How to Do a Liver Transplant (3 page)

What body part is that?

T
he first three years of medical school were all about cramming my head full of the fundamentals of medicine – anatomy, physiology and pathology. These subjects are the building blocks for understanding diseases. Even in those early days I had a surgical bent, tending to think that the lecturers teaching psychology subjects took themselves a little too seriously. I arrogantly thought that I had learned all the psychology I needed from watching a few seasons of Oprah Winfrey. I've since learned that psychology is often the subject I need to call upon most in my practice, so I wish I'd paid more attention.

One of my first priorities when I entered medical school was to debunk my mother's theories about the human body. I looked up the oldie-but-goodie ‘you'll catch a chill in the kidney' and found out that not only did no such condition exist, but that wearing an unattractive white undershirt wouldn't prevent one. I also learned that sitting on concrete would not give you haemorrhoids; you don't have to wait half an hour to go swimming after eating; and when you swallow chewing gum, it does not take seven years to pass through your bowels.

An essential part of studying to be a doctor was the afternoons spent in the anatomy lab. Anatomy class was by far the most interesting and strangely social aspect of life at university. When I told my family I might be going to medical school, they seemed to delight in telling me, ‘You will have to see dead people, you know.' To me, this was only commonsense. However, the dead body thing confronted me sooner rather than later. In the week before starting medical school, there was a time-honoured tradition called ‘O Week', short for Orientation Week. During these five days, older medical students took rookies on tours of the university, and at night they dressed us in togas and plied us with vast amounts of alcohol. One of the most infamous tours in O Week was a visit to the anatomy lab or – a better word for it – the mortuary. It was a rite of passage for all medical student inductees.

In the basement of a nondescript building displaying no visible signs of the chamber of death it housed, was the anatomy dissecting lab. The general layout of the lab had been explained to us before we went in, but it was hard to prepare my senses for what was inside. Even before I saw anything, the acrid aroma of formaldehyde burned my nostrils as I descended the stairs with my ‘tour group'. We were instructed to don long white coats, shower caps, overshoes and gloves. We were ushered down a long narrow hall that opened out into a room the size of a basketball court. It was brightly illuminated by rows of fluorescent lights, the floors and walls lined with sparkling white tiles. It had the sterile, easy-to-hose-out appearance of a butcher shop. My eyes were immediately drawn to the neat rows of stainless steel tables. Lying on each one was a human-shaped plastic bag. There were at least 40 of them. Pickled people, drained of blood, preserved with formaldehyde and wrapped in plastic. These corpses belonged to the generous folks who had donated their bodies to medical science. It was their hope that in death they might contribute to the betterment of man by allowing us to cut them up into little pieces. Apparently it is quite a popular thing to do and there is a waiting list to sign up for it. Imagine not making ‘the cut' even after you are dead! The whole thing was scary and fascinating all at once. It made being at medical school all very real and I felt quite important that I was allowed in there.

I spent hours and hours over the next three years in that smelly room. Our class of 200 was organised into groups of six and each of us was given a body that would stay with us for the duration. My group was assigned a lovely old girl who must have lived an interesting life with her breast implants and organs missing from various surgeries. We fondly concocted wild stories about what she must have got up to. We gradually dismembered her, spending hours reciting the names and routes of all the nerves and arteries, the attachment of muscles and the qualities of her internal organs. We had a fantastic time doing these dissections and I bonded with my anatomy lab partners. They went on to become my lifelong friends and three of them eventually became bridesmaids at my wedding. To an outsider, it may seem a little strange to be having fun in such a confronting place, but sometimes the only way to cope with this job is with humour, and the anatomy lab probably set the tone for how I deal with difficult problems to this day.

One especially light-hearted moment came on the first Tuesday in November – Melbourne Cup Day. This is a big day for many Australians. We were dismayed to discover that our final anatomy exam was to be held at the exact same time as ‘the race that stops a nation'. The exam was being held in the anatomy lab and we were each assigned to a table containing various dissected body parts. We were required to display our knowledge of anatomy by pointing out different body parts and naming them correctly. Close
to the time that the race was due to be telecast, everyone became more and more restless. Many of us had never missed it and were sad that we would have to do so this day. It was quite clear the examiners were feeling that way too, with several of them whispering about it during the exam. Then, without warning, the examiners halted the exam and the television screens in the rooms flickered to life.

