It looked like a fish out of water. I have never been fishing, but in movies the fish’s mouth puckers while it gasps for air, hoping to be given one more chance at life. This is how the heart looked as it was quivering in the chest. It was not beating to any discernible rhythm; there was none of the characteristic “lub dub” I had heard on all of my standardized patients. While still awestruck at what I was able to experience, I turned away from the heart to focus on the task at hand. I am not sure how much time had passed, but the next time I glanced at the heart I had to do a double take. The heart that was working so hard to beat was no longer moving.
Eight hours earlier, I was standing with my residents. It was nearing the end of my transplant surgery rotation—my first clerkship of medical school. I had not yet gone on an organ procurement, but this Saturday morning before rounds, my intern told me there was a liver available in California and that I was able to attend if the surgeon was agreeable. Even though the surgeon was extremely kind and welcoming in his OR, I was still very nervous to ask if I could join him. I was an inexperienced third-year and I would certainly only be a hindrance. However, when I asked, there was no hesitation when he said yes to my question. He gave me the name of the airport at which I was to meet him and the time I should arrive.
I was filled with nervous excitement about the procurement on my way over, but it wasn’t until I reached the very small airport that I realized I was about to go on a tiny, private plane for the first time. I have never been scared of flying, yet I am afraid of heights. I was anxious about how I would feel on such a small aircraft and even more anxious about how I would appear to my attending on the plane. I met the captain, who assured me a smooth flight, and then we boarded.
The pilot’s assurance was warranted, as the plane floated through the air and I realized this really felt no different than any other flight. I looked out the window and was in awe of the snow-capped mountains and the fact that this morning when I woke up, I thought it would just be another day of rotations in the hospital.
We landed and were welcomed by the crisp, cool California air. It was such a beautiful day, which almost felt wrong considering why we were there. I couldn’t imagine the grief the family must be feeling, even though as a part of the transplant team, I would never see them or know them. It was a very strange feeling, especially in contrast to my experience with the liver failure and pancreatic cancer patients we treated daily. We were with the family and could at least attempt to offer comfort and support. Nerves began to strike me again, and I realized that after the procurement, he would be the first recently deceased patient I have ever seen. I didn’t know what to expect from the situation or my feelings.
Walking into the operating room, the donor—our patient—was already on the table. It felt like every other OR I had ever been in. He was already draped. I never once saw his face. Before every surgery, you perform a “time-out” where you pause and state the patient, the procedure and the side to make sure everything is correct. However, the “time-out” before this case was one I will never forget.
The family had asked the nurse to read something on the patient’s behalf. It was a beautiful poem and it really highlighted the heroic act the donor was about to perform. He was going to give another the chance to live. The pinnacle of altruism. I started to feel choked up as she read the beautiful sentiment shared by the patient’s loved ones. The OR then took a moment of silence for the patient. The silence made the air feel thick and heavy; I was really contemplating the weight of what was occurring.
After the time-out, we put on our gowns—the same way I had done an incalculable number of times during my rotation. We began to work and I did my routine job of suctioning off the smoke as the skin was being cauterized. Early on the surgeon said to me, “Jenna, do you know what you’re going to do today?” and I excitedly replied, “Finally see a liver transplant!” as I had just been talking to him about how somehow with three weeks into the rotation, I had never seen a liver transplant. His reply caught me off-guard as he matter-of-factly stated, “You’re going to saw open the chest,” and handed me the bone saw. “Oh gosh,” I replied automatically in a voice that raised two octaves above my usual pitch, so much so that he chuckled and repeated my words to himself. I took the bone saw and he directed me how to use it. As I went to cut open the sternum, something I truly never thought I would be doing throughout my career, I was not prepared for the power of the electric saw and my initial cut took me off towards the side of the chest. The surgeon placed my hands in his and told me to push down further as the sternum split into two beneath us. I had heard bone work described as carpentry before, and I could now clearly see why.
