>> the topic of the recent book, "gifts of the heart." after that, british prime minister, david cameron. that, supreme court ustice elena kagan about the inner workings of the supreme court. >> this week on "q&a," surgeon dr. hassan tetteh discusses his medical career, his service in afghanistan and his new book titled "gifts of the heart." >> dr. hassan tetteh, you told me just before we sat down that you did a heart transplant overnight. explain that. >> while the transplant is a big team effort.

i was not the one responsible, but i was part of the team. i was the e, procuring team. so myself and some of the team embers flew out of state to retrieve and harvest the heart and bring it back to a patient in need. a long night. you have to go? >> midwest? >> you live in town. >> yes, sir. of the was the condition person you got the heart? obviously dead. story. always a tragic typically young person because hey're the most ideal candidates for organ transplants, the heart. motor vehicle accidents in this that's typically what it is. some common denominator of all the donors bring death. hat's ultimately what they succumb to. they become candidates for work and donation. so in this case, a motor vehicle accident and a traumatic brain injury and then the demise was

becoming a and candidate for, you know, donation. secrecy rules mean you can't go too far with this. >> absolutely. ecause we have to protect the privacy not only of the donor nd their family, but also the recipient as well. regard as a very precious gift that the family is offering and the individual is offering. the it the sacrifice of passing. revered and another side it's a joyous occasion. but at the same time, you want privacy of all of the individuals. >> without getting to the specifics, go back to how this all started for you. were you when you got the call? >> so that's a good question. i was at home. i was about to take my son to and the cub lly, scout meeting last night. we were on our way over there. said, elling my wife, i all right, big day is tomorrow, the interview, i need to get some rest.

edmond to scouts. and one of my partners called me san, we e said, also have a transplant going this evening, you know, are you available to procure? i'm technically on call. i said, up, yeah, i have this and he said, rrow well, i think the timing will be such that you can get back in certainly what it was. excuse the specifics, what airport do you fly out of? dulles, we usually fly charter. obviously, commercial, you have timing.dinate all of the the issue with hearts and lungs sort of the have short shelf life, if you will. have about u about four hours, six hours to we splant the organ once retrieve them. >> what time did you take off dulles airport here? >> 10-ish.

10:00 p.m. yet jet?e >> yes, sir. >> so what time did you get the heart? o.r. around e 11:00-ish. 11:30. midnight. little after we were wrapped up at about 3:00. >> well -- i'm confused. leave to go get the heart? >> oh, i left -- i left at we took off at about 10:00 p.m. >> what time did you get back here? >> 4:00 or 5:00 a.m. >> then when was the operation? >> when we bring the organ back, other team, you know puts it into the recipient. hospital there. >> i can tell you that, my inova fairfax. >> fairfax hospital in the suburbs. >> how many go get the heart? >> just two. >> what do you do when you get there? >> well, good question. get a lot of information from what we call network. it's actually an automated system now. so it's very nice.

a lot of this is done with phone calls and trying to nd coordinate things, once we have on tch and that's all based unos -- the that united network for organ sharing. get all of the criteria. they have the recipient, they have the donor, the match based type and the severity of illness. when we get there, we verify all primarily, ngs, three things, the blood type, to make sure it's compatible with on the pient we have other side. we lso want to make sure have proper consent. every state has a different rule regarding that. we we want to make sure document it and verify that there is, in fact, brain death. there, who -- t who removes the heart from the chest? >> our team does. yes. so myself and then my assistants. >> in the hospital? >> yes, yes, sir.

