Week 8 GOL (July 24- July 28)

Hi friends! I am back with another incredible week!! With only two weeks left of my internship with Gift of Life, I am feeling endlessly grateful, excited, and nostalgic about everything I have learned and experienced. It seems like time has just been flying by. This week was our last week out with Transplant coordinators and I learned so much it was insane. Read below for details! :) 

Monday (July 24): Today was pretty cool. I went to a hospital I had not yet been to before, and interestingly enough, it is a smaller-sister hospital that is part of a larger hospital that works with a medical school I will apply to. It was a relatively short day, however; it was very educational. The Transplant Coordinator I was with and I  spent the first part of the day huddling with the healthcare team before the family arrived.  When the family arrived and the healthcare team followed up with them on the grave prognosis of their loved one, the family decided they wanted to withdraw medical intervention and move to comfort care (sedating and making the patient comfortable before turning off machines). We then talked to the family in which half of them were organ donors and the other half were not for donation. This was a Muslim family with different beliefs about donation and the process. After talking with the family, the son admitted that he was an organ donor, however, his father was against donation and had said he did not want to donate due to his father's wishes. We thanked the family for their time, offered additional grief support, and left them to say goodbye to their loved one. After updating the chart notes, we headed out for the day as there was nothing further to be done regarding the case. I enjoyed this family conversation because even though the son was for donation, he still respected his father's wishes and chose not to donate because that was his father's decision. Sometimes I wonder why families say no to donation even when the patient decides to be a donor (on their license or registered), as that is what their loved one's wishes were. Regardless, I think it is important to know that Gift of Life will walk away from a case if the family says no to donation (despite designation status).  I will also note that before we talked to the family, a trained therapy dog, Thor, stopped by to say hi to all the nurses, doctors, and families that were in the ICU at the time. Thors's owner told me he comes to the hospital once a week and visits the oncology wards, ICU's, all the waiting rooms, the ER, and all other departments of the hospital to give the nurses, doctors, families, etc some love and a reason to smile that day. Overall, today was really educational on all fronts of approaching families and I am thankful for the experience. 

Tuesday (July 25): Today was INCREDIBLE!!!! Absolutely a highlight of my summer and experience with this internship. I arrived at the Donor Care Center in Philadelphia at 8 a.m. I met with the Transplant Coordinator I was meeting that day and they also had a TC in training with them. We spent a lot of the day trying to allocate all the organs the brain-dead donor would gift to people in need. The OR was initially set for 6pm, however, the heart recovery team did not arrive until 7:40, so the incision did not happen until about 8:30. When the heart is being transplanted, the heart must be the first gift to be recovered as it has the shortest lifespan outside of the body. This sequence is common. The organ that is being transplanted and has the shortest lifespan has priority. For example, if the donor was a kidney and liver donor, the liver would be the first gift recovered as it has a shorter lifespan than the kidney. After they made the incision at around 8:30, the heart team got straight to work. About an hour into the recovery, the surgeons INVITED me to scrub into the surgery to assist and learn. I was told that I am the first GOL intern to have ever been invited by the surgeons to scrub in (especially since only one was a GOL first assist and the rest were from hospitals not associated with GOL). I was able to help suction excess blood and fluid, hold organs and tissue out of the way so the surgeons could dissect and recover other organs, hold a surgical tool to hold a vein in one hand and suction in the other so that the recovery surgeon could recover a vein that would go with the liver or kidney as an extension in case the attachment cuff was too short for transplant. 

This is what they call a 'TransMedics' case, where the liver was going into the machine I talked about in my last post that simulates the human body. I was able to help the liver recovery surgeon and get the liver prepared to hook up to the machine. I was impressed by this surgeon as it typically takes about 3-3 and 1/2 hours to get the liver on the machine and this surgeon did it within 2 hours. I held the cannula that was flushing the liver so that he could see where leaks were in the liver's valves and connections so that he could clamp them for transplant. I also was suctioning the flushed fluid out of the basin the liver was in so that it would not overflow. This individual donated their heart, liver, and both kidneys for transplant (saving four lives in the process), and lungs to research. Gift of Life's first assist that was on the case told me that I would "make an excellent surgeon and doctor and that my background of living on a farm and working hard will serve me well'. He then wished me well and said that if I "stay humble" I will go far. The surgeons all thanked me for helping them as I thanked them for inviting me into an incredible and unforgettable experience. I will note that I did not leave the hospital until after 2 a.m. and did not get to bed until about 3 a.m. on Wednesday. I was at the hospital for a little over 18 hours. Overall, this was an incredible day and experience and really set me up for what I can expect in my future with long ORs, the hurry-up-and-wait atmosphere, the incredible human anatomy lesson, and the long long hours of working in a hospital. 

Wednesday (July 26): Today I woke up at 6am which was incredibly unfortunate as I got home at 3am today from my time in the OR. When I woke up, the previous day sort of felt like a fever dream. I wanted to go back to sleep, however; I was wide awake and hoping to receive a call for another amazing experience. Although that did not happen given there was nothing in the city for me to go see, I had a nice day of relaxing after my long day prior. I worked on my project a little bit and rested for most of the day. 

Thursday (July 27): Today I went to a smaller hospital right outside of the city. This was a very touching and emotional case to be on and I am so thankful I was. I met up with the Transplant coordinator who had been there all night and was finishing up their 24-hour shift. This was really cool as this was a Transplant Coordinator (TC)  I had been out with the last week I had gone out with TC's. They remembered I was interested in neurosurgery and were telling me about another patient GOL was following who could be suffering either from locked-in syndrome or who was actually brain-dead. The problem is there was no blood flow shown throughout most of their brain and brainstem, however, the CT scan showed slight slivers of light which could indicate minor blood flow. Very interesting case. 

