Sara Lazar, PhD: How Meditation Changes the Structure of the Brain
Episode #40 of the Charged podcast.
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PodcastApr | 1 | 2020
Dr. Leigh Anne Dageforde first realized her passion for transplantation surgery during a moment in her residency when she witnessed the immediate result a kidney transplant surgery provided to a patient. Over the course of her career, her dedication to the field has only grown. The field of transplant surgery is special to her because doctors can give their patients something new, and in turn, give them back their life.
In this episode of Charged, Dr. Dageforde shares her experience working in a what is still considered a young field and learning from role models who have forged the path ahead for transplant surgeons like herself. She discusses the unique nature of the field, the personal connections she has with patient and donor communities and the collaborative nature of transplantation.
Leigh Anne Dageforde, MD, MPH is an abdominal organ transplant and hepatobiliary surgeon at Massachusetts General Hospital. In the Mass General Transplant Center, Dr. Dageforde specializes in the care of patients with end stage kidney and liver disease needing organ transplantation, living kidney donors, pancreas transplant patients, and patients with liver and biliary cancer. Dr. Dageforde is interested in improving transplantation by thinking more holistically about patients’ care, particularly as they return to their lives post-surgery, and bringing more young surgeons into the field.
Dr. Dageforde completed her MD and MPH degrees at Vanderbilt University School of Medicine and completed her general surgery residency at Vanderbilt University Medical Center in Nashville, Tennessee. She completed her fellowship in Abdominal Organ Transplantation and HPB surgery at Washington University in St. Louis. She has also served on national committees in both the Association of Academic Surgery and the Americas Hepato-Pancreato-Biliary Association (AHPBA). Most recently, she was appointed to serve on the American Society of Transplant Surgeons Pipeline Taskforce focusing on the development of the rising surgical workforce in transplant surgery with a focus on mentorship of medical students and residents.
Dr. Leigh Anne Dageforde remembers vividly the moment she discovered her passion for transplant surgery. It was during a residency rotation working in the OR when she saw how immediate the result of a kidney transplant surgery could be. As she continued her training, Leigh Anne nurtured her interest in transplant surgery through both her clinical and research work. And what's kept her invested in the field is knowing that organ transplantation has the power to save and transform lives.
Now, as a surgeon on the Mass. General Transplant Center, specializing in liver, kidney, and pancreas transplant, Leigh Anne is working to improve transplantation by thinking more holistically about better care for patients, as they return to health post-surgery, and bringing more young surgeons into the field, to ensure that there are enough skilled professionals to meet the need. So welcome, Leigh Anne.
A: Great. I'm honored to be here.
Q: So to start off, Can you talk to me about that very first experience with transplantation, and what that was like for you?
A: Yes. We did it both as a second year resident and then third year resident, general surgery resident in Vanderbilt. And there were no transplant surgery Fellows. So, as a third year, you were the, highest person on the totem pole, other than the attending surgeon. And you got to take care of the patients, run the service. And then, in the operating room, got to help with the kidney transplants.
And I think the most powerful transplant at that stage was a living donor kidney transplant. And it was very special; because when you would unclamp the blood vessels and give blood back to the kidney, immediately the kidneys often make urine. Right away, before you even have time to fix the ureter to the bladder. And it was this immediate change that I saw in the operating room.
And then, I could see that in the patients postoperatively, their family notices as well. They get color back in their face. They feel better very quickly. It’s really a life-changing event for them.
Q: And was surgery something you were thinking about already?
A: I was interested in surgery. My father is in medicine. He’s an interventional cardiologist. So I had been shadowing a few times in the operating room. And each time, actually, I would feel like I was going to faint and have to step out. And I felt a little discouraged. And so, when I first went to medical school, I was interested in infectious disease, which is full of wonderful people, very smart. But they don’t have a procedure that they do, per se.
And then, when I rotated on that rotation, I felt like something was missing. And then I rotated on surgery. And the first case I scrubbed into as a medical student on my surgery rotation was actually a patient who had had a liver transplant and needed a revision to their bile duct. And at the time.
I wasn’t even thinking about transplant as a career. But, in that case, I didn’t feel faint. And the case went very well. And all my subsequent cases as a student, I was able to scrub into. And that’s really where I became more passionate about it.