do with the o you heart? >> we pack it on ice. we preserve it with -- with the arrests the heart. that does is slows down the and the eschemia. preserves the blood and heart as much as possible. arrests the , heart, slows the metabolism down, most importantly, we cool it. when we do that, the metabolic rate slows down. once you remove the organ from body, it starts to die. so until you place it into a new recipient and revive the blood and start to circulate the utrients and the oxygen again, the organ, you know, is dying. the clock starts to tick. that's why we don't have a lot of time. nd as i mentioned, unlike the organs like the liver, the a creas, and the kidney have

longer tolerance for eschemia, lungs are not so resilient. >> you get back to the middle of night, do you have a police escort? >> usually an ambulance. you at happens -- what do do once you got to the mopt? >> we bring it to the operating room and the team that's they have been working as well. a very well coordinated plan. they have to begin the surgery while we're working on the other side, oftentimes, depending on if it's local or out in a time and we plan. so ideally, in this case, in want the tion, you heart being removed as the new heart is in the hospital and is in the operating room. can just put it right in and just decrease the amount of eschemia time as much as possible. other end, was the family there? >> not in the operating room. >> do you meet them?

no, typically, we don't. although in my practice and over years, i will say that one of the things that's touching it's ransplant for me is one of those instances in medicine where you really see life and death. know? firsthand. you certainly witness death on the donor.th then on the other side, there's a recipient, there's the joy and life. and over the years, i received letters from both sides, from families and from the recipient families. letters of hanks, encouragement. gratitude, actually, for what, you know, our team has done. it -- it helpsnk the families that donate to have some lose yufrp and have peace that know that their death often a tragic one of their one wasn't in vain. and that they are a gift of life

is now, you know, helped to serve someone else. this at 11:00ding in the morning after you've been up all night in late october. you know at this stage the heart has been transplanted successfully? >> yes. >> how long does that take? typically depending on a case, a few hours, a couple of hours. > how many people total are involved in this? >> it's a huge undertaking. it's a big team effort as i beginning.rom the no one person is a single, you is canort of person that do the whole job. we have nurses, profusionists, anesthesiologists on both sides, two teams, typically. and this is just for the heart team, you understand. and on the recipient side, have the same cadre of individuals there. that's just the hospital teams. the other ke all of folks in, the transplant coordinators, the ambulance

the pilots, you know? it's a huge -- it's a huge effort. and one that is -- one that's seriously by a number of dedicated individuals who overnight and through the night on weekends and holidays because that's the times when a lot of tragedies occur. ith trauma, it's never really anything predictable. never happens in banking hours, unfortunately. sleep did you have since you took with your son night. >> snootzing on the flight and about an hour after that. a how often do you do this month? >> depends. could be some months where it's twice or three times. months it could be four or five times in succession over days. holidays unfortunately are of nessier than other times the year. endre you ever on the other

putting the heart in? >> i am, occasionally. ometimes you come back, the team needs some help. i'll come in and scrub in and help out. yeah. >> so we can get to your background now. i do have one quick question. ever put a female heart into a male? >> it does happen, yes, sir. it does. vice versa? >> yes, vice versa. again are eria compatibility with blood. you raise an interesting question, you know? we take into g account and consideration is very important, the size. large individual, small ndividual, you want to make sure that the size is compatible. female hearts are sort of considered a smaller heart for a male. so you would want to put a a smaller t in maybe male, typically, sort of -- of thisdea how much all costs?

>> one of these -- throwing middle of it?the >> you know, there are -- there amounts itely dollar that are ascribed to them, pretty much. you with can imagine, resources. are hard to measure as i found. i did studies in transplants and assess the costs. it's difficult to quantify things, different hospitals have different costs than different items than we use and utilize in the operating room. different transplants, depending on where you ear going, whether out of state. those incur different costs for local and we're just going to hospital, we're not going to take a jet and incur chargessts and the fuel and pilot time, etc. >> taking $1 million for some of these? >> i don't think it's that much, but -- >> several hundred thousand? >> probably not that expensive.

maybe in the six figure. low six figure and just under range. hassan e in my hands, tetteh and a novel called "gifts heart," are you dr. eligan in this book? no, i'm not. i'm not. i think at times i read my -- my characters sort of attributes nd his qualities, i wish and aspire to be like him sometimes. here are certain things that i certainly had the privilege and fortune in my career to have the of rise to to sort he occasion of some of his feats. >> who is he in the book. story. se is he in your >> does come fairly close. experience ot on my from, you know, my practice, my in the ces in -- hospital.

