Transplant teams take things one day at a time
'Lots of good memories and lots of bad memories'
Friday, November 28, 2003
Anita Srikameswaran, Pittsburgh Post-Gazette
A few outbreak victims needed liver transplants because their own organs had been irreparably damaged by hepatitis A infection.
Jeffrey Cook, 38, of Aliquippa, died shortly after transplant surgery at the University of Pittsburgh Medical Center. Dineen Wieczorek, 52, of Hopewell, died before the surgery could be performed at the Cleveland Clinic.
Jolan Dallatore has worked in UPMC Presbyterian's liver transplant intensive care unit since 1987. Privacy laws forbid medical staff from discussing specific patients without their permission, but it's obvious she's been around the liver transplant block a few times.
"Lots of good memories and lots of bad memories," Dallatore said. Still, "most of the time it's a pretty good place to be."
She works three or four 12-hour shifts, mostly daytime, per week. On those days, she gets going a little after 4 a.m.
The typical liver transplant patient, Dallatore said, is very ill before the surgery and looks it. Skin and eyes are a sickly yellow. The belly is bloated with excess fluid despite overall malnourishment because of an inability to eat.
After eight to 10 hours of transplant surgery, the patient, still on a ventilator to assist breathing, is taken directly to the specialized ICU.
"There are a lot of wires, intravenous lines, drains and tubing, which sometimes frighten families," Dallatore said.
"But as the patient recovers, these things start being removed." On the plus side, family members also notice the rapid de-yellowing of the skin.
The patient is gradually brought out of sedation and weaned off the breathing machine to awaken.
"Most of the time they don't believe it's three or four days later," the nurse said. "As they recover their strength and they're moving and starting to develop an appetite again, you definitely see it. They do feel better."
When the time comes for transfer to a regular ward, the transplant patient is walking and talking again.
The hepatitis A outbreak triggered some concerns because it was unusual and, as she put it, who doesn't eat at restaurants?
But for the most part, it was business as usual in the always-full transplant ICU.
"It's not anything I would go home and dwell on," Dallatore said. "It's just another day here."
(Anita Srikameswaran can be reached at firstname.lastname@example.org or 412-263-3858.)
More on this outbreak: Chi-Chi's Hepatitis A Outbreak