How to Do a Liver Transplant (23 page)

Rebekah and I absorbed this story and stared incredulously at this loving family who had just lost a muchwanted baby daughter and granddaughter before they had even met her. Now they faced the prospect of losing the baby's mother, all on the same day. I found it all a little difficult to process. I was truly speechless (and that doesn't happen often). It took a few moments before I could open my mouth to say something, but all that came out of me though was a big sniffle and then a sob. I tried to keep myself in check, tried to remain professional, but of course I couldn't and the tears came streaming down my face. Rebekah followed suit and we were all crying right along with the family.

‘We will not let your daughter die, that is not happening today,' Rebekah managed to say to Krystal's family. ‘We will take her to theatre now, fix her up and bring her right back to you.'

Rebekah and I literally scooped her up and pushed her bed around to the operating theatre ourselves. We were in charge of her now and we would not stop until she was out of danger. We called through to theatre on the way and told them to expect us shortly and to get ready for major blood loss. It would be a ‘chk-chk boom' case. Our team was on fire that day and when they heard the story of what had happened to this young woman they were even more efficient than usual. Everyone was desperate for Krystal to live. Fortunately the nurses were ready with my staple gun because the bleeding was truly horrendous. I had that ruptured section of liver in the bucket in no time flat but this only did half the job. As the torn blood vessels retracted deep into the remaining half of the liver, the blood loss continued. It gushed out so fast that it actually made a noise. This is what we call ‘audible bleeding' and it meant that Krystal was in mortal danger. When someone has received dozens of bags of blood, their body will run out of the little molecules that the body needs to make blood clot. It all happens so fast that there is no time for the liver to make any more. There was nothing I could do. Just like plugging holes in the dyke, every time I put a stitch in one place, blood spurted out from somewhere else. I
kept repeating to myself quietly,
‘I'll just keep stitching until Rebekah tells me she is dead.'
Many people say that when they have a near-death experience their life flashes before their eyes. As I stood over her, it was Krystal's life flashing before my eyes. As her blood rushed between my fingers I thought, ‘The next few minutes will determine the rest of this woman's life.' I pictured her family waiting outside and I imagined myself walking out to tell them that the person they loved most in the world had died.

The signs of a patient's deterioration during an operation can be very subtle and Rebekah has developed a way of telling when things are not going well. She calls her sixth sense, the ‘sounds of my surgeon'. She pays very close attention to the noises I make and watches the way I move when I am under pressure. Anaesthetists can't always see what I am doing in the abdomen, but after years of watching my body language, Rebekah can pick up the subtle changes in my posture that occur when I feel like I am seconds from disaster. She notices how my head leans forward to almost touch my assistant as we both focus our attention on a critical part of the operation. She listens to my little grunts of exertion and watches how I rock back and forth slightly when I am tense. She hears the suckers working overtime to mop up a sudden rush of blood.

Rebekah's senses were in top form that day and she knew that I had done all I could. It was now up to her. While I held my hand hard on the ragged surface of the
remaining section of liver, exerting as much pressure as I dared, Rebekah darted about at the top of the operating table with syringes of drugs in one hand and the telephone in the other. She was constantly talking to the blood bank letting them know what she needed – more blood, more clotting products, more everything. Send them around now, now, now. She was a picture of calm efficiency, issuing precise orders to the three nurses who were diligently carrying out her every request. Every time there was a new wave of blood loss, Krystal's blood pressure would plummet to dangerously low levels and Rebekah would respond, injecting powerful drugs to make it rise again, making a little more blood flow to her brain, keeping her alive. Rebekah watched my struggle and when it became obvious I could do no more with stitches, she sent me to sit in the doctor's lounge for ten minutes while she continued to pour the clotting factors in, trying to get the balance right in order to make the blood clot. We call this a ‘haemostatic pause'. Eventually, after dozens of stitches and fifty bags of blood, the bleeding slowed and the cut edge of the liver suddenly became dry. Rebekah told me things were steady and it was time to close up. The room looked like a war zone, with pools of blood on the floor and empty bags of fluid and blood products littered everywhere.

With the job done, we returned Krystal to the Intensive Care Unit, and after a few days this lovely woman's eyes fluttered open and she started breathing for herself.
When she became conscious enough to understand what had happened, Krystal still had the breathing tube down her throat. She knew that her baby had died even before we told her, but there was one important question that she urgently wanted answered. Tethered to the ventilator, she furiously waved her hands to demand a pencil and paper so she could write her question down. She wanted to know the sex of her baby.

Krystal has since told me that when her partner let her know that the baby was her much longed-for girl, she rolled her eyes and felt the painful irony:

‘Of course it was a bloody girl! Of course!' she said with anguish.

Her milk came in several days later as a cruel reminder of what could have been. She left hospital a few weeks after the ordeal began and she still comes to see me from time to time. Krystal has survived all this and has got on with her life with more courage than I thought was possible. Seeing her face – seeing her get on with her life – reminds me why I sacrifice so much of
my
life to do this job. It was many people working as a team that saved her that day and I never let my surgeon's ego forget that without them, none of it would be possible.

Buy a bra, save a child

I
believe that life hinges on the smallest things and nothing was more certain this day. I had finished my operating list early, all my paperwork was done, and things were winding down as I prepared to head off for a mid-winter vacation in Fiji with my family the following week.

I had bought a few resort outfits and decided at the last minute that I needed a strapless bra to wear with one of them. I was beginning to feel relaxed. It was Thursday afternoon – one day to go until no phones, no emails and no dying patients.

There are almost no spare moments in my life and an opportunity to get to the shops alone is a delicious treat. I seized the opportunity and snuck out of work early to my local department store. With a selection of bras in hand, I headed off to the fitting rooms to try them on. As I stood in the change room cubicle, topless and grappling with the hooks on a bra, I heard a high-pitched scream coming from somewhere outside. It sounded like quite a commotion.

