The Highs and Lows of a Transplant Surgeon

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Like many professionals who care deeply for their patients, I lived every day of my career with the horrible reality that more than half of the people awaiting an organ will never get them.

—Bud Shaw, MD


Title: Last Night in the OR: A Transplant Surgeon’s Odyssey
Author: Bud Shaw, MD
Publisher: Plume, division of Penguin Group
Publication date: September 15, 2015
Price: $16.00; paperback, 304 pages

Surgery has a distinct place in medicine. Surgeons cut deep into our bodies amid clusters of nerves and ligaments and pulsing organs; a slight mishap brings blood. And the scalpel—the tool of the trade—is just a specially designed knife, as is a butcher knife and a bayonet. And surgeons begin their work as we drift far away on a cloud of propofol.

Organ transplant is one of the most difficult surgical procedures—not just technically but with the emotions swirling around waiting for someone to die so that another may live. Bud Shaw, MD, captures the emotion, heartache, and drama of organ transplant and more in his gritty memoir, Last Night in the OR: A Transplant Surgeon’s Odyssey.

In his author’s note, Dr. Shaw sums up the emotional roller coaster of his profession. He writes: “Like many professionals who care deeply for their patients, I lived every day of my career with the horrible reality that more than half of the people awaiting an organ will never get them.”

His book, sometimes rough around the edges, is a fast-paced chronicle of the early 1980s, when the field of organ transplantation was pushing into uncharted medical territory, which was fraught with fear and ethical taboos. Dr. Shaw was on the front lines. “I was desperate to show how good I was that night,” he writes in his opening line, spoken like a true surgeon.

A Daring Profession

The book begins on Dr. Shaw’s last day as a surgery resident at the University of Utah in 1981. The 31-year-old doctor aspired to be a transplant surgeon, and, with pluck and good fortune, he was granted a training position on the surgical team of Thomas E. Starzl, MD, PhD, the “father of liver transplantation” and perhaps the most renowned transplant surgeon of that time.

Besides Dr. Shaw’s burning desire to become part of this daring transplant profession, the reader also learns of his passion for football and thrill seeking. More important, the cadence and voice of the book are established. It reads like a novel, and the author is clearly a fan of terse Hemingwayesque prose, which, given the sensitivity of his life-and-death profession, sometimes feels a bit too clipped.

That said, Dr. Shaw’s writing style is obviously tailored to capture the grittiness of liver transplantation and the men who got their hands dirty. Yes, at the time, this profession was gender-centric—the operating room of Dr. Shaw’s surgical adventures was scented with testosterone.

University of Pittsburgh

Dr. Shaw sold his wife’s car, loaded up their belongings, and schlepped across the country to the University of Pittsburgh Medical Center, where Dr. Starzl had his transplant clinic. Although there’s no shortage of drama in Dr. Shaw’s life, there is, however, a shortage of his wife’s presence in his life in the book.

Upon arriving in Pittsburgh, Dr. Shaw immediately gets embroiled in a scheduling brouhaha that almost cost him his position; inadvertently, dates were mixed up, and he was 2 weeks late. In some rather course language, Dr. Starzl’s assistant barked into the phone, “Get your butt here as soon as possible or else!”

A Closer Look at Surgeons

For readers looking for detailed medical descriptions of the nascent field of transplantation, they should look elsewhere. Instead, Last Night in the OR is textured with the internal workings of, what was at the time, a rough-and-tumble foray into the lives of surgeons who drop f-bombs, smoke, hang-glide, and hold football as a sacred pastime. It makes for an exciting read but sometimes a bit ham-handed in the delivery.

For example, on Dr. Shaw’s first day, Sandee, a nurse on the transplant team, grabbed him by the arm and showed him around the hospital. As they moved through the intensive care unit, a medical student with a clipboard approached and asked Dr. Shaw to sign a petition banning liver transplants on ethical grounds. When Dr. Shaw explained that he’s the new transplant fellow, the medical student responded firmly, “Then you should definitely sign it.”

After some rather staged barbs between Sandee and the medical student about the net worth of liver transplantation, the outgunned medical student resorted to a crass sports analogy to make her point. To this Sandee retorted, “This ain’t baseball, sweetie.”

Questionable Anecdotes

Dr. Shaw fills in his backstory with lively excursions into the past: some work, some do not. This book’s story, according to the title, is located largely in the organ transplant operating room, and there’s enough there to fill several books. However, somehow, perhaps to lace his book with dicey commercial anecdotes, the author recalls past events that don’t relate to the captivating theme of his profession.

For example, during his stint on the psychiatric ward in his third-year surgery rotation, a 40-year-old man named Ike with erectile dysfunction threatens suicide by gunshot if Dr. Shaw can’t help him. This is pre–little-blue-pill days, so Dr. Shaw’s prescription pad proved impotent for Ike’s issue. So, Dr. Shaw made the doctor’s cardinal sin: He got personally involved with a patient, no less one who is suicidal. Ike didn’t kill himself, but it got pretty messy, and Dr. Shaw explained his medical faux pas like this: “I felt so stupid. I felt like I should have known better, that my supervisor had taught us about this sort of thing and I’d dozed off.”

Last Night in the OR is structured in three parts, with each one broken into short chapters with catchy titles and an arresting opening. This format is stock and trade for commercial nonfiction. Dr. Shaw is a capable writer, but at times, he tries too hard to impress the reader with visceral prose.

For example, in a chapter called “Good Opera,” he unleashed this beaut: “On the table lay a man from Kansas. He had a wife, two daughters under five, and a bad liver. He had a belly full of fluid, skin glowing like a pumpkin, and a nest of veins like snakes between my knife and his liver.” Snakes? Knife? Dr. Shaw’s images invoke a Tarzan-like death struggle, instead of a risky and highly technical surgical procedure with a person’s life in the balance.

Much of the Story Left Untold

At times, Last Night in the OR is a rollicking read, but Dr. Shaw made several mistakes when taking pen to paper, beginning with the title’s subhead: “A Transplant Surgeon’s Odyssey.” The reader learns little about the intriguing science and techniques of organ transplantation; immune system rejection and HLA markers are absent from Dr. Shaw’s narrative.

And the last several chapters are flashbacks about his mother’s losing battle with lung cancer while Dr. Shaw was an adolescent. His mother was a heavy smoker, and there were some anger and guilt issues between Dr. Shaw and his father. OK, this was an important chapter in his life, but what does it have to do with last night in the operating room or a transplant surgeon’s odyssey?

By all accounts, Dr. Shaw is a skilled and dedicated surgeon who has saved countless lives. However, too little of that story was left untold. Instead, he attempted to write a commercial product, and to that end, he succeeded; Last Night in the OR is the equivalent of a medical beach read. For readers of The ASCO Post vacationing in Turks and Caicos or some other tropical destination, this book is recommended. For those in the clinic and elsewhere in the oncology community, it may not be. ■