Q: You had this challenge before of having trouble being in surgery when you were approaching it as a student. Were you nervous to go into the OR, knowing that you had had challenges previously?
A: I think I was nervous at the time. And, interestingly, I had a chief resident who ran the whole rotation. I was at the VA in Nashville, and it was a woman. And I think, somehow, that was very encouraging to me. I didn’t feel pressure as much, maybe, I felt like she was a good ally for me. And so I think that was very helpful.
And actually, after the first case, it went really well. And I was so interested. And the day just flew by, even though it was a long day, long hours. And from there, I didn’t really look back.
A: I felt like that was kind of the hurdle that I had to get over. I really came to love the patients, and came to appreciate what difference the operation makes in their whole life. And they really get their life back. And I think that’s what really is, made me committed to the field of transplant surgery.
Q: You mentioned the difference that transplant makes in patients’ lives. So can you talk to me a little bit about what it is about transplant that makes it special in that way?
A: I think in a lot of surgery, you are removing something that’s bad, such as a cancer, or doing a repair, a hernia repair. And you know, in some ways, you're kind of hoping, in the long term, these things don’t come back. And I think transplant, what’s really unique is you're taking something that's new or something recycled, but new to the patient, and putting it in. And it’s giving them life.
And so for kidney transplant patients, there is a backup plan. There's dialysis. But it only works about as well as 20% of your kidney function. And patients have to spend four hours a day, three days a week, in a chair. They can't work during that time. For a lot of them, they can't travel, because if they want to travel, they have to find an open dialysis chair in the location they want to go to do.
And it really affects their life. And they don’t really feel great. And then, for the liver patients, there is no backup plan. There is no equivalent to dialysis. And so those patients are dying without their transplant. And some of them are dying in the ICU actively. And we get a liver just in the nick of time.
And then, when you see these people back, you can't even tell they’ve had a transplant, and they’ve returned to their life, and they're visiting family. They're seeing their grandkids. They're planning trips. And you know, eventually going back to work. And this is what's so exciting to me.
And then the long-term outcomes are very good for liver transplant. You're looking at 65 to 70%, five-year survival. And so I think the long-term outcome is very positive. And that's what makes it so exciting, is to see people do well.
A: There is a patient that I was a resident at Vanderbilt. I was on the liver transplant service. And he had his transplant. And then he came back with an umbilical hernia that needed an emergent operation, just a few weeks after the transplant. So we fixed that. And his wife has stayed in touch with me, even until now. So I get a Christmas card every year. And I send them a Christmas card.
They're from rural Kentucky. And she sends pictures of him driving his granddaughter to prom in their old car, and going to Southern Florida for vacation. Now, he’s probably five years out, and just has this whole life that, when I first met him, was—was not even looking probable.
Q: Is that usual to have that kind of longer-term relationship with a patient?
A: A lot of transplant centers, the surgeons follow their patients for several months to several years. If they have any surgical complications, you're taking care of it. If, you know, heaven forbid, they had a liver transplant, and their kidney was affected, and they needed kidney transplant, sometimes we see them back for that. So I do think it’s a really unique area of surgery, where we get to take care of them for a very extended period of time, and build a really nice relationship with them and their family.
Q: How do you work with patients sort of through and after their surgery?
A: Especially for liver transplant, I like to tell the patients I grew up in the south in Kentucky. So I tell them it’s like a Texas two-step. But you kind of take a few steps forward, you shuffle back. You take a few steps forward, you shuffle back. So it’s unusual, because it’s such a huge operation. And they're on some medicine to suppress their immune system, so that they don’t reject the organ afterwards. And there are complications that come up, surgical complications, infections, things like that.
And while they get better, and they do remarkably well, they rarely just have a straight, upward trajectory of how well they do. And so I like to remind them that. You go forward a few steps. You come back a little. You go forward, you come back. And the great thing is that we have such a wonderful team to support them.
In the clinics, we have social work, pharmacy. We have NPs, PAs. We have coordinators that are nurses. Even our front desk staff, the people that draw labs, I mean we see them weekly for a while, and then every two weeks. And then we start to space it out. So we’re really there to help them through the post-op recovery period, so that they do get to that wonderful point where they're able to—to do all the things they were hoping to do.
Q: I imagine as a patient, if you're in that space of two steps forward/one step back, it could be discouraging. So how do you work with patients to coach them through those ups and downs?
