From the Wards
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Transplant


Day One

“So, how long have you been on surgery?”

“I mean … I had OB/GYN before this,” I answered in an attempt to set the expectations low without prompting the surgical residents to think I was incompetent.

“Oh,” one of the residents sighed.

I could tell by the way the other two residents turned back to their computers that my two weeks on transplant surgery would be my “first” surgical rotation.

“Follow me,” Dr. PGY-III said as I chased him down the hall into the supply closet. “You need a medical student kit.”

With that, he began filling my pockets with an assortment of items as he listed them aloud: Tegaderms, Kerlex, gauze pads of varying sizes, a binder, staple removers, suture removers, caps, a paper tape, cloth tape, culture tubes and flushes. He also threw four syringes in my pockets, thought for a moment and then threw another four in there. The words sounded like English, but I wasn’t really sure what any of the stuff was.

Later, as I rushed back from the cafeteria, a fourth-year medical student caught sight of my stretched pockets and smirked.

“Surgery?”

Day Two

Drs. PGY-III, PGY-II and PGY-I collectively decided that I was taking too much time to open the flushes and staged an intervention. Typically, I unwrapped them gently like one would open a Lindt chocolate bar: quietly and with intention.

“Just do this,” Dr. PGY-II said before he slammed the plunger of the syringe into his thigh so the tip burst from the plastic packaging with a loud pop.

As a medical student who had been operating under the ‘be seen, not heard’ protocol, this was startling.

I also learned a second thing on rounds that day. Apparently, there is a balance between having too much stuff in your pockets and not enough. In both situations, you can’t find anything you need.

Day Six

Dr. PGY-I decided to teach me how to use the copier with the automatic stapler.

“So,” he said as he pointed at the screen, “which corner are you going tell the copier to staple?”

“Uh…,”I hesitated.

Over the past two years, the baseline issues I have with distinguishing my right from my left have been exacerbated by the fact that all radiographs are mirror images. As a result, I no longer trust myself.

“Top left?” I responded as I glanced at my hands.

“No. Top right.”

I briefly wondered why this topic was not covered in surgical textbooks before I hit the ‘top right’ button on the copier. Magically, when the copies of the patient list printed, each packet was neatly stapled in the top left corner. I did not think too hard about this; there is so much that doesn’t make sense.

Day Seven

We transplanted a kidney. I was surprised to discover that the donated organ showed up in a little plastic container actually labeled ‘Tupperware.’ Dr. Attending #1 transferred it to a plastic, blue bucket containing ice and then handed the bucket to me.

“Hold this,” he said as he turned back to the recipient’s abdomen.

For the next thirty minutes, I could only stare down at the kidney and dig my nails into the bucket. By the time Dr. Attending #1 asked for the kidney, I was completely cross-eyed from the exhausting task of making sure it did not fall on the floor.

Afterward, the resident on pediatric surgery asked me how the transplant went.

“Oh my gosh! That was so cool!”

“That is literally the first time I have seen you smile,” she said, sounding surprised.

I was surprised too. I didn’t notice that I had stopped smiling.

__________________________________________________________________

I know that being a third-year medical student is like being a transplanted kidney. One starts the day in one body. School is composed of lecture halls and written exams. However, the world has shifted by the end of the day, and shockingly, one’s old body is not present. “Teaching” is reduced to five sentences whispered between patient rooms. “Exams” consist of single questions which present themselves just as sporadically. This new body is unfamiliar, and the medical student, the transplanted kidney, is expected to thrive in this bizarre, artificially constructed cavity.

In this scenario, much like a newly transplanted organ, one’s survival depends on the precise administration of a cocktail of immunotoxic medications. While these are not tacrolimus, cyclosporine or steroids as for organ transplants: They are residents who smile, nurses who make you look good, attending physicians who point to you and then the extra seat at the table, classmates who work with you instead of beside you and the free cup of coffee that occasionally crosses your path.

Unfortunately, not all transplants are a good fit for the body in which they are newly-housed. Even with all the medications, sometimes the organ doesn’t take. Sometimes, the vein becomes thrombosed. Sometimes, the immune system rejects the organ. Sometimes, there are other things going on — other anatomical or social factors — that make it difficult to care for the transplant. The result is that one ends up right back where you started: on dialysis and with an uncertain future.

Though I am now halfway through my third year of medical school, time has done little to relieve the indecision with which I started. And so, maybe, like a transplanted organ, I feel lost. Similar to how one transplant is not always a great match for an individual, I am not a good fit for every service. The truth is that incompatibility is built into the biology of transplant. So, when things don’t go according to plan, maybe it’s no one’s fault: Maybe, that is completely normal.

Despite the fact that transplantation is not a perfect solution, I can’t help but recognize something magical in the procedure. Where there is sickness and death, transplants can provide significant improvements in quality of life. The transplanted organs adapt to startling surroundings. Despite it all, they survive, and in doing so, they can dramatically change the trajectory of a patient’s story.

As medical students, I think we all dream of playing this role. We want to change a patient’s experience for the better. We want to make the observation, sift out an overlooked detail in a medical history or provide an encouraging conversation that makes a difference. We are eager to be needed and wanted. Sometimes the ambiguity of our roles makes it unclear how to do this. But when those moments come, no matter how small or infrequent, they leave lasting impressions. Deep in the chaos of third year as we find ourselves flying awkwardly from one rotation to the next, we find moments when we belong.

Hillary Mullan Hillary Mullan (4 Posts)

Writer-in-Training

University of Massachusetts Medical School


Hillary is a member of the MD Class of 2020 at University of Massachusetts. She received her BA in Neuroscience from Oberlin College and is interested in the intersection of art and medicine. In addition to writing, she also enjoys creating medically inspired paper art and has had pieces published in "Intima" and "Pulse."