What it’s like to
SAVE A LIFE WITH AN ORGAN TRANSPLANT
Program Director for Lung Transplantation at University of Washington Medical Center
I was driving to work at UW Medical Center on 9/11 when I heard that a plane hit the first of the Twin Towers. An hour later, my team got an organ offer out of Alaska. At the time, we had one patient with cardiomyopathy who needed a heart and one with emphysema who needed new lungs. The FAA had grounded all civilian aircraft, so we figured we wouldn’t be able to retrieve the organs. But the medical director of the hospital came marching into our operating room and told me, “If you don’t fly up there to get the organs, the terrorists win.” We decided to go.
I asked my father, a former naval pilot, how best to navigate the restrictions. Then we flew up to Fairbanks, harvested the lungs and heart, and started back toward Seattle. We were almost home, flying over the Space Needle, when we suddenly veered back out toward the water and headed north. I tried to alert the pilot that we needed to land immediately, and then I looked out the window and saw two fighter jets off our wing. It turned out that our flight plan was not correctly registered with the FAA; we were identified as a civilian aircraft with no registered flight plan, flying at max velocity toward Seattle on 9/11. The jets had us targeted, and our pilots were on the wrong frequency.
They finally forced us down in Bellingham. The organs were in the cooler, and we were on the clock. The patients had already been prepared for surgery, and it was going to go very badly if we didn’t get to them fast. Both would have been at an acute risk of death.
We woke up a colonel on Whidbey, and he personally cleared an air corridor right down to Husky Stadium. They set up a helicopter and said, “We can take one person and the organs, that’s it.” So I jumped in with the helicopter pilot and we flew down and landed just outside the stadium. We were only allowed 60 seconds on the ground, so I quickly grabbed the coolers from the back of the helicopter, and sat down on the field as it took off with a torrent of wind. I took a few deep breaths, and then rushed to the hospital and transplanted the organs. The surgery was perfect, and both recipients did phenomenally. It was a matter of not relenting. Eyes on the prize.
What it’s like to
RESCUE A TRAUMA PATIENT
Chief of Trauma at Harborview Medical Center
An 18-year-old man from Eastern Washington was driving his car with friends when they crashed into a fence. A two-by-six fence post came through the floorboard of the car and then up through his body, just above the hip, and out his back. He was trapped in the car with the large piece of wood traversing his entire abdomen. The medics cut the board on both sides but left it in place, and he was taken to a rural hospital where they stabilized him and then transferred him to Harborview by airlift.
When we got the call, we had the whole team mobilized in the emergency department. We’re used to seeing odd things but this one was particularly challenging from a medical management standpoint because impalements involve so many kinds of specialists and several operations. Fortunately, Harborview is designated a Level I trauma center and has resources to provide the highest level of care. I can have an operating room in less than five minutes.
He was brought in and we quickly determined that he had no pulse in his leg because the board was likely compressing his blood vessels. This is common with impalement: You never pull out an object that’s impaled because it is often pushing on a blood vessel that may be damaged. If you pull the object out too quickly, the patient will bleed to death. We got an x-ray to look at the vessels, and then we took him to the operating room, where, with the help of a vascular surgeon, we were able to get control of the blood vessels both above and below the fence post.
Over the next several days he had multiple operations. We closed his abdomen, we closed the holes in his body, and we called in plastic and general surgeons to do reconstruction work. We had a team of nurses in the ICU after each surgery that resuscitated him. Eventually the patient recovered completely. What’s really impressive is that all these practitioners really care about these patients. They love taking care of severely injured patients. It’s what they live for.
What it’s like to
BUILD A FAMILY
Reproductive Endocrinologist at Seattle Reproductive Medicine
As a provider of fertility care, people seek my counsel for solutions to one of life’s most important challenges: family building. They relate life’s changes brought about by children, the absence of children, and the need this absence creates. In some cases, they describe the emptiness left behind when a child dies. Their narratives are poignant tales of change, of coming of age regardless of age, and of what it means to be simply human.
A patient in her mid-40s came to me recently and asked if I would help her have a son. Yes, we could do that. And yes, we can identify gender. Technology can offer hope and options, I explained.
In straightforward, restrained terms, she related her life’s progression that led her through hospital hallways to my office. The first change was subtle, she said. A texture in her right breast different from what she usually felt. The lump moved easily, a reassuring sign she thought. She kept a pact of silence with her newly discovered change and moved on.