hospita hospital. life experiences to come one the character. there are parallels. my mom is alive, my dad has passed away. ghana. from >> your mother was sierra deon. what measure of lebanon ancestry got into that? some rly accurate, in ways. the grandfather, my mom's dad lebanon. he was a remember neetz businessman that migrated or one some business in sierra leon. >> and your name is hassan tetteh. out as a roman catholic? >> yes, sir. from?re was the name >> my grandfather. >> his name. you're born in brooklyn. where did you go to school along the way? >> born in brooklyn. were born in west africa. my dad would always mutz and say

the usa.e in i like to say that. nd i like to specifically pledge allegiance to my brooklyn it's an ause i think interesting place to grow up in, one that builds a lot of makes a lot of characters. but i went to -- inwent to atholic school for the most of elementary. i transferred in middle school to a public middle school system. brooklyn technical high school in the ft. green area of brooklyn. amazing experience, great, great, great high school. i went back actually for career recently. we have a huge alumni network, individuals 1,000 every year. great experience from high school. still to this day, keep in touch. i went to a small arts and

science college. background behind that is i like many ecause of my brooklyn tech students fairly bright. in my case, ill thought that i would sort of do well at one of big schools, the ivy school, so to speak. nd i went to my college counselor and i wasn't the aledictorian and certainly salute torrian. i was an okay student. should have applied myself a little more. i suggested i go to the ivy school. e suggestled i lower the expectations a little bit. apply to some of the other schools. schools out other of state because like most kids then, we wanted to get far away from our parents. so i applied to florida and

and i got d alabama accepted. and i thought to myself, i hould have applied a little higher. probably would have gotten in. graduated from high school, it have the i don't money to go. they send the financial aid package. go school i was supposed to to, actually, was moorehouse. i got accepted. were going toends go. it was going to be exciting. when the financial aid package came, wasn't much of a package. even with loans and subsidies and everything else, mom said, know, i can't afford to send you. in fact, if i have you uh go to don't think i can even pay for the plane ticket for you to go to atlanta. it was that bad. so i found myself without a university and a mother who told can't stay here. you need to go to school. to any of ot applied the city schools in new york, good.gh they were all

didn't apply to the suni schools either. >> state university of new york? >> correct. they could do was connect university of new york office. i sat there with my transcript woman who with a made a phone call to every single one of the suni schools july.e school was starting in a couple of weeks. application to the big university school bing ham tons e and albany. none had room. filled to capacity. the two schools that had a place purchase, state university of new york in purchase and the other one was university of new york college at plattsburgh. looked on a map and the map showed that plattsburgh was up border.canadian

and it looked so far from home, i said i'll choose that. purchase looks too close. where did you get your medical degree? downstate. >> when did you join the navy? >> after medical school. >> what year? 1998. >> are you still in the navy? >> yes. >> navy full time? yes. >> how do you do navy full time private hospital fairfax? a we have a -- we have understanding between the fairfax hospital and navy hospital. since coming to this area, i've working with the group primarily because of the and wanting aining to keep those skills sort of current. the agreement to work with each other. they help us with our cases at

vice versa ion and in my case. you're located where? bethesda? >> right, right. time when you he were in afghanistan? >> yes, sir. >> when was that? >> that was in the summer of 2011. 2011. >> how long were you there? >> six months. > what was your purpose for being there. >> deployed to support the second marine expeditionary case, i was my there to provide medical support, specifically surgical support. ypically, when physicians and we go primarily as surgeons. despite your specialty, whether plastics or card i can't believing, the main role is to erve as a combat trauma

surgeon. >> where were you located in the six months? portion of uthwest afghanistan. province?d >> helmand province. were you in the city or in the country? desert valley.he very austere. roll 2 base. that mean?s >> in the hospital sense, it echelons of 's care. again, we're supporting the arine marines. we're there to help them when they get injured to take care of them. were five echelons of care. one is the time of injury. a corps man putting a bandage on a wound or tourniquet. that's out in the field, realtime. happens, we call that roll 1 care.