A: I think we do our best to kind of tell them to expect that. We do a lot of reassuring that this is pretty normal. We see this. You're not an outlier. So that’s very encouraging. I think they build nice relationships with all the people I mentioned, so they feel like there's a team of people taking care of them. They recognize the familiar faces when they come into clinic.
And some of the longer-term things, we've had some patients with—that have expressed concerns about depression or PTSD or thinking about that someone died so they could have the organ. And so I think that’s an added component of recovery from a transplant that may be different than recovery from a general surgery type of operation.
Q: Is it common for donors and recipients, or donor families to meet one another?
A: It’s all done through the organ procurement agency. That’s another whole component of the team, is a whole group of people that make getting the organ to our patients an option.
If both sides send in information and want to hear from the other side, then the OP acts as a link, and will connect them. And then they're able to communicate.
So some people do meet their recipients or their donors. But they do try to give a period of time between the operation and the meet, because for, the donor family, they’ve had a pretty sustained tragedy, a loss of a life that resulted in these life-giving organs, up to eight organs out of a donor.
So it’s amazing. And it’s a real positive experience for a lot of donor families. And they talk about it later, about how it was a wonderful opportunity for them to turn a tragedy into something good. I think there's a lot of really wonderful stories of how people have, met the people that have changed their lives.
A: We have an interesting story. A patient who her son died years and years ago in a car crash. And they were at the transplant games, which is an opportunity for recipients. And she tells a story about her husband coming around the corner, and running into somebody, and starting to talk to him. And it turned out that he had received their son’s lungs. And it was just a chance meeting. And then, interestingly enough, recently, the father of the donor, the husband of this woman needed a kidney. And she donated her kidney to him. So they have the most amazing transplant story, on both the deceased donor side, and the living donor side.
Q: I know something that gets talked about a lot in the context of organ transplant is the need, statistics say something like 20 people die each day while they're waiting. You hear stories like this, and they're so powerful, you think, why wouldn’t anyone just donate? So why is there this gap and need in supply?
A: I think the first thing, it’s always good to be positive. So each year for the last nine years there's been an increase in the number of donors, and increase in the number of transplants. And so 2019 had a record number of lives that were saved, and an increase in donors by 11%, and transplants went up by 9%. We had a record number year of living donors.
There's definitely a huge gap, like you mentioned, but there's also signs that we’re making really good progress in the right direction. And since it’s Donate Life month, I can't help but do the plug to, if you go to registerme.org, and sign up, that’s how you become a deceased organ donor. And all that is the same as signing your driver’s license.
I think there's some maybe misperceptions that if you’ve signed your driver’s license, that the health care professionals will do less to take care of you if you were to be in that situation, which is not true at all. No one checks your driver’s license. We do everything we can to save the person. And, in fact, the—the organ donation process and team doesn’t even begin until much later down the road.
And so I think that’s maybe one perception.
I know that if people have a discussion with their family, or sign their card in those difficult times, it’s much easier for your loved ones to make the decision, knowing that that’s something you wanted to give. Than having them already be in a difficult time and then having to decide if that's something you would have wanted. So having the discussion early, signing up yourself, all of that really promotes a donation, if that were to be an opportunity.
And I think there's also a really neat progress on the living donor side. There's discussion about ways that we can try and protect people who have donated their organs as living donors. But there's still definitely a huge need, like you said, there's 93,000 people waiting for a kidney and over 17,000 waiting for a liver. And that doesn’t even cover the thoracic organs.
Q: Could you talk a little bit more about living donors and what that means and what it looks like?
A: Right. It’s my favorite part of my job. I am—One of the surgeons here that does the living donor nephrectomies, meaning I take the kidney out of one of the donors when they want to donate to somebody else. And it’s really meaningful experience to get to be a part of their journey. And they're giving this incredible gift. And sometimes people donate to a family member, but sometimes they donate to a friend.
So we've had a lot of interesting stories. And then some people, just out of the goodness of their heart, feel that this is something they want to do. And they donate anonymously to the list of people that are waiting.
One of the wonderful things that’s happened recently is this opportunity to exchange kidneys, even across the country, and to start donor chains. So potentially, if I needed a kidney and my donor didn’t match my blood type, they could donate to somebody else. And then we could start even a progression to donate a lot more pairs to get people to be a good match. And I think that’s a really more recent, novel change that’s happened.