Three months later, the lump seemed harder and fixed to the surrounding breast tissue. Concern trumped reluctance. She broke her pact of silence and described her findings to her husband who insisted she seek care. Questions and answers ultimately led to a biopsy and a diagnosis of breast cancer. A cascade of surgery, chemotherapy and radiation followed in quick succession. She lost her hair and her menstrual cycle and marched forward through her radiation treatments, hairless, menopausal and hopeful. She graduated into the class of the treated. And that was a long time ago.
All was well and life was good until suddenly, it wasn’t. Life confronted her with another unwanted change. One spring afternoon, her teenage son left with friends for the day. Dusk grew deeper. While preparing dinner, a knock on the door announced an unexpected visitor. And with one fluid movement in an unguarded moment she opened the door to a different future. She was eye level with a badge on a blue uniform and learned of the death of her son in a motor vehicle crash.
She reiterated that she wanted a son. And then made a simple request. She said, before you view my proposal through a medical prism, imagine life without your daughters. She motioned toward a photo on my desk. Pick one and imagine life without her special imprint on your heart. And if you can get that in focus, you’ll understand in some small part why I am here.
I explained that our goal was to meet her needs within a plan of safety and not make judgments. She described the time after the accident and the healing that occurred over the years. Healing that was almost complete.
She said in quiet recall: It’s been what seems like decades to that spring day. The end of high school and a life yet to be written. His would-have-been college years for us to watch his life unfold. All gone.
But time eased her grief and the fog of the trauma thinned. She was in a better place to weigh her options and bring change into her life on her terms. And that’s why she came to see me: to find some way around the loss. Not to remove it but to step around the enormity of it and find a way forward beyond its shadow. She wasn’t complaining about how unfair life had been. There was no self-pity. It was simply a well-thought-out request in response to life’s events.
We discussed her menopause, the need for an egg donor and the process of gender identification. We talked about the risk of the pregnancy and the impact if any on her longevity. We spoke with her oncology team and discussed a spectrum of risks. We sought psychological screening. We discussed the ethics and consulted an ethicist about the decision.
In the end and after all the discussion, we proceeded. We identified an egg donor and collected 15 eggs. We fertilized them with her husband’s sperm and grew several embryos. And after a few days of growth we gently probed each embryo to reveal its gender. We transferred to her one carefully chosen embryo with a Y-chromosome, her hoped-for next son. Two weeks later, her pregnancy test was positive and nine months later, she changed her life—this time on her terms. She delivered her son.
The pain of her loss eased ever so slightly with this birth. She was grateful for the partnership with me. She was on the other side of the loss now, beyond its shadow and moving to the next phase of her life. Her new son reminded her each day of how good change can be.
Changed lives have a way of changing lives. Her choices and decisions reminded me of a life lesson, a coda that defines life not by the events that happen to you but by your response to events you have no hand in making. Our response defines us more than the event. She taught me that we have two options: hope that things will work out without our input or seek a path up and over, around and beyond the event.
What it’s like to
PROVIDE END-OF-LIFE CARE
Gynecological Oncologist at Virginia Mason
The reason we do chemotherapy is to give patients the best quality of life for as long as possible, and sometimes when chemotherapy gets in the way of that best quality of life, we make arrangements, we change medicines, we change doses, we change administration days.
I had a patient who had ovarian cancer, whose chemotherapy was preventing her from going to her grandson’s soccer games. We modified her treatment plan so she could be more energetic on game days. Many times, even when we were having hard discussions in the past 18 months before she passed, we’d laugh together—she always made me laugh—and we got along famously. It would have been nice if she’d never had cancer and we’d never met, but because we were not faced with that choice, we were able to have a relationship and make the best of a situation that neither of us wanted to be in.
When the time came to talk about whether to continue chemotherapy, she told me she was at peace with her decision that the toxicity of treatment was no longer worth any small benefit it might have. She died peacefully, with her daughters and her husband at her side.
About three weeks after his wife passed away, her husband came by the chemotherapy clinic to talk and offer his thanks to our staff and me. He said his wife had been so grateful that we talked honestly about her diagnosis; that I gave her realistic expectations that allowed her to make decisions about treatment. You have to maintain some separation from patients; you have to be able to make objective decisions. But it’s times like these, when I see a patient’s husband and hear his heartfelt words after a patient is gone—that I realize how close I really was. Administering end-of-life care helps me realize how important family is and how short life can be and how important it is to enjoy the time we have here.