is an outpost away from the activity. though sometimes the activity right there as well. what we do there is stablize the them to trying to get the point where we can arrest the bleeding or temporarily stop get them to a d roll 3. and that's still usually within the country. facility.ger bastion in our case, we brits to run, the andahar, the hospitals are quite visible. and in germany, row 4. so each successive stage of care, the member -- the injured member is getting more and more care.f an acuity of and then finally, row 5 would be one of the big hospitals back side. >> like bethet da. go, ke bethesda, and yea sammc. >> have you seen combat before

months when you were there? >> in some sense, yes. -- i spent two years on an carrier. >> uss carl benson? >> the first deployment, if you the after some years in navy. my last six months, weer with deployed to the persian gulf and iraqi freedom at that time. so combat but different kind of combat. aircraft carrier, we're launching and recovering the flying to at are support the mission. >> 2002 in afghanistan, you're in a ere in the field field hospital. medical in ple are that area. with 200 medical people all together to support

contingent. we were distributed to different areas in the region. area, we had 30 medical folks with us. and it's story -- novel pretty close to what happened in afghanistan? >> there are some similarities and some parallels. remember the battle wounds injury came to you. circumstances? >> the most vivid was our first arriving at our final location. the transport took some time combination commercial aircraft. ilitary aircraft, going to be staged in the big base and then

file. to our respective so the day we arrived as our fob. >> forward operating base. >> yeah. new ay we arrived as the surgical team to take over and colleagues were aware we're going be leaving there, we saw real rst, you know, casualty. i rebel vividly. it? was not by name but -- >> sure, a young marine had been ied, an improvised device.ve and the young man -- and it does and one quick step back say, you know, i wasn't kidding brooklyn was a formiddive place to grow up, it trauma. to train, for i thought i'd seen every possible thing. gunshot wounds, stab wounds, explosive injuries, motor

accidents, anything. i felt very comfortable with my level of experience with trauma my brooklyn and kings county experience and so forth. saw that day, the first day he was there, even though i had been at walter reed and with, you viduals know, extremity injuries and and some of them still undergoing additional they needed. i hasn't seen it raw in realtime and after it occurred that's what i saw upon arriving. no delay. some of my colleagues went to they didn't see a casualty for weeks or months after being on station. day.ught it the first it just continued. individual isthis someone who shouldn't be living.

he had no legs. the skin on his extremities was all charred. the clothes were tattered. he was just so pale, almost ghostlike because you could tell he must've lost so much blood already. he had this sunken, hollow look in his eyes. i could tell he probably had no idea what had happened to him. we talk about shock from the biological sense of not getting enough blood, not refusing yourself, but this was shock -- emotional shock. it was shock for all of us. many of us like myself, this was our first experience, graphic and face to face with what war was like. we weren't out in the wire, engaging the enemy, but we were experiencing the dangers all around us. at the same time, we are taking care of individuals that were in that conflict.

>> you refer in the novel to the fact that even the medical people when they see something like this one to throw up. >> absolutely. >> does it ever happen? >> yes. >> what do you remember -- obviously you write about these things, but what do you remember from that marine that was brought in? >> he had some figures that were missing, close all tattered, dirt all over him. he must have stepped on this thing and, boom. >> was he awake? >> barely. almost just kind of holding on. just a little bit of consciousness. >> were you in charge? >> no. again, it is a big team effort. we certainly weren't in charge when we first got there. we literally strolled off of the aircraft that delivered us here. as soon as we land, the team is

awaiting a casualty to take this casualty in and we are just shellshocked. literally. we are standing by like fish out of water because many of us had never experienced this before. even the people that had experienced it before in terms of the playing other campaign, this was different for them. so, what we did is we followed the lead of the season folks that were there. what i immediately noticed was their poise and composure. i think that in retrospect, certainly looking back, reflecting on that experience, the first day and over the six months and ultimately leaving and having other folks come to relieve us, what i think i

appreciated was the fact that there is a socialization that occurs with each of us. each one has their own different kind of way of dealing and coping with it. in essence, what happens is that you just become immune to it in a way. your emotions sort of get pushed to the side. you just deal with the matter at hand. >> tourniquets, what were those put on? >> this is the fascinating thing. i learned this soon after being there. if you looked at the injury, you would just think to yourself, how could one possibly get something around what was left of the leg and the thigh with the distraction around the extremity to stop the bleeding? it would be almost impossible. the person would just go out

