Archive for May, 2010

SLICE: He’s a smooth operator

Published Feb 23, 2010
Published Tuesday February 23, 2010


Dr. Dave Mercer transplants a new liver into Thomas Martin of Sedalia, Mo., at the Nebraska Medical Center. Helping him are scrub tech Erin McLaughlin at left and medical student Mandy Byers at right. Music is playing from an iPod. Mercer likes to keep the atmosphere light during surgeries. At one point a scrub tech called him “sir” and he replied: “Sir? What’s with sir? I never get sir.”


By Rick Ruggles
World-Herald staff writer



Dr. Dave Mercer transplants a new liver into Thomas Martin of Sedalia, Mo., at the Nebraska Medical Center. Helping him are scrub tech Erin McLaughlin at left and medical student Mandy Byers at right. Music is playing from an iPod. Mercer likes to keep the atmosphere light during surgeries. At one point a scrub tech called him “sir” and he replied: “Sir? What’s with sir? I never get sir.”

Dr. Dave Mercer took a final glance at his BlackBerry and walked through the operating room doors.


For the next few hours, he would hold a man’s life — and liver — in his hands.


As a surgeon who performs transplants of the small intestine, liver, pancreas and kidney at the Nebraska Medical Center, Mercer had been summoned this afternoon to the operating room. A liver was available. A patient was ready.


For the moment, though, the talk in the operating room revolved around Mercer’s music.


“Did you bring your iPod?” a member of the operating team asked him.


“No,” Mercer said.


“Darn it.”


“I didn’t think we were going to be transplanting today,” Mercer said.


Mercer, 39, defies the stereotype of the brooding surgeon, perpetually irritated at his subordinates. Mercer likes to keep the atmosphere light. His orders come out more as questions, with a polite lilt. He’s Canada cool — he grew up just outside Edmonton, Alberta.


Thomas Martin lay on the operating room table, thoroughly anesthetized and with a ventilator tube down his throat. He and his wife, Penny, had rushed by car from Sedalia, Mo., to the med center when they learned this morning that a liver was available.


It had been a rough year for Martin, 52. His feet and stomach swelled with fluid because his liver had ceased breaking down foods and cleaning his blood. Sometimes over the past year he needed a needle in his belly to drain the fluid.


Dr. Lori Kautzman, a transplant-surgeon-in-training, would help Mercer on this operation. Already her value had been evident. She had her iPod, and it would provide the music through the surgery.


Placed on a platform just above and behind the operating area, the iPod began to quietly rumble out rap music, then a tune by Aussie rockers AC/DC. The anesthesiologist, Dr. Michael Fee, said AC/DC was more like it.


Nurses bathed Martin’s chest and stomach in yellow-orange iodine to sterilize the skin. They covered his head and body in blue drapes.


Mercer trimmed away part of the drapes to expose Martin’s stomach. Mercer tapped the stomach with his hands, then with his fingers. He figured this surgery would take from four to six hours.


“Everybody ready to go?” Mercer asked.


At 4:05 p.m., the left-handed Mercer took a scalpel and lined the area on the stomach that he would open. He handed the scalpel to the scrub technician and took an electrocautery device, which cuts away tissue with an electrical current. A bit of smoke rose from Martin’s stomach, and a dull smell of smoke and burning skin pervaded the air.


It took only seven minutes to open the stomach for a look at the liver. The surgical team suctioned 1½ gallons of fluid from the stomach.


A woman brought in a cooler containing Martin’s new liver. No information was divulged about its origins.


As Mercer cut, blood squirted on his gloves and then onto the front of his blue surgical gown.


The iPod seemed stuck for a moment. “Is that part of the song?” Mercer asked.


He had opened a large enough area for metal retracting devices to be connected to the abdomen. The abdominal wall was pulled back to leave a large cavity from which Mercer could remove the liver and put in the new one.


Mercer and Kautzman leaned over the stomach, peered in and began to tie off veins with silk thread so they wouldn’t gush blood. Mandy Byers, a third-year med student, also stood at Martin’s side.


“Never panic when something bleeds. When you panic, that’s when you jack things up,” Mercer said to Kautzman and Byers from the other side of the operating table.


“There’s an old saying — you operate slowly to finish quickly.”


Mercer asked that the music be turned up “just a teeny bit.” The Beastie Boys came through more clearly, suggesting that you fight for the right to party.


Mercer remembers the day he decided to become a physician. A doctor showed up at his third-grade class with a stethoscope. Mercer put it on and listened to people breathe. “That was the exact moment,” he said a few weeks ago.


He earned his medical degree and a Ph.D. at the University of Alberta, then became a fellow in surgical transplantation at the Nebraska Medical Center early last decade.


He joined the University of Alberta’s surgery department in 2004 but returned to the Nebraska Medical Center two years later. It’s a superb institution for transplantation, he said. More small intestine transplants are done there than anywhere in the country, he said, and no institution in a six-state region does more liver transplants.


