Chicago Magazine - 09.2019

SEPTEMBER 2019 | CHICAGO 151

was a potential match for Sarah, and she

had three healthy organs. Was UChicago

Medicine interested?

Bucio called Bryan Smith, Sarah’s

attending physician. “Well, I guess

nobody’s getting any sleep for the next

48 hours,” she said.

“What are you talking about?” Smith

responded.

“Sarah,” she explained. “We have an

offer.”

“You’re kidding?”

Smith soon found himself, for the

second time in two days, knocking on

a patient’s door with life-altering news.

A month earlier, not long after she’d

been admitted, Sarah had endured a false

start. The transplant team’s members

believed they had organ matches, and she

was already in an operating room when

word came that there was a problem with

the heart. The surgery was off. It was a

hugely disappointing turn of events for

her and her family.

Smith felt sure that wasn’t going to

happen again. He’d seen the charts of

the donor patient. Her organs were in

perfect shape. Still, he forced himself

not to get too excited when he entered

her room, where the family appeared to

be celebrating.

“So you’ve heard the news?” he asked.

“Yeah,” said Sarah. “Daru got his

organs and his surgery is going really

well!”

“No, no, we actually have an offer for

you.”

Sarah stared at him in disbelief.

SHE WASN’T THE ONLY ONE

having a hard time fathoming what was

happening. No hospital had ever per-

formed two triple transplants within a

year. UChicago Medicine was preparing

to begin a second one within 27 hours of

starting the first. Was that even possible?

It had to be. The offer of three matching

organs simply could not be turned down.

Bucio had already sprung into action,

working out the logistics. Because Sarah’s

organs were coming from some distance,

UChicago Medicine would need three

jets, plus ground transportation to and

from both airports.

Meanwhile, the cell phones of sur-

geons, nurses, anesthesiologists, and

assistants were lighting up with group

texts. “It’s all hands on deck,” Bucio told

her team.

Less than 24 hours earlier, Yolanda

Becker, director of UChicago Medicine’s

kidney and pancreas program, had been

starting her Christmas staycation, with

plans to go to a spin class, spend time

with her family, maybe pamper herself

a little. Then came the call about Daru.

The hospital’s only other kidney trans-

plant surgeon, Piotr Witkowski, would be

retrieving the donor organ. Could Becker

put in Daru’s new kidney? “Of course,”

she had said.

Now she would be doing Sarah’s, too.

For some members of the surgical

teams, the two procedures would mean

not just being awake but working for

up to two days straight. But doctors are

used to taxing stints. Over the years,

Becker has learned to nap standing up.

Jeevanandam, the heart surgeon for both

transplants, once flew to India, spent a

few hours lecturing students shortly

after he landed, performed a transplant,

went to dinner, and caught a plane back

to Chicago — all with no sleep.

For months, the staff had gone over

the logistics of pulling off a triple trans-

plant. But the uncharted ground of a

second one presented unforeseen com-

plications. Becker worried she might not

have enough sterilized instruments on

hand. Altogether, the surgeons would

need some 600 to 700 instruments for

each of the two triple transplants. There

were also three other transplants hap-

pening at the hospital at this time, one

of which was a double: kidney and liver.

In between each use, instruments

have to be taken to a sterilizing area to

be washed and inspected before they

are loaded into a special sterilization

machine. After that, the instruments

are inspected again and assembled

onto trays, each of which holds about

100 tools. Those trays are wrapped and

boxed, then loaded into an autoclave, a

pressure cooker of sorts that uses steam

to kill microorganisms resistant to

detergent and boiling water. The entire

process takes three hours.

To ensure that Becker and the other

surgeons had the instruments they

needed when they needed them, the

sterilization team would monitor a giant

scoreboard-like screen that tracks what

stage every surgery is in. They would give

the tools of the triple transplant surgeons

top priority.

AT 8:18 A.M. ON DECEMBER

20, his triple transplant completed after

more than 17 hours in surgery, Daru

was moved back to the ICU. Less than 10

hours later, and in the same operating

room, Sarah’s triple transplant began.

As Jeevanandam had anticipated, the

heart portion of her surgery required

extra care, taking nearly twice as long

as Daru’s. The scar tissue that had built

up in her chest from past surgeries

made hunting for all the arteries and

veins like an archaeological dig. Just

as an archaeologist uses little brushes

to carefully clear away dust and debris,

Jeevanandam had to use special instru-

ments to tease apart the tissue to find the

arteries underneath. A single millimeter

miscalculation with a scalpel could cause

a nick in the heart itself.

Sarah’s liver posed special chal-

lenges, as well. Because she had been

on immunosuppressive drugs for most

of her life, her tissues were extremely

fragile. Baker had to work slowly and

precisely, taking painstaking care with

each incision and suture.

Becker was last up. And as the final

surgeon, she had to not only perform the

kidney transplant but also make sure

the heart and liver were still function-

ing, which meant keeping a close eye on

all of Sarah's vital signs. She also had

to navigate the minefield of drains and

chest tubes and pacemaker wires left

in place by the previous two surgeons.

Dislodge any of the tubes or drains and

she could miss internal bleeding. Detach

(Continued from page 85)

The Double Triple