before you had the opportunity to do that. our marines would go out on their patrol and on their missions with the tourniquets already on, not tightened, not fastened but already in place. it wasn't a matter of if. it was a matter of when. that one maneuver actually putting it on before going out, i would say is probably responsible for saving a lot of their lives. when it does happen, that injury does occur, that explosion does injure the extremity, in that moment that it happens, you have the wherewithal to turn it and they are designed in such a way that it only takes a couple of twists and you can get very good inclusion and arrest of hemorrhage. or your buddy that is near you or somebody comes to your aid, they could quickly just to do

this rather than fumble and try with the injury to take something out of your bag and get it around and tie. you just wouldn't have enough time to do it. the fact that they were already in place beforehand, that gave you that window to stop the bleeding to the point where you could stop it enough so that you can get to some roll 2 echelon of care and progress through. >> did that marine survive? >> he did. >> is he still alive today? >> i believe so. that is a good question that you asked because many of us care providers knew that we would go back to our hospitals, our respective hospitals and be able to see some of these marines that we had taken care of. we were going back to the big hospitals in san diego, walter reed in my case. i have to say that it was a part

of me that almost didn't want to know what happened to them. we know that we got them from the roll 2 and we would have follow-up. it was a very elaborate trauma system that provides a very good feedback and a constant loop of communication among all of the echelons of care so that we can learn what worked, what didn't work, how the patient is doing. also, just to help with morale. you wonder if what we are doing is making a difference. we would get the feedback, we would get reports from the folks back stateside. that gentleman that you took care of, that wounded warrior that you took care of, he is doing fine. he is getting better. in our case, we did get that feedback. >> he was at roll 2 -- how long did it take him to get back to the united states? >> that is another testament to

the teamwork and orchestration and level of resource and for lack of a better word, ingenuity, for what we learned over this last campaign. there was a time when -- certainly in vietnam and words before that, it would take months for someone to get injured -- for someone that was injured to get back to a hospital with their families. in our case, typically, they would get back between 36 to 72 hours from the point of injury to a stateside hospital. back with their loved ones, back in the state-of-the-art facility where they have every resource at their disposal. a team of every specialty needed to care for that individual. it is a great testament.

what has happened is that over these years, we have learned so much about the logistics of transporting critically ill individuals. we virtually have flying icus in the sky that can take a critically ill person from the other side of the world and bring them back safely. >> it may sound cruel, but has there ever been a case in the field where somebody dies, a soldier or marine, and they are giving their organs away and you save the heart? >> not in this case. >> not in combat, that is not normally done? >> no. >> you are there six months, how many times did you have a casualty that you dealt with? >> in our particular area there we were, we dealt with them

unfortunately too frequently. what i mean by that is, we typically saw one or two, 3, 4 cases a week. sometimes multiple in a day. the longest we would go without seeing a case would maybe be a stretch of three or four days. that was a lot. and the injuries were not benign, these were people coming in with devastating life-threatening or fatal wounds. >> you say there was an indifference after a while. i don't mean about the people but about the motion and all of that. do you ever turn to any of your colleagues and say, why are we here? >> all the time. but not in the sense or the way that one might think, with all of the removal of what was graphic for us. our asking why we were here was a different kind of question. it was a kind of question of, we are here to support a mission.

