What do you do when the career that you were singularly focused on for 16 years, actually focused on since you were about 5 years old is making you miserable. What is your next step when every page, phone call, donor offer creates chest pain and anxiety and you just want to be left alone? What do you do when the politics of the workplace have become the focus of your day, your thoughts, and are making it difficult to sleep at night. What do you do when you have answered a calling to be the ultimate caretaker for people and it seems to be less appreciated, less valued (even though my debt to achieve this career isn't being lowered), and you are treated more like a factory worker by hospital administrators who sign your paycheck instead of being valued also for your role as a professional and for all those things that are a part of your job that cannot be counted.
I don't know the answer for everyone but I will tell you what I did. I cried, and then I tried to remember the very reason I navigated down this career path, which is actually more of a way of life than a career. At the end of the day, the only thing that matters is my patients. I believe that being a physician is a calling, as the sacrifices to your own life are too great to do this job for monetary success. There are much easier ways to make the kind of money that surgeons and other physicians make. There are much more lucrative jobs that don't deal in the currency of life and death. Life and death are the very realities that we face everyday, especially in transplant. At each transplant occurrence, outside of living donor transplants, we experience the reality of the very final moments of a life and the very exact moment when someone is given a second chance at life. I view this as a gift and not a burden. Remembering this helped bring purpose back the the chaos of my everyday reality.
What happened next added to my resolve to remember exactly why I chose this career path. Now, those of you that know me know that there is no way that would I believe that cleaning and organizing my office could be a cathartic event. In fact, it wasn't my idea. Chris, who is the yin to my yang in organization (and many other areas) decided that I needed some help. Now, before you scoff at the mental benefits of cleanliness and organization, let me reassure that although I did feel much better after my office was clean and organized. It was what happened during the cleaning that helped me to see through the fog of the everyday annoyances of my job and remember that what I do is important and worthwhile and it is impossible to put a price on the rewards that are returned to me. While cleaning out my desk drawers, I found all of the cards, gifts, and letters written to me by my patients. Also, while cleaning, I checked my office mailbox and there was a package from a patient who I had dropped by to visit about a month ago while she was in the hospital for something unrelated to her transplant. These letters and gifts were not all from patients and families who necessarily had good outcomes or those who had no complications. There were even gifts from family members whose family member had suffered the ultimate outcome......death. Let me tell you about these patients, their families and their gifts to me and by gifts I do not mean the physical affects I found in my office and desk drawers but the gifts of love, encouragement, respect, kindness, and the reassurance that I have made the right choices in my life to answer the call of being responsible for the health and life of others.
Here are some of their stories.
Mrs. P-I found a piece of paper with her email address scrawled in my hen scratch. Mrs P underwent a kidney and pancreas transplant when I was in fellowship. I did her transplant and took care of her while she was in the hospital. She had been described as difficult before I met her on the day of her transplant. As patients who have been chronically often regress and act a bit like a spoiled child when they are sick, I was expecting the worse when I went in to meet her. What I found was a woman who I connected with immediately and I could see that she seemed to feel the same way. Her transplant went well and she was discharged home. A couple months later, she returned to the hospital with a bowel obstruction which is not terribly uncommon after having abdominal surgery. I took her back to the operating room with my attending to investigate and relieve the bowel obstruction which is almost always due to adhesions (scarring from previous operations). As I was untangling her bowel from around adhesions, I used the electrocautery to divide an adhesion but what I didn't realize is that her bowel had actually twisted around the artery to her transplanted kidney and I made a hole in the artery to her kidney. I knew immediately what had happened and although my heart was in the pit of my stomach, I managed to get control of the artery, which stops the bleeding but at the same time, deprives the kidney of blood flow which can injure the kidney and cause her to lose the kidney that we had just transplanted a couple of months before. I repaired the artery as quickly as I could and restored the blood flow to the kidney. Even though there was a modicum of relief, I still knew that her kidney was not out of the woods, we would have to see how much damage the kidney had sustained and there was also that possibility that the artery would clot from the damage and she would lose the kidney or she would get a narrowing in the artery that would keep the kidney from blood flow and ultimately lose the kidney. I knew that I had just done something, although not carelessly or not on purpose, but it could have devastating affects on this young lady not only physically (having to return to dialysis) but mentally as well. My next task was to talk to her about what had happened after she woke up from anesthesia. I remember that I stayed at work until early evening when she was awake enough to understand what I was telling her. I sat down on her bed and told her exactly what happened and took full responsibility and said, "I'm sorry." I talked to her about the potential devastating outcome. I was prepared for her to be angry and specifically angry with me. However, what happened was her first gift to me. She was, of course, upset and scared but she said, those magic words, "it's ok". She said that she knew it was an accident and that she believed that everything would be ok. Forgiveness......the ultimate gift. After a couple of days it was clear her kidney was going to make a full recovery. I left fellowship, but never forgot her. About 3 months ago, I received a call at my office from Mrs. P. She is now about 3 years out from her transplant, has had another bowel obstruction but for the most part is living a normal life and working full-time. She called because she wanted to tell me that she never forgot me and how good I was to her in the hospital. I reminded her about the episode with her kidney and told her how she had helped me when I really needed it also.
