Many Sleepless Nights: The World of Organ Transplantation

by Lee Gutkind

Although organ transplantation is the preeminent medical miracle of the last quarter of a century, Many Sleepless Nights is the first book to go beyond the headlines and describe the patients who have embraced this last chance to hold on to life, the intricate medical procedures that can save them, the surgeons and nurses who work in this emotionally charged world, and the ethics which complicate this “miracle” high-tech therapy. Lee Gutkind was granted unconditional access to the world’s largest transplant center - the University of Pittsburgh’s Presbyterian-University and Children’s hospitals, where there is an organ transplant every eight hours, 365 days per year.  For four years he immersed himself in the frantic night-and-day world of transplantation, living side by side with transplant candidates and recipients, jetting though the night with organ procurement teams, monitoring patients with surgeons and nurses, observing in the operating room, participating in the ethical and psychosocial evaluations of prospective patients which help to determine who will receive scarce organs. During his four years at Presbyterian and Children’s Hospitals, Gutkind established close relationships with many patients, and his portrayal of them, living and sometimes dying under unbelievable stress, is a moving and dramatic statement about the capacity of human beings to endure. Many Sleepless Nights also outlines the history of organ transplantation and tells the story of the large and complex medical teams behind the operation.  It captures the tension of the search for viable organs; the pressure decisions about which patients, among many, will receive them; and the surgery itself.  Its vivid portrayal of the transplant pioneer Thomas Starzl -  a man obsessed with saving lives - shows how a major innovator in American medicine functions during days and nights of extreme pressure.

Genres: Medicine

378 pages, Paperback

First published January 1, 1988

About the author

Lee Gutkind has been recognized by Vanity Fair as “the godfather behind creative nonfiction.” A prolific writer, he has authored and edited over twenty-five books, and is the founder and editor of Creative Nonfiction, the first and largest literary magazine to publish only narrative nonfiction. Gutkind has received grants, honors, and awards from numerous organizations including the National Endowment for the Arts and the National Science Foundation. A man of many talents, Gutkind has been a motorcyclist, medical insider, sports expert, sailor, and college professor. He is currently distinguished writer in residence in the Consortium for Science, Policy, and Outcomes at Arizona State University and a professor in the Hugh Downs School of Human Communication.

Reviews

[El · Rating 4 out of 5]

About a month ago I received a promotion at work and while I haven't had a chance to really delve into a lot of my new responsibilities yet, I did have to sit in on a meeting for something that will probably never come up again. While I sat there listening to others talk, my eyes fell on the bookshelf across the office. I recognized one book (The Puzzle People: Memoirs Of A Transplant Surgeon by Thomas Starzl) which had been recommended to me by another surgeon in the office years ago. Beside Starzl's memoir was this book, Many Sleepless Nights, which I did not recognize. Without being obvious, I wrote the title down in my notebook to look up later.

When I had the opportunity to do a search for the book, I realized it's written by Lee Gutkind, the guy that has come to be known as basically the grandpappy of the Creative Nonfiction genre that my partner likes to scream about as something that doesn't really exist. (It does.) This piqued my interest in the book even more, and luckily I was able to get a copy through the library seeing as the topic and the author are both local to Pittsburgh.

Having already read Starzl's book about his experiences in the world of transplantation, I wasn't sure what Gutkind's book would bring me. I will admit that for a few moments I was a bit snooty about - "He's not even a surgeon, what could he actually say about surgery..."

What I found out was that Gutkind spent about four years with Starzl and others at the University of Pittsburgh Medical Center as they really started taking off with this fairly new-fangled transplant stuff. Not only did Gutkind spend time with the surgeons and the staff at the hospital, he also got to know several candidates on the transplant waiting list and their families. He spent time really understanding the ins and outs of surgery - the terminology, the process, the full experience - and just as much time understanding the psychological and physical conditions of those requiring a transplant.

I admit that the majority of my interest in this book was the local connection. I recognized a lot of the names of surgeons and other hospital staff mentioned in this book, some merely by reputation as many have either moved on or retired. Additionally, after having read Starzl's memoir, I was interested in hearing a different version of the story. Gutkind did not shy away from the fact that Starzl was a grizzly in the operating room, which is not a side of Starzl one encounters in The Puzzle People. But when you think about it, if your life sat in someone else's hands... wouldn't you want him to be a bit of a grizzly? He wasn't fucking around. He wasn't a saint, but he put his patients first, and no one can deny what he did for transplantation in medicine.