I paused for a moment and listened carefully. I have become cautious about rushing into situations where there may be danger. I had almost got myself into difficulties a few years before when I leapt without thinking into a flooded creek to help out a cyclist who had fallen in. I had learned from this, and from countless emergencies in the course of my job, that first appearances may be deceiving. I now take care to hang back for a minute or two until I can take stock of a situation. It is not that uncommon for people to faint or fall over at the shopping centre, and as I stood there I thought to myself that this was probably all it was. There are usually plenty of people around to help. I lingered in the dressing room in my semi-naked state and wondered if it was worth the effort of putting my clothes back on to go and see what was happening.

The woman's screams become louder. ‘Help, help me!' she pleaded. A ‘code blue' announcement came over the loudspeaker and then I knew it was serious. Who knew
there even
was
a code blue procedure at a department store? What did it mean? I heard the woman scream, ‘My baby's dying!' It was the visceral cry of someone who was going through something very bad.

That was enough for me. I was now compelled to get involved and I began to pull my clothes on as fast as I could. As I left the change room, still optimistically clutching my bras, I could see a crowd of people gathered a short distance away. There were store managers and security guards buzzing around the periphery, barking commands into their walkie-talkies. ‘Call an ambulance,' I heard one say. I pushed my way through the throng and was confronted by the sight of a chubby toddler with a mane of curly blonde hair lying lifeless on the parquetry floor. Her skin was a deep shade of blue.

I announced to no one in particular, ‘I am a doctor. Do you need some help?' The woman I had heard calling out was red-faced and frantic.

‘She's choking, she's choking on a cracker,' she yelled.

This was all the information I needed and I knew exactly what was going on and what I had to do. Without waiting for permission I sprang into action. The bras were flung sideways as I sank to my knees and hoisted the little girl up by her ankles. Her hair dragged on the floor as I slapped her vigorously between the shoulderblades with the palm of my hand in an attempt to dislodge whatever was blocking her windpipe. No response. She remained
as limp as a ragdoll. I commanded a burly man standing nearby to keep holding the little girl upside down so I was free to pummel her even harder. I could hear her mother babbling incoherently into her mobile phone a few feet away. On the other end of the line was her husband, working more than 100 kilometres away from the horror of this unfolding scene.

‘She's dying, our baby is dead,' she cried. I could only imagine how helpless and wretched this poor man must be feeling as he listened on the other end of the line.

I realised my efforts weren't having any effect and time slowed down. The words,
No one is going to die in the underwear section
, kept running through my head.
I am not going to let this happen.
I was keenly aware that there was now a very big crowd watching my every move, stunned at what they were witnessing. I could feel them willing me to make this right. How could a trip to the shops lead to my holding a dying baby in my arms? Twenty precious seconds later, I knew I had to try something different. The toddler's colour was fast becoming a shade of deep violet that belongs only to the dead. I flipped her back onto the ground and laid her out flat. I put my finger in her mouth and probed around, trying to feel the soft, macerated cracker obstructing her airway. Her chest was not moving and her eyes were wide open, staring lifelessly toward the ceiling. I knew that shortly it would be all over and she would be irreversibly brain damaged.

I weighed up the options for my next move. If something is lodged in the main windpipe, it can be impossible to remove it without surgical instruments. This is always the problem for a Good Samaritan – while you might have the skills, you don't have the equipment to do what you need to do. When someone is choking, unless you can blow air past the blockage, the victim will die. Foreign objects often lodge fairly high in the windpipe and the only option if they won't budge is to try to make a cut in the neck and insert a makeshift tube into the windpipe below the obstruction. Doing this type of emergency tracheotomy in a hospital, to an adult, with all the available technology, can be difficult enough, let alone on the floor of a department store with a robust, no-neck toddler. I had previously heard of a tracheotomy being done on a person who had choked in a restaurant. They used a kitchen knife and a drinking straw to make an airway to deliver lifesaving oxygen. I had given some thought to how I might do this, if I was ever faced with that situation. I wondered if I should send someone to the kitchenware department to get me a knife. I had a pen in my bag that I could pull the ink tube out of to use as a temporary breathing tube. I also wondered how this huge crowd of onlookers would react if I took a knife to this little girl's throat. What if it didn't work? I'm not sure they would understand what I was trying to do and I wondered if I even might find myself arrested.

Given it was at least two minutes since this baby drew a breath, I figured that I didn't have enough time to get a knife. I had to do something else. I knew that the little girl's heart was still beating because I could feel her strong pulse beneath my fingers. It was only her lungs that had stopped working, collapsed beneath the blockage. The priority was to get oxygen to her brain. I thought if I gave mouth-to-mouth resuscitation, I might be able to blow enough air past the blockage to get her going again. It was a risk, because doing this might push the cracker further down her windpipe, making a tracheotomy impossible. The other possibility was that I could blow the cracker all the way down into one lung, meaning that only one would be affected and the other might work enough to buy the time needed to get her to hospital.

I decided that this was the only practical choice and worth the gamble. I threw her little head back and it hit the wooden floor with a loud clunk. Her mother was looking on in horror as I got in position to start mouth-to-mouth. Now it was really life or death. I stared into the baby's eyes, willing this to work, and then pressed my lips to her open mouth, pinched her nose and blew.
You are not going to die today,
I said to myself as I blew. Strangely enough, after all the resuscitations I had attended over the years in the hospital, this was the first time I had ever given actual mouth-to-mouth or ‘the kiss of life'. In the hospital there are masks and tubes to do this job. As I clamped my mouth over hers,
this very close interaction with a complete stranger was an unusual sensation.