How to Do a Liver Transplant (9 page)

While this storm of controversy was raging,
his
major concern lay with a minute detail that would have never occurred to anyone else. He was worried about what might happen after he joined the tiny blood vessels that allowed blood to run through the new liver. Over the years would these little stitches stretch and grow with the child? If they didn't, it might mean that the baby would outgrow their liver and either die or need repeated transplants until they were an adult – a bit like needing a new pair of shoes every year. It was a complete unknown. As it turned out, everything was all right. Remarkably, the join-ups did stretch and life found a way. Australia's first child liver transplant recipient is now in her late 20s and has two kids of her own. As a society, we owe a great deal to Russell Strong
for standing firm in the face of extreme opposition to do something he knew was right. I feel humbled that I now sit in an office next to his.

Working alongside Professor Strong was Dr Daryl Wall. He was the person who took care of all the problems no one else could fix. These were broken and often institutionalised patients with volumes of hospital charts thicker than the phone book. Dr Wall was always charming and impeccably dressed in a suit and tie, even at three o'clock in the morning. Whenever I called him, he would answer with words of enthusiasm and praise for the job I was doing. His greatest gift was the ability to bring sunshine and optimism during the most desperate of times. It was likely he could find something life-affirming to say whilst amputating a leg during an earthquake. He also had the extraordinary skill of remembering and using the name of everyone he had ever met, from the cleaner to the CEO of the hospital, and everyone loved him because of it. An imaginary Dr Wall still sits on my shoulder when I am operating, guiding my hands, his surgical aphorisms sounding in my head. There is no doubt that my love for looking after complicated problems has come from him.

Professor Stephen Lynch, better known as ‘the Chairman' for his skill in negotiating both the operating room and the maze of hospital administration, originally hailed from New South Wales. He joined Professor Strong in the earliest days of the liver transplant program at the PA and
was by his side through all of the exciting ‘firsts'. By the time I started there, he was the Director of the Liver Transplant Unit. I didn't know it at the time, but he was the man who would eventually change the course of my life. Professor Lynch was a quick and precise surgeon and watching him operate was like poetry in motion.

Finally, there was Professor Jonathan Fawcett, the newest member of the group. He was a young British surgeon, headhunted by the PA for his amazing research pedigree and giant intellect. There was literally nothing he didn't know and he would be my ‘phone a friend' if I ever went on the TV show
Who Wants to be a Millionaire?
He combined being a brilliant surgeon and dedicated researcher with the likeability of British comedian Hugh Grant. I would never have believed that we would one day become the best of friends and that I would think nothing of picking up the phone and calling him for a chat four times a day.

These awe-inspiring men aside, being a transplant registrar was a terrifying job because it was just so different to any other type of surgery I had ever done. These were long, bloody operations performed on critically ill patients who took unfamiliar medications and got bizarre infections. The catch cry in the transplant ward was ‘All bets are off', meaning just when you think it couldn't happen to these people – it did. Transplant medicine is a high stakes business and I was constantly worried about making an
error that could cost someone their liver and ultimately their life. That feeling never goes away, even now.

Then there was the mystique that surrounded where all these spare livers and kidneys came from. It was not unusual to arrive at work in the morning and find out that a donor team had slipped out unnoticed during the night, flying to another city to retrieve organs from someone recently departed. It was always discussed in hushed tones because the secrecy regarding the origins of transplant organs was paramount in order to protect the privacy of the donor families. We would all cringe when a high profile person received a transplant because it got a lot of coverage in the press, giving a donor family the opportunity to put two and two together and figure out where their relative's donated organ went. Of course on my first day I wasn't really aware of this reverence for donors and made my first of many transplant faux pas.

‘Would it be possible for me to go on a harvest?' I asked, meaning, ‘Could I attend a donor operation someday?' I received a quick and venomous rebuke from the crotchety transplant coordinator.

