at 14,000 feet

the writer is out of her element, and reflective during a recent trip for organ procurement with Dr. “Shaker” Reddy during her week on lung transplant at Duke.

** When discussing or writing about organ donation or transplantation, more stringent privacy rules apply for the protection of all parties. For this reason, when discussing both the donor and the recipient, gender pronouns and other identifying features have been intentionally omitted. Post dates have been randomized to further prevent identification of recipients**

After spending most of the day in surgery with Dr. Lin, it’s time to meet with Dr.Lankala Reddy, the procuring surgeon and head for the airport.  Dr. Reddy, or “Shaker” as he’s known, has a clipped British accent, and confesses that he hasn’t be home to the UK since he came to Durham four years ago.  He came to Duke as part of his fellowship in Lung Transplant, and after completing his studies, stayed on as a procuring surgeon.  He also evaluates new patients for the Lung transplant program.

At the airport, we are met by two pilots and the final member of the procurement team, the preservationist on call, Lee Hinesley.  Lee is a lanky young guy with small laugh lines at the corners of his eyes which speak of his pleasant, and laid back manner.  “This isn’t Three Rivers,” he says with a wry smile, speaking of one of the popular melodramatic medical soap operas.  On the way to our destination, Lee pulls out a thick textbook and begins to read.  He’s studying for his certification as a preservationist. He’s completed all of his training some time ago, but the exam is only offered a few times a year he explains.

Like Lee says, our journey is ‘not like on TV.”  There is no frantic, controlled chaos or adrenaline surges.  Procedures have been streamlined and refined to eliminate most of the extraneous time-consuming variables. Routes are carefully planned, with several check-ins and updates to the surgical team back at Duke, who are awaiting our return.  Instead of hectic activity, there is calm and carefully scripted movements, as part of an established routine.  As one of the busiest transplant centers in the United States, the amazing, and incredible idea of taking an organ from one person, and placing it in another has become, if not quite routine, almost common.  So there is no need to worry; they have it all down to a science.

The plane itself is an executive jet; comfortable but by no means luxurious.  Rookie that I am, I am greatly relieved.  For some reason, I had pictured the close confines of a LifeFlight helicopter.  These flights aren’t called life flights – that term is reserved for the emergency flights that bring in trauma patients, and the critically ill; but in my mind – I’ve renamed our journey.  “Procurement” is such a cold, clinical term that erases all of the magic of the surgery.

(Now, readers should notice that I don’t usually talk in such fanciful terms, but to me, transplantation, like cardiac surgery doesn’t lose it’s awe-inspiring ability just because the medical community is ‘getting good at it.’   It’s still an amazing miracle every time, even if it’s done 140** times a year here at Duke.)

After flying across several states, we land at a small airport.  Within minutes, the plane for another surgical team (who are taking the heart) is landing.  We see them arrive through the window of the local sheriff’s vehicle.  He and another EMS person were waiting, to transport the teams to the “host” hospital.

The donor is tragically young, as they often are.  Looking at the donor, as we enter the operating room, I am stricken by how difficult this must have been for the family, during such an incredibly painful time.  Even as an experienced health care provider, I am taken aback.  I know that the donor has died, but (particularly in this case, where there is little visible injury) I feel deeply for the family; machines give the appearance of sleep with rise and fall of the chest though this patient will never wake up again.  What a caring, compassionate family they must be – to be giving at a time when they are hurting.  I hope this gives them solace in the future.

The staff of the local hospital are friendly, accommodating, if a little confused by all the unfamiliar, masked staff in the room.  Even without the official badges prominantly displayed the surgeons are easy to identify by their confident, self-assured manner.  I stay out of the way, standing near the anesthesiologist.  We banter a bit, and do the ‘six degrees of separation’ until we find several points in common, which awkwardly brings home the situation, as I consider the degrees of separation between donor and recipient.

The procedure itself is pretty standard, but intricate as vessels are gently untangled, ice applied and preservation solutions infused to protect the organs during transit.  Then steadily, quickly, efficiently but unhurried, the organs are packed for transport.  A quick thank you to the staff and we are off to the airport again.

When we land, we notify the operating room, and at 3:45 am, the surgeon wheels the cooler containing the lung into the operating room, where Dr. R. Duane Davis (and the patient) are waiting.

** current lung transplant procedures for the first six months of 2011, place estimates for year end totals around 140.

Lung Transplant at Duke: part one of a series

a series of articles based on a week with the surgeons of the Lung Transplant service at Duke University in Durham, North Carolina including interviews and highlights from my trip for organ procurement.

Durham, North Carolina (USA)

I recently received an amazing invitation from Dr. Shu S. Lin, MD, PhD at Duke University Medical Center.  Dr. Lin** and I previously worked together when I was at the Duke cardiothoracic surgery clinic in southern Virginia.  Dr. Lin would often rotate up to our facility to help cover the service so the attending surgeon could have a (much-needed) weekend off, so I got to know Dr. Lin fairly well.  Dr. Lin is currently the Director of the cardiothoracic intensive care and step-down units, as well as an associate professor of Surgery (cardiovascular and thoracic) and an associate professor in Immunology and Pathology.

I always enjoyed working with Dr. Lin, who is a very calm, quietly brilliant and confident surgeon.   He enjoys time with his patients, (and always makes time for them, spending as long as it takes to answer their questions and address their concerns.) He is an elegant surgeon, a throwback to a previous era in surgery – he doesn’t delegate, he manages the smallest details himself.

Working with Dr. Lin at the smaller hospital in Virginia gave me a very different perspective and experience than is typical of interactions with attending surgeons in large volume academic centers.  Since our facility was uncluttered with the detritus  of academia, with no residents, no students or fellows it was just the surgeon and the NP, which gave me a better chance to know the person inside the surgeon.  This is important, because it’s the first thing that often gets lost in academic medicine. It will be interesting to see him here in his native (academic) environment.

During my week down here, I will be interviewing Dr. Lin at length and spending time in Lung Transplant for an upcoming series of articles here at Cirugia de Torax.

Since lung transplantation is such a huge topic, I am devoting a series of articles to my experience here at Duke.  As part of the series, I will be publishing articles about the surgeons, the facility itself and more on the lung transplant procedure.

For now, I have including some information on the basics of lung transplantation.

Since many of you are as unfamiliar with lung transplant as I am – I have provided a couple of links that provide a nice overview of Lung transplantation.  (Despite working in thoracic surgery for several years, I have never worked with transplant patients, so it’s a learning experience for me as well.)

Medline: Lung Transplant

Roger Steven’s perspective:  a patient created website with information on lung transplantation, as well as his own story.  Mr. Stevens had a double-lung tranplant in 1997 (at the University of Maryland).

Patient education guide from the American Society of Transplant – (a little dated but written in a patient friendly fashion. (pdf)

Duke affiliated websites:

Lung Transplant at Duke

Patient resources for Lung Transplant

Lung Transplant friends – a support group for patients at Duke undergoing lung transplantation.

Duke Transplant Services

I will be updating these links periodically.

** In-depth article based on interviews with Dr. Shu S. Lin pending.