And when people donate just out of the goodness of their heart to the list, it can start very long chains of multiple pairs of people. So just donating one kidney can actually result in, 10-plus transplants. So it’s a really powerful opportunity.
Q: How does the chain work?
A: So there are a few different organizations that do these exchanges. But the one that we use most frequently is the National Kidney Registry or the NKR. And we actually put our patients into the bucket or the pool. And they have algorithms and things that they run. And they find potential matches out of the pool.
Sometimes the chains are quite long. So you would be receiving a kidney from California, and sending a kidney to Wisconsin or something like that. And it’s all designed, it’s timed correctly. The airlines shipping is coordinated. We put GPS trackers.
So actually, from my phone, I can tell where the kidney is that I have sent out somewhere. So it’s really exciting.
Q: So is there usually a person, like, with the kidney? Or the kidneys go on their own?
A: So kidneys are not usually sent with somebody. So kidneys can be out of the body for, we’d like it to be less than 24 hours, but up to 36 hours on ice. And so there's a little bit more flexibility. the liver, we would aim for less than 12. And then, for heart and lung, it’s even shorter. So those organs rarely travel without somebody with them, or by private jet, actually.
But the kidneys have a little bit more flexibility. So they go through commercial airlines. And so a courier would take it from here to the airport, and hand it over to the airline. And then a courier on the other side, would pick it up, and then deliver it. we know, down to the minute, when it was signed out from the courier to the airlines, et cetera.
And that’s really what I think is exciting about the field, is that it takes a team. It’s a team effort to get this to work for each patient.
And one of the hot topics right now is how to get organs more equitably distributed around the country. And so we want the patients with the highest need to have the greatest access to organs. And so this is a huge discussion that’s happening. And cost is definitely a component.
Q: Can you talk a little bit more about what the challenges have been historically, in making sure that organs are equitably distributed?
A: Transplant’s a relatively new field. The first kidney transplant happened here in Boston in the 1950s. The liver followed. So this is a really fresh area.
And there's been a recognition that maybe some more high population density areas on the coasts have maybe longer wait times for—for kidneys. And they transplant sicker patients for livers, because the patients have to wait longer. And so a lot of discussion has been that you should have an organ quicker, regardless of where you live.
But there's a lot to consider, too. And thinking about proximity to the transplant center, how close the patients? Is a sick patient in rural Nebraska the same as a sick patient in Boston as a sick patient in Bangor, Maine?
Everybody involved really wants their patients to get the fairest shot at an organ. And so out of that comes this very passionate drive to find a fair way that’s also reasonable to get the organs allocated.
So obviously, it’s not reasonable to send organs back and forth across the country all day, every day. And so that’s one of the logistical considerations. And then the time limits for how long the organs can be out. And so there's just a lot of discussion right now, because people feel so passionately that they want their patients to have the organs that they need.
Q: Is most of the decision-making about who gets which organs, is most of that made, is it a computer, an algorithm? Or is there a person behind it?
A: There's a national list. And the lists work differently for each organ. And you know, for most purposes, the liver list is based on medical necessity. Like we talked about earlier, there is no dialysis, there's no backup plan for those patients. And so the list right now is designed that the sickest patient has the first shot at the liver, because if they don’t get it, they may die.
And then, for the kidneys, there's some other components that go into it, some medical factors, how long they’ve been waiting, how long they’ve been on dialysis, which is also related to mortality. The longer you spend on dialysis, the higher risk for not having long-term survival. So that’s a component of it too.
And each time an organ becomes available by blood type, then the list is produced for that organ at that moment for that blood type, really. And then, from there, it goes—goes on down. And things change by the moment. So someone that might have needed a liver in Hartford could have gotten it overnight. And so the new list may look somewhat different than yesterday’s list, because there's been movement or change, or somebody came in really sick. And they go into the top of the list overnight. I think that is sometimes hard for patients, is it’s very hard to say, “You're at the top of the list,” because the list always, always changing.
Q: I was thinking, as you were talking. I grew up in Montana, but there isn't a big academic medical center. I don’t even know if there's transplant services. So if you live in a place like that, and you need this care, what happens?