‘We try not to use the word “harvest”, my dear,' she said. ‘The families don't like it, it sounds like we are plundering the corpse. Procurement is the politically correct term. You see, we have to show respect for the dead. Only laymen use the word harvest,' she explained condescendingly. Of course, she made sure to deliver this dressing-down in
front of several of my new transplant bosses. I was red-faced with embarrassment at my gaffe, but thankfully they just ignored me.

The transplant job was crazy – on call 24/7 for six months. The patients were unbelievably complex and needed all of my attention all of the time. I even carried my pager when I went to the toilet. These surgeons did not care how long I had been awake and I was certainly not going to complain about it because invariably they had been working many more hours than me. I really wanted to do my job well and impress them because even if I could become a fraction of the surgeons they were, I could hold my head up high. My daily routine became one of complete unpredictability, and being someone who likes a plan, I still struggle with this now. At any time, day or night, I could receive a call letting me know there was going to be a transplant and suddenly the next 24 hours of my life would be occupied.

Cruelly, the most common time to be called was late in the afternoon, just as the sun was setting and there was a glimmer of hope that I might be finishing work for the day. Intensive Care rounds were done in the morning and the patients who were more than critically ill, i.e. dead, were deemed to be that way shortly after. By the time the deceased's family gave their consent to donate the organs and all the tests were done, it was often late in the day. Only then could things get underway and a donor team
from the PA be dispatched to retrieve the organs from as far afield as the Northern Territory or even New Zealand. At the same time, the lucky person who was to receive a donated organ would be summoned by the urgent bleat of their pager. When they heard that sound, they had to drop everything, pack a bag and dash straight to the hospital. Once there, they waited on tenterhooks to hear whether or not the organ they had been counting on to save their life was going to be usable. When the word came through from the donor team that the organ was good, the recipient would tearfully kiss their family goodbye and be wheeled around to the operating theatre to begin what might be a rocky road to recovery.

My little contribution to the whole proceeding was to greet these excited and anxious recipients when they arrived at the hospital and to congratulate them on this first big step toward a new life. I also had to remind them of the grim reality that they had a one in a hundred chance of not being alive tomorrow.

About 9 pm, when most people were getting ready to settle into their beds for the night, I would be standing at the scrub sink washing my hands for what would be six to eight hours of standing perfectly still while an old liver was exchanged for a new one. I would be at the left elbow of the transplant surgeon and we would be accompanied by three of the overseas surgeons on the other side of the operating table, all jostling for the best vantage point. With our
masked faces only centimetres from each other, we would all work together to remove the patient's old liver, moving perfectly through a set of carefully choreographed manoeuvres. Professor Strong would usually operate in complete silence for the duration of the transplant. The only sounds in the room were the ping of the patient's heart monitor and the slurp of the blood going up the suckers. The overseas doctors frequently spoke next to no English but occasionally the silence would be punctuated by one of them letting out a grunt of approval as Professor Strong put in a stitch they particularly liked.

I stood amongst them as the most inexperienced person in the room, desperately hoping no one would notice that quite often I wasn't exactly sure what I was doing. There was no instruction forthcoming and because I didn't want to bother anyone with stupid questions, I just had to figure out what to do by paying close attention. Occasionally Professor Strong would move my hand to where he wanted it and I would will my fingers to perform with some semblance of coordination and do whatever he asked. If I was lucky, this involved cutting a stitch or holding a thread as fine as a human hair, releasing it at just the right moment so it didn't break. If I did snap it, Professor would scold me with a roll of his eyes and a disapproving shake of his head that clearly meant, ‘Don't do that again, you moron.' Most of the time, though, my job was to stand without moving as I held a sharp-edged metal blade lifting the liver up so
they could see what they were doing. This was achieved by perching precariously on a tiny platform and intermittently peering over the Professor's left shoulder to catch fleeting glimpses of the operation. There were long periods of time, though, when I couldn't see a thing. This was the customary position for a junior assistant in liver surgery and an apprenticeship that all budding surgeons must go through. A colleague once told me that the only thing he had to look at during a marathon liver transplant was a small mole on the back of Professor Strong's neck. After eight hours, he had stared at it for so long that he became convinced that the mole had turned into a melanoma and that the Professor should seek urgent medical attention. A different assistant standing in this position became so bored that he jumped off his box and sat down in the corner of the operating room. It took Professor Strong a few minutes to notice that he was gone. When he was discovered sitting down, Professor Strong shot the junior doctor a dangerous look.

