Mismatch

Copyright (C) 2003. Robert S. Rosson. All rights reserved.

GIRL IN TRANSPLANT MIX-UP DIES AFTER TWO WEEKS. Headline, New York Times: February 23, 2003.

Only those who were in the operating room know exactly what happened on that fateful day two weeks before. This is one person’s idea of what might have occurred.

* * * * *

The operating room is large, bathed in bright white light reflecting off soft blue-gray tiles. The team is assembled: the surgeon, his assistant, two residents, the anesthesiologist, a pump technician, a scrub nurse and two circulators. The transplant coordinator is filling out papers in a corner. There is the usual small talk and the inevitable chatter about basketball.

A phone rings and is picked up by the assistant surgeon. “Right,” he says, “I’ll tell them.” “The harvesting team is in the OR in Boston; they estimate they’ll be here in three hours.” “Great, let’s get started,” says the surgeon.”

The team swings smoothly into action. The diminutive Mexican girl is anesthetized and placed on cardiopulmonary by-pass. The tedious, delicate process of removing the diseased heart and lungs begins. About two and a half hours later the organs are ready to be excised.

The phone rings again. “They’re on the ground here, about twenty minutes to go.”

The final removal goes quickly. The open chest cavity is virtually empty. She is completely dependent on the machine. Now there can be no turning back.

The OR door opens and a technician rushes in carrying a large cooler. “A twelve year old boy, MVA with massive head injuries, blood group A positive,” he announces.

The anesthesiologist looks up at the blood bag, then quickly checks the chart and the patient’s wristband. She looks at the surgeon. “This girl is O positive!” she exclaims.

“That’s not possible! Are you sure?”  Her eyes reveal the answer.

A profound silence, except for the whirring of the pump, settles over the room.  Suddenly a loud epithet echoes off the tiles, accompanied by the sound of a hemostat bouncing off a metal cabinet and clattering to the floor.  No one seems to notice. 

“Lord Jesus, save us!” someone cries.  Another makes the sign of the cross.  Then silence again for what seems like an eternity.

“O.K. people, let’s put in these organs; they’re all we got,” says the surgeon, hoping his voice does not betray the sinking feeling deep in his gut and his sense of doom.

For the next four hours, there is no talk except for terse surgical commands.  At last it is done.  The lungs are inflated and the warmed heart begins beating rhythmically.  The surgeon leaves the closing of the chest to his team and walks out. “Keep her on the list,” he says to the coordinator, her face buried in her hands.  Anesthesia orders massive doses of steroids.

The surgeon enters the locker room and heads quickly for the bathroom, overcome with nausea.  He dashes into a stall where he is gripped by paroxysms of retching.  He sinks to his knees.   At last the retching subsides and he stands.  He is drenched with sweat and he feels faint.  He makes it to the lounge, where he sinks into a worn leather couch and tries to collect his thoughts.

The assistant comes in.  “Are you all right?”

“I’ll be fine, he says, “I’m going to speak to the family now.”

“Want me to go with you?”

“No, this happened on my watch; I’ll deal with it. You could page the Catholic Chaplain and ask him to meet me in the family lounge.”

With that the surgeon stands and strides out of the room.

The author is indebted to Dr. David Crombie for his helpful and insightful comments concerning this piece.

Published originally in YJHM March 20, 2003