As we put the instrument away, for the first time I really took in the body in front of me. He was cut open from sternum to pelvis, similar to our anatomy dissections, only this time everything was much more vivid and animated. The body was still functioning although his brain, tucked away behind the curtain, was not. This is when I noticed the heart struggling in the chest. The patient had congestive heart failure and so he was ineligible to be a heart donor. Because of this, I was able to cradle the bloated heart. It was an unbelievable experience. Even just seeing a heart beating in the chest was something that I once discussed with a friend, and here I was holding it.
We moved toward the process of collecting the liver. I was given the intestines to hold out of the way, but as I was handed one piece, it immediately slipped through my fingers. I was mortified as my fears of slowing him down became a reality, but he just handed me the bowel again. I felt as though I was holding back a slick snake from biting the hands of the surgeon as he delicately extracted the liver. The body was flushed with cold saline and exsanguinated. It was after the blood was removed that I glanced back up at the heart. It had shrunken down and was still. Realizing what had truly occurred, I offered another internal moment of silence for the patient.
I then asked what had happened to the patient. He was older, but still surely was meant to have more time to live. I was very curious to know him and try and place a person with the donor. Throughout my rotation, I had heard of donors who had died from anything ranging from a car accident to choking to death on an orange slice. The rotation had opened my eyes to the unnerving reality that death really was occurring all around us whether or not we were aware of it. A statistic that in and of itself isn’t a surprise, but when you are presented with an individual story, it resonates so much more.
The nurse then told us that the patient was at his own retirement party. He was finally going to retire after a long life of hard work and was planning on returning to his family in South America. At the party, he missed a step and fell down the stairs. And that was it. My heart wrenched when I was told this. He and his family could not have been any more unsuspecting. It was supposed to be a joyous day—the day he would finally have the freedom to do as he pleased and rejoin the people he loved. I wanted to call my family and tell them how much they meant to me. Counting my blessings, I felt for the man and those who would never get to hold him again.
Once the liver was extracted, it was placed into a cooler and we headed back to the airport. Standing on the tarmac as the package was being loaded under the plane, I realized the oddity that we were about to fly an organ across state lines. I took in the views one last time on the quick flight back to Phoenix.
In this instance, the organ was coming back to our hospital to one of our patients. I was going to be able to see the whole organ donation process from start to finish. The recipient was a very young woman who was in drug-induced liver failure from taking an antibiotic for a UTI. One day she simply was having burning with urination and the next she was bright yellow, with a belly full of fluid and an uncertainty about what would happen to her. A UTI was such a common thing and the antibiotic was such a nonoffender that this occurring at all was so striking to me. She was moved to the top of the organ donor list, as she urgently needed a liver and we were on our way with her chance to live.
The surgeon went to work and deftly exchanged her failed liver with the donor liver. The procedure was a success. The donor had lost his life due to an unfortunate circumstance, but was able to save this woman’s life from her unfortunate circumstance. He was a hero. All donors are heroes. It was very late at night as I left the hospital, and I was full of mixed emotions. I had seen a life lost and I had seen one saved. I was simultaneously experiencing sadness and joyfulness. Walking away, the experience felt surreal, but it was one I knew I would never forget.
On the final day of rounding on the recipient before she went home, her main concern was about when she would be able to pick up and hold her daughter again. It wasn’t about having to be on immunosuppressants for the rest of her life. It wasn’t her questioning and being angry at the situation that had befallen her. It was just about spending time with her family. Even though I never knew him, I like to imagine that the donor would have really cherished that, as his goal was to one day rejoin his loved ones. As we left for another long day in the OR, I realized this chapter was finally closed although similar ones were being written all of the time. The donor gave the greatest gift to a complete stranger. It was the most humbling experience and I feel extremely grateful to have been a part of it.
Jenna Koblinski is a member of The University of Arizona College of Medicine – Phoenix, Class of 2021. She graduated from The University of Arizona in 2017 with a Bachelor of Science in physiology and a psychology minor. She is an aspiring dermatologist. In her free time she loves to dance, socialize, and watch anything and everything on Netflix.