we have all volunteered to serve and that is what we are here to do. we are not questioning that. from a medical standpoint, maybe speaking for myself more specifically, what i realized was that my role here was to support these injured marines and support them. the question you asked, why are we here, i had to leave on my colleagues all the time and ask the question just to make sense of it to myself. there were so many young people who we knew their lives were going to be forever changed

because of the injury that they had. some of those individuals that come back without the physical scars certainly have the emotional scars. yet i understood that the service that i was providing and the service that my team was providing was one that was so welcome and so needed and so much appreciated, that that was what defined our purpose. my being here was, i am here to help individuals that have volunteered to serve their country. that is it. that was my scope of thinking. talking to my colleagues and leaning on them to answer that question and ask a question back and forth, that was primarily the conclusion we all came up with. more importantly, we were there to support each other as well. we also realized that if we couldn't take care of ourselves emotionally and physically, then

we wouldn't be able to deliver the kind of care that we needed to make sure that those -- >> do you have a master in public administration? from where? >> from the kennedy school of harvard university. i did that in 2009. >> you have an mba? from? >> johns hopkins. i did that in 2011, right before i deployed. i completed the program right before i deployed. >> you are now a congressional fellow or you're going to be. >> i am. i am part of the robert wood johnson policy fellowship. >> that is a years commitment. they said they can keep you for another year. how much time do you spend on capitol hill and who do you work with? >> right now i work with the congressional budget office as a staffer and advisor. >> how long do you spend there? >> typically, one of the things

i do during the day, that is my day job if you will. my fellowship is coming to an end at the end of the year. >> any chance that you might stay on longer? >> unlikely. i'm going to take all that i learn and go and serve the needy. >> one thing that you might have passed on in policy that they are using? >> providing a clinical perspective. you almost appropriately segued into what my identity is. that is a physician. i had an opportunity through helping and individual who had a daughter who was interested in medicine, providing an opportunity for him to come see open-heart surgery. that led to some other opportunities to come together as well. the program that we have that in nova that is designed to give people the perspective. >> you have published this book yourself. >> right, correct. the editor and the folks that i

was introduced to were willing to publish it through their venue and through their company. but, you know this more so than i do. the publishing industry has changed. it is totally different than it was years and years ago. he was very frank with me, the editor and the publishing company's owner, he said i can't put any marketing dollars at all into your work. you are a relatively unknown author. so you're going to still marketing everything on your own. and i am going to own all your rights to your book. he said, if you are willing to put up the cost of the production, then you will have it on your own and you still have to put in all the marketing. >> my point though, was -- how many years in the united states navy? >> if you can since 1998, about 15. >> how long are you going to stay?

>> i plan on making a career of it. >> how much time do you spend at fairfax innova hospital? >> intermittently, a couple hours a week. sometimes overnight. >> so you don't go there every day? >> no. >> how much time do you spend at walter reed or bethesda? >> minimum time at this point. most of my time has been focused on this fellowship on the hill. >> you have a website and you tweet and you speak and all that. when do you have time to do that and when do you have time to write? >> writing for me, the mechanical process of doing a book really occurred for me over about a six or seven month period. mostly in the middle of the night, between 2:00 and 4:00. that was the time when it was quiet in the house and my two children were sleeping. my wife was ok with the absence

of me for a little bit. i could work during that time. obviously, you have listed all the other responsibilities that i have so i didn't have time to work on it during any of those other waking hours. >> how much sleep do you need a night? >> typically i do about three or four. >> you exercise? >> i do. i had to run two miles this morning so i could wake up and be fresh for you. >> most doctors would tell you that sleep is more important than anything. >> they do. i have to agree with them to some extent. i just know that over time and over all of my training and being in the hospital, during my fellowship and the nature of cardiac surgery, the demanding schedule that it imposes on individuals, it just necessitates that you have to operate and work on less sleep than most people.

maybe my body is acclimated to it. i certainly feel i am getting older and it is harder and harder to do it over these years. i don't know. i certainly don't advocate doing it because i know there are certain people who just don't function without a good amount of sleep. it certainly is important. i would never purport that people do it. >> where did you meet your wife? >> i met her my first year out of medical school in the hospital. >> it is kind of the same story in here? >> it is different because the timing for this particular character happened much later in his career. in my case, i met my wife right out of medical school and she was right about nursing school. >> what is she doing now? >> she is the school nurse at our children's school. >> how old are your kids?

