How to Do a Liver Transplant (2 page)

From time to time a patient will show up with this terrible problem. It can happen when something blocks the artery or vein supplying the bowel, starving it of its blood supply. The afflicted section of bowel will rapidly die, usually just a few hours before the patient does. If you catch it early enough, an operation can occasionally save the day. When you open the belly of a person with dead bowel, the smell is so foul it goes straight up your nostrils and socks you in the brain. The memory of it lingers for days afterwards. I find this smell so sickening that when I know it's potentially coming, I douse my surgical mask with a powerful menthol solution that goes just a little way toward disguising the stench and distracting my nose. This is an odour so powerful that it also somehow manages to transfer itself onto my fingertips, even through two pairs of
gloves, and I have a weird and terrible compulsion to keep smelling my fingers long after the operation is over.

Another extraordinarily unpleasant smell that emanates from a human being is melaena. Such a pretty word that belies its true meaning. It is the term used to describe faeces that contain digested blood, usually from a haemorrhaging stomach ulcer. It is another aroma that must be smelled to be believed. Nurses (usually with a wry smile on their faces) will often save a melaena stool in a bedpan for the doctor to inspect on rounds in the morning, just in case we might not believe that it has occurred. There is usually no need to see it, though, because the diagnosis can be made from anywhere within a 200-metre radius.

What we do in general surgery is a little bit of a mystery, I think. Everybody seems to have heard of plastic surgeons, ear nose and throat doctors and even brain surgeons, but plenty of people stare at me blankly when I mention what I do. General surgeons deal with every surgical conundrum that the human body can dish up. We largely work in the abdomen and when things go wrong there, it can really mess up how everything else in the body works. Twenty years ago, general surgeons were jacks of all trades, proficient in repairing bones, bladders, brains and bowels, but as technology has advanced, general surgery has evolved to the point where a surgeon might focus their attention on just one microcosm of the body and become a so-called ‘super specialist'. We are now loosely united under the
general surgery banner but might spend all our days operating on just the breast and thyroid (breast-endocrine doctors), the bowel and anus (colorectal doctors), the oesophagus and stomach (upper GI doctors) or in my case the liver and pancreas (hepatobiliary doctors).

My official job title is Hepatobiliary, Pancreas and Liver Transplant Surgeon. This essentially means that I do life-threatening things to high-risk patients that take many hours and involve copious amounts of bleeding. I then spend the days and weeks afterwards trying to keep them alive and helping them recover. Liver and pancreas surgery has only really become safe enough to do relatively recently, and in the early days of the speciality, it was frequently fatal. Even in my surgical lifetime, the aftercare and chemotherapy available to these patients has evolved to such a point that I am now operating on people who we would have never considered before. We are really pushing the boundaries of what is possible and it is a very exciting time to be a liver surgeon.

Not very many folks think too much about what their liver and pancreas do. Whenever people ask what job I do, I usually say that I am a liver transplant surgeon because that's the only thing that they seem to have heard of. There are so many things that can actually go wrong with a liver – cancers, lumps, infections, worms and stones – and I can do a great many things to it besides replacing it with a new one during a liver transplant. In fact, only a
minuscule number of patients I see ever end up having one of those. Most of my time with the liver is spent neatly cutting pieces out of it in a multitude of permutations. Liver resection (that is, removing part of the liver) is the most technically challenging part of the job. Sections must be cut away using only my mind's eye to visualise invisible lines that represent the eight segments of the liver. If I am even a centimetre or so off in my calculations, the blood supply to the remaining section will be compromised and the consequences can be fatal.

The other part of my job is removing sections of the pancreas. Yes, you
can
live without your pancreas (this is a common question) and I do regularly take it out when it is invaded by cancer and other horrible problems in what can only be described as operative extravaganzas. Operating on the pancreas can be treacherous because it is so soft and delicate – like butter. As one of my colleagues eloquently put it, ‘to stitch the pancreas is like sewing flatus to moonbeams'. These surgeries require precision, judgment, attention to detail and extreme dedication. It is a lifestyle and it is often all I think about, much to my husband's annoyance when he is trying to talk to me about whether we need to buy more milk for the morning.

You might get into medical school, you know

M
y mum grew up in a small town in far north Queensland called Ravenshoe. In the late 1960s the only jobs for a single woman were either hairdressing or working at the local bank. Mum chose the bank and it was there that she met my dad, a peanut farmer's son from Kingaroy who had been sent to the Ravenshoe branch as a teller. They were in their early 20s when they married and were transferred to Townsville where, within a year, I was born. I was joined four years
later by my sister, Lauren. Mum and Dad were hardworking people who often had more than one job at a time. Anything from Mum taking in ironing and childminding, to Dad working as a bookmaker at the local races to make ends meet. The bank moved us around a little too often for Dad's liking and he soon tired of the itinerant life while trying to raise a young family. He decided to settle us on my grandparents' sugarcane farm in Bundaberg and to have a go at making a living off the land. My carefree childhood was spent playing hide and seek amongst tall rows of cane, riding my bike and catching fish in the local dam. Farming, though, is a feast or famine lifestyle and I'm sure there were times when Mum and Dad found it hard to put food on the table.

When the bottom fell out of the Australian sugarcane industry in the early 1980s, my parents again searched for a better life and the year I turned 13, they moved us to Nambour. They bought a newsagency and started working 100 hours a week. They are still there 31 years later doing the same thing and I can smell the newsprint whenever Dad comes into the room. The long hours they spent at work meant my sister and I had to look after things on the home front. We would have dinner on the table at the end of the day and manned the front counter of the shop on the weekend to earn a little pocket money. As much as we disliked seeing our parents so infrequently, their work ethic left an indelible mark on me.

