BY GUEST BLOGGER Anne Zerby
There are no windows in the rooms where I work. My view is the insides peoples’ bodies; I’m a surgical technician and I work elbow to elbow with surgeons. My job is to prepare the sterile field, that is, to get all the instruments and suture ready to pass to the surgeons. I even work with high-tech robots initially designed for NASA and computer navigation systems that target tissue with great precision.
I work at a large university hospital. It’s phenomenally different from day surgery where people go for things like hernia repairs and total hip replacements and appendectomies. We’re not trauma I, so we don’t see gun-shot victims or car accident victims. Our people range from fairly sick (cancer) to chronically sick (diabetes) or acutely sick to verge the death (ruptured major vessels; organ failure). I’ve seen billions, maybe trillions, of cancer cells. In prostates, breasts, uteruses, bladders, necks, brains, inside throats and lungs and intestines, and on kidneys, livers and pancreases. The surgeons I work with do extensive research– looking for patterns, looking for breakthroughs, looking for cures. They bring fellows and residents and medical students to the OR to train them to be the future generations of super-heroes to fight cancer.
Cancer is even more mysterious when you see and touch it in muscles, bones, organs. Tumors in organs like the prostate can be hard as a rock. A tiny tumor in the breast can represent (but not necessarily) more danger than an enormous one elsewhere. Who doesn’t know someone whose had breast or prostate cancer? Most of us have faces of people we know and love to attach with cancer treatment. I’ve seen cancer look like mucous. There can be literally gallons of mucinous gel in an abdomen with appendicle cancer. It’s as shocking as it sounds to see, and the person has on average, one to five more years to live. We win some battles, increase life-spans and health, but there are times it’s an uphill battle at best, and palliative care is all we shoot for.
For me, I meet patients very briefly, they are on sedative drugs already, just before they go to sleep, while my compassion and fears triggered, I have it easier than the nurses who visit with patients and families before coming to the operating room. Surgeons have it tough and floor nurses have it the toughest. People without cancer have some instinctive, personal, defensive shield when facing those who do, but it does make an impact when you work every day looking at and cutting out cancer.
There is, in this cancer-filled environment, an incredibly bright side to my university hospital. Transplant. An organ transplant can completely turn a life around. A person whose days are numbered, gets a chance to live and feel better again, usually for the first time in many, many years. Not instantly and not always, but almost always. The families and friends of those who’ve passed away and donated organs, know the depth of grief with their loss, and the height of love and pride from the new life that’s generated from their loved ones’ donation. Transplant is often compared to rebirth.
The happiest surgeries for me are putting in organs. The general public is familiar with deceased organ donation. (Most aren’t aware that only five percent of those organs make it to implantation.) A far less familiar form of organ donation is by living donors. It is tremendously moving to meet a living donor who rolls into the operating room to give a kidney or part of a liver to someone. The living donor could be family, a friend, a co-worker, or a total stranger. The donor is scared. Excited. Nervous about what will happen. Afraid of the pain when they wake up. People who are willing to undergo major surgery and risk their own health to improve someone else’s health is about as personal and as sacrificing and frankly, as odd, as it gets. The range of responses from the general public (on the outside of the transplant world) about living organ donation runs the full gamut- from hero worship, to thinking those people are insane, to near revulsion. For the public who briefly considers and weighs living donation, these responses are fleeting thoughts. The realities for living donors of what donation means goes much deeper and lasts forever, for any and all, good and bad, outcomes.
Before I worked in kidney, liver, and pancreas transplant, I didn’t know what a healthy kidney looked like. It might sound funny, but it is so beautiful and perfect. And almost everyone has two and can live just fine with just one! The healthiest patients I see are living organ donors. And they aren’t all in their twenties and thirties- they can be in their forties, fifties, even in their sixties, if they are in good enough shape. Even so, there’s more to the story if someone surgically donates one, figuring he or she will be just the same with the remaining kidney. More physically, emotionally, socially, financially.
