Dr. Jasleen Kukreja is a lung surgeon and director of UCSF's 肺移植项目, one of the most successful programs in the nation in terms of patient survival. 下面, Kukreja talks about what drew her to this specialty, the keys to the program's success and the thrill of helping the sickest patients survive and thrive.
When I was training as a general surgeon, I operated on everything but the chest. I was curious to find out what was on the other side of the diaphragm. The chest seemed like such a fascinating — almost spiritual — cavity.
Plus I knew not a lot of women went into cardiothoracic surgery, which made the career a challenging choice and, 因此, 更吸引人的是.
I consider UCSF to be the Harvard of the West Coast. 2004年我从波士顿来到巴黎人贵宾厅, where I had been training at Brigham Women and Children’s Hospital. 巴黎人贵宾厅是一个理想的机构. 它有优秀的基础科学研究, clinical research and patient care expertise that have achieved national recognition.
我喜欢合作的环境. Everyone is supportive of each other and that makes a big difference. There is a huge team effort behind every patient’s success story.
在正常的一天, we don’t even think of our work as particularly remarkable and that’s what’s remarkable about the program.
UCSF's 肺移植项目 is known for its excellent outcomes, in terms of patient survival and graft survival (survival of the transplanted lungs). 秘诀是什么?
Lung transplant is all about teamwork and we have a truly spectacular team. Every person in the program — pulmonologists, 护理人员, 术前和术后协调员, 呼吸治疗师, 物理治疗师, pharmacy staff and surgeons — is top-notch.
We also work very closely with patients to prepare them for transplant. That includes educating them about what to expect before, during and after surgery. By preparing our patients for what's to come, we can alleviate a lot of their anxiety.
UCSF has a reputation for accepting patients who are too sick to qualify for transplant at other centers. What's the key to success even with a high-risk patient population?
We don't shy away from high-risk patients and, 这是真的, we have been very fortunate to still have the best outcomes. I've had people who we were doing CPR on and then successfully transplanted and are now several years out. The majority of transplant programs would not take those patients, 但我和他们相处得很好. Our success boils down to our aggressive perioperative management as well as long-term comprehensive monitoring. 再说一次，这都是团队合作的结果.
How does it feel to save patients others deem too sick for transplant?
Restoring a person's ability to breathe is one of the most satisfying parts of my job. When I meet them, they are hanging on for dear life. 移植后, 他们给我发照片, postcards from vacations where they are skiing, 攀岩, 冲浪, 慢跑和骑自行车. Lung transplant patients are keenly aware that they've been given a second chance at life, and they don't want to waste a single second.
Lung transplants used to be performed on a first-come, first-served basis but we realized that the people who needed transplants most urgently (the sickest) were the least likely to survive the wait. Now the system is designed so that the sickest patients go to the front of the line because they stand to benefit the most. Since making that change, the number of patients who die 而 waiting for a transplant has declined.
捐赠d organs are a very precious resource. Each donor and recipient is very carefully considered and selected by the transplant team. We need to balance the needs of the recipient with the wishes of the donor’s family during what is usually a very painful time. The family wants the gift to be put to the best possible use. It's up to the transplant team to help discern who will benefit the most from this organ. We weigh each case from a scientific and ethical point of view. 这从来不是一个容易的决定, but the complexity of each case is one of the things that makes organ transplant surgery so rewarding.
My job gives me an enormous amount of pleasure and satisfaction. I am exhilarated by what the human body is capable of overcoming. Not many people can say that about their jobs.
I also enjoy working with a team of people who are unbelievably brilliant and dedicated, 而, 同时, 风趣、随和. 我真的很感激这次经历.