The Honor Walk

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Medical staff lined the hallway from Room 234 to the elevators which led to the operating room (OR) elevator. The patient was brain dead, but she was going to save three lives. 

The anesthesiologist and OR nurses served as temporary pallbearers as they pushed her bed, her family following behind, wiping away tears as they prepared to say their final goodbyes. A group in blue scrubs followed behind like ghosts. 

We were the team that would help her save three lives. We were there to procure her organs. 

My surgical mask hung like a necklace around my neck. I wanted nothing more than to put it on so no one would see my lip quiver; to cover my clenching jaw as I held back an onslaught of unexpected emotions. 

Eyes down, I blinked away tears that threatened to fall. 

One life was ending. Three were being saved. Countless were touched by the procession. 

Some deep emotion seemed to move through each witness as we recognize the juxtaposition — the balance of life and death; the charity of an act; the mourning of a family. 

Arriving in the OR, I removed the flowers that her family had placed in her hair. Her body is prepped and draped. Before the technicians began, we took a moment to acknowledge this generous act that will benefit the lives of people she had never — and would never — meet. 

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A first incision from sternum to pubis was made. I watched in rapture from behind the sterile drape.

Anatomy of the human body is amazing. Two lungs expand and collapse as the heart rhythmically pumps — *lub-dub, lub-dub* — in between. The diaphragm separates these life-giving actions from the digestive system. The liver, tucked up under left rib cage. Bowel dominates the rest of the view but, underneath, there’s a stomach, spleen, pancreas, kidneys. All of these organs joined together by a series of inbound and outbound vessels that bring nutrients and oxygen and take away waste. As I watched them — identifying the organs to procure, marking important vasculature with silk ties — I was invited to join in on the work. 

“Scrub in, young doctor, we’ll put you to work.”

“Hold the liver back for us. Good, just like that… See that, there’s her left adrenal gland. The kidney is just south of it. Here’s the vena cava and the aorta. Feel along the bifurcation. That first bump you feel is the ureter. We don’t want damage it. When you hold the vessels with the pickups, always grab the adventitia, not the lumen… you’ll damage it. This fascia around the kidney that holds it in place when you jump is called Gerota’s Fascia. One of the most important things we do is keep the organs cold. More ice please. Switch places with me. Hand me a 3-0 silk tie. Now tie 3 knots for me. Good…” 

Six weeks of surgery and my medical school anatomy class came together in one moment. It was amazing.

With the donor organs ready and out on ice, we did a last check of the remaining viscera for neoplasms. We opened the heart to check for vegetations on the valves that could host an infection. None were found, so the donated organs were good to go to their recipients. Now we close. 

I started at the sternum, stumbling through the first few sutures. I was frustrated that they didn’t look good. I knew that only the funeral home technicians would see them, but I wanted to do my best. I wanted those sutures to look as good as possible. For her.

After the sutures were tied off, we removed the sterile drapes and I saw her face. Pale. Lifeless. Her eyes were barely open. In the mist of the procedure I had forgotten that, during this process, we had allowed her body to fade, joining what we had declared the brain to be — dead. 

Death. 

I felt its presence. The weight of it seemed to hit my forebrain. Her body was here, but her consciousness was no longer amongst us.

I offered to extubate her, deflating the balloon that held the breathing tube at the ideal place in the trachea, then gently pulling it out. Normally, this would elicit a cough from the sensitive mucosa lining the back of the throat. The dead don’t cough. The nurse began to move the sheets back to reveal the body-bag that was beneath her all along. During the procedure I had forgotten the end of this operation meant the end of her life — the OR table had not. 

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Placing a toe tag, we zipped her up into a white cocoon. Finding myself at the head of the bed, everyone looked to me to initiate a count to move her onto a metal bed. Then we placed a black drape over her. She was ready for the morgue to prepare her for her final appearance on earth: her funeral. 

The string of events that led to her demise no longer mattered. Her past accomplishments were a distant consideration. 

In that moment — in death — she was a hero that saved 3 three lives. 

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Anne Keeling

Osteopathic Medical Student - 3rd Year (OMS III)
Pacific Northwest University of Health Sciences

Anne Keeling