‘There will be a brief pause so we can all watch the Melbourne Cup,' one of them announced. ‘Please don't talk to each other, because if you do you will fail the exam.'

A loud cheer erupted and 150 students accompanied by 40 dead bodies watched the horses race. Only in Australia.

There was another facet of anatomy teaching that was memorable for its distinct lack of dead bodies. This part of the course truly involved the living – it was the surface anatomy class. Part of the study of the human body is to learn how the contours of the skin correspond to the muscles and bones that lie beneath it. The whole idea of the exercise was to observe and feel these things in real live subjects – those subjects being our classmates. This class was nervously anticipated because it required all of us to strip down to our bathing suits in front of our group and explore each other's bodies. This disrobing also extended to our lecturers who did not seem to share our embarrassment. Rumour has it that some groups got completely naked, but thankfully no one in our group was devoted
enough to the pursuit of complete anatomical disclosure to go that far. It was bad enough having a bunch of strangers staring at my cellulite without having to decide if someone had one testicle hanging lower than the other. Whilst all of this sounds like an exercise in perversion, I understood the point. One of my lecturers described it well. He said, ‘Doctors are not like other people, we put our hands in strange, intimate places and seem to be able to detach ourselves from the fact we are doing it. This is not normal.'

For those first three years, the study was relentless. There were endless lectures, note-taking and learning by rote from dry, humourless textbooks. There was little time for anything else. There was a lot of basic science and very little actual medicine, so it was hard to stay focused on the ultimate goal. Sometimes I would forget that one day I would be seeing patients. But there was no way they were going to let you near the infirmed until you had learned the basics, so I did my best to study everything I could. There were major exams every six months, and the week before these was completely devoted to study. This time was called ‘Swot Vac' and was largely spent irrationally panicking about how little I knew. My butt was planted firmly at my desk, surrounded by dozens of books and papers in a frenzy of learning. I lived on Diet Coke and caffeine tablets. It was outrageously unhealthy and some nights I could not go to sleep because of the caffeine-induced palpitations. There was no time to lose so even eating became
a low priority. I suffered terribly with constipation and my mother suggested I try to eat a few prunes to get things working again. I was so hungry and they were so delicious, that before I knew it I had eaten a whole packet. A few hours later I felt the deep rumbles as the prunes worked their magic on my colon. I spent the wee hours prior to my pathology exam sitting on the toilet with profuse diarrhoea. Even this couldn't stop the study. I just took the textbooks into the toilet and got on with it.

After the first three years, the learning switched gears and my study became dedicated to applying my basic knowledge to patients and their diseases. This was a big change. I no longer had carefree days of skulking around the university campus in flannelette shirts and Ugg boots. I now had to dress like a professional and act like a doctor who knew what I was doing.

Around the same time, something else happened that would change the course of my life. This was the day I met my future husband, Andrew, an extraordinary man who would soon share my life and put up with the demands of my job. Andrew was at university studying economics. As it turns out we had already met 15 years before, when we attended the same preschool together in Toowoomba. Our memory of that encounter was less than dim. The second time we spoke was one afternoon while I was lazing around the college dorm room of my best friend and fellow medical student, Jamie Von Nida. I was going through my
short-lived goth period and was wearing black leggings and what I felt to be a particularly cool black leather motorcycle jacket. Andrew had gone to school with Jamie in Toowoomba and they now lived in the same dorm. Andrew had dropped by for a visit. He had long flowing hair, just like George Michael from Wham!, and was wearing blue John Lennon sunglasses. I thought he looked great.

‘Cool leather jacket,' was all he said to me. I was quite strapped for cash at the time, so I smiled and replied, ‘Thanks, would you like to buy it?' I sold it to him for $200 and when we moved in together six months later, I got that jacket back. We still have it in the back of the closet 20 years on as a memory of that time.

