This photo of a human heart ready for transplant that I came across in National Geographic took me back years to my internship in general surgery in Hawaii in 1992-93.
Not a bad place to be, of course like all general surgery training you worked like a dog 12- 14 hours a day, never left the hospital every second to third day when your team was the on call team and got one day off a month. But damn on that day you were in Hawaii.
It was an interesting and diverse teaching experience in Hawaii, it was a blend of military medicine, tropical medicine, dive medicine and many diverse cultures. The islands have a multicultural feel with Japanese, Filipino, Caucasian, Pacific Islanders and many other cultures that tourism attracted to the beautiful beaches.
Also the island was geographically isolated in the middle of the Pacific and was the major surgical referral source for the military in the entire Pacific region including Japan, Philippines and Korea. And at any time the military population which is already over 35,000 on the island can balloon by 5000-10,000 with the docking of an aircraft carrier over at Pearl Harbor.
One aspect of the Islands that I had never really known about was that it is an huge source of organ donors.
Why? Well there's a million or so inhabitants crammed onto a 20 by 40 mile island. A major method of transportation on the island is motorcycles, scooters and bikes. Mix that in with the vacation partying atmosphere and you have a recipe for head trauma, and head trauma begets organ donors.
My surgical team was on call one night at the civilian hospital, Queens Medical Center when one such trauma occurred. The patient was brain dead and the family consented to organ donation.
He was young, maybe 22-24 and he was a specimen of health and fitness until he took a spill on his sport bike, or "donor mobiles" as they are called in the emergency rooms of the world.
When I scrubbed and walked into the operating suite he was already on the table and under anesthesia. He looked like a healthy male about to have some routine procedure where he would wake up and go home the next day.
But this was anything but routine. The team was about to remove his heart, and kidneys and send them 3000 miles away to Los Angeles. A plane was on stand by.
I really don't remember a lot about the actual surgery. I recall looking at it with the fascination of a young clinician, and I remember the surgeon asking me some anatomical questions about the surgical approach.
But what I will always remember as long as I live is the end of the procedure.
After the organs were harvested and packaged and sent on their way to LA, the surgeons turned to me and said "OK, doc he's all yours close him up, and don't worry too much about appearances, approximate the layers."
"WOW!!" I remember thinking, how lucky was I to merit such a procedure. I excitedly started my closure, requesting the appropriate suture from the surg tech as the surgeons stepped back form the table and busted out of their disposable gowns.
Then the anesthesiologist said something about the respirator from the head of the table as he reached up to shut it off.
Almost instantly the healthy pink tissue in my hands turned a dusky grey, and the bleeding, slowed then stopped. The tissue I was sewing back together turned from firm and healthy to a mushy mess. It's unsettling and unnatural to operate on dead tissue
As surgeons we are trained, we EXPECT to have LIVE patients at the conclusion of surgery. We expect to see out patients wheeled successfully into the recovery room, to round on them the next day. You only chose surgical candidates that will benefit from the procedure. That usually precludes a patient if they are going to be dead at the end of the procedure.
But organ harvests are not for the patient they are for another patient.
It was unsettling and almost surrealistic to see the anesthesiologist turn off that respirator.
But no sooner had I closed the patient then my pager went off and I was off to my next encounter, just another day in training.
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