Terry Ratner RN, BS, MFA - nurse, writer, educator - click to return home
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Nurses' Corner
Personal Memoir


Relinquishing a Soul

At the moment you are most in awe of all there
is about life that you don't understand,
you are closer to understanding it all than at any other time.
~ Jane Wagner

I watched a stranger's heart beating today. It was the size of a fist, flesh-colored, and pulsating as blood pumped oxygen through his vascular system. I knew little about the man whose naked body lay before me, only that he had come into the emergency department four days earlier as a hit and run victim with a closed-head injury, two fractured femurs, multiple broken ribs, and a fractured right arm. His family said he wanted to be an organ donor and assist others in need when he no longer had use for his body parts.

One of the surgeons asked if I wanted to observe the procurement of organs. I thought about the recipients, somewhere, waiting for the delivery of a kidney or a liver. Were they dreaming of organs, packed tightly in ice, flown to their destination, to be transplanted in their failing bodies? I wondered if their thoughts weren't mixed with the sadness of losing a life to gain a life.

This was something new to me, as I worked as a nurse in the post-anesthesia unit and seldom ventured into the operating rooms. I hadn't viewed a surgical procedure for years and had never seen a beating human heart.

Two masked surgeons were gowned and gloved while one nurse filled out paperwork and the other set up suction and positioned the overhead lights. A surgical tech gathered shiny steel instruments and formed the sterile field around the patient.

The body on the gurney had been ventilated for the past four days. Calloused areas appeared on his feet and hands. He was a large muscular man, thirty-five years old, with a mole, the size of a dime, on his left hip. When I leaned in close over the gurney, I could see his pulse beating in the arteries of his neck. When I touched his arm, it felt warm and resilient, just like mine.

I watched as one of the nurses prepped his upper chest with Betadine and the surgeons prepared to cut. The man's lateral chest was discolored with purple and red ecchymoses, and his broken arm was bandaged with cast padding and ace wrap.

The surgeon spread sterile towels that hid the patient's face, but from behind, I saw thick strands of his long dark hair. Every few minutes my eyes wandered down to the coarse black hair that moved with the slightest motion. It somehow proved that a person was under the sterile blue cloths. I didn't want to see his face; that would have been difficult. It might remind me to look once again at the monitors that provided evidence of life-heart rhythm, heart rate, and oxygenation-proof that he was still living, not yet departed from our world.

The surgeon started to cut, as if unzipping a parka from the patient's lower abdomen up to the base of his neck. Then, with a sharp instrument he sawed lengthwise, so that the rib cage could be parted, before installing a large retractor that pulled the two sides of the incision apart. Now it was as wide as it was long.

Dressed in blue scrubs, a yellow isolation gown, and a mask, the surgeon held an electric cauterizing wand. It looked like a like a cheap bank pen on a cord but functioned like a scalpel. The wand cut and burned as the surgeon made his incisions, melting shut each severed vessel, causing less bleeding and an odor like seared meat.

Even on the inside, the patient looked very much alive. I watched the pulse of his heartbeat in his liver and all the way down to his aorta. The electronic beat from the heart monitor reinforced the impression that the patient was a living, breathing, thriving person.

I thought about my science class in high school and how I had dissected frogs. Some of the girls had giggled and turned red, but I'd wanted to take part in the dissection and learn about their anatomy. I used sharp blades to carve out organs and set them on a blue towel before labeling. I watched the delicate hands of squeamish girls unable to cut through the slimy skin. Boys laughed to cover up their feelings while slicing their frogs into cubes. The ambiguity I felt then was with me today.

In college, I remember the cats, all different sizes and colors, waiting to be dissected by eager pre-nursing students. Then there were the cadavers, a man and woman who donated their bodies to science so that nursing students could probe and use scalpels to dissect each organ. Somehow it seemed easier to work on bodies that were cold, stiff, and discolored than to observe organ procurement. I knew the cadavers were dead; more like rubber mannequins than humans, but the man on this gurney had soft skin, with some color to his face, and his symmetrical lungs moved up and down with equal breathing-inspiration and expiration.

