This is a story about a liver. Just one liver, and three people. I am not one of those three people. The role I play in this story is rather
insignificant. In fact if they were to
make this story into a movie my role would be what they call a ‘cameo
appearance.’ Well…I guess one would have
to first be famous or important for it to be a ‘cameo,’ so not even that. Just ‘appearance’ then. An appearance that would get credited as
‘random hospital resident’ or ‘H&P taker.’
But now I’ve jumped all the way to the credits of the story and only
talked about myself….not the best start for this liver’s story.
The story starts with a death. The death of Person A. This was the liver’s first human, the one who
had grown and nurtured him since birth. We
don’t know how Person A met their doom, but it is of little consequence to this
story since the liver is our center piece.
Not the human. Unbeknownst to the
liver, prior to death, Person A, had signed the papers donating him. And this
is where Person B comes into our story.
I arrived to work one night, and getting sign out from the
day teams, was told about Person B. I
was told that Person B was already in the hospital, currently getting a liver
transplant, and would probably go to the Surgical Intensive Care Unit post
operatively. In other words, good to know
about Person B, but nothing really for me to specifically do in terms of his
care. Shortly thereafter sign out was
interrupted by a text message from the transplant fellow. Informing me of a new patient in the
hospital, there for a liver transplant, could I do the History &
Physical? Very surprised that they would
be doing two transplants the same night I responded, it would be no problem,
would it be for that night or the next day.
His response, ‘tonight, 8pm. Same
liver. New recipient.’ Apparently while on the operating table, Person B had
gone into Ventricular Tachycardia and then Atrial Fibrillation. Case was cancelled. Enter Person C.
All the while the clock is ticking for the liver. Hence the
need for urgency. Person C was called up
and told a liver was waiting, time was of the essence and get to the hospital 5 minutes ago.
Time for my ‘appearance’ in the story.
The transplant fellow is entering orders into the computer. Anesthesia is in the room interviewing the
patient. Nursing is in the room getting
the patient ready according to the pre-op orders. And amidst all of that I
sneak in, ask the appropriate questions etc, and sneak out again to enter my
H&P into the computer. And thus my
‘appearance’ ended. The liver was still waiting.
Person C is taken to the OR and the liver transplant
commences. At one point during the night
a problem arises with another post-op transplant patient on the floor. I attempt calling into the OR to talk with
the transplant fellow and get turned away at the phone by the nurse saying very
hushed that it just wasn’t a good time as hands were moving very rapidly. Found out later that the patient’s portal
vein had ruptured intra-op. In the end
however, Person C made it okay, liver securely transplanted, and transferred to
the SICU post-operatively to recover.
And recover they do, both Person C and the liver recover from the
transplant beautifully.
Don’t worry. That
isn’t the end of the story. Not yet.
I come into work the following night, to once again have
sign out interrupted by this liver. Person
C had suddenly and dramatically died in the SICU. Was doing absolutely beautifully, and after a
simple, standard routine procedure started bleeding. Within seconds heartrate had dropped, and
within 2 minutes had flat lined.
And that’s it. The
end of the liver. A crazy story of one
liver and three people expanding no more than 48 hours total. Person B the only
survivor….still waiting for a liver transplant.
I could go into much more detail about just what that simple
standard routine procedure was and possible reasons behind Person C’s
mystifying rapid demise. But in the end,
all would be, at best, nothing more than educated conclusions.
Much Love.
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