Getting a phone call from my manager while at home is never fun, curious as to how my evening will unfold I answer, they were letting me know I was going to be doing an organ harvesting this evening and wanted to let me know they would not be sending a endoscopy team. I was immediately filled with rage, as these cases can become extremely task-full and I would not have the time to deal with the endoscopy side of things. I make my argument, expressing that the more organs we are going to be retrieving the more surgeons I will be dealing with. They agree to discuss it amongst managers and let me know. I love how people who have never experienced the chaos of these cases tell me how easy they are and why I need less help.
Arriving to work to find the endo charge nurse Becky, letting me know she agreed to do the case and report to managers if she was needed. It was said with a smirky tone that I knew I was going to be watched, and I just told her “good”, and went on about my business gathering my things. The coordination that goes into these cases starts upstairs, with massive amounts of tests done on the patient to see which organs are still functioning, which will match someone, as well as coordinating with the surgeon’s schedule. I inquire how many organs we will be taking as this is how many tables my tech will need to setup. I connect to the organ harvesting team who tells me heart, lungs, kidney, liver.
This is a big harvesting, I haven’t gotten to see the heart or lungs before. I begin to help my scrub gather all the equipment to be able to get our set-up down. Searching for the internal heart shock paddles, and crash cart to be brought in the room as well just in case, since we are dealing with the heart. I am now fielding phone calls from the physicians coming in, requesting special instruments, glove sizes, giving time of arrivals. I quickly jot down notes while running around attempting to gather everything. I am now up to four surgical teams.
When the surgical teams arrive, they are typically being flown in by private plane to complete the surgery and gather the organ they will take back home to implant in their patient. They always arrive looking like the red carpet should be rolled out, and pictures should be taken. Always asking for locker room locations, asking to come be retrieved from the ER, not a single basic navigation skill in their bone. Depending on whether I have the time or ability, I may go retrieve them, or call the house supervisor to go escort the celebrities to the locker room.
Surgeons arriving, the ICU is calling to let me know they are on their way down with the patient. I tell my scrub tech Susie that we are about to get our patient, and she gives me the nod of recognition, that we will be ready. Susie is my evening call partner, a badass tech that can handle any situation without losing her cool and serves as a first assist to the doctors. I’m grateful I will be tackling these four surgeons with her.
I meet the patient in the hall, asking for consents, brain death testing’s, verifying arm bracelet with the organ harvesting team. They are clearly annoyed that I am taking the time to do so, as they had cut off the arm band from the facility, and I demand it be replaced before we proceed. Once I confirm this is the correct patient we are about to harvest from we roll into the operating room suite. Positioning of these cases is totally different mentality then elective surgery. Positioning consists of placing the patient in a tight, arm’s tucked with a chest roll bump to give the best visibility of each organ, while also keeping unwanted body parts (arms) out of the way. No worry of pressure injuries, or brachial plexus compression. It feels more like we are butchers in these cases, than professionals, something I still struggle with.
The surgical time out, consists of the organ harvesting team having a quiet “honor of life” minute in the OR, at completion you hear scalpel. The surgical field is packed, with the start of the exposure done by the kidney surgeon. The door opens and in walks another group of doctors, they go to the top of the bed and begin to do a bronchoscopy (scope in lungs), asking for suction and washings as the surgeon examines the lungs to determine if he will take them. The field surgeon is talking to his resident adjacent to him, attempting to teach landmarks and dissection points.
The door opens and in comes another surgical team, asking for size 8 gloves and specialty items for the heart. Well, I guess that means this is cardiology. No one really introduces themselves, just surgical teams walking in, group by group announcing their glove size. Me frantically scrambling for each over and under glove for each pile of teams. At the head of the bed the lung doctor is still assessing the lungs, and I see Becky fighting for her life to attempt to keep up with one doctor’s request. I smirked in my mind, thinking of her keeping an eye on me.