A: The patients travel. I was in Tennessee. I grew up in Kentucky. I trained in Missouri. And the patients travel there quite a distance, because there's just more land mass. So one thing that was really fascinating when I got to Boston, I thought of it as being very urban. But then I realized, in New England, we don’t have a transplant center north of Boston, really, for liver transplant.
And so all the patients from Vermont, New Hampshire, Maine, they're having to travel to Boston for their care. And that can be onerous, you know.
A: And then, when they need an organ, you know, and they're sick at the very end—some patients have to move closer, because you don’t have time to travel. And so –
Q: You need to be ready, at the drop of a hat.
Q: Is there work that’s being done now with—You know, we have all this technology that’s revolutionizing other areas of medicine. Are there ways that it’s changing the way transplant works?
A: Yes. I think there's a lot of excitement in transplant. There's so much research being done in basic science, and patient outcomes. And then, in technology as well. So there's a lot of opportunity, because it’s a young field to really advance it forward.
Something we've done here, as we've done a few telehealth clinic visits for the liver patients that are post-op, that live far away, and that saves them a trip into the center. And I think that’s something we’ve explored doing more of, also building relationships with, potentially primary care providers, and advanced practice people, like NPs or PAs in a more remote area, where potentially they would be the first stop for the patient before they would have to necessarily come all the way into Boston.
So we do some things as much as we can to try and limit transport into Boston. But I think there's a lot of potential for that to be expanded as well. And the telehealth is maybe the first step for that.
Q: It strikes me that there's a difference between being a living kidney donor and living liver donor, where a kidney you're going to give up a full organ. But the liver, it’s just a piece of it. So is there a movement to try and expand the liver donors? Is it—Is it less risky to be a liver donor? Should we all be liver donors?
A: It’s actually probably the other way. It’s a little bit less risky to donate a kidney. And there is a movement, both here at Mass. General, and then I think across the country, given the need of all these people waiting for a liver, to think about living liver donation. It’s been around for quite a long time.
I think the added risk over a kidney is you do have to split the liver in the donor. And the liver is, you know, all of our blood supply goes through our liver every. And so there's a bit more involved in potentially the donor operation to—to give a piece of the liver.
But definitely, the demand is there. And I think that as everything in surgery advances with technology, there's laparoscopic, there's robotic, there's ways to minimize the risk to the donor. And, as those things are less and less, I think the potential for increasing the liver donation is definitely on the forefront of people’s minds.
Q: And —if you're the donor, how long does it take you to get back up to sort of normal with your body, and your liver?
A: So they almost don’t notice that a piece of the liver is missing. So it’s not like there's a physical difference. Now that, you know, the recovery from the surgery, it’s just like having a hepatectomy. So, you know, part of the liver has come out. So there is some recovery time from that.
But then, as far as liver function, most donors don’t even notice a decline, And I don’t know that I know the exact timeframe when the liver is totally back to normal. But it’s fairly quickly that it’s recuperated. So maybe by a month you would— see that, their liver had—had grown a bit back to—to not necessarily exactly what it was, but grown to compensate.
Q: I know you’ve started to think, too, about how to improve aftercare. So can you talk about what that looks like, what do you think is missing in the current aftercare for transplantation?
A: I think, overall, more than any other field, it’s fairly comprehensive. It’s very unusual to go to a surgical visit post-op, and to also have an appointment with a nutritionist or social worker, a pharmacist, a nurse. So in one area, we’re ahead of the game, because we have all of that built in.
But in some other areas, I think especially for liver transplant, now the indication or the reason that people need a transplant is changing. So we’re seeing a lot more alcoholic liver disease and a lot of fatty liver disease. And you know, in the past, there was a fair amount of hepatitis C. And amazing thing is that hepatitis C is curable now. And so I think the rates of people needing transplant for that are going down.
But, in the same nature, we do a transplant for somebody that has fatty liver disease or alcoholic liver disease, they're at risk for recurrence of that afterwards. And I think as a whole community of transplant surgeons and providers, one thing we can think about how are we going to prevent them from ending up in this same situation a few years later. And overall, that’s uncommon. It’s not very common for someone to relapse to enough alcohol use that they need a retransplant, but we do know that both alcohol use and the fatty liver phenomenon is associated with metabolic syndrome, diabetes. And all of those things impact long-term survival, regardless if you're a transplant patient or not. They increase the risk of cancer.
