“Love the life you live. Live the life you love.” ~ Bob Marley
Medicine is a job of passion, devotion, conviction and excitement. The field of medicine gives one a wide spectrum of possibilities, to have the lifestyle you desire, living life to the fullest. Each day, as it comes, may be full of new expressions and adventures. Eventually one may choose the lifestyle one wants and shape one’s future, all the while having the satisfaction of being able to help the ones in need. I am a minimally access and open GI-HPB surgeon based in Delhi. I have been in the practice of gastro-intestinal and hepato-pancreatobiliary surgery for past 5 years with specific focus on liver transplant for past two and half years.
Background and Scope
All through my MBBS, the field of surgery always intrigued me. All through my anatomy hall dissection, I was always curious to see and work with the real organs inside the human body. As I progressed into my MS, more complicated surgeries attracted me more; the fields like CTVS, GI-HPB surgery and organ transplantation were so interesting to me that I planned my career in the said field. Liver Transplantation combines them all. This surgery entails a donor and a recipient.
A donor may be a deceased person, brain dead yet heart beating (and more recently after cardiac death as well), having donated the body for organ donation and the organs such as liver, kidneys, bowel, bones, cornea, heart, and lungs are harvested. Donor can also be a living person who is willingly donating a part of his/her liver to someone related and in need. Liver recipients are the patients with damaged livers (chronic liver disease or cirrhosis) due to chronic alcohol abuse, prolonged fatty liver, hepatitis B and C infections, autoimmune and other causes. Sometimes, patients who have liver cancers with cirrhosis also receive liver transplant in certain situations. The babies which undergo liver transplant mostly have an inherited liver developmental anomaly known as extra-hepatic biliary atresia. Living donor liver transplant (LDLT) is technically more difficult and is relatively done by fewer centers in the west. India, however, is the hub of LDLTs with over 2000
LDLTs happening per year in our country. We receive patients not just from various parts of India but from around the world. South east Asia including indian subcontinent, middle eastern countries, African countries, eastern Europe and far eastern countries make the major international medical tourism for liver transplant to various centers of India. Liver transplantation is a team work, involving a multidisciplinary team of surgeons, hepatologists, anesthesia and critical care specialists, infection control team, physiotherapists, dieticians, pediatricians, nurses, among others.
A liver transplant surgeon has a busy lifestyle and marginates towards a flamboyant one, in a good way. One needs to learn to make a balance between personal and professional life. There is a lot of love and respect for the liver transplant surgeon among patients, friends and society and the satisfaction rating is high. Most patients are very sick pre-operatively with significantly guarded prognosis and a reduced lifespan to as short as a few days to weeks. The transplantation of liver is almost like giving another life to the patient and it feels extremely satisfying to discharge patients and see them coming to the followup clinic with a big smile on their faces. The field requires dedication and devotion to one’s patients and needs extensive mental and physical involvement in welfare towards the patient’s betterment.
Inside the operating room
Liver transplant is a long surgery, probably one of the longest few. A typical donor surgery lasts about 8-10 hours while a recipient surgery may last about 14 -16 hours, latter being variable. There have been times when I have operated for more than 24 hours on a recipient and tiresome as it may have been, it’s a great feeling to be coming out of the operating room having saved someone’s life.
The operating room is full of high-end tech, including most advanced anesthesia setups, various energy devices, intra-operative doppler machine, C-arm, various sets of instruments, including microsurgical and vascular instruments. Three surgeons operate on the patient along with a scrub nurse, and surgical loops for magnified view of the surgical field are used by each of the surgeons. The ones I use give me a 3.5 times magnified view, which helps me clearly see even the intima of a tiny artery!!
Growing up the ladder and retirement
Getting into any field, one wants to know how is it going to treat you in long run. My advice to anyone’s seeking career advice from me is – How do you see yourself at 6 months, 2 years and 5 years from now? If you are ok with hard work and lots of learning near future, learning newer skills and starting to settle down at 2 years and finally having a settlement at 5 years, Liver transplant may be the field for you.
This field has a learning curve to it. One gets the independence in 8-10 years of time and may start their own liver transplant programs. There is no age of retirement but with experience comes more freedom to choose one’s lifestyle. It’s a field which gives you lots of thrill and excitement, name and fame and satisfaction.