An anesthesiologist stood behind the hidden face, watching the monitors and regulating the patient's oxygenation. The hum of the ventilator, the beats reverberating on the screen, and the click of the staple gun blended in with Billy Joel's greatest hits playing on the stereo. I stepped up on a stool to view the opened chest and stared at the amazing muscle, the human heart, counting the beats and watching the synchronized movement gently lift and fall. It's a mixing-machine part, the human body's most animated organ.

The patient had hepatitis C, and transplanting his heart was not an option. I was told that a recipient wouldn't last a year with his heart, but his kidneys and liver would be transported to someone in need.

I watched as the surgeons carefully examined his liver, turning it side to side and noting the healthy color and size. They said it would be sent to California for a hepatitis C recipient. One of the donor network nurses explained that people with hepatitis C share the same body chemistry, and so a recipient with hepatitis C adapts easily to a hepatitis C donor's kidney and liver.

I stared at this brilliant creation, thinking about God's creatures and my heart, your heart, the hearts of all the staff in the room. I've heard that when surgeons take out a heart for transplant, the room becomes silent, prayer-like. They say that once you hold the human heart in your hands, you'll understand that feeling. It's like holding someone's soul.

The lungs were striped with black lines from smoking, and I wondered what those tar-damaged organs might have looked like in thirty years. The intestines were as long and amazing as I remembered them, a coiled labyrinth of machinery perfected by the same creator. One of the surgeons bundled them together under sterile green towels, as they continued to suction and do their work.

The abdominal and thoracic aorta had to be crossed-clamped before the kidneys and liver could be removed. I watched as the heart muscle quieted, as the fast dance became a slow waltz. It quivered a bit before it stopped its movement. The anesthesiologist turned off the monitor and the ventilator and left the room. His work was finished.

A dose of Heparin was given to prevent clotting, as a nurse poured crushed ice into the abdominal cavity. The surgeons suctioned out blood before procuring the liver and kidneys.

The differences between life and death became issues in my mind as I tried to understand the organ donation process. I thought about the spirit and soul and wondered what the difference was. I'd always felt the soul to be in one's heart. I wanted to pinpoint the precise moment when the spirit, the soul, whatever you wish to call it, has ceased to exist. This very body that looked only bruised an hour ago began to turn a darker shade with a tint of blue and had a hardened, cold exterior. I knew the look of death. Before my eyes, the body had discernibly altered. Something-call it spirit, or soul, or life force-had departed. I heard myself sigh deeply, as though, with his departure, I too had been freed. The quandary of that thin line between life and death was no longer there.

I thought about a soul's passing. Do departing spirits fly by loved ones, brushing against them in noticeable ways? Do they hover over their useless bodies, procrastinating over their fate? I'd heard many stories. A patient in the recovery room told me she had once died in a previous surgery and was brought back to life.

"I was above my body, looking down at the chaos taking place in the surgical room. Then I was in the waiting room watching my husband and family cry in a corner. I knew the time wasn't right to die," she'd said. "When I recovered, my heart and soul were somehow changed. I saw things in people I never noticed before."

We looked at one another and held each other's hand. We both understood.

But this body lying before me wasn't going to recover. His soul and spirit must move on. Is there a special heaven set aside for people who die like this?

I listened to the sound of my own breathing, felt the puffs of breath that circulated around my blue mask. I breathed in and I breathed out. For a moment, I felt lost even within the area around me. I looked across the room and imagined all of us with that miraculous muscle pulsating, keeping us alive, that familiar sound reverberating in my ears when I place my stethoscope on someone's chest: lub-dub, lub-dub, lub-dub. We were here, my co-workers and I, still part of the material world, our souls still somehow, somewhere attached to our bodies, perhaps to our hearts. Rays of light seemed to radiate through the room, past the man with long, dark hair, past the surgeons and nurses. And I knew a man's soul had moved on.