Mr B was a farmer and a horseman who had unfortunately been diagnosed with pancreatic cancer. He was referred to me for a Whipple procedure. I took him to the operating room and unfortunately he had developed a pancreatic pseudocyst from pancreatitis and I had to drain the pseudocyst because of all the inflammation, it was not possible to do the resection required to perform the Whipple procedure. A very seasoned surgeon, Dr. D was helping me with the case and he and decided that the best thing to do was to drain the pseudocyst and put in a feeding tube into Mr. B's small intestine. This way we could feed him liquid nutrition for a month while we let the pancreas rest and heal and then we would attempt the whipple procedure. I had to go out and inform his family. A month later we were able to do the whipple procedure and he recovered well from surgery. He endured several months of chemotherapy and radiation. Unfortunately, he had a recurrence of the cancer and died a little over a year after his operation from metastatic cancer which is unfortunately the case for many pancreatic cancer patients. I had become very close to the B family including Mr B's sister. She continues to send me Christmas and birthday presents even two years after his death. Right after Mr B died, she sent me a package with pictures of Mr. B and his brothers who all came to visit when it was clear that Mr B would not be well enough to visit and have fun with them for too much longer. I get tears in my eyes, ok, I really cry each time I get something from her.
DH is a young man who is 26 years old and on his third liver transplant. After I had been out in practice for just a few months here in Dallas, my office gets a phone call from a mother who said her son who had been transplanted as a baby at the age of 3 at the University of Chicago, which is where I did my transplant surgery fellowship, was having problems with his liver. The mother said that Dr M (who is the head of the txp department at U of C) stated his recently graduated fellow was in Dallas University of Chicago Texas
Her field of battle is close to her heart.
Her scapel, a sword, which busts death apart.
Biliary Atresia, hepatitis or virus…..
She’ll defend that liver, and be there beside us.
When your liver fails, and faith can’t be found,
She brings light to the darkness, and hope will abound.
She’ll fly to the donor, and bring back new life.
She never gives in, without a fight!
This organ is too fat and that one’s necrotic!
Oh wait, this one’s a match! Let’s get this fight started!
Bleeding,rejection, and just ole’ infection…
None will survive or get by her detection.
She’ll fight the good fight, and never give in.
Her battle is death, but she fights to win!
She’ll never forget the patients she has lost.
They live in her memory, nailed to the cross…
The hours are long, and the war is forever.
Everyday brings more patients and more storms to weather!
She never complains, or throws in the towel.
She believes in miracles, good health is her vow!
For she is a liver transplant surgeon,
Ordained by God, living with purpose.
The families line up, and shout out with Glee!!!
To the best of the best, Dr. Tiffany Anthony!!!!
Love you, doc!
KE, mother of DH, age 23
Triple Liver Transplant Survivor.
I know there are days ahead of me which be long, difficult, and deprived of sleep, but I promised myself that when I set out on this career path, I wouldn't let it change who I was as a person (or the person my parents raised me to be). When I read these things from my patients, it reminds me that someone sees me as having made a difference in their life. It will be much harder to get upset, angry, and frustrated at the things that are clearly small when compared to the rewards I get back 100 fold from the people who matter most in this career…..the patients and their families.
I will save the rest of their stories for another day.