>> 9, my son and 7, my daughter. >> this is a really open question, but how have you done all this? >> i have a very supporting wife. a very supporting family. i think that i have always felt that my parents sacrificed so much to sort of help may be successful, that if there is any moment of idleness in my life, then i am sacrificing that gift and i am sacrificing an opportunity. i think that is what has driven me and that is what continues to drive me. i also know that i have, through the various things that i have been able and fortunate enough to be involved in, have helped a lot of people. that has been very very rewarding. >> so why did you decide to go public? you speak a lot and you have a website and all that. what drove you to do that?

>> i don't know if i have gone public so much as -- i think that i have come to maybe appreciate that a lot of people could use some inspiration. i have been so blessed and fortunate to have been inspired by a lot of people. i want to in turn, help as well. the main purpose i think of writing a book was severalfold. one was, it was a way to release a lot of that indifference. i came back from afghanistan very changed in terms of my feelings about what i had experienced, the trauma of taking care of trauma. that was a really difficult time. it wasn't until i was leaving

that i really had the emotional release that i probably should have had all along or maybe that i should have had from the first day. i just couldn't because i realized that if i had done that, i wouldn't be able to perform. i wouldn't be able to help. i wouldn't be able to contribute and do what i needed to do to help individuals that were relying on the. as i came back and sort of adapted and integrated back into the real world, or our world here, it dawned on me that there was this whole other experience that many people were having and continue to have when they come stateside. no one knows about it. i don't mean that they should know about it in a political or geopolitical way. i mean they just don't know that lives are changed. people have served. people have contributed.

they weren't asked to do that. they volunteered. i think in those stories and in the stories of the people that have helped those individuals, i think there is a lot of inspiration there. there is a sense that we should not take for granted what we have. i have read lots of books -- i read a lot when i was there and continue to read every day. one of the pearls of wisdom that i came away with was this. wisdom only comes through suffering. i really believe that is true. i won't say that i was tortured or i suffered during deployment but it was uncomfortable. it certainly wasn't pleasant, it wasn't fun to be away from my family and children. yet when i came back, i had such a tremendous amount of gratitude for them and for my comfortable life here, that i think some people take for granted. i hope that in some small

measure writing about these experiences will maybe impart a sense of humility and gratitude to individuals that read it, inspire them and also maybe have them look introspectively and say, what am i doing with my life here? how can i help some individuals that may need some help? to use my talents and my background to be able to do that. i will give you a story of what i mean by this lack of appreciation for what we have. we did on rare occasions in my case take care of afghan locals. it dawned on me that they have no health care system. they have no 911 system. if you get in a car accident in afghanistan, you could die. just because you are in an

accident, you had the misfortune of being in an accident that doesn't have a 911 system. it could be from something that is so benign, but you would die. we were taking care of these individuals and it dawned on me that just because you had the misfortune or you were unlucky enough to be born in a certain place in this world, you could have a totally different life than you would if you were born just by circumstance and chance and luck, in this country. it has its issues, but it has a lot. i don't know if people understand or appreciate that. unless you travel and see other things and get a different perspective, you don't really appreciate that. a very illustrative point of this came back to me when i came back home. i understand that i have come back jaded and i had this tremendous experience. i have seen so many people

tremendously changed. when i got back, it was just may be my first couple of weeks. i got on an elevator and i was going somewhere - i can't remember where my destination was, but two individuals got on. two young ladies. one of them was so distraught, she just kept saying, i can't believe this happened. my pay is just awful. i felt like, so much empathy. like oh my gosh, it someone die? a parent, maybe she is sick or her child is sick. maybe she has got some bad news about her health. but it was so much pain in her voice. i am thinking in my context of transplant, death, what i just saw in afghanistan. we get to the floor and she is getting off and she turns to her

friend and says, i can't believe they didn't have my flavor latte at starbucks. i said to myself, what a country we live in that that could be the biggest problem that you have today. think about what i saw in the last six months. what i see in transplants and the trauma that rips the patient from the family's life. all of these trauma patients that we ultimately have as organ donors, they weren't expecting or planning for something bad to happen to them. typically not. it was trauma, motor vehicle accident. how many of us get in a car everyday -- we don't even think about it. it comes back to my whole explanation for why i do what i do. i always feel like there is limited time. some of us feel like we have all

the time in the world. i don't think so, maybe because i have been so close to death and i keep seeing it and reliving it. certainly my time in afghanistan made it graphic for me. it wasn't sanitized what it is with the operating rooms and our different transplant teams and things like that. it was more raw and visceral. yet, the common understanding that i come away with is that we don't have a lot of time here. no one knows how much we have. it sounds cliché and its like i have heard that before, but i feel like i have lived it. i continue to live it all the time. >> in the book, you describe with the main character, that he actually put his hands around the heart and massaged the heart with the chest cavity open.