What it’s like to
PERFORM A FIRST SURGERY
Cara Beth Lee
Orthopedic Surgeon at Virginia Mason Medical Center
I performed my first major surgery several weeks after I had finished residency. I was on call, walking my dog on a Friday night when I was paged about a patient in her late fifties with a subtrochanteric femur fracture, which can be a very complex injury to reduce and stabilize. My adrenaline immediately rose. There are much easier cases to start with.
I had seen a lot of trauma and had operated on many extremity fractures during my resident rotations at Harborview, but as a resident you’re never alone. There’s this big fluffy pillow there as your safety net: you always have a fellow and an attending physician by your side. But this night I was on my own for the first time, the safety net was gone, and I was feeling anxious. I was tennis player growing up, and the butterflies that bubble up before surgery remind me of game days: You get nervous, but you're also eager for the challenge. You have to plan well and visualize success for each match.
I headed to the hospital and talked to the patient, who was extremely anxious. Before this fracture, she had been seeing one of my senior partners for other musculoskeletal concerns. She asked me over and over to get him; she wanted to see a surgeon she knew and trusted. I tried to reassure her by saying, “This is something I’m very comfortable doing; I just finished all this work at Harborview; I’ve treated lots of fractures recently…” But she was insistent. She told me, “You look too young, I don’t trust you!” (I have a lot of grey hair now, but at the time I did look very young. I tell patients that I’ve earned every one of my grey hairs. These are badges of honor!)
So I respected her request and called my senior partner to alert him that she was in the Emergency Department. He said, “Tell her I’m out of town, but if you need me, I’m five minutes away.” When I told her, she was disappointed but she resigned herself to my care. As for me, I was reassured that I had remote backup if I needed it, but also more determined to do my best. We performed the surgery the next morning and it went very smoothly.
I’ve now done hundreds of surgeries in the past 13 years, and I still have a feeling of ‘high alert’ for big cases, and even for what some may consider routine operations. I take it very seriously when a patient consents for surgery—it’s an expression of trust. Again, it’s just like game day. The way to succeed is to focus on the moment and get in the zone. With surgery, the mechanics are the same: you concentrate on each move, each step, whether it’s a 30-minute procedure or a 6-hour case, and you stay patient and execute the plan that will lead you to the best possible outcome.
What It’s Like To
IDENTIFY A MYSTERIOUS INJURY
Emergency Medicine Physician at EvergreenHealth
I was working in the ER on a recent Saturday afternoon when I got a call about a man who had been in a car crash. The medics told me his blood pressure was really low and he was acting very sick, presumably because of the crash.
So we got everything set up in the trauma center to deal with an automobile accident victim, but when he got there, something didn’t seem right. We looked at the facts: He had hit a wall going 10 miles an hour; he is 54 years old; his blood pressure is really low; he’s sweaty. We started working on him as a trauma victim, but his symptoms just didn’t add up. On a hunch, I grabbed our ultrasound machine to look at his belly, and sure enough he had a ruptured aneurysm. The rupture was what caused him to crash in the first place, not the other way around.
So we called off the trauma surgeons, brought in vascular surgeons, and took him directly to the operating room. We performed an ultrasound right there, diagnosed the problem, and shifted our approach from trauma to vascular in the blink of an eye. We saved his life. In fact, if he had just pulled up on the side of the road and not hit anything, the medics might not have found him fast enough. By hitting this wall at 10 miles per hour, this guy ended up saving his own life, really, because the medics brought him straight to us. It took us less than five minutes from the time he entered the ER to get him into vascular surgery. He was in recovery 30 minutes after that. He walked out of the hospital completely fine three days later.
It’s a skill you develop working in trauma centers: You look at patterns and figure out solutions for every new problem, every day. Many of us in emergency medicine do it because we like all aspects of medicine. We like taking care of sick people, from a one-day-old baby to a 99 year old all in the same shift, and taking care of everything.
What It’s Like To
DEVELOP A LIFELONG FRIENDSHIP WITH A PATIENT
Infectious Disease Physician at Overlake Hospital
A patient came to me in 2007 for treatment of cellulitis, which is a common infection of the skin and soft tissue. He had contracted it when he was in Mexico with his church group building houses. He had a few reoccurrences of the disease, so I saw him more than once and we got to know each other during the course of treatment for this very common, non-life-threatening disease.
