An empty operating room in the witching hours of the night is as spooky as any haunted house. Most of the rooms I work in do not have outside windows. Like a casino, or an underground bunker, “daytime” is relative. Even so, I often get goose bumps whenever I walk alone into an operating room to set up for an emergency nighttime case. I am the first to arrive. The noises, bright lights, and bustle of the many concurrent routine operations of the day are replaced by the low hum of the air ducts and the soft fluorescent glow of monitors and machines. The room is cold and mostly dark as I enter, and it is easy to imagine the lingering spirits of all the people who have undergone operations in here. Shadows play in the far corners of the room, and distant footsteps from outer halls echo off the linoleum floors, stainless steel tables, and pallid green walls.
I’m still a bit groggy from my few hours of sleep before the after-midnight summons to the hospital. The call is followed by a foggy and wind whipped drive south over the Golden Gate Bridge. Sporadic northbound headlights of oncoming traffic pierce the gloom, and still startle me despite the hundreds of such nighttime trips. The bridge has no median barrier, and the center lane markers are flimsy moveable rubber pylons. Like invisible hands, sudden ocean gusts shove my car into the oncoming lane. I repeatedly correct my course and drive cautiously, with the window open to stay awake and alert, bracing myself with the cold night air.
Night cases are often transplants of one sort or another. The frequency of organ transplantation has greatly increased over the past four decades due to better tissue preservation, immune suppressing drugs, surgical techniques, and technology such as operating microscopes and Jedi sabre-like argon beam coagulators that cauterize the thick, bleeding edge of a transected liver. Kidney transplants are now routine, as are heart, lung, liver, pancreas, cornea, and recently even face transplants.
In 1968 the famed Dr. Norman Shumway performed the first heart transplant in the United States at Stanford. Ten years later, one of my college friends, Sam Poole, had heart transplant #120 by Dr. Shumway. These transplants were still so new that Sam’s mother, Victoria, wrote an inspiring book about him called “Thursday’s Child” subsequently made into a Hallmark movie starring Rob Lowe in one of his first screen appearances. What I remember most about Sam was his incredibly infectious enthusiasm and lust for life. His body ultimately rejected the transplanted heart despite the steroids and cyclosporine immune suppression therapy that made his skin thin, his bones brittle, and ruined his kidneys. We have come a long way since, and those who undergo transplants can live long and healthy lives.
The case I am here for is a kidney transplant. Like soldiers, firefighters, and police officers, doctors and nurses often engage in dark and decidedly inappropriate humor as a way to deal with the illness and death to which we are exposed. We joke about “donor-cycles”, and Darwin Awards. However, there is no levity when one considers the source of transplanted organs. Specifically, this case is an en-bloc kidney transplant: not one, but two kidneys. The paired donor organs come from a child.
I am a father of three healthy teenagers. I can’t even begin to imagine what it would feel like to make the decision to donate your child’s organs following an unthinkable, and tragic death. It is simply beyond my capacity. So now, in the middle of the night, in a dark and silent operating room I am setting up to transplant this dead child’s kidneys into a man suffering from end-stage renal failure. I look at my wristwatch at the time: 2:12 A.M.
The wristwatch is a 1960 vintage Swiss made Pierfa quartz, as old as I am, with a bright gold Speidel Twistoflex band. I have just had it repaired after the many years it sat unused in my dresser drawer. It belonged to my father, Lieutenant Commander L. Bush Swisher, Jr., who was a young and perpetually smiling Navy anesthesiologist from Morgantown, West Virginia. The watch is one of the few possessions I own from my dad, who suddenly, and with only the briefest warning of a severe headache, suffered a bleeding intracranial aneurysm on a sunny but bitterly cold morning in late January of 1968. He died two weeks later, just before twilight in a small hospital intensive care unit in Glen Cove, New York at the age of 34. I never had a chance to say goodbye. Had this happened today, we may well have saved him. Novel calcium channel blocking drugs, high resolution CT scans using catheter angiography, and the ability to thread small metal coils into the ballooning aneurism, greatly diminish the risk of arterial rupture, bleeding, and death. But not in 1968… and my life, and the lives of my mom, brother and sister were forever changed.
Now, as I stand at the head of the bed after successfully inducing anesthesia on the middle aged man comfortably asleep before me, I intently watch the surgeon as he carefully places the tiniest of circumferential sutures connecting the vessels of the donor kidneys to the recipient. And then I feel the presence of someone right behind me… It is 3:23 A.M. The room is hushed as everyone concentrates on the task at hand. The hissing rhythmic sound of the ventilator is hypnotic as it delivers each breath; pauses then sighs as the anesthesia machine scavenges the expired gas. It is a child- a very sad and frightened child. I don’t know why, but I envision a six-year-old girl, and I do not turn around. I can’t… because I am in turn scared and overwhelmingly sad. At that moment, the surgeon releases the arterial clamps. The mottled gray-blue donor kidneys begin to pink with new blood and life, and I feel a gentle touch on my shoulder… and I know… I absolutely know without any doubt, that my dad is standing behind me as well. A calm, warm, reassuring feeling suffuses me, and just as suddenly as I was stricken with grief, I become unable to contain an emotion I can only describe as pure joy. I close my eyes and see a boyish, broadly grinning young man in Navy dress whites extend his hand to a little six-year-old girl. Holding hands, they recede from me… away from the bright overhead lights whose beams are focused on the living pulsatile kidneys that are a precious gift and a new beginning for the sleeping man before me.
I look at my watch and it has inexplicably stopped… It is now 3:25 A.M., and I see no point in ever having it fixed.
For my Dad.
Jeffrey L. Swisher, M.D.
San Francisco, CA
Dr. Jeff Swisher is an anesthesiologist who practices in San Francisco. He graduated from Stanford University with degrees in International Relations and Medicine, and lives in Marin County with his wife Dana, three teenagers, two large dogs, and a merciless take-no-prisoners black Bombay cat named Gin. He also plays in a middle-aged-guy rock band named “Blatant Malpractice”.