how many times have you done something like that? >> every time we do a case. >> explain how that works. >> it depends what you are doing it. almost any heart surgery, you have to manipulate the heart as the surgeon. whether you're during a coronary artery bypass graft were transplanting the heart, we have to remove it from the patient and we put it back in and implant it. it sounds strange to say this but it is routine for us to do that. i remember the first time that i had to handle the heart. i was very afraid. with extreme trepidation was how i was manipulating it. i was scared to touch it because i felt like this was it. this was the engine of life. i am very biased, by the way

because of what i do. i felt like this with the engine of life, you can't touch it, you can't manipulate it. this is too sacred. just because of the symbolism, the heart has so much attached to it for so many people. talk about, that person has heart. they have the heart of a lion. where is the location of your soul? it is in the heart. there is so much that is just in the heart in terms of its connection to so much, that you just can't separate it. what i was trying to convey in the book was some of that awesome experience. from time to time, i step back and think about it. just last night, we took a heart from an individual and we brought it back. now someone else has a new lease on life. that is amazing. >> how often does that not work?

>> rarely, rarely. usually it does and that is why we do all of this preplanning, to ensure that that is going to be the case and that things will go well. but it does happen on occasions. >> when you go back to the afghanistan experience, the impression is left from the book that it is not the most sanitary situation out in the field. >> not at all. that is another dimension of it. most of us in our training, certainly me, everything has to be sterile. there is high risk of infection. we are in the desert and there is dust everywhere. you inhale it. it goes everywhere. you blow and you can see dust. certainly, there is this sort of conventional wisdom but you take that and kind of throw it away. in this particular circumstance,

you just have to work with what you have. you work with what you have an you try to be as resourceful as possible. there is certainly a high rate of infection just given the nature of what is going on. but that is not uncommon in any one of our work campaigns. that is just what comes with the territory. >> how did you cope with that first experience in afghanistan where you had a man on a gurney with two missing legs and a missing hand? when it was all said and done, how do you deal with that when you walk out of that tent? >> that is a good question. there was this initial shock. i saw it, that look that he had on his face. i could close my eyes and see him on the stretcher right now. i could see him putting his hand

up. i could see his eyes. i could just close my eyes and see it. i will never forget that first case, that sort of bringing me to reality of what was going on here. after he got into the tent, there was this initial triage. he gets to there, we get the report, we see him and he goes into the tent. the other team starts to work. we got pulled in, myself and my colleagues. we got pulled in. the other team wanted us to begin right away. they didn't want us to be bystanders. they said, you guys have to get involved right away. once they did that and pulled us in, it was like a jolt. wake up, now you have to act. you have to be a doctor. you have to be a surgeon, a care

provider. you have to dismiss your emotion. you have to tuck that away. just work now. you have one objective. you have to save this guy's life. you have to stop the bleeding, get him back home to his family. when we were done, it was almost surreal. you try to start thinking about it again, but somebody else would come in. there may be a gap of a couple hours and somebody else came in. maybe a gap of a couple of days and in between, we are talking about -- someone else comes in. over time, you just hand a bit desensitized. there was certainly for me a wall that was erected. there were others that would cry every time they saw them. some of the providers would cry every time they saw someone. they would get choked up every time. they would still feel that urge

to heave because it was still real. it was real everything on time. >> we unfortunately are out of time. before we you go, if somebody wants to read your blogs and all, where do they find it? >> doctortetteh.com. the book is available online. >> and it is called "gifts of the heart." thank you very much for joining us. >> thank you. >> for free transcripts or to >> in a few