How to do a liver transplant

How to do a liver transplant: Stories from my surgical life

Kellee Slater
Copyright Date: 2013
Published by: UNSW Press
Pages: 272
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  • Book Info
    How to do a liver transplant
    Book Description:

    When everything is in place and both teams are ready, someone cries out ‘Cross-clamp!’ Then it is on for young and old as the clock is ticking. Up to this point, it has been a careful and considered surgery. Now it is all about speed. We move like Edward Scissorhands, chop, chop, chop. This is the trickiest part – to move fast without cutting something you shouldn’t. Welcome to the adrenaline-charged world of transplant surgery. Top Australian surgeon Dr Kellee Slater invites us inside the operating theatre with her dedicated team as she performs life-or-death surgery on a newborn baby, brings a dying liver back to life with a staple gun in each hand, and undertakes the confronting task of removing donor organs. How to Do a Liver Transplant is an enthralling – and often blackly funny – glimpse over the shoulder of a gifted surgeon.

    eISBN: 978-1-74224-643-7
    Subjects: Health Sciences, History

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Prologue
    (pp. vii-viii)

    Like everyone, there are some days when I don’t want to do my job any more. These are the days when I have to tell four people in a row that they have cancer. Then there are the times when I have worked all night and feel like my eyes will bleed if I don’t close them soon. I want to give it all up when I haven’t seen my husband for three days.

    But all of this pain is balanced out by the days when I get to do a liver transplant. This is the one operation that keeps...

  4. I was born to be a general surgeon
    (pp. 1-10)

    I realised that I was going to be a surgeon pretty early on by figuring out what Ididn’tlike about medicine. Take phlegm, for example. Some patients think there is nothing I’d like more than to inspect a giant lugie they have coughed up and spat into a cup. They are just so wrong. Then there are feet – if you show me any problem concerning the foot, you will be sure to see me using mine to run in the opposite direction. This phobia stems from two ofthemost ghastly things I have ever seen.

    As a medical...

  5. You might get into medical school, you know
    (pp. 11-17)

    My mum grew up in a small town in far north Queensland called Ravenshoe. In the late 1960s the only jobs for a single woman were either hairdressing or working at the local bank. Mum chose the bank and it was there that she met my dad, a peanut farmer’s son from Kingaroy who had been sent to the Ravenshoe branch as a teller. They were in their early 20s when they married and were transferred to Townsville where, within a year, I was born. I was joined four years later by my sister, Lauren. Mum and Dad were hardworking...

  6. What body part is that?
    (pp. 18-27)

    The first three years of medical school were all about cramming my head full of the fundamentals of medicine – anatomy, physiology and pathology. These subjects are the building blocks for understanding diseases. Even in those early days I had a surgical bent, tending to think that the lecturers teaching psychology subjects took themselves a little too seriously. I arrogantly thought that I had learned all the psychology I needed from watching a few seasons of Oprah Winfrey. I’ve since learned that psychology is often the subject I need to call upon most in my practice, so I wish I’d paid...

  7. Girls shouldn’t do surgery
    (pp. 28-33)

    My passion for general surgery began almost as soon as they let me into the hospital. The moment I first got to see an operation, I was hooked. I loved the precise nature of it all – the smooth, organised way that things got done. The confidence of the surgeons was intoxicating as they worked away for hours, heads bowed in concentration, calling out the names of exotic-sounding instruments. I wanted to be just like them, strutting around in crisp surgical scrubs, barking orders and having people follow them. Surgeons appeared to be respected by everyone and they did things that...

  8. I heart gallbladders
    (pp. 34-43)

    F or most surgeons, it is pretty easy to recall the first operation you ever saw and the feeling that it gave you. Getting to help Dr Smith remove the gallbladder that day (at least the small part I saw before I hit the deck) was the beginning of my love affair with that little sac of bile. Never let it be said that there was a gallbladder I didn’t like. Even after claiming the scalps of more than 2000 of them, I never get tired of taking them out. It is really relaxing and it sends me to my...

  9. It seems that I’m a doctor now
    (pp. 44-53)

    After a fun-filled graduation ceremony at Brisbane’s City Hall that involved more than one bottle of red wine and a midnight dip in the fountain out front, it was time to grow up. I was now Dr Kellee Slater MBBS, with second class honours, I might add. Internship and the realities of daily working life loomed. It began to dawn on me that I would actually be responsible for looking after real patients who might die if I made a mistake. This worried the hell out of me (and still does). That last carefree week of university also saw another...

  10. I can’t believe they are going to let me operate on people
    (pp. 54-60)

    Starting to operate on patients marked the beginning of a surgical way of life. Dr Smith instilled in me a work ethic of seeing my patients seven days a week and I still adhere to that to this day. He quite rightly pointed out that if I was going to have all the fun of operating on people, then I had to be totally responsible for their wellbeing 24 hours a day, no matter how tired I was. There was no way he was going to look after my patients while I was off lounging around with my friends telling...

