Dr. Josh Mezrich spends his days performing a medical phenomenon: organ transplantation. The procedure first gained ground in 1945 and has become more mainstream since 1983. Since then, advances continue to be made, but challenges remain as demand for transplants outpace the organs available. It is work that creates life from loss and one Mezrich details in his book, “When Death Becomes Life: Notes from a Transplant Surgeon,” released in January. The book is part memoir, part history, and reflects on the world of organ transplantation including where it has been and where it is headed.
The Cap Times spoke with Dr. Mezrich about his new book, how he manages the stress and anxiety of holding people’s lives in his hands and what’s on the horizon for transplantation science.
What about transplantation do you think people don’t understand or misunderstand?
There are probably some misconceptions about what it’s like to do surgery, to live this life, to make these decisions, so I wanted to give people an inside look into what it’s really like. It’s incredibly gratifying and a huge privilege, but at the same time there is this burden of anxiety and worrying about patients. It is a wonderful job that definitely keeps you up at night. You’re sort of most in control in the operating room but outside of the operating room it’s kind of a constant worry.
How do you cope with the anxiety and worry the job brings, how do you find balance there?
We all have various coping mechanisms and some are healthier than others. I think there is a lot of elements to this. We train really hard and we work a ton with our partners and colleagues. I think you have to be really, really humble. One of the nice things about working at a big academic center like UW... (is you're) always reaching out for help, never leaving the operating room until you’ve left things as good as you can. You’re not trying to prove anything to anyone, you’re just trying to get it right. I’ve always gotten a lot of comfort after developing a close rapport with patients and their families. I feel like we’re all human beings and we’re in this together. I’m not perfect, but I am going to be there for them to get through it.
For me, humor is a huge part of my life. Comedy and humor has been a part of my coping mechanism. The one thing I write about in the book and I think this is really real, is that you have to find some way to put some of this aside when you go home. Every surgeon has this proverbial metaphorical box. You have to be able to access it so you can be there for the patient but you have to be able to get out of it. When a patient is doing badly, it’s really hard to be there with your family and to not be thinking about it and be checking your lab. I don’t feel like I’m an anxious person but I always seem to be aware that things can go wrong. It’s a constant balance for sure.
In your book you mention an operating room ritual before you begin operating on someone. What is that for you?
First we will go meet with the family and talk to them about the process. Once we go into the operating room we do this 'time out' and our organ procurement coordinator will read something about the donor. It’s really special because it helps us remember why we’re doing this and the solemnness and solemnity of the moment, (but) then you quickly turn it off and move on. Some of these can be very poignant and emotional. When you come back from procurement you hug your kids a little tighter.
How has publishing the book affected how you see your work? What have you learned through the process?
The book has made me think a lot about our field and what is special about it. One thing that is unique about transplantation from other areas of medicine is where others are trying to prevent people from dying …in transplantation we start from death. We take from death. We interact with these donors and their families. I really do believe the donors are our patients, too. The donors, the gift they are giving, is so incredibly special. These people are heroes to me and they should be celebrated.
Since I’ve written the book, I’ve gotten a ton of emails that have been awesome. A lot have been from donor families about how the one positive thing they still remember from their loved one’s death is to know their loved one's heart is out there beating. It’s just something that makes them feel so grateful. People can be amazing. I think similarly for the living donors, I see these people as such incredible heroes. They give a piece of their organ to save someone. It’s just very beautiful.
I did one today, someone donating to a kidney chain, so this one transplant is leading to (several other transplants.) It just shows there is greatness in mankind. There are still really great people out there.
What is the trend in the frequency of donation?
Deceased donation has gone up significantly since the opioid epidemic. That’s the silver lining to this horrible problem. With a living donor, it’s been pretty stable. But the thing that has changed dramatically is the ability to do this (transplant chain.) Instead of donating to someone who’s related to them, a donor can give it to someone else and it allows someone who is not compatible to give an organ to save someone else. We have had more and more people coming forward who just donate into the pool.
In your book you mention how, as a resident, you found yourself becoming more focused on completing tasks than exercising compassion and connecting with patients. How did you change that mentality?
You’re so incredibly busy that the patients can almost feel like they’re in the way. You’re on this team, trying to get all these tasks done, but you can get to the point where you don’t think they’re people. Obviously that’s not great.
People are focused a little bit more now on the compassion piece and maybe the teams are a little bit better. We have a lot of support in what we call the mid-levels, like physicians assistants now. I think the hospital I’m in now is just run really well. I think regardless, it’s a real challenge. It’s a tough balance because there can be all these things you need to do to the patient, procedures or tests, and although they want to get well, they don’t want that test. Getting that stuff done but taking the time to relate to the patient is a challenge. (But) I think we’re better now.
When you do surgery you do have to detach… once you start an operation, you are really focused at the task at hand. I don’t think about them as a person when I’m doing the surgery. I try to block that out and (so) the focus is really on the procedure. There is an element of that that is needed.
What do you know now that you wish you could go back and tell your younger surgeon self?
I was definitely obsessed with trying to be the perfect resident and trying to get everything done. I always went all in and the rest of my life was pretty chaotic. I actually got evicted from my apartment in Chicago. I didn’t pay my rent or my electricity and came home to find a sign on the door that I was evicted. I was literally just working every second and while I think I gained a lot knowledge and self-reliance, I didn’t try to balance my life in any way. I think there are better ways to do it (and) thinking more about not always trying to get every box checked but kind of living in the moment more. I don’t have regrets but I certainly gave up a lot to that.
What’s the biggest challenge you see in transplantation today?
There are challenges in how you deliver health care and how you pay for things. When I think about transplantation, even though I love the field, the health system loves these heroic things like organ transplants but hasn’t figured out how to pay and support the day-to-day care to prevent a transplant. A lot of kidneys we do is for Type 2 Diabetes and a lot of livers we do is for alcoholism. And while I’m all for transplantation, it would be great if we somehow found a way to focus on the day-to-day care. The biggest challenge in transplantation is a shortage of organs. We do have these selection meetings where we decide who and who not to list (to receive an organ). We have a great team who works through these things. It’s hard when you have a treatment that could save someone but because of the limited resources you can’t do it.