The TC then showed me the case GOL was primarily following. Their relief showed up shortly after I did and we got to work. We huddled with the healthcare team to receive an update on the patient's status and progress. They had scheduled the patient to have an electroencephalogram (EEG) so they could pronounce brain death. I will note that EEGs are the worst test to declare brain death given that the ventilator, sun, or any other abstract waves could make it look like there is low voltage activity. The golden standard for declaring brain death is an angiogram or cerebral brain flow (CBF) test which actually shows blood flow. The results came back as inconclusive which is what we expected and the health care team scheduled a CBF exam for a confirmatory test. In between the EEG readings and the CBF, we spoke to the family. The family has supposedly given verbal confirmation on Wednesday and so we were following up with them and what they wanted to do. The husband had confirmed that the patient had stated they did not want to be hooked up to machines if there was no hope for recovery but also that they had wanted to be an organ donor and help other people. We spoke to them about what that looks like and how they could honor both wishes that would cause an OR and recovery the following day. We then went into a family conference room where we went over the medical and social history of the patient with their loved ones. I really enjoyed this conversation and authorization because the patients' loved ones told funny stories about the patient, there were tears, laughter, and an air of acceptance and sadness. It was an extremely complicated mix of emotions and I am happy the family granted their loved one's wish to be an organ donor and that Gift of Life could provide them with the opportunity and something to hold on to in their grief. After the conversation, we wrote notes and updated the chart. Given the Transplant Coordinator, I was with had a 24-hour shift ahead of them, they sent me out so that I could be well rested for the following day. I left around 7pm. Overall this day was absolutely incredible. When I was on my way out, I saw the patient's family in the waiting room. The little ones and some adults looked like they were laughing, and telling stories, and I am happy they all have each other through this difficult time. I said goodbye to them on my way out, shook the patient's husband's hand, and thanked him for the gift he and his loved one were giving to others in need. 

Friday (July 28): Today I woke up around 6:10 am with a start as my phone was ringing. Today was my last day of rotation with the Transplant Coordinators. The Advanced Practice Coordinator in charge of assigning us interns to a case and hospital every day called me and told me I was being sent back to the hospital I was at the day before to observe the recovery. The OR was scheduled for 7a.m and I was about 40 minutes from the hospital. I jumped out of bed, got dressed quickly, brushed my teeth, and texted the Transplant Coordinator I had been out with the day before that I was coming as quickly as possible. Thankfully, the OR was pushed back by about an hour, so I made it with time to drink coffee and be there for the OR to be set up and start. Today was really amazing given the fact that I was able to see a case from somewhat the start to the finish. We had spoken to the family the previous day and created a connection, and now I was able to see this donor save lives through the gift of organ donation. We made our way to the OR and the surgeons scrubbed in. We then did a moment of silence and honor to give the donor respect and appreciation for the lives they were going to save. Today was also interesting because instead of changing into scrubs, I put on a bunny suit which kept me much warmer in the OR and I did not have to change my clothes. I was able to shift around to see the surgeons dissect and recover the gifts the donor gave for transplant. This individual gifted their liver and kidneys for transplant (Saving three lives in the process), and their lungs and heart valves for research. An example following what I described with timing in entry Tuesday is this: The surgeons first clamped the heart's aorta and suctioned the donor's blood so that the organs would not bleed when recovered. They then left the heart in the donor's chest and recovered the liver and then the kidneys (the Liver has a shorter lifespan than the kidneys). Because the heart valves were not going to be donated for transplant, the heart was recovered after the translatable organs and then the lungs followed. 

An interesting event occurred in the OR that I had not yet seen before. The primary center rejected the liver offer because of something they did not like about the liver for their potential recipient, so the Transplant Coordinator called backup center after backup center to review the donor, the liver, and decide of if they wanted the gift for their patient. During this time, the heart still needs to beat in the chest for oxygenation and further actions of recovery cannot occur until the liver is placed with a definitive recipient and transplant center. Luckily a center accepted the liver after about an hour of calling and recovery was able to proceed smoothly. During the time of the heart beating and waiting to recover, I was able to get somewhat close to the donor and see their full anatomy. This was just such an incredible experience. After the recovery, I helped the OR techs, nurses, and the Transplant Coordinator who had come in near the beginning to relieve the one who was there for 24 hours by removing tubes, wires, and lines connected to the donor. I then assisted them with moving and throwing away drapes and just doing some cleanup work. After, we made our way up to the ICU and updated some chart notes. I then headed out, thanked the Transplant Coordinator, nurses, and healthcare team I could find on my way out, and wished everyone a good day. 

This week was absolutely insane, educational, beautiful, sad, and overall just amazing. I will not lie-I am exhausted and will be sleeping in late tomorrow to recover haha. I am happy that I got a real taste for working late nights and long hours (Even though I know the hours I worked weren't even long when it comes to the healthcare field). Through my experience with the Transplant Coordinators, I will forever be able to hold on to and take the skills, experiences, knowledge, and communication skills in, explaining scientific/medical jargon that is understandable for families and patients, and be a dual advocate in the most respectful way possible. This experience has made me even more excited to be a doctor, save lives, and overall just be an honest doctor, while also being compassionate about prognoses.