After that I didn’t hear from him until 2009, when he was hospitalized with newly diagnosed diabetes. He was in the hospital for a week, where he developed a bacterial bloodstream infection, and I became involved in his care even though it was unrelated to his cellulitis. We were able to reconnect and reestablish a wonderful doctor-patient therapeutic relationship. Over the course of the ensuing weeks, we got to know each other as individuals, because we had many opportunities to sit in the examination room together and talk.
He was interested in knowing about me and I about him. I learned more about this church work, and I told him that I sing in the Seattle Men’s Chorus. He was interested in knowing about my family, where I was from, and I learned that his wife and daughter were both nurses. We got to know each other really well during that time.
He was an obese man, and partly with my encouragement he decided to change his eating habits and began exercising regularly. Four months after his hospitalization, he sent me a note to tell me that he had lost almost 100 pounds. He was exercising and eating fruits and vegetables, and was able to control his diabetes extremely well. I told him I was so proud of him, and to keep up the good work. He expressed appreciation to me for my support.
Then last fall, he sent me an email advising me of the fact that he had been diagnosed with a strange mass in one of his legs, but it hadn’t yet been characterized. In the same note, he asked if I was still singing in the chorus and how I was doing, because he’s just a lovely man. I wrote back to tell him how sorry I was, and I would hope for the best.
A few months later he told me that his oncologists diagnosed the mass as a rare form of cancer. He told me he would have to have a surgical procedure to remove it, and he told me how sad he was about that. I sent my condolences in a reply note, but I also extended my support as a doctor and a friend. And I had this moment before I sent the note where I thought, “Wow, life’s tragedies are visited on even the most wonderful people, and they didn’t ask for it and they didn’t do anything to get it.” But still, the relationships that we forge sometimes with patients enable us to share moments with them that are so significant and consequential and the connectedness, the relational connectedness that is established in so doing allows for some wonderful sharing, and for some opportunities to give to people and help them.
By nature I have a desire to get to know people, and I can’t suppress it even in the context of a clinical situation. If you break down the barrier of doctor and patient, if you recognize that we’re both people, we both have interests, we both have mothers, we both have families, then doctors and patients can meet in the middle. My friendship with this man is just one beautiful example of the humanity that can exist in medicine.
What It’s Like To
GROW A “MO” FOR MOVEMBER
Oncologist at Seattle Cancer Care Alliance
Movember is a campaign to raise awareness for men’s health, specifically to raise funds for two men’s cancers: prostate cancer (the most common cancer in men overall), and testes cancer (the most common cancer in men between the ages of 18 and 35). During the month of November, men grow mustaches and people look at them funny because mustaches aren’t in style and they ask, “What’s up with the mo?” And that allows us to talk about the importance of screenings and regular doctor visits, and people can donate money to fund research. It’s that simple.
Since I deal with urologic cancers and provide care mostly for men, this was an outstanding opportunity for me to be a part of a solution. We all know men hate going to the doctor. I don’t like going to the doctor. I don’t like talking about it. Growing a mustache is a fun and funny way to get everyone involved. Women obviously can’t grow a mustache, but they can talk to their partners, their brothers, or their friends, about the importance of men’s health.
So I started a Seattle Movember team in 2011, and I’m the captain. It’s called MoDawgs, in honor of the Huskies. (I’m a big Seattle sports fan. I have season tickets to the Huskies with my buddy from preschool.) Until 2011, I’d never really had facial hair. I never had a goatee, never had a fumanchu, never had a beard. This is the only time in my life I grow facial hair, during this one month. Mine comes in very thick, very bushy, it’s solid top-to-bottom—kind of a Tom Selleck look. My wife tolerates it. Patients and friends just look at you funny, but that’s the whole point. I’m like, “I’m doing this for this reason. When was the last time you saw your doctor?”
We give awards during the month for different mustaches. You can do any shape or size you want. But you can’t have a goatee; it’s gotta be just a mustache. At the end of the month, we have a party, and last year we rented out a restaurant space. We had probably a hundred people in there from cancer research centers and hospitals around Seattle, and all of them had these terrible mustaches.
This year we hope to have well over a thousand members of MoDawgs. A big part of our work is not just taking care of the patients but also trying to find a cure, and since a large part of it comes back to prostate and testes cancer funding, it’s a wonderful thing for us to be involved in.
Published: August 2013