My First Heart Transplant

7.17.2013

 

Greetings from Columbia University Medical Center: TAKE 2

 

Luckily today was a more successful day.  I CAN SAY THAT AGAIN. Excuse my lame humour. Upon arriving at the hospital, I texted Dr. Singh in the hope that I could get situated immediately and begin work.  False. He informed me he was in a meeting and that he’d get me when he was done.

 

In the meantime, I sat reading my book.  I decided, “perhaps I should try to obtain my Columbia ID now,” and walked to the office, but was essentially turned away because I did not have a “Uni ID.”  Figures, eh? I walked back to the heights caf, munched on a chocolate bar, and began to read again, living the intern life.  Then I got a second message from Dr. Singh that read “there is a heart transplant at 10:30 that you should see”. 

 

It literally took full effort for me not to reply “YES, YES AND HELL TO THE YES!!!”  Instead I typed something along the lines of, “Sounds good! Let me know where to go”

 

By 11:30 I had changed into scrubs and was in OR 22. I soon learned that the heart was flown in at 4:30 am that morning from the donor and the surgery truly began, including all preperatory phases, at 8 am. Unfortunately, I missed the majority of the actual implantation; however, I was able to observe the most intense of the surgical stages.

 

I stood there mesmerized, blood spouting in all directions, staring at a beating heart and comparing it to the X-Ray juxtaposed right by the 42-year old patient and her new heart. 

 

My main regrets were: 1) I should have just found my way to the OR as soon as I learned of the heart transplant and 2) I wish I had known more about the procedure prior to entering the OR. 

 

I arrived knowing that hearts are recieved from deceased or neurologically dead donors, but that was essentially the extent of my knowledge.

 

Luckily a PA (Physician’s Assistant) noticed my futile attempts to comprehend the steps of the operation and began explaining the pre to post- operative procedures to me.  Once a donor heart is recieved, it is often inspected to ensure accuracy of blood type and overall reliability. The patient recieving the heart is provided medication to suppress the immune system, as implantation of a new heart would activate such cells as lymphocytes that view the donated heart as foreign and potentially activate the immune system to combat the organ.  The operation begins by slicing open the sternum, followed by the pericardium, where the body’s main blood vessels (i.e. aorta and vena cavas) are dissected so that the patient can be temporarily attached to bypass to allow for continuation of blood and oxygen circulation throughout the body.  I’ll spare the great details, but the donor’s heart, which had been packed in ice for adequate preservation, is cut to fit onto the remainder of the patient’s left atrium wherein the blood vessels are consequently sutured back into their positions (this is the point at which I walked into the OR). The patient is then taken off of cardiopulmonary bypass and then the thoracic cavity is sutured and, in this patient’s case, stapled, back together.

 

Fun fact: Kelly Perkins, who receieved a heart transplant in 1995 while her 30’s, was the first one to mountain-climb up multiple peaks, including that of Mt. Kilimanjaro in 2001!

 

Thank god I had a PA there to explain the nitty-gritty details of the procedure.  Everything in the OR is sanitary. At one point I accidently grazed a blue tissue and all of the tissues then had to be replaced.  Also, even your backside is considered to be unsanitary.  Wow, what a change from Africa: from one end of the sanitation spectrum to the other.  The PA advised me of how nice her job is as compared with surgeons, because she essentially gets to do what surgeons do without having to undergo the long years of med school and training.  At that point I realized that I had to either become a surgeon or not enter the medical field at all.  Why?  Because I’m obstinate and desire to undertake the glory of conducting a successful cardiac operation or the predominant responsibility that comes with an unsuccessful procedure. 

 

Cardiac surgery is tough; physically, mentally, emotionally. My boss, Dr. Gopal Singh, a thoracic surgeon, was on call with cardiac surgeons 26 times last month.  He barely slept and brought a sleeping bag to Columbia University Medical Center because on the off chance that he wouldn’t have to fly to Texas to obtain a heart, or assist in a pulmonary transplant, he took naps at the hospital.  This field of surgery definitely does not go hand-in-hand with developing a family and more domestic life.  Nonetheless, I think this is a challenge I can take on. I’d rather be saving lives than sitting on my ass all day behind a computer screen, or playing chauffeur with my future (?) children. I need to fulfill my role and be the best person that I can be.  It truly is all or nothing.

 

Approximately only 2,000 cardiac transplants are performed annunally, and the fact that I was able to observe and slightly assist with such a procedure today is a phenomenal opportunity for someone like me, who dreams of becoming a successful cardiac surgeon.

 

Because every end is merely a new beginning

The Most Bittersweet of Goodbyes: A Reflection of My Past 18 Days

7.1.2013

I feel that now, on my cab ride back to Kilimanjaro International Airport, is an adequate time to reflect upon my experiences here in Arusha, Tanzania.  I cannot accurately put into words the permanent and irrevocable impact my journey has had upon my life, but I will give it a shot.  Never before have I encountered such bliss and agony, two emotions on opposite ends of the spectrum, in a single day.  Perhaps such emotions define a “bittersweet goodbye.”  Waking up this morning to a sea of new volunteers, I felt replaced in a sense.  However, the second the gate to my volunteer house flew open with Nicole giving me her classic goofy smile, Chaeli ready to tear off her scrubs, Fran sitting down beside me, and Karla reaching for a smoke in her typical panicked state, with all of them acknowledging my presence as I sat serenely reading on a bench, I suddenly felt at home again.  The sense of belonging and love that I have felt, given, and  received here are sentiments I never have experienced before, at least to such a degree.  Such emotions are quite inexplicably the most beautiful ones I have ever encountered.