More than a decade after working in transplant, when a healthy kidney, especially one from a living donor, is put into a person with end-stage renal disease, it is like Christmas. With 120,000 people on the list for a kidney in the US, one person an hour dies every day, waiting.
For the kidney transplant surgeries, the donor is in a room adjacent to the recipient. The surgeon who takes out the organ of the donor literally walks it (safely!) right next door to the surgeon who is going to put it into the recipient. When I’m the surgical technician in the donor’s operating room and the kidney first comes out of the donor’s body, we have a large bowl filled with ice and solutions to preserve the bright healthy organ. The surgeon takes the solutions and flushes all of the blood out, and inspects the renal artery, vein, and the ureter. When the kidney is flushed free of blood and sitting on ice, it is white. Like a navy bean. The kidney is carried in a basin into the OR right next door.
When I’m in the recipient’s room, I have ice too. The kidney has to stay cold until it is in its new home. When the surgeons have the sick person’s iliac vessels all cleaned off and ready to house the new kidney, I give the surgeons all the sutures to sew the artery and vein of the new kidney there. Just before they sew it they have to clamp off the blood in the vessels of the sick person. That way, the surgeons can see clearly how to sew those pipe pieces perfectly. Once they are sewn together and the new kidney rests perfectly in its new nest, the clamps are taken off. The blood flows into the new kidney, and it goes dramatically from white (navy bean) to red (kidney bean J), and begins to work immediately. The new ureter on the new kidney will have pee coming out in a matter of minutes! We can see it because we haven’t connected it to the bladder yet.
After a few years working in transplant I decided I wanted to give someone one of my kidneys. I went through a rigorous evaluation process. I was turned down due to a history of depression. I had surgery when I was a teenager and know a bit about how the physical impact of surgery almost automatically brings a person down. It’s a brutal blow to the body to be sliced open, the innards rearranged, something originally meant to be there as part of the body’s whole system of working mechanics is shockingly removed, the near-by pieces put back in, no longer in their normal positions, and the layers of tissue and muscle that have been cut through are stitched back together. Really, it’s incredible that a body can withstand all that, and even have a chance to heal up and run just as well as or better than before.
I knew from my ovarian cyst removal that my body was not the same again. I developed adhesions and when I jogged for a certain while, my lower abdomen hurt. It wasn’t until I began working in surgery that I could imagine scar tissue that had grown on the walls of my abdomen pulling and causing sensation that didn’t used to be there. Not a huge deal, but my body is different, and it is because of surgery.
Imagine for living donors, when an organ is taken out to boot, and the body is expected to return to its original state. Things don’t happen that way. Over the ten years I’ve worked in transplant, it’s become a huge desire of mine to keep these amazing people, living donors, in the great health they roll into my OR with. I’ve begun volunteer fundraising for a nonprofit that strives to help living donors with anything they need help with from the point of donation and through the rest of their lives. Living donors need support. No one “makes” living donors donate- yet, if a loved one is suffering and may die, that’s a lot of motivation to want to help. A lot of the community focus is about the sick person who needs to the organ. Someone who donates, who is healthy, can feel like their needs go to the wayside. Especially if things don’t go ideally and health problems occur for donors after donation.
Living donors go through a huge evaluation process, but no matter how much a person learns before-hand, it will never fully prepare anyone for what the donation reality becomes for each individual. It is emotionally, physically, financially, and socially, a complex and transformative experience. From my vantage point of working in transplant I see living donors and recipients as being bonded by a near-death experience and a life-after-near-death experience. They’ve gone to an indescribable place, met, and come back together. Imagine sitting on a couch next to someone you love who has one of your kidneys, and you’re watching Saturday Night Live, laughing at Alec Baldwin, just enjoying the moment. Sometimes it occurs to you that your kidney is in that person you’re with, and sometimes not. But there’s no getting around that all the moments now, consciously or not, are connected between the two of you. My room with no view has given me a perspective on life that no window could have provided.
Anne Zerby lives in White Bear Lake, MN with her husband. She is a volunteer fundraiser for American Living Organ Donor Fund and works as a surgical technician at the University of Minnesota Hospital, M Health.