I started high school at Nambour High, a huge public school with a pretty good reputation. It was a school that would go on to produce an Australian prime minister in Kevin Rudd, a deputy prime minister in Wayne Swan, and a rock star – Powderfinger's Jon Coghill. In the final year of high school, with the rest of my life ahead of me, I didn't really have any idea what I wanted to do aside from the usual teenage plan of making a lot of money in exchange for very little work. It was the late 1980s and the widespread use of the internet was still a few years away. Career opportunities were fairly limited and it was not necessarily expected that a student from Nambour High would go on to university. Many of my classmates were planning to leave school and work for a few years before they got married and had kids. The likely occupations for someone like me were nursing, secretary or shop assistant. I learned typing and shorthand in Years 9 and 10 in preparation. I vividly recall my dad – a lover of the sweeping statement – regularly pronouncing, ‘The problem with the world today is married women in the workforce.' That was more than enough impetus for me to want to contradict him. He certainly whistles a different tune now that both of his daughters are university-educated working mothers.

Even though I didn't know what to do with myself, I
was
quite sure I wanted to go to university. The thought of striking out and moving to a big city on my own was really exciting. If I got into university I would be the first in my
family to do this since 1905, when distant cousin Robert Alexander Slater from Scotland also became a doctor. Sadly, he died of tuberculosis aged 34, so I had to do better than that. Still, there was very little encouragement for me to get there. This was vividly illustrated during my schoolsponsored work experience in Year 12. I had to choose somewhere to work for a week so I could see if the job was something I would like to do as a career. I became much more interested in maths and science in my final years of school but the only thing on the list of jobs available for work experience that was even remotely scientific was optometry. I signed up for it, but at the end of the week when all I had done was run the reception area, vacuumed the floor and fetched the mail, I enquired if I might be able to sit in on some patient consultations and, heaven forbid, look into a few people's eyes. The optometrist suddenly looked sheepish as it dawned on him that I was not there because I aspired to be a secretary. To his credit, he was really embarrassed at his assumption and let me sit in with him for the last few hours of the day. He even threw in a free pair of Ray-Ban sunglasses. I was pretty excited about the sunglasses – optometry, not so much.

I thought about a few different careers that year. My boyfriend at the time was a Black Hawk loadmaster for the Australian Army and that, combined with the movie
Top Gun
– a huge hit at the time – made being in the military a very cool prospect. I made enquires and got the forms to
apply for officer training in Canberra. I could fly planes and earn a degree at the same time. I was all ready to be a female ‘Maverick' until I found out that they wouldn't let girls fly fighter jets at that time – something about the uterus's propensity to fall out under negative g-force. I was indignant and swore I would not enter an organisation that didn't treat women as equals.

My next idea was to be a home economics teacher, and I forged ahead with this plan until the day before university applications closed. I loved to cook and sew and still do. It's really not very different to being a surgeon – both jobs involve stitching and there is a simple pleasure that I derive from making or fixing something with my hands. It wasn't until I went to see the career counsellor at school about my university options that she suggested that I apply to medical school. This was really the first time that I had thought of such a thing.

‘Hmm ...' she said, peering over her spectacles, ‘I had no idea you were getting such good grades. You could get into medical school, you know.'

I considered what she said for a few days. I loved biology and chemistry, so maybe medicine would be all right for me. I only vaguely knew what doctors did. They wrote prescriptions, delivered babies and took blood pressure. I didn't think of doctors as surgeons. The one thing I did like was that it would probably be easy to find a job at the end of all that studying. Doctors also seemed to be very
well off, and that is an attractive thing when you are 17 and earning $5 an hour working at your parents' shop. What didn't occur to me was that jobs involving high incomes were not actually very easy. If I knew then how hard I would be working now, I might have run a mile.

At the counsellor's insistence, I filled out my university application, and almost as an afterthought wrote down medicine as first choice and home economics teacher as second. I readied myself for teaching because I never thought I had a hope of getting into medical school. That didn't happen to people like me.

The day came for the university offers to be delivered in the mail. It was Christmas holidays and I was working in the newsagency that day. I went home at least three separate times to check the mailbox – nothing. It wasn't until 5.30 in the afternoon that the postman, exhausted from the increased volume of work that day, finally delivered that official yellow envelope. I held the letter for a few moments and eased it open. I slid out the thick white paper and to my surprise it said ‘Medicine – University of Queensland'. All right, that was unexpected. So I was going to be a doctor.

My biggest concern about going to university was that I felt they might be letting me in under false pretences. It was my distinct impression that I only did well at high school because 80 per cent of my classmates were more interested in going to the beach than studying. I would look
up from my Year 12 calculus exam to see everyone around me flicking through surfing magazines, so I figured I had had a pretty easy ride to the top of the academic heap. University was the big league and I was thoroughly intimidated by the private school kids. They seemed to be smarter, prettier and better dressed and I wasn't sure I could compete. It is something that I still struggle to overcome and even now when I sit in a room with other doctors, I feel they know much more than me. This inferiority complex is what still drives me to do better all the time.

Happily, most of my fears about not fitting in at medical school turned out to be unfounded. Within a few weeks of starting, I knew I had found my people: the other medical students were my kindred spirits. Six years of serious study and exams stretched out before me. Mum and Dad set me up in a share house with four school friends in a leafy riverside suburb near the University of Queensland. I packed up my teenage bedroom, got some garage sale furniture and prepared to face the world on my own. Well, not quite. Mum and Dad paid my rent and gave me $60 a week to buy everything else. We ate generic brand dim sims and were regular attendees at the ‘$5 Tuesday' all-you-can-eat buffet at the local Pizza Hut. I didn't have much, but I was living on my own schedule and it was an exhilarating feeling of freedom.