He estimated that he does 30 transplants a year and 200 additional surgeries annually, typically fixing intestinal problems.


In a brief meeting with Mercer an hour and 45 minutes before the surgery, Martin talked about his extensive guitar collection.


“That’s pretty hip of you,” Mercer said. “Cool.”


The surgeon owns two guitars but doesn’t claim to be much of a player. He has a Kiss mouse pad in his office.


Mercer, who is married and has three young children, is tall and lean and plays men’s league hockey once a week. He often doesn’t tuck in his shirt. He talks rapidly and likes to laugh.


He believes it’s wise to never be too optimistic about a surgery. It’s when you think it went perfectly that they’re calling you back to the operating room at 2 a.m. because of complications, he said.


Nevertheless, he’s not the kind to get uptight and figures everyone performs better when they’re relaxed.


By 5:10 p.m., Mercer had snipped most of the connections that held Martin’s liver in place. He made sure the donor organ was available.


“OK,” he said. “I’m gonna cut the liver out.” Mercer made some more snips.


“Do we have some better scissors? These do kind of suck,” he said.


He had cut the bile duct, veins and artery. Out came the diseased liver, rough and hard, almost as big as a football. He held it in his right hand and placed it in a blue bowl.


He poured several small buckets of saline into the cavern where Martin’s liver had been. Kautzman used a suction device to drain it out. The saline washes away blood and helps the surgeon see where there is new bleeding.


“I’ve got to get the clamp on the kidney and then pull the kidney out of the way,” Mercer told Kautzman and Byers. “And we are going to need the liver up in about 20 seconds.”


He told Byers to hold the new liver, one hand under it, one on top. They placed it inside the hole and began threading it in with what is virtually fishing line.


The old liver weighed about 3 pounds and 5 ounces, the new one just a bit less.


Mercer was quiet and serious as he sewed for the next 25 minutes. Bon Jovi sang on the iPod: “It’s now or never. I ain’t gonna live forever.”


Erin McLaughlin, the scrub tech who had been handing Mercer the tools, turned that job over to Molly Gunter.


“Dr. Mercer, you’re getting Molly now,” McLaughlin said.


“Oh, thank God,” Mercer said facetiously.


Now it was time to unclamp a key vein into the liver, meaning cold preservative solution and waste products stored inside the organ would flush into the heart. This could overwhelm the heart and shut it down.


“You guys have the paddle in the room?” Mercer asked, referring to the paddles that could jolt the heart back to life. “Four minutes from unclamping. Four or five minutes.”


Then Mercer said again: “Paddles are up?”


“Yep,” said Gunter.


“OK. Is everybody ready?” He unclamped the new liver about 6 p.m. The heart kept pounding and the liver began to fill with blood. It pulsed like a little animal with the beating of the heart.


“That is nice,” Mercer said. “And we’re not bleeding very much.”


He poured a bucket of solution in and Kautzman suctioned it out. The blood flow made the liver turn from brownish to pinkish.


“That means the liver is happy,” the surgeon said.


The atmosphere lightened. “Is that ‘Funky Cold Medina’?” Mercer asked, referring to the absurd tune from the 1980s.


The heart’s pounding was evident against the diaphragm inside the open cavity. Mercer asked for a bucket of saline and Gunter handed it to him.


“Will you take that back?” he said of the bucket after he had emptied it into the hole in Martin’s stomach.


“Sorry, sir,” Gunter said.


“No worries. Sir? What’s with sir?” Mercer said. “I never get sir.”


He trimmed off the gallbladder, which looked like a long, fat minnow. Mercer’s favorite Pearl Jam song played, and he commented on it.


They took the retractors off and Kautzman started stitching up the huge wound. With the drying iodine turning light brown, the skin and cavern in Martin’s stomach looked a bit like a half-eaten Thanksgiving turkey.


Mercer and Kautzman sewed, and then Kautzman stapled the remaining flap of skin.


“When a case goes by quickly, I think, ‘OK, did we do everything?’’’ Mercer said. And this had gone quickly. They finished at 7:04 p.m. — just less than a three-hour transplant.


“Dr. Kautzman, thank you very much,” Mercer said. “A pleasure.”


He headed toward the waiting room with a spot of blood on his right knee from the surgery.


Lots of bad things could still happen, some involving blood clotting or blood leaking, but the surgery had gone smoothly.


He walked toward Martin’s wife.


“It went exactly as we would hope,” he told her. “We put the new liver in and sewed it up and it looks like it belongs there.”


Tears came to her eyes.


He told her that things could go awry. He said he would remain “paranoid” for a while and suggested they “hope for the best and plan for the worst.” He patted her on the knee.


“It’s surreal, isn’t it?” he said to her.


“Yeah,” she said.


Mercer walked out of the waiting room. He looked forward to watching the Winter Olympics on TV with his family.


Contact the writer:


444-1123, rick.ruggles@owh.com