Life without a Lung and other Vital Organs

Listening to the new Pope Francis address the crowds on a cold, wet and emotional night  in St Peter’s Square you’d never have known he had only one lung.

We all know now of course. Thanks to intense press speculation and the power of the internet there’s barely a detail of his pre-pontiff life that has not been published in the 24 hours since the cardinals signaled their decision with plumes of white smoke emanating from the chimney of the Sistine Chapel.

And while no one is saying exactly why he underwent a pneumonectomy (surgical removal of a lung) back in the 1950s, there’s been plenty of speculation.  Back then, before antibiotics, removal of a lung wasn’t that uncommon in cases of severe pneumonia, whooping cough or TB.

Whatever the reason, living with one lung is not entirely uncommon. In America alone, it’s estimated that more than 40,000 people have only one lung. And most of them do just fine because the body tends to compensate by making the other lung grow larger.

Which got us to thinking, which other organs can you live without?

Top of the list would be the kidney.  Most humans have two kidneys, but need only one to survive. However some people may be born with only one, while others agree to part with one for donation. Generally, people can live with one kidney with few or no health problems. People can even live with no kidneys, but they of course require frequent renal dialysis.

Then there’s the appendix. Nobody is exactly sure what the appendix is for and no one is really ever aware that they have an appendix until it becomes inflamed or ruptures and has to be removed. Once gone, after a brief period of recovery, life goes on as before.

And, as one in three women over the age of 60, who have undergone hysterectomy know you can live quite comfortably without a uterus. For younger women, there may be some wrench over the loss of fertility, but for others the cessation of monthly periods may be the cause of celebration.

Men can also survive without their reproductive organs – should cancer necessitate removal of either the testes or penis.

Humans can also live without their spleen should it have to be removed because of trauma or medical conditions such as thrombocytopenia. However because the spleen is part of the immune system, those who have undergone splenectomy are more prone to infections.

We can also survive without most of our gastrointestinal tract too. The stomach, gallbladder, pancreas and colon can be removed and although each is associated with it’s own challenges and problems, loss of these organs is not incompatible with life.

And the list goes on…  Today thanks to advances in biomedical engineering, people can even live without a heart.

While we wouldn’t wish the loss of an organ on anyone, it’s good to know just how dispensable most of them are! Turns out our vital organs may not be so vital after all.

Can I Cut You Open, Please?

I remember the day, almost 30 years ago, when as a nervous student, I handed an eminent neurosurgeon the wrong instrument by mistake. I recall even more clearly having to duck the bloody swab he threw in return and the ensuing stream of expletives that followed.

Such incidents were common place in the operating room (O.R.) back in those days. As students we all had our “war stories” and we vowed never to be as tyrannical, should we ever reach the dizzy heights of our learned mentors.

So, it was with interest, that I read a commentary in the July issue of Archives of Surgery showing that surgeon’s behavior in the O.R. affects patient outcomes, healthcare costs, medical errors and patient and staff satisfaction.  According to the article’s primary author, Andrew S. Klein, MD, MBA, a prominent liver surgeon and the director of the Cedars-Sinai Comprehensive Transplant Center, in our increasingly rude society where it is rare for a stranger to give up a bus seat to a senior citizen or a child to thank their parent for a meal, the lack of civility permeates even the surgical suite.

“Often, surgeons get hired on the basis of their knowledge, training and technical accomplishments,” says Klein, “but operating rooms are social environments where everyone must work together for the patients’ benefit. When a surgeon, who is in the position of power, is rude and belittles the rest of the staff, it affects everything.”

Klein and co-author Pier M. Forni, PhD, cite numerous studies to demonstrate the links between rudeness in healthcare and how it affects patient care:

• A study of 300 operations in which surgeons were ranked for their behavior shows a correlation between civility in the operating room and fewer post-operative deaths and complications.
• Because co-workers tend to want to avoid a doctor who belittles them, 75% of hospital pharmacists and nurses say they try to avoid difficult physicians, even if they have a question about the doctors’ medication orders.
• Hospitals with high nursing turnover generally have increased medical errors and poorer clinical outcomes.
• One survey reports more than two-thirds of nurses are verbally abused by physicians at least once every three months.

During operations, surgeons cannot seek consensus on whether to employ staples or sutures. But it is bad medicine for them, for example, to berate a technician for wrongly handing them a clip if they, instead, have asked for a clamp, says Klein. Further, he states, once surgeons leave the operating room, they must understand the importance of relinquishing authority. By empowering others to lead, surgeons gain immeasurable respect among peers and subordinates; they create a culture of loyalty that surpasses what can be achieved via the strict, top-down management style that can be the typical persona of surgeons, Klein says.

Forni, founder of the Johns Hopkins Civility Project says two elements conspire to promote incivility – stress and anonymity. While surgery, by nature, is a stressful discipline, if surgeons took the time to know their co-workers better, it would help establish a positive workplace culture. That, he adds, translates into better patient care and outcomes, as well as higher job satisfaction for colleagues.

When people, especially team leaders, act rudely, Fomi says, “the stress response is activated, blood pressure increases and the body’s immune system is weakened. Studies show that incivility in the surgical workplace is associated with increased staff sick days and decreased nursing retention, both of which are associated with increased medication errors.”

Klein says that the steps to create a culture of civility in operating theaters must start early in surgeons’ formative years. The challenge for medical mentors of the next generation is how to nurture important traits in their charges of ego strength, confidence, focus, work ethic and dedication – without abandoning the practitioners’ commitment to civil behavior.

SRxA’s Word on Health could not agree more.  Thank you for reading!