  11. The life of a surgical registrar
    (pp. 61-69)

    My first year as a fully fledged surgical registrar got off to a terrific start when I was assigned to work in a hospital situated in a picturesque beachside setting. Working at a coastal hospital was a coveted posting and six months there meant living the high life in a beachfront apartment and hanging out every night with the other junior doctors in the local restaurant precinct. The hospital was two minutes from the shore and there was a spectacular view of the sparkling Pacific Ocean from every floor. The transient tourist population made every day feel like a working...

  12. In the poo
    (pp. 70-80)

    No book about the life of a general surgeon would be complete without a chapter discussing faeces. Dealing with poo sounds strange, I realise, but someone has to help out the people who have problems in this area. It is a part of my job I just attend to with very little fanfare. As I’ve mentioned, as a teenager considering a career in medicine, I don’t think I knew much about what doctors actually did with their day. The one thing that Ididknow for sure was that they all spent some time sticking their fingers up people’s bottoms....

  13. The call of the bile
    (pp. 81-96)

    My second year of surgical training saw me move to Brisbane, the subtropical capital of Queensland. Andrew and I moved yet again and he found yet another job as a flight instructor at a local airport. I was slated to work at one of the most famous surgical hospitals in Australia, the Princess Alexandra or ‘PA’. The whole point of working at the PA as a surgical trainee was to be exposed to the different specialties within general surgery or ‘super specialties’.

    The Princess Alexandra was home to world leaders in all the specialties of general surgery but none more...

  14. Rocky Mountain High
    (pp. 97-106)

    After that momentous night, I felt my life click into gear. I am a girl who likes a plan and the thought of having my career pathway sorted brought me great comfort. All I had to do now was get through the rest of my surgical training without any problems. I operated myself silly, did all the requisite exams and after the required four years of training, qualified to become a Fellow of the Royal Australasian College of Surgeons. This meant I could now go out and independently operate on people without having to check in with a boss every...

  15. You want me to start at what time?
    (pp. 107-114)

    I wanted to make a good impression on my first day on the job in Denver, so I arrived at 7 am. I was used to starting work around 7.30 in Australia, so I thought that showing up half an hour early would be a pretty safe bet and would let everyone know that I was keen. I nervously approached Dr Kam’s secretary and told her who I was and what I was there for. She didn’t seem to know much about me, mainly I think because she didn’t understand my very broad Australian accent. I repeated myself, this time...

  16. Kellee, there is a donor
    (pp. 115-130)

    Imagine you are going about your day, picking up the kids from school, stacking the dishwasher or sitting at your desk at work. Suddenly, like a bolt from the blue, you experience a headache that is so blinding you would swear you had been trodden on by an elephant. You clutch your head, a dark curtain comes down over your eyes and you collapse on the floor. That terrible pain is the last thing you remember, ever. You are discovered lying there, barely alive, and they rush you to the hospital. You are put through a CT scan and the...

  17. How a donor is done
    (pp. 131-142)

    A doctor I passed in the hall at a donor hospital once asked me, ‘Is that my patient you have there in your cooler?’ I chuckled because my strange job reminded me of the grisly scene in the movieFargowhere heavily pregnant police officer Marge Gunderson matter-of-factly says, ‘I guess that was your accomplice in the wood chipper … and it’s a beautiful day …’ It was usually late at night when we slipped into the donor hospital as discreetly as we could. We came and went via back entrances and dark alleyways just in case the family of...

  18. We have found a new liver for you
    (pp. 143-154)

    Can you imagine what it must be like to sit at home waiting for a telephone call that has the potential to save your life? Can you also imagine what it must be like to know that the call may never come and your life will just dwindle away? This is the daily reality for a patient on the liver transplant waiting list. When the telephone rings to say that there is a suitable liver available, I expect it must feel like escaping the hangman’s noose. Some patients will wait for more than two years for their reprieve to come....

  19. How to do a liver transplant
    (pp. 155-171)

    After I had been in Denver a few months and had spent many hours assisting Dr Kam, he became confident enough of my abilities to take me through my first liver transplant as the primary surgeon. I was thrilled. This was followed a few months later by my first solo transplant, that is, without one of the bosses scrubbed. This was a big day and I was every bit as nervous and excited as I was with my first appendix. I didn’t even know it was going to happen until I was well into it. Dr Kam sat in the...

  20. Born in the USA
    (pp. 172-184)

    Winter was nearly over in our second year in Denver when the city received a once-in-one-hundred-years blizzard. Eight feet of snow fell in one night. We woke to a winter wonderland of fresh powder right up to the rooftops. Cars left on the street had become white mounds, and there was no clear indication where the road was. The snow ploughs could not cope with clearing the highways, let alone suburban streets, so no one could get to work that week. The nurses who were already on shift that first night had to stay in the hospital for days until...

