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December 10, 2006

'Death Match' — by Pauline W. Chen


The above-titled essay appeared as the "Lives" feature on the final page of last Sunday's (December 3, 2006) New York Times magazine.

It's the stunning story of an eerie occurrence during Chen's transplant fellowship (she's a surgeon), when for a brief period of time she forgot that "the patient is the one with the disease."

The piece follows.

    Death Match

    Procuring organs was part of the job description during my transplant-surgery fellowship, and the operation was like any other. There were patients who required more care, others who seemed made for a surgeon’s hands. And though brain-dead, they all seemed remarkably alive. They bled bright red, and their chests rose and fell regularly, albeit with the aid of medications and life-support machines.

    We often worked in the middle of the night, keeping the body functioning for as long as possible. The less time we exposed the organs to the stillness of death, the greater the chances of success in waiting recipients. But every operation ended the same way. The senior surgeon cross-clamped the aorta, the anesthesiologist disconnected the medications and breathing tube and I snipped across the vena cava, letting blood drain into tubing connected to clear wastebasket-size canisters on the floor.

    I always emerged from those operating rooms feeling more alive than when I had entered. I became energized by the act of operating, the hope of transplantation.

    That was until my 83rd procurement. She was a 35-year-old Asian-American woman, like me. She was driving on a Southern California road when a drunken driver collided into her car. Three days later, brain-dead, on my operating table, she looked merely asleep. Her warm skin was taut, with few blemishes, and her full hips and thighs suggested a metabolism beginning to slow. Her toenails were painted pink.

    Hasan, the senior surgeon that night, began working on her abdomen. I was to open her chest.

    As I placed the pencil-like electrocautery instrument at the top of her breastbone, the surgical drape covering her right breast fell away. I pulled it up again but noticed the undulations of each rib and the gentle fall of breast tissue to her side. Her nipple and areola peeked through; they had a coloring and shape that I had seen on only one other person: myself. In fact, the very shape of her breast, the thinness of her chest and the texture of her skin reminded me of my own upper body. It was as if I were standing naked after a shower, looking in a mirror.

    I stopped for a moment, unable to put my instrument back to her chest, and my nose suddenly filled with the smell of flesh burned by Hasan’s cauterizing pen. It was a familiar odor — surgeons use electrocautery in almost every operation — but this time, it found its way into the pit of my stomach. I stepped back, tasting the smell in my mouth, and looked away to try to breathe in anything but what was wafting up into the air.

    “Are you sleepy?” Hasan asked gently. The clock read 3 a.m.

    “I’m all right,” I replied, trying to recover.

    “Come here and feel her liver.” He took my hand and plunged it into the woman’s upper abdomen. “It’s perfect.”

    The abdominal incision closed around my forearm. Her liver — soft, smooth, well formed — was perfect, but my fingers felt lost in the warm sponginess of organs. Loops of bowel slid by, and her pulsating aorta persistently nudged my palm.

    Hasan asked me to hold her abdominal incision open. I tried to pull the edges apart, but her abdominal wall had a vibrant elasticity that resisted. I looked closer at the cut edge and noticed that her dermis, the layer between the fat and the outer skin, was particularly thick. It was white, pearly.

    I remembered that as an intern I let medical students practice placing intravenous catheters in my arms. They always noted how difficult it was to drive those needles through. “Thick skin,” I’d say, trying to make a joke about internship. But then I would add, “My dermis is probably pretty thick.”

    Looking at her dermis now, I felt as if I were looking at my own. As we snipped away at the organ attachments, about to take her liver, pancreas and kidneys, I tried to ignore the aliveness of her body, to believe that she was only a cadaveric reflection of myself. But then, in my sleep-deprived state, I found I could not bear to think of her — of myself — as dead.

    The drape across her chest continued to slip, and I would have to see her breast yet again. Her thick dermis kept resisting our attempts to keep her belly open, making it difficult to take my eyes off that strong layer below the skin. And in the end, as I watched her blood fill those canisters on the floor, I felt as if my own life force were draining away.

    When we finally closed her stone-cold body, the warm blood replaced by preservation solution, my mind felt as emptied as she was. The muscles in my palms ached, and my legs were numb. I was profoundly exhausted, from sleep deprivation, overwork and an unbearable grief.



December 10, 2006 at 04:01 PM | Permalink


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Amazing isn't it? How we often do not think about the giver of one of the most precious gifts? A life saving organ. I see kidneys, hearts, livers, limbs, etc. transfer through and never once think of the person that it came from? I think of the person that is going to get them instead. You know I don't want to think about life and death too much. We all know we have to do the death part. But do we know that before we do that we still have to do the life part?? That might be the hardest part of all. And yet shouldn't be. We make it hard thats all. Too much thinking now.

My thanks go to the donors and their families. That is something in itself we can say we would do. But when the time would come... would we really??

Posted by: Rhonda | Dec 12, 2006 10:15:12 AM


Posted by: Tom | Dec 11, 2006 12:55:44 PM

Tears. I've no idea why this is so moving... but it is.

Off to ruminate now..

Posted by: IB | Dec 10, 2006 11:32:24 PM

Thank you for sharing this. I was moved.

Posted by: mattp9 | Dec 10, 2006 6:17:58 PM

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