I also like medical books because I'm a big medical nerd. I may work in the administrative end of things, but I am also a naturally curious person and love to ask the surgeons in my office about medical things. This book appealed to that side of my nature. I found myself reading this book during my lunch and then catching myself, wondering if anyone in the cafeteria around me realized that I was reading some really gruesome descriptions of a particularly bloody surgery. Some might find that strange lunchtime reading material, but it hardly fazed me.

What did faze me (surprisingly, I might add) was the emotional toll this book took on me. I tend not to be a weeper when I read, no matter how emotional a story might be. But I found myself tearing up on more than one occasion while reading this, even in public. It's not an easy read in that Gutkind spent so much time getting to know the candidates, and followed their experiences - some especially heartbreaking. For some reason I was not prepared for the human end that would be shown to me in this book. I wasn't prepared to get an inside look at the guilt many transplant candidates and recipients carry every single day because they so desperately want whichever organ will make them live a longer, healthier life, but understand that in many cases the only way they can get that organ is if someone else dies. I wasn't prepared to get excited when Gutkind detailed a woman's beeper going off, the anxiety I felt when they flew from Kansas City to Pittsburgh to receive her new organ, only to feel the crushing blow that came when the organs that were being obtained in two different states were no longer viable and she had to go home empty-handed and still incredibly sick.

This is a side of transplant that not everyone understands or even sees. This is not the department I work in either, so I also don't see it. But this book showed me things that I hadn't considered because it's not always comfortable to think about, but we should all be thinking about it. Do you know the wishes of your loved ones as far as organ donation goes? Have you expressed your own wishes to your loved ones should they find themselves in a situation where you would not be communicate it? It's not just a matter of checking a box on your driver's license.

It's not all clinical. There really are people depending on your decision. And you never know - one day, you could be one of those people depending on someone else.

[Judith · Rating 3 out of 5]

Written in 1988, this book provides insight into the rise of organ transplants. Even today, transplants are relatively rare, but in 1988 many doctors were still working out how to do some of them. Of course they are always trying to find better ways, better outcomes, but in 1988 some transplants were only done in a few locations in the world.

This book features two hospitals in particular: Stanford and Pittsburgh (Presbyterian-University Hospital). However, Gutkind spent time in a number of transplant hospitals around the world to gather information about techniques, doctors, staff, and patients.

The book gives us a brief history of some historic transplants ( including the first heart transplant and Baby Fae, the baboon heart into an infant), then moves into the current state of the art and where transplant doctors and support people were moving then. Actual patients are introduced and then followed in later chapters.

A few things I learned:

* Transplant surgeons are a breed of their own. It takes special training to do this work, both in the surgical removal of organs from a brain-dead donor and in the surgical implantation of the organs into the recipients. Certain doctors have developed techniques and explored immune-suppressant drugs and have changed the course of transplant methods.

* There are support staff who do the work of finding organs and choosing suitable potential recipients, and who even travel with the transplant team to coordinate the removal of organs and return to the recipient's hospital. These hardworking souls have been on call 24/7 to work with patients, doctors, and hospitals, coordinating the whole transfer.

* Because of the scarcity of organs, only the sickest usually get the organ(s). And once transplanted, if that organ goes bad the recipient is still first on the list for the next (once transplanted they take priority; the surgeons are committed). Many transplants fail, and in some cases a single person can receive three or more of the same organ over time.

* Life after transplants is like life with a chronic disease. The patient has to keep taking immunosuppressant drugs and must avoid exposure to infection. Failure can occur at any time. There are many side effects that have to be managed. It is life on the edge and often is a life of misery.

In this history-biographical book, the donors are already dead. There is little mention of living donors, except early on, where it is noted that doctors take it particularly hard when a living donor dies or has other tragic responses to her surgery. It is one thing to lose the patient needing the organ; altogether different to lose the donor.

The book provides good information about those involved in the early ground breaking transplants and in the surgical centers that specialize in transplants. At times I found the organization of the chapters a little mysterious and would have liked more continuous coverage of the patients, but by the end I was generally satisfied.