Upon my arrival in Arusha a couple weeks back, I was ready to cancel my trip and book a flight home.  To put it simply, I felt out of place.  As much as I desired to offer my medical volunteer skills at an impoverished location, I truly felt my coming to Africa would not be worth the hassle in the long run.  I assumed incorrectly. Maybe I had the “luck of the draw,”  considering I was placed at the “new new” volunteer house wherein every volunteer initially arrived at pretty much the same time I did. Thus we were more-or-less all new and lost in a country so dissimilar and unfamiliar from our own.  After meeting Chaeli, Nicole and Fran on a picnik blanket outside the house and being immediately invited to join their conversation, I felt a bit more solace. After conversing with more, equally generous, people that night, I realized I could truly start afresh to have the kind and compassionate soul I’ve perpetually strived to attain yet have never achieved. The 4 -day safari I embarked on a week later with the same people only reaffirmed my strive to reciprocate the generosity I received and express sentiments in the chastest of ways.  Even at my placement at the Arusha Women’s Health Clinic I was consistently greeted with warmth and accepted by the staff. They perhaps believed in me more than I did myself, letting me draw blood and deliver babies.

I have come to cherish the fact that Tanzanians believe in staying close (literally) because it only aggrandizes their abilities to demonstrate their love and lack of general boundaries, which are perhaps a main source of isolation and barrier to compassion elsewhere.  If I could give a speech thanking everyone for all they’ve given to me and taught me, and how they have allowed me to grow in both internal and external scopes, I would be rambling on forever (kind of like I already am).  In sum, my experiences in Tanzania have taught me to accept people, overcome personal hindrances, and adapt to new cultures.  From traversing the rugged, muddy walkways of St. Joseph’s Orphanage, to driving up a mere arm’s length away from elephants, lions and zebras on a 4-day safari in the Serengeti/Lake Manyara/Ngorongoro Crater, to bartering for Massai delicacies in the Market, to squishing with almost 30 others in a daladala, to creating and consuming coffee at a coffee plantation, to embarking on a 5 hour hike at the base of Mt. Kilimanjaro (Africa’s largest mountains), to surviving the Arusha political bombings, to assisting and partaking in the “miracle of life” at the Clinic, to witnessing 4 deliveries in a single day, to reverting to a Toyo/tractor form of transportation (dalas ain’t got nothin’ on us) to being forced to view The Lion King in its entirety for the first time and recognizing bits and pieces of my life in the film, to name a few, my time in Tanzania will indubitably leave an everlasting influence upon my life and play a significant role in shaping my future actions.

I hope that I will be able to give back to Tanzania what it has given to me, at least to some degree, by donating thousands of dollars worth of medical supplies to the Health Clinic I worked at and by sponsoring a child.

A few shout-outs: Fran, thanks for teaching me to appreciate the beauty in the smallest things, like reading a novel, writing a journal, gazing at the stars. I love how we can sit together in silence and be so contemplative.  Also, your sense of English pride is quite admirable–hopefully we can enjoy some crumpets and tea in Manchester sometime soon.

Hannah ( squash banana), you are a gorgeous person inside and out.  Your indefinite kindness has influenced me to appreciate and respect the differences between people. I envy your ability to lighten up anyone’s day by merely being yourself. Hopefully my wardrobe will one day resemble yours.  Miss you and your mutual love for cheese, Ms. Posh.

Nicole and Chaeli, thanks for always putting spunk and life into any ordinary task, such as dishwashing. You will both make amazing doctors someday, I am sure of it. With you two I have always felt ready to help and be helped. Also, thanks for for epic discovery of Nutro hazelnut wafers, Nicole!

Megan and Jordan, you girls are the greatest bigs ever! I wish you really were my bigs. Thanks for providing me constant entertainment from the safari car to Via Via to our dorms.

Tom and Hans, I gained a newfound respect for you two after seeing the authenticity of your smiles in pictures of you at Hannah’s orphanage. Tom, your hobo story made me feel quite better about my Serengeti experience. Thanks you both for being so sincere and fun, and always offering to pay. You two define yolo swag.

And of course, thanks to the House Mamas, chefs, and medical staff at the Health Clinic for their perpetual kindness, guidance and assistance.

I have not found myself yet but I still have time; I’m only 19 years old. Tanzania has aided in the process of me finding my way to becoming a successful human being, through my own lens.  I am about to embark on my journey from Dar Es Salaam to Amsterdam–my fingers are crossed that I will depart Africa a more geniune person with a purer heart.

Hakuna Matata.

Asante Sana.