Ryan Lee, c/o 2013

When I began medical school, I made it a point to remain vigilant and circumspective in my growth as a student. I'm now halfway finished with my first year of school and I can already exact the turning points that are shaping my values as a future physician, as well as my understanding and expectations of medicine's role in the cycle of life and death. For me, this cycle came around during my procurement run.

I was handed the pager on Friday, about a week before it buzzed. It's every medical student's dream to carry the pager, to feel some utility. But the pager wasn't ringing out of its clip, however. It was sitting there quietly, like a ticking time bomb-its mere presence shook my nerves to the point where I'd wake up dreaming it had rang, only to see that the LCD screen still read "calm down, still no new messages". Lying back down, I realized how strange it was that my excitement was completely dependent on a patient's death, a thought that persisted for the first couple of days that I had the pager. But as the days passed, the routine wore down my anticipation and I began to absorb the anxiety. 

I've had this sentiment before. Dissecting cadavers, interviewing patients, and interacting with doctors used to make me anxious, but are only now beginning to feel routine. Holding the pager was the same; it's an experience that I feel is initially frightening, but will eventually become regimen. 

On Thursday, the pager buzzed. My hand, on standby for the past six days, shot into my pocket and flipped it open. It was anti-climactic: "Pick up 10:30pm" is all it read. I joined Dr. Vagefi and the rest of the transplant team in the van and we made our way to Castro Valley. I wasn't nervous-I had observed many surgeries at UCSF before. But when we arrived at the Eden Medical Center's operating room, something felt different. The OR suite wasn't crowded with surgeons and nurses, and the waiting rooms weren't full of patients and families. The entire hospital was quiet in the night, with plenty of empty ORs waiting for just the six of us. A middle-aged woman was wheeled down the empty hallway on a gurney and prepared for procurement. As I helped move her from the gurney to the operating table and prepare her for procurement, I felt her warm skin against my gloves and I saw her chest rise and fall with each breath, in sync with my own. Dr. Vagefi made the first incision, not just a few inches across the abdomen as I had seen in other operations, but rather from the suprasternal notch to the pubis. The entire body cavity was exposed, and a strange feeling swept over me. To me, this was not a cadaver; her tissues were bright pink and pulsating with the beat of her heart, pumping in the mediastinum. 

As the operation proceeded, Dr. Vagefi and the transplant team worked with incredible efficiency, each step completed with confidence and with perfect communication as if they were actors reading a script. Dr. Vagefi was constantly updating Dr. John Roberts, who was preparing the recipient for transplant at Moffitt-Long. I realized that my own interest in surgery is partly manifested by the confidence and dependence on teamwork. 

Dr. Vagefi and the rest of the team spoke to me throughout the entire procedure, quizzing me on different aspects of transplantation and explaining the variations in the patient's vessel anatomy. I had thoroughly reviewed the ACS chapter given to us by Dr. Vagefi, but I was quizzed until I couldn't answer any more of his questions. I realized that surgical education is different in that students need to be assessed before any direct teaching begins, which therefore makes it critical to do as much self learning before the most difficult concepts can be taught.

When it came time to flush the organs with UW solution, I watched the monitors suddenly become irregular until finally the beeping was silenced and the anesthesiologist thanked and dismissed. The donor's body cavity had been filled with ice, her face no longer flush, but rather pale and withered. It was the first time I saw a body make the transition from person to tissue and my thoughts jumped from the thrill of observing Dr. Vagefi to the family who had lost their loved one just hours before. The placidity of the operating room as the liver and kidneys were packed away brought on a feeling of dejection in me that lasted throughout the ride back to San Francisco. 

Once we arrived at Moffitt-Long, I rolled the cardboard box into the hospital and through the OR doors, where I was surprised by the scene: the recipient, a young man in mid operation, was surrounded by surgeons, carefully resecting a cirrhotic liver, and anesthesiologists, attentively monitoring a regular heart beat. This operating room had a vivacity that dissolved my despondence as I watched Dr. Vagefi clean the liver for transplantation. It was life being given to a man with liver failure-and my thoughts went from the death of the donor to the new life of the recipient. 

This experience was and will be one of the most memorable events during my time at UCSF. I have not only learned the subtleties of organ procurement and transplantation, but also how to approach new situations in order to benefit the most from each new environment.

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