‘I couldn't see,' the exasperated assistant proclaimed, realising he was in trouble.

‘No, neither can I,' Professor Strong replied, ‘you are not doing your job any more.' Needless to say, that doctor is now doing orthopaedics.

There were many nights when I watched the sun rise over the city through the window of Theatre 12. It was prophetic, really, because it was the start of a new day for us
and symbolised the dawn of a new life for the patient as the clamps were released and warm blood surged through the new liver. Typically at around 4 am my head would begin to nod as fatigue took hold and told my body it would be all right to take a little nap. Professor Strong, accustomed to the signs of a wilting registrar, would sense this happening as my grip on the retractor would start to loosen. He would grab my arm and yell ‘Wake up!' just before I fell face first into the wound. For some strange reason I always found singing the American national anthem quietly to myself would keep me awake. ‘
Oh say can you see by the dawn's early light, What so proudly we hailed at the twilight's last gleaming,
' I would hum. Maybe I was dreaming that I would one day live there? It took my mind off my locked knees, rumbling stomach and the full day of regular work that stood between me and my bed. It was also around this time that the smell of bacon would come wafting into the theatre from the breakfast trolley that was supplied for all those staff involved in the transplant. This was like torture and our mouths would water at the thought of that first taste of greasy pork.

Professor Strong always displayed boundless stamina. He would finish the surgery and quietly slip away to his office to write the operation notes with his red pen. The trademark of a liver transplant patient's chart was the Professor's loopy crimson handwriting emblazoned over two pages, complete with complex diagrams portraying how
the liver was sewn in. While he was writing, he would relax in his office for a little while, then reappear on the ward dressed in his light blue scrubs and a puffy white theatre cap, holding a styrofoam cup full of steaming coffee. He would be ready to do the morning rounds and, annoyingly, would look fresh and awake no matter how little sleep he'd had. He was never demanding, never arrogant, you would just turn around and there he would be, sitting quietly in the corner of the ward waiting for you to notice him. I only wished that I could look that good after no sleep and I was half his age.

Despite the gruelling hours, I found myself loving that transplant job. I was moved by what you could do for someone by replacing their liver. The results were powerful and immediate. These people were literally days away from dying and within two weeks they would be walking out of hospital almost as good as new. Where there was no hope, there was now plenty. Suddenly they could return to work and there were birthday parties and having children and grandchildren to look forward to. It was like there had been a stay of execution. The other thrill was the calibre of the surgery and the prowess of the surgeons and I wanted to be just like them. My aspiration to be a bowel surgeon specialising in proctology started to waver and thoughts of doing liver transplants as a career occupied my mind. I had experienced the ‘call of the bile'. Transplant jobs only came up at the PA three or four times in a lifetime. Never in a
million years did I consider that I would be good enough, so I kept my feelings to myself.

My husband Andrew, however, was not so sure about my new-found career direction. On the rare occasions that he saw me in those six months, he told me in no uncertain terms that it would be over his dead body that I would do transplant as a career. We hadn't been to a movie or out for dinner in months and whenever we tried, the night was ruined by constant phone calls. Andrew would even drive me to the hospital in the middle of the night when I was so tired that I thought I might fall asleep at the wheel. I somehow thought that I was still safe enough to look after the patient I was going to see. Andrew was definitely looking forward to seeing the back of the transplant job forever.