Little Things

Everyone from Mother Teresa to Sherlock Holmes to Little Debbie has something to say about "the little things" and there's no shortage of little things in transplantation either.

I'm writing this post while watching a documentary about a multiple organ transplant, part of the "Surgery Saved My Life" series on the Discovery Channel. Like most portrayals of medicine on TV, the narration, background music, and scene setup exude overdramatization, but real life has an intensity that television could never capture. They describe the complexity of the procedure in every way possible, but the explanation that most caught my attention was that the surgeons would "...perform virtually every abdominal procedure devised, back to back, and as fast as they can."

Yikes. Every abdominal procedure...every last one, huh? Even though some steps of the multivisceral transplant operation are the more challenging procedures in medicine (such as removing the liver or pancreas), the real challenge seems to be how extensive and all-encompassing such an operation is. The same seems to hold true for the medical aspects of transplantation (versus the surgical). For example, all transplant patients are at an increased risk of skin cancer from chronic immunosuppression. Renal transplant patients have usually faced bone disease with renal failure, and may still have bone disease after transplantation. Finally, non-renal transplant patients have a risk of developing renal failure that ranges from 7-21%. These are just a few examples, and volumes have been written on medical complications of transplantation. Looking at the whole picture, it sure feels like every last problem devised can show up in one way or another, and that they come on you as fast as they can.

The climax of the surgical story is when the surgeon steps out to talk to the patient's mother. This happened after the organs were reperfused (had a blood supply restored), but the narrator brings forth a caveat: "A long series of minor procedures lies ahead."

The minor procedures of that day probably include surgical adjustments such as creating a stoma and placing a feeding tube, but the "minor procedures" (surgical or not) will continue a lot longer. For me, this week's features were blood tests and a bone density scan. Not an excessive list, but the previous week had a few and next week will have a few more...it adds up. Of course, the burdens of post-transplant care and this slew of tests is a lot less than that faced by patients on dialysis, and doesn't even compare to those who are critically ill and awaiting a heart transplant or liver transplant. Transplant patients' lives are generally in the realm of chronic illness. Jon Carroll recently wrote about the boring but unending nature of being diabetic, and entire blogs have been written about chronic illness.

Finally, in the last scene of the show, the narrator makes the only drastic understatement of the program: "Gretchen's medical odyssey is not quite over..."