And so in the general population, that’s something that we’re thinking about, is how to help patients with addictions, mental health concerns, and definitely obesity is a growing problem that we have. And I think we are going to need to focus on that in our transplant patient population as well. Not necessarily because we don’t want to repeat the transplant, but I said my whole passion for transplant is to give people their life back, and give them a fresh start and a new life.
And so if I just address the care of their physical needs and not necessarily think about potentially improving their overall health, reducing their metabolic syndrome, adding exercise, maybe changing diet and helping people with mental health things, PTSD, trauma, addiction, things like that, then I feel like I've done a small piece with the liver transplant, but not really given them their full potential.
Q: Do you have a vision for what that more holistic system may look like?
A: And I think there is a lot of potential with the telehealth component. One of the struggles in less urban areas is there's not a lot of mental health providers.
And so, is there a way that you could leverage technology and telehealth to potentially let patients be in rural Vermont and still have access to addictions counseling? I think there could be a lot of potential for having transplant recovery coaches, so not just about the physical overcoming of transplant, but maybe helping address some of their other needs.
And a lot of patients that have been through this process are eager to share their experience and help more patients coming behind them. We have a support group that patients come to. But again, it’s on an afternoon on a Tuesday. And so it’s hard for some patients to travel in for that.
And so being creative in all the technology that we have now, is there a way that we can build that community, get them plugged in, and help with maybe what they're missing in their small community, without necessarily saying every time you have to come to Boston?
Q: Do you find there's almost a mental reset that patients have to go through? I imagine if you’ve been living with dialysis, or some dire health situation for a period of time, to have a transplant, and you have sort of almost this new lease on life, is that ever difficult for patients to process through?
A: I think so. I struggle to speak for the patients. I feel like we should ask them to share their own struggles. But I think for some, when they get so sick, a lot of things they just can't do. They can't exercise. They can't eat necessarily. They can't drink their alcohol.
And so, when they get back to this feeling good again, they're not only having to get recovered from the surgery, but they're having to think about, what do I want my life to look like now? And it may not be the same life they had before.
I also think we can't diminish the role of the caregiver. We really expect every transplant patient to have a caregiver. And those people are amazing. They're devoted. They're loyal. I talked about the transplant patient that I met in residency. But I don’t communicate with him, I communicate with his wife who is his caregiver, because my interaction was actually largely with her, because he was sick.
Q: I want to go back to something you said earlier. You mentioned that transplant is a very young field. What is it like to be in a field that is so young?
A: It’s amazing that on Wednesday mornings, we have a meeting, and Dr. Russell still comes. And he’s in his 90s. And he was the original— did kidney transplant here at Mass General. And I still get to interact with him. It’s just very unusual, I feel like, that the leaders in the field that really started the innovation are still around, that somebody in my shoes can meet them.
I think that there's actually a lot of women in the field that is unique. And when I finished my residency, there were three of us that were women, that went into transplant out of my residency class. Because it’s a young field, women have actually relatively been involved early on, compared to maybe some other areas where, because it was around for so long, and things took a long time to change, and integration of women took a long time. So that’s really exciting too.
Q: It’s interesting what you said about it’s a young field. And, as such, women have, been able to get in on the ground floor. And we've talked with a lot of women who have been in surgery for a long time. And some of them, you know, had to break barriers. And you’ve had the privilege to follow in those footsteps. So I'm wondering what that’s been like, and what have you learned from being able to look to these role models ahead of you?
A: I feel very fortunate to have people like Cristina Ferrone that you—you’ve interviewed, that really started out early as a liver surgeon. And one of my own mentors from WashU is Majella Doyle. And, you know, I think there's Nancy Asher, who is incredibly well known in the field of surgery outside, and Liz Pomfret. And I won't even name all of them. But there's a lot of women that have done amazing things in transplant.
And I feel very fortunate to be able to see them. There are still firsts that happen. I was just at a national meeting. And one of the more historical lectures, this was the first year that it was given by a woman. And it was given by Nancy Asher. So I think there's still things up and coming.
I joined this group here, and there are six transplant surgeons here at Mass. General. Every single one is wonderful. But I wasn’t the first. Heidi Yeh was here long before me as a woman in transplant.
