Heather (not her real name) was airlifted to our hospital, a large tertiary care teaching institution, with a very serious medical condition. She had fulminant liver failure, a life threatening condition that causes severe liver injury which in turn can cause kidney failure, brain swelling and ultimately death if not treated urgently by performing a liver transplant.
Just twenty four hours prior, Heather was at work as a primary school teacher, wrapping up the day and about to head home to her family. She woke up that morning feeling under the weather with a head cold and body ache and also had a slight fever as well. Never the one to complain or take a sick day off, Heather got ready, had an extra large cup of coffee on her way to work and started her day in earnest, like she did every single day. As the hours passed by, Heather continued to feel sick and at 4 p.m., was looking forward to going home and get in bed. It was in the next few hours that things started to unravel. Upon reaching home, she felt extreme weakness and nausea and soon began throwing up. Her husband John, who fortunately was home early, decided to take her to the nearest ER. By this time, Heather was barely responding to any of John’s questions and was breathing heavily. Upon reaching the ER, she was immediately taken in and a slew of nurses and physicians gathered around her. Very soon, the ER physician came in to talk to John about Heather. He told him that Heather had severe liver failure and she was in serious danger of losing her life unless she was airlifted to the nearest transplant center, which is where I first met Heather and John.
The ER had intubated Heather and she was breathing via the ventilator. She was completely unresponsive to any kind of stimulus and most of the history I got was from talking to John. Other specialists had also been summoned to Heather’s bedside. Based on our collective evaluation, it became very clear that Heather needed an urgent liver transplant. Fortunately, all her other organ systems were still in good shape and we listed her as a status 1 A, the highest status possible and reserved only for the sickest patients who would otherwise if not for an urgent liver transplant in the next few hours. Now, all we had to do was to keep Heather alive and wait for an appropriate donor liver to become available.
We got a call that night about a local organ donor, whose blood group matched Heather’s. We set out to retrieve this incredible gift this donor and his family were making. Not only were we trying to save Heather’s life, there were other potential recipients for the heart, lungs, kidneys, intestine and pancreas in other hospitals who would get a new lease of life due to the generosity of this donor.
After a few hours of work at the other hospital, my colleagues and I were back to now begin the transplant operation on Heather. We first removed Heather’s own liver while a different team of surgeons worked on removing some extra tissue on the donor liver. Once we were ready, we brought the donor liver and started sewing the blood vessels, the vena cava, the portal vein and the hepatic artery, in that order. We had just finished sewing the portal vein when the anesthesiologist informed us that Heather had lost her pulse, which meant that her heart had stopped beating. We looked up and saw a flat line on the monitor. We had to do something fast or we were going to lose Heather right there. My attending transplant surgeon, who was assisting me with this procedure, looked up at me and said, “ Let’s open the diaphragm”. The diaphragm is a muscle that helps with breathing and separates the chest and abdominal cavities. We opened the diaphragm from below and I reached inside and started to manually pump Heather’s heart, while the anesthesia team and others worked frantically to save Heather’s life. After a few tense minutes, Heather’s heart started to beat on its own, and very soon, it regained its normal rhythm and started to pump blood like it was doing before. Once this happened, we sutured the diaphragm and were able to continue to work on sewing the remaining blood vessels and the bile duct. A few hours later, Heather was in the ICU, with a new working liver and her family at her bedside.
In a few hours, Heather opened her eyes and we were able to disconnect her from the ventilator. She was breathing well, her heart and liver both doing great as well. Heather made an uneventful recovery and was able to be discharged home in less than a week.
Even though this happened many years ago, I still remember that night as if it was yesterday. We brought Heather back from the jaws of death, not once but twice. Heather is doing well, still working full time as a teacher and living a full life with John and the rest of her family. In reviewing what caused her own liver to fail, we were able to point to a herbal supplement that Heather had just started to take for energy and vitality, something she picked up just a few days prior from the local drug store.