By Cherylyn Pangaibat
My journey as a scrub nurse were like scenes in Grey's Anatomy series... Air ambulance landing on our helipad with an injured patient from a road traffic accident needing surgical intervention immediately.
Time is of the essence. There is no time to follow the routine surgical hand washing or extensive checking of swabs and instruments. Because during this time, sterility and surgical count are only secondary to saving the life of this patient whose vital signs were hanging by a thread.
This kind of experience has honed me to become a better nurse. I can proudly say I have built a good foundation of skills and knowledge through my clinical experience over the years. A decade of being a theatre nurse trained in the biggest government tertiary hospital in the Philippines and a major trauma hospital in Wales has provided a roadmap to my successful nursing career.
Despite the impressive professional experience I have, it was never enough for me. I wanted more and there’s one thing I have not done in my career, Transplant Nursing. My journey as a transplant nurse wasn't straightforward. Life had its mysterious way of showing me what I am destined to do.
Several years ago I moved to a town in Bedfordshire area for personal reasons. I landed a job there but only to find out that the Trust offered a temporary contract. Hence, I leaned towards the practical choice, which was to look for a stable job.
I received a job offer from a prestigious eye hospital in London but I've been there, done that and I don’t want to do it again (no offence to ophthalmic nurses). I looked further and applied to one of the highly academic Trusts in London. The application process was extensive. There were five stages in the recruitment day: Drug calculation exam, Nursing theory exam, Group discussion, practical exam and finally, the panel interview. At the end of that day, I was mentally and physically drained. But the challenge was well worth it because a job in Liver Theatre Unit was granted to me.
Being a part of the biggest liver transplant unit in the United Kingdom and third in the world was not exactly a walk in the park. One thing I realised in this role is- Transplant Nursing is not for the faint hearted.
You may be wondering why?
How difficult is transplant nursing really?
How is it different from any other procedure?
Well, allow me to paint a picture in your mind. The kidneys, heart, lungs, liver, pancreas and intestines are the organs that have been successfully transplanted to a patient whether it is from a cadaveric organ donation or a live donor. Liver transplantation is what I am involved with.
Liver transplantation has three stages: Procurement (Organ Retrieval), Hepatectomy and Transplantation. We are all trained as a team to perform specific tasks during these stages as well as gaining expertise on liver perfusion.
During my training as an abdominal organ retrieval nurse, I was only shadowed for two nights and then I was on my own. The organ retrieval team comprises of the Clinical Lead (Fellow or senior registrar surgeon), assistant surgeon, scrub nurse and the perfusionist nurse.
As a scrub nurse, you are solely responsible for organising all your instruments, consumables (I even bring my own gloves at times), fluids (NaCl) and frozen NaCl. Though your perfusionist help you set up connecting your diathermy and suction, you as the scrub nurse is actually a one man army during organ retrieval. You must be highly organised to ensure you have everything you need for the procedure because not all trusts have the same specialty or stock the same item that you need. For instance, it is very seldom to find frozen NaCl in certain hospitals unless there is a cardiac centre within.
In this particular trust, I was also trained to perfuse the organ taken out from the patient. Forget about the surgeon transplanting the organ. If you did not perfuse the organ properly with the cold storage solution, no matter how great the surgeon is, it will fail. Thus, it is in your capable hands to keep the organ viable for transplantation to the recipient.
There are two kinds of retrieval the Donation after Circulatory Death (DCD) and the Donation after Brain death (DBD).
Donation after Circulatory Death or DCD is an organ donation where all the care supporting the patient to live will be withdrawn as per consent by the next of kin. The retrieval team must be on standby ready to commence with the procedure. Once the patient has expired the team has to wait for 5 minutes until the Specialist Nurse Organ Donation (SNOD) confirms the patient no longer have audible heartbeat. Once the patient is pronounced dead, we then start the procedure.
If you have seen a ruptured Abdominal Aortic Aneurysm Repair in your nursing career, imagine this, but 10 times faster. Each member of the team has a specific role to do. No one can afford to make a mistake because the procedure is time sensitive. A mental rehearsal of the procedure must be done by the entire team before the care is withdrawn.
However, not all patients die. In my experience only three out of ten expired. It is the waiting time that is the worst with DCD. Each organ has its window as to how long before you can stand down. The most excruciating part while waiting for the patient to die is hearing the relatives mourn for their loved ones.
Bear in mind that death does not choose age so there will be times that you will be retrieving from a paediatric patient as well. In the past, our team was called in one of the biggest children hospital for a retrieval. Unfortunately, I was the on call that weekend. My worst nightmare happened as we needed to retrieve for a child who was exact gender and age as my son at that time. As we travel towards the hospital, I kept thinking how will I cope emotionally after this. The patient did not die but we witnessed the agonising pain the parents were going through as they were in the anaesthetic room as they would usually be.
Donation after Brain Death is more straightforward. The average procedure time from knife to skin is five hours. The only setback of DBD is when the Cardiac team is involved. Organs harvested from a heart beating patient are well perfused until the point where the cold storage have been infused. That would be for another topic as to why the cardiac team have delays during retrieval.
An organ retrieval nurse does not only require vast emotional stability but a great physical stamina as well. There are instances when our team was called to travel depending on where the donor patient is located. We may be called in a nearby London or other UK hospitals but we may go as far as other European countries. In my experience, we have gone all the way to Malta to harvest organs for patients needing transplant in Paris, Italy and our base.
When I started my training as a transplant nurse we were sent out back to back. This means that if you were sent out for an organ donation while you are on call and another organ retrieval has been accepted, then you have no choice but to go back to the base, replenish your item and wait for the team to leave to go to another trust for another retrieval.
The longest time I have worked non stop was 36 hours, and that was the time we were sent to Malta. It might sound grand but it was a challenge to keep myself awake while doing the procedure. Nevertheless, transplant nursing is a rewarding and specialised experience that probably only few from the nursing population will consider to pursue.
I didn't intend to deter newly qualified to go into transplant nursing but to enlighten how challenging this career is. And I am not exaggerating when I say, Transplant Nursing is not for the faint hearted.
About the Author:
Cherilyn is a UK registered nurse with over two decades of experience in the theatre complex. She has vast experience in different specialities including Transplant Nursing. While she loves being a nurse, writing is one of her passion and have recently started a printing business in the UK. Above all, she is a single mum to a gorgeous boy who keeps her going everyday. Follow her twitter handle #empoweringnurses #empoweringwomen #proudtobepinoy