“That’s the surgeon in him,” says his wife, Gloria, whose office at Georgetown Hospital is a short walk from his. “He takes care of it, deals with it, and that’s the end of it.”
He has other things to think about, such as the fact that his daughter’s going to college soon. Weekends are filled with the kids’ basketball games, travel soccer tournaments, and the occasional golf or fishing trip. “When I finish my career as a surgeon,” Johnson says, “I’m gonna get a charter fishing boat and take people fishing.”
He and Gloria try to fit in dates when they’re not on call, but if his pager goes off, he’ll often go back to the hospital. If it’s a tough case, he wants to be there.
Says Gloria: “It’s not a date if you have to drive in separate cars.”
Johnson’s kids aren’t interested in medicine. “They look at how hard we work, and I don’t think they want to do that,” Gloria says.
She stays at the hospital overnight once a week to deliver babies; Johnson never knows when he’ll have a transplant. He likes when he gets home after surgery and feels washed out, then sleeps for three hours and does it again, but it’s hard when his seven-year-old is asking questions about NFL quarterbacks while he’s trying to finish a PowerPoint on organ allocation.
Jazz music, heavy on the saxophone, fills the operating room as Johnson’s gloved hand grasps a young patient’s liver. A metal crucifix hangs on the wall beneath the clock.
Johnson lets residents decide what will play from the iPod when he’s doing surgery. He talks and teaches while he operates. The piles of paper in his office stress him out—everything, even prescriptions, should be computerized, he says—but an operating room puts him at ease. He was more nervous about the birth of his children than he was about most of his transplants.
Live-donor liver transplants used to be tougher on donors. The surgery left them with a 24-to-30-inch incision that looked like a Mercedes-Benz insignia. During a laparoscopic-assisted procedure like this one, Johnson makes two small incisions for instruments and a third for his hand. Donors are usually home in four or five days.
Johnson, who wears orange clogs in surgery—a gift from a cancer patient—keeps one hand inside the woman’s abdomen and the other on the laparoscope, a thin surgical tool with a video camera attached. The laparoscope allows him to see the patient’s liver magnified on a screen next to him. It also helps him dissect—he has to cut tissue away from the liver before he divides it into two pieces.
Johnson’s patient is a 21-year-old aspiring veterinarian named Tovah. Her cousin, Jessica, a ninth-grader, is in the next room. It’s Johnson’s job to remove the left lobe of Tovah’s liver and hand it off to Jessica’s surgeon, who will perform the second part of the transplant. Johnson has done this operation many times, but he knows there can be surprises.
“I don’t think there’s ever going to be a time when I’ve got this mastered to the point where I’m never going to be fooled,” he says.
Tovah’s mother, Jacqueline Dorsey, raised Jessica, her niece, and the girls grew up like sisters. Jessica got in the car after dance class three years ago and told Jacqueline she couldn’t keep up anymore. She’d fall asleep at dinner and wake up disoriented. She was diagnosed with a form of liver disease likely caused by an autoimmune disorder.
Doctors told Jacqueline that Jessica had three to five years to live. Jacqueline assumed her niece would get a new liver if she needed one, the same way she’d get stitches or a cast. When she realized Jessica might not get a liver—there were hundreds waiting who had a higher score than she did—Jacqueline started looking for a living donor. Tovah was a match.
The stakes are high with donors like Tovah: They come into surgery healthy.
“Every other operation we do, regardless of how risky, is done with the intent of making the patient better,” he says. “With donors, there’s absolutely nothing wrong. We can only try to keep them as close to their health as they were.”
It’s more dangerous to donate a liver than a kidney because kidneys don’t have to be split. Johnson says that about 20 percent of liver donors nationwide have minor complications; two have died. That’s why Johnson operates on donors, not recipients, during transplants like this—he wants the responsibility to lie with him.
Potential donors, such as Tovah, have to be approved by a committee at Georgetown before the transplant can happen. The committee, which includes a retired surgeon, a psychiatrist, a donor advocate, and a risk-management consultant, decides whether a donor is mentally and physically fit for surgery. About 80 percent of live-donor kidney and liver transplants at Georgetown go forward; committee members might say no if they don’t believe a donor understands the risks. Donors occasionally change their minds.
The hospital used to require all liver donors to have an emotional bond with the recipient—you couldn’t donate part of your liver to an acquaintance or a stranger, the way you could a kidney. After months of consideration, the committee recently allowed one patient to receive part of a liver from someone in his church whom the man didn’t know.
“Our beliefs are evolving,” says Johnson. “We were very restrictive starting out because of the risks involved. The question is: Are we being too paternalistic by making these arbitrary decisions about who can and who can’t? What right does an individual have if they really want to go forward with something like this?”
As Jacqueline Dorsey sits in the waiting room, her daughter in one room and her niece in another, she remembers when she felt helpless—when she realized she couldn’t get Jessica the one thing she needed.
“Don’t cry for me, Aunt Jacquie,” Jessica had said.
Jessica had shown her the letter she wrote to Tovah, thanking her for giving her a second chance. A priest had made prayer shawls for both girls. Today’s surgery, Dorsey says, is a miracle.
A nurse stops by about an hour into the transplant. Tovah’s surgery is going well; Jessica’s asleep.
“I know the waiting is hard,” the nurse says. “They’re in the best of hands.”
“And those hands are in bigger hands,” Jacqueline says.
Johnson walks into the waiting room a few hours later and leads Dorsey and other relatives to a private room.
“Her surgery went fine—we didn’t have any trouble at all,” he says. “Our only concern at this point is that the left lobe of the liver is a little smaller than what the MRI indicated. That’s not a problem for Tovah at all, but we’re more concerned about Jessica.”
Johnson explains that Jessica’s blood flow can overwhelm such a small piece of liver. Doctors are trying to slow it down.
“There aren’t many things you can do in life that are greater than this,” Johnson says of Tovah. “We’ll keep our fingers crossed.”