And, in some ways, being the first is exciting. You get to set the rules. Make it what you want it to be. But, on the other hand, it’s a lot of work for the people that went ahead of me and showed that they could have their families, live their lives, and be feminine, and still be a surgeon. And I don’t feel nearly as much stress about that, I think, as maybe the people that were ahead of me.
And excitingly, it’s changed a lot in 10 years, even. So there was still a minority of women going into surgery when I applied for residency, I guess, 12 years ago. And even now, I think our intern class from last year had majority women. It’s becoming more and more just a part of everyday life. You have a surgeon, you don’t have a male surgeon or female surgeon. We’re just surgeons.
Q: And I know you’ve done a lot of work with trainees specifically, within the world of transplant, to try to bring more young people and young surgeons into the field. So can you talk to me a little bit about what that work has been about?
A: I love what I do. I think I have an amazing blend of technically complicated cases, and more straightforward things, and patients that I get to make relationships with, and lives I get to change and be a piece of just a small part of their journey. And I think it’s really special.
And so I would love for the people coming behind to get that opportunity. As times have changed, there's more restrictions on work hours, which is probably good. But that also limits people’s potential exposure to transplant, because it’s a relatively subspecialized field. And also, our trainees are getting to direct themselves into a specialty much quicker.
So things that used to be a subset of general surgery, they now match into directly, vascular surgery, plastic surgery, thoracic surgery. And so if we’re waiting until they show up on their rotation, like I did as a third year, some people may have already made their choice before they even got a chance to see how amazing this field is.
Q: What's the one thing you would want young people who are thinking about these careers in medicine to know about transplant?
A: I think it’s the patients. It’s this opportunity to be a part of a story that takes a potentially tragic experience of a death, and gives life to up to eight people. And it really gives life in a really meaningful, powerful way. And it’s a unique field. And anything that you get to see that transformation.
You see the whole story’s transformation of a tragedy turned into life. I mean it is a really powerful thing. And just as a surgeon, to be a small piece of that story is really, it’s worth getting out of bed for every day.
Q: Well, thank you so much, Leigh Anne.
Q: It’s been wonderful. Before I let you go, I have my final five questions.
Q: What rituals help you have a successful day?
A: I run. I really value my exercise. I think it’s just as much for mental sanity as it is for the exercise component. And so that’s really powerful. And I have a dog. Most of the time he runs with me. But then also, just at the end of the day, to go home, and he’s always happy. It doesn’t affect him how my day has been. And so it brings a lot of joy to my life to have him there.
Q: If you weren't a doctor, what would you be?
A: Well, if I had a different athletic capacity, I wish I could run professionally. But that would never really happen. So I think I would have been interested in economics. It’s a nice way to combine math with real life decisions that impact people.
Q: What advice would you give your younger self?
A: My mentor, which maybe this would go under advice that someone else had given me, but he often says, “Be your own best friend.” And I think that a component of self-compassion, I think is something that I probably have missed along the way. I've been pretty hard on myself.
Q: What was your first job?
A: My dad sent me up to work as a radiology tech for the summer. But they didn’t have films online yet. And so all the films had to be hung on the boards. And then they would be switched for the radiologists to read them. And so I learned how to hang the actual films for the radiologists.
And I made minimum wage. And the people I worked with would often go to the cafeteria for lunch. And it cost the whole amount of an hour’s worth of the food. And so after the first few days, I went home, and I said to my mom, “Can you go to the grocery store and buy bread and peanut butter?” And she said, “Why?” And I said, “Well, I don’t want to spend a whole hour of what I'm making on my lunch every day.” So I ate peanut butter and jelly the whole summer, so that I could save more of my money.
Q: What is your guilty pleasure?
A: I really like live music. So I was in Nashville for years. And I went to so many concerts. There's something really special about it. You know. And I’m in awe musicians, they stand up and they play, and they entertain. And they're very transparent. They show their emotions. And I just, I think it’s amazing. I don’t know if it’s guilty per se, but I've spent a lot of money on live shows over the years.
Q: Well, thank you so much, Leigh Anne.
A: Oh, thank you very much. I'm very honored. I was so honored, too, that you even asked me to participate in something like this. So thank you very much.
Q: You're welcome. It’s been a pleasure. And we’re so happy you could come.
A: Thank you.
Charged is a podcast devoted to uncovering the stories of the women at Mass General who break boundaries and provide exceptional care.
Episode #40 of the Charged podcast.