  21. Do you think I could have a piece of your liver?
    (pp. 185-193)

    A round the world there are thousands of people who give away parts of themselves so others may have a chance to live a better life. This is called living donation. These people voluntarily put themselves in harm’s way. They are selfless, brave and just incredible.

    None more so than a quiet, unassuming man I met one day. His entire family were recent immigrants and understood little in the way of English. It turned out that they had a family member who was very ill, his liver was failing so badly that he was being considered for a liver transplant....

  22. Love you Lynn
    (pp. 194-207)

    During my time in the States my life was touched by some amazing patients; a patient in his 70s who returned to his demanding job within three weeks of his transplant; a snowboarder who won an Olympic medal shortly after his; and hundreds of people who were kind enough to allow an Australian girl to look after them for a little while. But the most remarkable patient I have had the privilege to care for was a lady called Lynn. She was a 32-year-old woman who came from a small town in Colorado. I met her for the first time...

  23. Transplant Mom
    (pp. 208-214)

    Six weeks after my beautiful daughter emerged, it was time for me to start back at work. Americans take extreme pride in their jobs – they live to work and their enthusiasm easily rubbed off on me. With most working mothers only stopping for a short time to bond with their newborns, I felt like I had to get back to it quickly too. No one seemed to bat an eyelid when I kissed my daughter goodbye and picked up my job again like I had never left. Those six weeks at home with Abigail were blissful. There is no doubt...

  24. A fully fledged surgeon at last
    (pp. 215-219)

    On our return to Australia, Andrew and I set about adding to our family. Madeleine Shelby, named after Coloradan and former US Secretary of State, Madeleine Albright, was followed eighteen months later by Priscilla Dana – named of course for the wife of the King (aka Elvis Presley) and my hero fromThe X-Files, Dana Scully. Three girls in three years, what were we thinking? We were thinking that we could have everything and we were right, we could – satisfying jobs and a lovely family. I wasn’t getting any younger, so we had to get on with it.

    Again I worked...

  25. Give me the gun, this liver’s coming out
    (pp. 220-232)

    I got an unusual email one day. The subject line read URGENT, PLEASE HELP, MY CHILD IS DYING! I dismissed it as another scam trying to get money out of me, but just as I was about to hit delete, my secretary rang and told me I must urgently call the international telephone number in the email. An Australian family had been holidaying in Argentina and they were frantic: their 11-year-old daughter had been enjoying a day of skiing when she had slipped and slammed straight into the pylon of a ski lift, splitting her liver in half in the...

  26. We will not let your daughter die
    (pp. 233-242)

    While taking out a section of liver in a hurry represents the pinnacle of a liver surgeon’s skills, I am nothing without my team, especially my anaesthetist. Dr Rebekah Ferris is one of my best friends, and I’ve known her since we were junior doctors. She also happens to be one of the best anaesthetists I know; the person at the head of the patient who I rely on implicitly. Without her, I couldn’t do what I do and have a live patient at the end of the operation.

    Rebekah’s brilliant work was no more evident than on the day...

  27. Buy a bra, save a child
    (pp. 243-251)

    I believe that life hinges on the smallest things and nothing was more certain this day. I had finished my operating list early, all my paperwork was done, and things were winding down as I prepared to head off for a mid-winter vacation in Fiji with my family the following week.

    I had bought a few resort outfits and decided at the last minute that I needed a strapless bra to wear with one of them. I was beginning to feel relaxed. It was Thursday afternoon – one day to go until no phones, no emails and no dying patients.


  28. Transplanting babies
    (pp. 252-262)

    It was a very unusual thing, to have my fingers inside the abdomen of a tiny baby. At a mere 3.1 kilograms, he was one of the smallest people to have received a liver transplant in Australia and I was there that day, assisting Professor Jonathan Fawcett, the head of the paediatric transplant program. When I walked into the operating theatre to start the case that morning, the first thing that hit me was the heat. Liver transplant theatres for babies must be 30 degrees so that our precious charges don’t lose too much body heat when their tummies are...

  29. You have three months to live
    (pp. 263-277)

    I sat on the edge of the bed, trying to hold back my tears as I held his hand. This man had been in and out of my life for four years now. I knew him well. I called his wife and kids by name and I knew how hard he had fought his cancer. We had gone through a lot together. I had stood over him for hours, working to remove half his pancreas, his bile ducts and part of his stomach that were all riddled with cancer. I had done this on Christmas Eve, no less. I had...

  30. How do you do it all?
    (pp. 278-286)

    For some inane reason, I thought becoming a fully fledged surgeon might mean that I could relax a little and let my underlings take up a bit of the slack. The biggest secret they keep from the registrars is that this is not the case at all. I imagine it is like that because no one would actually become a surgeon if they knew that the pace never relented. The hook is that once you have committed eight or so years towards training for it, you can hardly walk away. As well as working at the PA and Royal Children’s...

  31. Acknowledgments
    (pp. 287-290)
  32. References
    (pp. 291-296)