The beginning of the fourth year of medical school saw me shift my location from the main university campus in St Lucia, to the School of Medicine. This is a grand building in the Brisbane suburb of Herston, resplendent with Roman columns and domes, heavily steeped in the history of medicine. Its halls were decorated with portraits of wise and slightly angry-looking professors who had discovered amazing things. The building was designed to be an intimidating reminder of the special nature of the profession we were entering. Andrew and I, along with all our friends, moved into share houses a few streets away. We happily set about decorating our rented Queenslander-style house. It was dilapidated and came complete with natural air conditioning in the form of a big hole in the bathroom floor that
you had to be careful not to fall through when stepping out of the shower. They tore the house down shortly after we moved out. We all turned 21 that year and it was an endless round of parties amply catered for by our substantial home brewing activities.

Lectures began every day at 8 am, outrageously early for a student. We would drag ourselves, bleary-eyed, into the back row of the stadium-style lecture theatre, listen to the professors talk about pathology and pharmacology and try to take copious notes to read later when we were more awake. The latter half of the day was spent in small groups seeing real patients in the hospitals. I was assigned to a group of six other students and each day we went to the hospital to poke and prod the public. We would wear stethoscopes around our necks and short white coats over our clothes, so we could be identified on sight as student doctors. Patients who were ‘in the know' would run a mile when they saw us coming before they could be subjected to our stupid questions about how they were feeling and heavy-handed examinations. Just as many others would welcome us with open arms, happy to regale us with intricate stories about their bowel movements in order to break the monotony of their long hospital stays. We learned to examine patients from top to toe, practising over and over. Andrew became my very understanding practice dummy: he had his heart listened to, his abdomen pushed on, bright lights shone in his eyes and his eyelids everted. In some
places this might be called torture but Andrew never complained. He did, however, draw the line at undergoing a rectal examination. Even he had his limits.

Girls shouldn't do surgery

M
y passion for general surgery began almost as soon as they let me into the hospital. The moment I first got to see an operation, I was hooked. I loved the precise nature of it all – the smooth, organised way that things got done. The confidence of the surgeons was intoxicating as they worked away for hours, heads bowed in concentration, calling out the names of exotic-sounding instruments. I wanted to be just like them, strutting around in crisp surgical scrubs, barking orders and having people follow them. Surgeons appeared to be respected by everyone and they did things
that no one else could. But the ultimate thing was that good surgery meant someone who might otherwise be in pain, or might even die, could be made well enough to return to a normal life, or at least a better quality one. I felt there was a real payoff that would make all the hard work and training worthwhile.

My parents were very keen to foster my newfound interest in surgery. Every afternoon a doctor called Allan Smith would come into their newsagency to buy the Melbourne
Sun
newspaper. A football fanatic, Dr Smith would buy the paper so he could read the latest gossip about his favourite team, the Brisbane Lions. My Dad was a fellow sports fan and the two quickly became friends. As luck would have it, Dr Smith was also a general surgeon at Nambour Hospital. Dad mentioned that his daughter was a medical student who was interested in being a surgeon, so Dr Smith kindly arranged for me to spend some time during my vacation watching him in the operating theatre. This one event was to have a profound effect on the course of my life, and with that simple gesture, my surgical career was born.

Dr Smith took me into the operating theatre and introduced me to all the masked faces. Using what I quickly found out was irony, he announced, ‘This is Kellee Slater, she is a medical student who wants to be a surgeon. Does anyone think that a girl should do surgery?' I was already pretty anxious and now I was a little embarrassed to be the
centre of attention in such an intimidating place. I tried to calm my nervous stomach with a few hard swallows. Obviously used to these sorts of tongue in cheek comments, the nurses and anaesthetist nodded a brief and indifferent hello in my direction before turning back to their work. Dr Smith asked one of the nurses to teach me how to ‘scrub up'. He was going to be removing a gallbladder via keyhole surgery that day and it seemed that I was going to be allowed to stand at the operating table and assist with the surgery. I was not expecting this on my first day and it brought about another wave of nervous butterflies. I thought I would be sitting in the corner, not actually taking part in the operation. I had never scrubbed before, let alone touched a live person while a cut was being made in their flesh. I stood excitedly at the scrub sink feeling more than a little important as I tied a surgical mask over my face. The nurse, obviously a bit tired of teaching surgical novices, rolled her eyes, clearly indicating all of this was a little beneath her. She began to instruct me on the finer points of a full five-minute surgical handwash.