[Kristin · Rating 4 out of 5]

Although the book is 30 years old, Gutkind provides insight into what were the early years of extra-renal organ transplant, specifically livers, hearts, and heart-lung combos. Gutkind is given access to the University of Pittsburgh Medical Center, home to Thomas Starzl, regarded to this day as the pioneer of liver transplantation, plus one of the few centers in the country at that time that also performed heart and heart-lung transplants. While telling the history of organ transplant both in the U.S. and abroad, Gutkind focuses on a number of patients awaiting transplant and staying at the Family House, a group of restored Victorian homes near UPMC specifically designated to house transplant patients, both while they wait for organs and immediately after discharge following surgery, plus their loved ones. To a lesser degree, Gutkind discusses organ donors, specifically a teenager from Charlotte, NC, whose organs are accepted by the Pittsburgh doctors for two of the patients Gutkind follows.
Not all is happy however, as some of the patients profiled do not have positive outcomes. These are still primitive years in transplanting organs other than kidneys, so complications are many, surgical techniques are still being refined, wonder-drug cyclosporine has just been discovered (and its long-term effects have not), and criteria for accepting donors for hearts, heart-lungs, and livers are still being determined.
Because most of what I do for a living deals with kidney transplants, I found this book very educational in regards to transplanting other organs, specifically how new all of it is. Nowadays, doctors can transplant a pancreas, digestive system, and lungs without hearts, but all of that was still in the future, as were many of the medications used today to stave off organ rejection. I was familiar with Dr. Thomas Starzl, having read a book by Dr. Bud Shaw, one of his longtime colleagues, but I liked this second look at his story and accomplishments. Naturally, I felt bad when a patient's transplant didn't work out or they died of complications, but given the perspective that 5-10 years earlier, those patients wouldn't have even been offered that glimmer of hope of a replacement organ, some positive outcomes amid many negative outcomes is still an improvement over what would have been all negative outcomes.
Definitely a book worth reading, specifically if you are familiar with organ transplantation today and want to see how far we've come as a medical community. That said, because Gutkind is a journalist and not a medical professional himself, I felt it was written such that non-medical readers would enjoy it too and not get lost among endless medical jargon.

[Judd Street · Rating 3 out of 5]

Gutkind's "Many Sleepless Nights" is an immersive dive into the world of organ transplantation. Spanning more than four years, Gutkind follows both doctors and patients through the complex journeys that characterize the process. From illness to waitlist, and from surgery to recovery (in the best of cases), we're shown a revealing picture of life from the front lines of organ transplantation. Gutkind's book is, unsurprisingly, good at following characters and making the issues personal.

The book suffers from two struggles. It's a little drawn out at times, and I struggled to make it through the last quarter. The message is clear - that organ transplantation is complicated, and that it has a profound impact on the lives of all those involved - but unless you get deeply attached to the characters involved, it feels a little lengthy. The other challenge is simply its era: the book is now somewhat dated, and it's hard to suss out what to take away that's relevant to organ transplantation decades later.

If you're into organ transplantation or character studies, I'd highly advise a read. But, it's likely a little in depth and a little too old to recommend to the broadest audience.

[Nancy · Rating 3 out of 5]

This is a book I've been wanting to read for some time now as it explores a little talked-about area of medicine: transplant donation and surgery. The author writes about all of the aspects of transplant surgery: from the donor and loved ones, to the recipient and their family, and the medical professionals that make it all happen including not just the surgeons but the nurses, coordinators, and even social workers. This was a fascinating glimpse of this area of medicine and I felt like I really learned a lot about it. The one thing that I did not like about this book, and which I had not anticipated, was that this book was written in 1987 and published in 1988 and medical science has changed quite a bit in the 30-odd years since this book was written. For one, there are more types of transplants available (there was a Uterus transplant in the news recently), insurance issues have changed, and even policy (HIPAA anyone?). So far as I know, however, there is not another book quite like this one, though, so if you're interested in the world of medical transplants, you're likely stuck with this book. It's a good book, just a teensy bit dated.

[CJ]

Interesting narrative journalism look at the early years of organ transplantation. It's incredible how far this technology has improved over time.

[Jessica · Rating 5 out of 5]

I read this every year. Reminds me how grateful I am that I had my dad for so many extra years~interviews of my parents in the book.