LAST NIGHT IN THE OR

A memoir of a high-achieving surgeon.

Retired transplant surgeon Shaw was a protégé of Thomas Starzl, “the father of liver transplantation,” when the specialty was considered radically reckless. Despite youthful doubts, the author decided that “working on the real frontiers of transplantation was a far more glorious pursuit than playing it safe.” Starzl’s harsh pedagogical manner (“Don’t hinder me, help me”) informs the tone of these clipped, anecdotal chapters, which provide a good sense of an elite surgeon’s development and attitude. As he writes of the team’s typical late-night helicopter arrival, “I suppose it was all so glamorous [but] mostly I worried about being disliked for our hubris.” Shaw trained in Starzl’s Pittsburgh-based program and then established his own transplant center in Nebraska, noting that demand for their innovations grew once Medicare approved the procedure. The author portrays the surgeon’s high-pressure lifestyle as grueling and surreal, depicting his first two marriages as casualties and discussing the invisible toll taken on his father, a revered general surgeon. Mainly, as the title suggests, Shaw focuses on the drama of the operating room, recalling both successful and failed transplants in terse, graphic terms: “I wanted to tell him that we pumped on her chest off and on for more than an hour…until finally I saw that everyone was standing back staring at me.” He suggests that if surgeons hold laypeople at a remove, they are their own harshest critics: “Yes, shit happens, but it’s still your fault. You’re the one who has to be better, smarter, more careful.” Shaw’s lean prose is lucid on technical aspects and moves briskly, more so than in some late-career memoirs, and he offers insights into medical professionals’ private perspectives as well as a sobering sense of human fragility and the scientific strides taken to counter it.

A bracing, unusual personal narrative that should appeal to aspiring physicians as well as to those considering the “big questions” around high-risk surgery.