Out of the Box

I happened to be reading Ozan Varol's book two days ago, when I was on call looking after patients with kidney disease. As a rocket scientist turned award-winning author, Ozan Varol championed moving out of our comfort zone. That means taking off the training wheels and moving away from the familiar path.

One of my call duties was to look after and orchestrate kidney transplant from a brain death donor after a tragic traffic accident. My two patients were waiting for the new kidneys. They didn't speak much, and somewhere in the background rose the ticking of the clock in our medical ward, an unwavering rhythm of stability, sharply at odds with the uncertainty on their faces. I was counting my fingers. We weren't sure how long the wait would be. Waiting, for my patients on dialysis, was a bitter cocktail of aching awareness, visceral pain, and mental crush.

The organs had already been taken out of the road crash victim's body for over ten hours. I didn't want to disclose too much to the two taciturn kidney transplant candidates how we are in a race against the clock as soon as a kidney was recovered and placed on ice. Patients should not be bothered with the science that kidneys would start to degrade during the high-stakes window called cold ischaemic time. Yes, prolonged cold storage of kidneys inside the box is no laughing matter – there are starving kidneys at stake – but, hard as we tried, our operating rooms were all occupied with emergency surgery that afternoon.

Ozan Varol reminds me the pitfall of managing uncertainty. In other words, our brain often steers us toward the seemingly safest path – inaction. The brain, to paraphrase psychologist Rick Hanson, is like Velcro for the negative but Teflon for the positive.

To overcome the uncertainty, my urologist friend and I quickly threw away the training wheels and old rules. We tried out best to generate as many new ideas as we could. So we explored the idea of transporting the kidney organ and patient to another hospital nearby, where we can operate. Before we worked out the plan in more detail, we were told the availability of operation room in our hospital. Not one but two. If we followed our tradition like what we have been doing for the last twenty years, we would have sent the first patient to have the kidney transplant operation, and then the next one. One after another. Such tendency to follow the tradition isn't too wrong, but it means another few hours' wait for the second kidney. We knew the kidneys' quality would be better if we can beat the clock. At the end of the day, we were able to gather more than six hardworking surgeons, not to mention two teams of anaesthetists, to carry out two kidney transplant operations in parellel. Wait. I shouldn’t say “at the end of the day”; our transplant surgery started at one in the very early morning.

I am really grateful. Two days later, I am still telling it.