The cardiologist quickly takes over, I’m not sure if this is etiquette, are they just top dog, I do sense an annoyance from the kidney doctors who were pushed down towards patient’s legs as he works. I’m taking biopsies from the kidneys at this point to pathology to give live time interpretation of the health of the kidneys. Running this specimen to her, as it’s now 11pm and I’m the only one there. Racing back to the room, I see cardiology looking stressed, he asks for paddles, Susie throws them to me, I scramble to pull my crash cart up. I look briefly at the monitor to see the rhythm looks like V-fib. I attach the paddles, I hit charge, look at the surgeon holding the paddles around the heart, making eye contact, he screams “clear”, and then he squeeze the paddles, my heart is in my chest, waiting to see if the rhythm was broken. Surgeon asks for a second charge, I charge again, lock eyes, “clear” he screams, another shock delivered. The rhythm returns to normal. He asks for those strips to be printed, and he is calculating in his mind if this changes anything about him using the specimen.
Back up top the chest doctor had finished his bronchoscopy, and Becky pulls me to the side, letting me know that she would tell the upper management that there is no way I could have done the case alone. I thanked her for confirming what I already knew, but appreciated her verbalizing it. As she rolls out with her equipment, that means the lung doctors will now scrub in, sending me to gather more gowns and gloves. Now heart and lung doctors would be working hand in hand trying to get the timing down that each organ will be taken out at the right time.
I hear cardiology saying we are getting close, I assess my IV poles of fluid, my suction, and prepare for cross-clamp. The heart surgeon places terminal clamps near the heart and then insert cannulas into the major heart vessels and pumps preservation fluid through the patient’s body. A large amount of blood volume is being pumped into suction, as the preservation fluid replaces it. This is time of death in the OR, whereas the patients legal time of death was the moment they were declared brain dead days ago. This is always a heavy moment, this is the moment a surgeon is physically killing the patient. I hold my breath.
Cross clamp 01:07, bags are flying on the IV poles, communication quickly to organ harvesting team frantically writing down all the times the bags were hung, when the cross clamp was applied. Within minutes the cardiologist pulls the heart out, quickly walking over to the heart table to assess its size, and place it on ice. The lung doctor is working, using the sternal saw to make his field more easily accessible. Within minutes this huge, beautiful set of lungs comes out. I stand in awe, this is the first time I have seen the lungs being pulled from a body.
The kidneys take a bit longer, just due to how deep they are within the body. Now all surgeons are away from the field and getting ready to race back to the ER to catch their planes to return and place these organs within their patients. The kidneys can be put on pumps that keep them alive, the heart and lungs are more time sensitive. I walk the surgeons back to the locker room and get them back to the ER for their return journey.
Arriving back to the operating room, it looks like a bomb has went off. Tables full of fluid, and chunks of body parts. Blood on the floor, and patient now lifeless sitting there, all life removed. Dealing with death is never easy, and when I came to the operating room I thought I would avoid it a little more. I wait as they close the incision, from chin to lower abdomen, until I begin to remove lines. Going to the head of the bed and removing the tube in the throat, I always attempt to close their eyes, for my own sake, not always do they stay. Going to each body part and removing lines that once were intended for saving their life, that then transitioned to saving someone else’s.
I try not to get overwhelmed with emotions, sitting in this operating room, with a body, a body that once had purpose, that I know nothing about. Wondering if they had children, have parents, if they found happiness, I hope. I try not to let my mind wonder too much, because the sadness can be crushing. Sometimes the answers make the mind suffer more. When I was a ICU nurse taking care of these patients upstairs preparing them for organ harvesting, I saw the stories. I saw the children begging mom to come back, or spouses laying on top of their loved ones begging for a different outcome. It is much easier for me to not see that part anymore, to compartmentalize my role, and pretend this body in front of me is a task to complete and not allow my mind to wonder. Wondering if my body is in fact emptier than the one in front of me.