew and I had spent all of our 20s taking measures to avoid the possibility, and starting a family still seemed like something that only grown-ups did. I fancifully wondered if it might just happen serendipitously one day and the decision would be made for me. But this was unlikely – I am simply too much of a planner ever to allow an egg and sperm to meet in an accidental way. There had never seemed to be a ‘right time' before now. Medical school was a time of social awakening, with days spent doing nothing but studying and partying. Then,
surgical training was one endless 36-hour shift and countless exams had me shackled to a desk whenever I was not working. My time was not my own and I had nothing more to give. I had had bosses regularly telling me that I had to be in the operating theatre on a Sunday at 10 pm with no notice. There was scarcely enough time to see Andrew, let alone having a tiny baby to vie for my attention.

Now, with ten years of happy marriage under our belt and the critical part of my training behind me, the time to reproduce suddenly seemed right. I became painfully aware of my biological clock ticking away and I assured Andrew that we would be able to manage. The other thing that cemented the plan was that having a baby in the USA meant he or she would be born an American citizen. I was in love with the idea of belonging to this amazing country in some small way and if I couldn't be an American, making one was the next best thing. Of course, I had a number of fears. Because I had seen almost no female surgeons juggle both a family and a career, I was very concerned whether I would find it impossible. What if I had to walk away from all that training? It was all well and good to think I could deliver a baby and then waltz back into work a few weeks later, but when the time came, would I actually be able to leave my precious bundle in the care of someone else? I was also worried about the physical aspects of the pregnancy. Would I be able to keep up the pace of being a transplanter while I was pregnant? What if I got sick and was put on
months of bed rest? How would my pregnant belly fit at the operating table? Would I vomit into my surgical mask if morning sickness took hold?

It is in a doctor's nature to imagine the worst-case scenario and I thought of all the bad stuff. Where most women chose their birth hospital based on its well-appointed rooms and the availability of birth balls and spa tubs, I chose mine because their Intensive Care Unit was excellent.

I thought it would be a good idea to go and see Dr Kam before we started trying to conceive. It was important for me to have him on board with the pregnancy plan in case I became sick. I breathed a sigh of relief when he seemed excited and genuinely supportive. He was thrilled that we would be producing an American baby. He was a relatively new American citizen himself and he understood how proud we would be. So Andrew and I launched headlong into adding to our family and, to our surprise, two weeks later I peed on a pregnancy test stick and a little plus sign appeared in the window. I burst into tears and then really started to panic. I hadn't expected it to happen quite so fast.

The morning sickness kicked in right away and I spent the first three months trying to keep my lunch down. The tiredness was extreme. I was used to sleep deprivation but this was something else. Because of my fatigue, it became increasingly difficult to try and keep things a secret at work. Everyone guessed what was happening when they
found me asleep on a pile of charts in the office. During the second trimester the nausea abated, and my pregnancy progressed along with very few problems and I was able to work as I always did. In fact, working was really good because when I was operating, the concentration took my mind off how much my expanding body was hurting. The most difficult thing was to convince Drs Kam, Wachs and Bak that I didn't need special treatment and I could still handle being awake for two days, flying on planes and managing a busy service. It seemed that Drs Wachs and Bak were being nagged by their wives that they were working me too hard and how unreasonable it was to make a pregnant woman fly around the countryside in the middle of the night. ‘Pregnancy is not a disease,' I would insist.

One of the things I loved about Americans was their generous hearts and the transplant team opened theirs widely and rallied around to make sure Andrew and I had everything we needed for a new baby. We were a long way from home and any help from our families. My pregnancy had injected a lot of excitement into the department and because I was always at work, everyone got to feel the baby kicking and watched my bump grow. They all looked forward to being surrogate uncles and aunts to our little person. We knew we were having a girl, and I felt very loved and humbled when the transplant nurses threw me a pink-themed baby shower to celebrate. I came away from
that party with cribs, prams, rocking chairs and diapers – enough to furnish a nursery, feed a baby and keep her bottom (and everything else) clean for the first two years. I had to hire a truck to get it home. All that stuff has gone on to serve our four children well. They were generous beyond words.

Pregnancy did pose a few unexpected issues. I was quite a bit more emotional than usual. Dealing with donors was already psychologically confronting, even without the hormones. I usually got through the adult donors just fine. I was careful to not look at their faces and just concentrated on the job at hand, thinking only about the people they were helping. It was a totally different story when it came to teenage and child donors. These little people had usually died in a terribly sad way, through accidents, gunshot wounds or drownings. To cut their small bodies open and retrieve their organs was too much for me to bear. Even now, it makes me very uncomfortable. I cannot help but imagine the unbearable grief that the parents of these kids must go through.

