No one remarked on the irony when the band Dada came on the radio singing Shot my gun into the night/I'm going to dizz knee land/I just saw a good man die...
Kam made pass after pass with his needle, each perhaps a thread's width apart, around the circumference of the vein ends.
How many passes? No one had ever counted.
After the portal vein was sewn together at 10:40, Kam asked how long the donor liver had been out of the ice. "Thirty-five minutes," Adams replied. Kam released the clamp on the portal vein, and almost immediately, Chris's new liver regained a dark-purple color as blood rushed in.
Kam didn't wait to admire his handiwork. He started right in on the hepatic artery. Fifteen minutes later he released the clamps, and the artery turned a bluish purple and began to pulsate to the rhythm of Chris's heartbeat.
Almost as an afterthought, Kam took the bouvie and burned a white bubble the size of a fish bobber off the liver. It was the gallbladder, which, other than as a storage place for bile, serves no purpose and is a potential source of problems in the form of gallstones.
Throughout the operation, Kam's cell phone had rung and was answered by one of the nurses, who relayed the messages. One call was from Donor Alliance, concerned because their calendar didn't indicate who would be on call at University Hospital or Porter Adventist Hospital, which has a smaller liver-transplant program, for an upcoming weekend. Kam didn't even look up as he told the nurse to assure the agency that "one of us will cover." Donor organs were too hard to come by for any to be wasted because of a scheduling snafu.
Another call suggested that Chris's fear of someone "snaking" his liver had almost been realized. A higher-status-level patient had been brought in during the night, but the patient was running a high fever and therefore not eligible for the operation. After he dealt with that call, Kam began lifting Chris's intestines out of the abdominal cavity and piling them on top of his groin area. The surgeon deftly handled these slippery ropelike parts, cutting here, stapling there, and burning a small hole at one spot just as the funky bass lead to Stevie Wonder's "Superstition" got the heads of Goldberg and the nurses moving in unison. The mood in the room was lightening; they all knew the operation was almost at an end.
When you believe in things that you don't understand... Kam connected the donor liver's common bile duct to the hole he had burned in the small intestine rather than to Chris's tied-off bile duct. The duct could not be attached to the new liver for fear that whatever caused PSC might find its way in from the old duct. Even with that precaution, there is a chance that the PSC could return someday, but such cases are rare. With that step completed, the surgeon plopped the intestines back into place.
At 12:20, Kam removed the retractor that had been holding Chris's belly apart. The yellow Ioband was stripped off, after which Kam used the bouvie to burn a hole through the skin and muscle near Chris's navel. A tube was inserted in the hole that would serve to drain any fluid, including blood, from Chris's belly while he recovered. Kam began closing the enormous wound by stitching a suture through the muscle layers as Goldberg followed behind, tying the sutures into knots. Finally, there was nothing left for Kam to do but staple the outside of Chris's skin together while Goldberg stitched in the drain tube.
At 12:50 p.m., five hours after the first cut, Kam threw up his hands like a concert pianist finishing a recital. "Thank you," he said to those he worked with, then walked away, removing his gloves, gown and mask. He placed the loupes carefully in a felt-lined wooden box.
As Kam spoke into a tape recorder, making notes about the operation, Henthorn began waking Chris with different drugs. A nurse bent down near his head and called his name. His eyes flew open, uncomprehending, then closed again. He began to shift restlessly and attempted to pull the intubation tube out of his nose.
"Chris, you're doing okay," a nurse assured him. "Can you try to move your leg?"
The request was perhaps a mistake. Chris began moving too much and struggled to get up as the nurses tried to hold him down. "Chris, you've had your operation," the same nurse said. "You've got yourself a new liver."
Chris said something indistinguishable but calmed down. He seemed satisfied to slowly flex and straighten his legs. Kam left the room to go talk to the family as Chris was moved onto a gurney for transport to the recovery room.