I got to do my first transplant today.
More precisely, I assisted the attending for the first time today; but I have high hopes of getting to do more of the procedure later on. I really didn’t want to ask for anything more; I was still figuring out the anatomy (well, ok, so the external iliac artery and vein are not that complicated; but the way that the donor artery, vein, and ureter fit in is), and I don’t have much experience sewing blood vessels yet. So I’m content to wait through a couple more of these till he feels like letting me do some of the work.
The transplant attending, as I’ve mentioned before, is completely dedicated to his work, and is extremely hyper when there’s a transplant in the air. He haunts the OR, pacing back and forth, waiting for his room to be ready, calling the coordinators to check on the exact location of the organ in transit. He greets the patient, hugs them, asks if they’re all ready, or have any last-minute questions. He helps position the patient, helps anesthesia put the lines in (ok, so I’m not sure anesthesia wanted any help, but they got some), helps put the foley in, helps arrange the blankets, all the while commenting, “transplant means paying attention to details, Alice; you have to check on everything.”
Then we’re scrubbed in, and the noise level drops off. Everything has to be just so for him, but he has a reason for all of it, so I just do my best to adjust to the way he wants things. No extraneous movements. No unnecessary tension on anything, and above all on the donor tissues. Stay in the bloodless plane between tissue layers; watch the muscles split apart, the artery and vein separate off of each other. Tie countless knots onto nearly-invisible branches off the artery and vein, which will bleed all over the field after the anastomosis if we don’t get them now (“you’re tying better now than when we first met, Alice”). And then the nerve-wracking, painstaking business of matching the veins together, placing the stitches, sewing down; repeat for the artery. The ultimate test: “we’re about to take off the clamps, anesthesia, you all set? all the meds in? the pressure is good? here we go. . .” And the dead-white kidney turns in a split second to a beautiful pink, and you can feel the blood pulsing through if you just lay your finger against the capsule. Watch, and the urine comes dribbling out the ureter. Success! Then the last steps, catching all the little bleeding spots and sewing them shut, patching the ureter onto the bladder, tucking the whole thing into that artificial space at the edge of the pelvis, and watching as you close the muscles to make sure the pulse stays strong, nothing kinks.
I love the sewing and tying, the part where I got to help the most. When I read him right, and had the sutures ready to throw down the minute he had the right-angle clamp where he wanted it, it was beautiful, like a miniature dance. I can’t wait to do this some more, so I get better at predicting the next step, and can do more to smooth things along.
At last, everything closed, we got ready to move the patient off the OR table. The foley bag was already filling up with pale urine, the first that patient had made in years, and it was the most beautiful thing in the world. We changed that patient’s life. We, and the family who donated the kidney. (I didn’t ask how the donor died; I knew it was a young person, and I didn’t want to think about it.)