When I was 24 weeks pregnant I was asked to perform donation surgery on a young woman who had become brain dead while delivering her own baby. Unlike Australia, in the USA it was quite common for the deceased's family to want to meet with the donor team just before we wheeled their loved one away to the operating theatre. These would be the final moments they would spend together and it
was always an emotionally charged meeting. There would be tearful goodbyes and loving embraces. I hated to see these farewells, not because I am cold-hearted but quite the opposite – it was just too raw. These meetings ruined my carefully cultivated disconnect with the donor, the shield that I established to get through the day. This particular donor had died of pre-eclampsia (high blood pressure during pregnancy) and her baby had been delivered by caesarean section shortly after. The baby had miraculously been born alive and was perfectly healthy.

The woman's courageous family wanted to donate her organs and her husband asked if he could meet my team before we took her away. I didn't want to do it but found it difficult to refuse. I was already holding back tears simply having heard the story and felt myself well up even before I got to her room. I walked in to find the lady's husband cradling his beautiful newborn daughter in his arms. He was sitting next to his dead wife, telling her how lovely their baby was. I could see the pain etched on his face, unable to comprehend the job that lay ahead of him over the next few days, weeks and years. He was dealing with the cruel dichotomy of the pain of losing his wife and the joy of raising this delightful bundle. Life had changed forever for him.

‘Please look after her for me,' he said quietly, looking up at me. I thanked him for his incredible strength and the unbelievable gift of his wife's organs under the
circumstances. As I extended my hand to shake his, it turned into a hug. I admired his new daughter.

‘What's her name?' I asked him.

‘Sydney,' he replied, and at that I completely lost control of myself. Sydney was the name I had chosen for my unborn baby. I felt my bottom lip quiver and my throat close up and I let out an audible sob. Tears poured down my face and I found myself in the unusual position of being comforted by him. He held me in a long embrace that I think we both needed and we cried together. I was so upset that they called the hospital chaplain to try and calm me down. I eventually had to collect myself and perform the donation surgery. I am not religious in any way, but I do believe that life gives you signs and I felt that the fact that that baby was called Sydney was an ominous one. I changed my mind about using the name and it was probably for the best, especially for a kid who was eventually going to be an Australian.

I didn't miss a day of work during my pregnancy, and when I was only two months away from delivery, I had the biggest week of my surgical life. Transplant is either boom or bust. Some weeks you do nothing and in others there is no end in sight to the work. That day began with the usual donor call and it did not stop for a week. Just as we finished one transplant, we were called about another and then another. In all, we did six donors in five days. That is, six livers and twelve kidneys. Every donor takes about
six hours; a liver transplant, between four and six; and a kidney about two. You do the math. I ran on pure adrenaline and put my heavily pregnant self through almost all of those operations in one way or another and did not go home in between. My back ached and my haemorrhoids throbbed. My growing foetus felt so heavy that when I stood up, I thought she might just fall out. Each evening Andrew delivered a bag of clean underwear and scrubs to the hospital. He was worried, but he left me to it, knowing that there was no way to talk me into going home while everyone else was continuing to work. My only rest came in half-hour blocks, when the chief resident and I took turns to close our eyes on well-worn mattresses in the call room. We sent the junior residents out for food and they would deposit brown paper bags filled with cold fries and cheesy burgers next to our beds to eat when we awoke. Along with the food, they provided updates about the condition of the various transplanted patients. Someone would ask my opinion about a patient's results and through a blanket of fatigue I hoped I responded with the right answer. At the end of the week, they were all still alive, so I guess I did. There were so many patients that none of us was really clear about who had which organ. To avoid mix ups, we resolved this problem by assigning each patient a number corresponding to the order in which they were transplanted instead of using their names – impersonal but effective. It was just crazy and at the end I think I slept for
two days. But, because we were all in it together there was a special camaraderie that developed and at the end of that run, we couldn't believe what we had achieved.

Good health favoured me for my pregnancy and I was able to work right up until the day my beautiful girl was born. I had worried needlessly about how I would fit at the operating table. I just seemed to accommodate it, using the little bit of room at the side of the patient's belly to wedge my bump. The main side effect of late pregnancy was a resurgence of the overwhelming exhaustion. As I neared the end, I would find myself staring longingly at the patients in their beds, wishing I could change places with them so I could lie down just for a minute. My tired mind was envious that they could just lie there and not be woken every few hours in the night by a pager going berserk.

My other big problem was swollen legs. There were days when I couldn't wear shoes because the hours spent standing at the operating table would result in my ankles almost doubling in size. Extremely tight stockings – the kind you wear when you are a patient in the hospital – became essential for me to get through the day. Of course wearing these stockings, along with the layers of gowns, masks, glasses and headlights that are part of being a surgeon, would frequently cause me to overheat. I was always burning up and sweat continuously ran down my back, often distracting me from the job at hand. They could never get the air conditioning in the room cold enough for
me. Our innovative theatre technician, Anthony Adams, came up with a fantastic solution to my cooling issues. He rigged two hoses up to a fan that blew cold air. While I was standing in position at the operating table, he would feed a hose up each leg of my pants and secure it at my ankles with duct tape. It was like having my own private air conditioning system. My pants would billow out and I was comforted by the very pleasant breeze. It wasn't long before everyone at the operating table wanted to try it.