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On Organs and How We Learn

Posted Jan 26 2011 7:38pm
We're almost done with our Immunology module, and one of the last lectures we had was on organ transplantation. On a biological level, it's pretty astounding what modern medicine can offer. By understanding how the immune system works, we can make modifications to help sustain life. But, as we've learned in lecture, it's not as easy as it seems. The cellular intricacy of transplant rejection is complex and smart and frustratingly sad. Just another reason why the human body is so fascinating.

But we've been learning about organ transplants from a sterile, safe perspective. We're in the neutral confines of a lecture hall, discussing a hypothetical case. No name, no memorable characteristics, no face. Just patient X who had an hyperacute rejection of his kidney transplant. We don't talk about patient X, the person. Instead, we talk about patient X's preformed antibodies to the donor organ's endothelial antigens. We don't discuss who patient X was or what will happen to him after his donated kidney has been rejected. We focus in on the inflammation that developed in his blood vessels and we study the complement pathway that led to the rejection. And this is fine for an Immunology lecture. In that one hour span patient X taught us about organ transplantation, then we move on to another hypothetical case for another class - Patient Y who has lupus perhaps? But in a few months' time I'll be learning about medicine from patients who have names and memorable characteristics and faces. No more imaginary scenarios.

Over the summer I was fortunate enough to go on a tour of a surgical department in a local hospital. The plan was to scrub in and watch a robotic surgery. But when I arrived, the hallway was congested with a large group of people in uncoordinated scrubs. Each person was on a cellphone, a cacophony of surgical instructions and medical abbreviations filling the room. On the other side of the hallway stood a stack of coolers and ice chests waiting to be grabbed, filled, and hauled off on the nearest ambulance or helicopter. I had walked into the middle of an organ harvest.

I was led into the operating room and the nurse immediately scoured me for any source of contamination with her hawk-like gaze. She was protective and fierce, and she let me knew with just one look that I should stand in the corner and stay out of everyone's way. It was both terrifying and awe-inspiring.

He laid on the table, iv bags attached to his arms that had been spread out. Two gun shots to the head. We were the same age. A drape was set up to shield his face. I stood quietly in the corner taking it all in.

The physicians were in the process of removing his liver, alternating between deft cuts with the scalpel and looking up at the monitors to check the stats. Surgeons walked in and out of the operating room, some with their cooler and others hurrying out to make an urgent phone call. It was a symphony: seemingly chaotic on the surface but there was an unspoken understanding that made the procedure run smoothly. When the last cooler was filled, I walked out and tore the mask off my face and took a deep breath of the cool, antiseptically-clean hospital air. The crowd of mismatched scrubs had dissipated. Only one lone cooler laid there in the corner.

As I was observing the organ harvest, my mind bounced between trying to absorb the surgical and anatomical component, and the fact that only the day before this young man was alive. He was living his life, and we had been the same age.

I didn't learn about the physiological pathway of transplant rejection that day; that lesson would take place seven months later. There were no made-up cases to prove a point, and there was no patient X. What I did take away from that experience was an introduction into the art and humanism of medicine. And while my amazement at the body grows with each lecture in school, that moment in the operating room impressed upon me the complexity of human life - the physical and the emotional.
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