September 2009

The Nation Reviewed


By Gay Bilson
Illustration by Jeff Fisher.

The South Australian autumn had been wet, and in the early morning the soggy earth steamed, especially under the pines in the Adelaide hills. These are perfect conditions for mushrooms. They have had a bumper season, which is to say it has been a bumper season for foragers who know which are edible. Forage is a pleasing word. Its origin lies in the Old French verb fourrager, which came from the word for straw, fuerre. A homeless person might be said to forage for food in garbage bins, although Agnès Varda, in her documentary The Gleaners and I, calls those who forage in the boxes and dumpsters at the close of market days “gleaners”. To forage is to search a wide area for food or provisions, whereas to glean is to gather what remains from harvest. Both terms apply to a gourmet who thinks it worth his early morning to find mushrooms; to the person who must find leftover food in order to survive; and to one who knows where produce might be left after picking. Harvesting, on the other hand, is the formal and profitable gathering of a crop. Its origin lies in the Old English word, haerfest, meaning autumn, which is truly the season of harvest.

Between us on the kitchen bench was a basket of slippery jacks, Suillus luteus.  Luteus refers to the colour, yellow, of the lovely sponge of pores on its underside. Nick (not his real name) is a registrar at an Adelaide hospital and is doing further training to qualify in anaesthetics. “It’s a good balance between routine and emergency,” he said. He had been on duty the night prior to foraging these mushrooms, but wasn’t tired. We drank green tea and nibbled on membrillo made from the final harvest of quinces and apples. “Last night was definitely not routine,” he said, as we wiped the slime from the slippery jacks.

This is the story he told me.

That night, medical staff on duty knew that a young woman, a registered donor, was being treated in the intensive care unit. She had suffered an intra-cerebral haemorrhage and had been declared brain-dead. Nick described the work of the donor-and-transplant co-ordinators. Even if a person is a registered donor, discussion of their organs’ removal begins again from scratch. The transplant co-ordinator had taken the donor’s measurements, including chest size and the dimensions of organs, and noted her relevant medical history. Ultrasounds of the liver and kidneys were taken to ensure there were no cysts. The donor was already on a ventilator and would continue to be connected to it to maintain homeostasis: that is, the maintenance of the best possible dynamic condition. “This young woman,” Nick said, “was struck down in the prime of life by rapid trauma, and so was the best possible kind of donor.” I should declare here that I am a registered organ donor; also that Australia has one of the lowest organ donor rates in the developed world.

Public hospitals in different states are on a roster for organ donation and transplant. On this particular night, the hospital caring for the donor’s body would take the kidneys, another South Australian hospital would take the liver, and a Brisbane hospital was rostered to take the heart and lungs. Two senior cardio-thoracic surgeons from the Brisbane hospital flew in by private plane.

The body was given an anaesthetic even though it was brain-dead. When I asked why, Nick said this was a contested area, a highly debated topic. “Some don’t,” he said, “but you can’t not do it.” Along with anaesthetic, oxygen and intravenous fluids, morphine is given in order to iron out any fluctuations in blood pressure.

The donor’s chest was opened from the sternal notch to the pubic symphysis. A symphysis, I’m told when I raised an eyebrow, is the fusion of two bones. The aorta, the great artery originating in the left ventricle of the heart, was the last to be clamped, after which an infusion of cold cardioplegic solution (“it is rich in potassium and disrupts the balance of the environment”) was performed. This stopped the heart, washed out the blood and ensured there were no clots. It was done by the cardio-thoracic surgeons from Brisbane. They knew the medical history of the donor but had it repeated to them (as with many points in Nick’s story, I’m impressed by the amount of double-checking which is carried out). They would take out the heart and lungs as one, retaining the air in the lungs by clamping. In this case, the possibility that the heart was too badly damaged by the arrest meant that it was rejected. But its valves would be used – valves are a collagen matrix and last longer. “Although the heart was not considered a viable transplant organ, it looked remarkably healthy and strong,” said Nick. “The lungs were nice and clean, healthy, and there was a bit of ‘soot’ on the outside.” This, he said, is normal for someone living in a city.

The entire procedure had taken some four hours, finishing at two o’clock in the morning. I asked about stress. “The surgeons had done their jobs,” he said. “There had been absolute focus and no chitchat. Everything was neat and tidy.” Neat and tidy? It was a reference to the judgement which will be passed by the consultants receiving the organs. If the arteries and other connecting tissues are cut cleanly, then the best outcome is possible. “Perfectionism is part of the job,” Nick said. “Stress is not a factor because the work involves judgement all the way down the line.”

We pan-fried fat slices of slippery jacks with butter, garlic, parsley, sea salt and pepper, adding a squeeze of lemon. I asked Nick why he had been so moved by his first experience of organ collection. This had surprised me. Wouldn’t doctors, even young ones, at work in a surgical unit take it in their stride? They were, as he had said earlier, doing their job.

“It was the heart,” he said. “To say that the heart is a pump is to understate its strength. Pump is the wrong verb, suggesting something mechanical. The heart wrings and spins and works so hard.” He told me that his lecturer in cardiovascular medicine had once said, interrupting his technical class, “There’s something mystical about the heart.”

The slippery jacks were fantastic, not least because they had been foraged that morning. The lemons had been gleaned from a neglected tree; the garlic was from the harvest of last season’s crop. I happened to read a translation by Seamus Heaney of a Rilke poem, ‘The Apple Orchard’, not long after listening to Nick’s description of the removal of organs from a young woman who had so sadly died. The apple trees in the poem are:

Ready to serve, replete with patience, rooted
In the knowledge that no matter how above
Measure or expectation, all must be
Harvested and yielded …

The medical term for the removal of organs from a person for transplantation is ‘harvest’.

Gay Bilson
Gay Bilson is a writer, literary critic and former Sydney restaurateur. Her books include Plenty: Digressions on Food and On Digestion.

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