>> secrecy means you can't go too far with this. >> absolutely. we have to protect the privacy not only of the donor and their family, but the recipient as well. it is something that we regard as a very precious gift that the family is offering. the sacrifice of the passing. it is very revered and on the other side, we want to respect the privacy of all of the individuals. >> without getting into specifics, go back to how this all started for you. where were you when you got a call? >> that is a good question. i was at home. i was about to take my son to scouts. he had a cub scout meeting and we were on our way over there. i was telling my wife, all right, big day tomorrow. you need to get some rest and i will take edmund to scouts. one of my partners called me and

said, hassan, we have a transplant going this evening. are you able to pick your? i was technically on-call. he said, i think the timing will be such that you can get back in time. certainly it was. >> what airport did you fly out of? >> dulles. usually we fly chartered aircraft because commercial -- you have to coordinate all the timing. the issue with hearts and lungs is that they have sort of a short shelflife. we have about four hours, six hours at the max to transplant the organ once we retrieve it. >> what time do you took off out of dulles airport? >> roughly about 10:00 p.m. >> what time did you get the heart?

>> around 11:00, 11:30. we started a little after midnight. we were up till about 3:00 a.m. >> when did you leave to get the heart? >> i left at about -- we took off at about 10:00. >> and what time did you get back here? >> just about 4:00, 5:00 a.m. >> when was the operation? >> when we bring the organ back, the other team puts it into the recipient. >> one hospital here? >> i can't tell you that. fairfax. >> fairfax in the suburbs. how many people were with you to get our? >> just two. >> what do you do with the heart when you get there? >> good question. we get a lot of information from what we call our donor network. it is an automated system now so it is very nice. in the past, a lot of this was done with phone calls and fax

and trying to coordinate things. once we have a match and that is all based on the criteria that unos establishes, they establish all of this criteria and we have a recipient on a list and they have the donor. they are matched based on blood type and severity of illness. when we get there, we verify all of the things, primarily three things -- blood type to make sure that it is going to be compatible, we want to make sure that we also have proper consent. every state have is a different kind of rule regarding that. we also want to make sure that we document and verify that there is in fact brain death. >> when you get there, who removes the heart? >> our team does. myself and my assistant. >> what do you do with the heart? >> we packet on ice.

we preserve it with a fluid and what that does is, it slows down the metabolism and the ischemia, that is a lack of blood and oxygen that go to the muscle. you want to make sure you preserve the heart as best as possible. what we do is infuse and arrest the heart, make it quiescent. most importantly, we cool it. when we do that, the metabolic rate slows down. once you remove an organ from the body, it starts to die. until you place it into a new recipient and revive the blood and start to circulate the nutrients and oxygen, the organ is dying. the clock starts to take. that is why we don't have a lot of time. as i mentioned, unlike organs like the liver and pancreas and kidneys, they have a little bit of a longer tolerance for ischemia. the heart and lungs are not so resilient.

>> when you get it back to washington in the middle of the night, do you have a police escort to the hospital? >> usually an ambulance. >> what did you do once you got to the hospital? >> we bring it into the operating room and the team that is there, they have been working as well. it is a very well coordinated plan. they have to begin the surgery while we are working on the other side often times. depending on if it is local or out in the distance, we time and plan so that ideally you want to have the heart being removed as the new heart is in the hospital. so you can just put it right in and decrease the amount of ischemia as much as possible. >> versatile question, on the other end of this, with the family there? >> not in the operating room, no. >> did you meet them? >> no, typically we don't. in my practice and over the

years, i will say that one of the things that is always worry touching about transplants is that it is one of those instances in medicine where you really see life and death. you have certainly witness to death on one side with the donor and on the other side, there is the recipient. there is this joy and this new life. over the years, i have actually received the letters from both sides, from the donor families and from the recipient families area letters of thanks, letters of encouragement, letters of gratitude. i think it helps the families that donate to have some closure and have some peace, to know that their death, often a tragic one of their loved one, wasn't in vain. their gift of life is now helping to serve someone else.

>> at 11:00 in the morning, after you have been up all night in late october, do you know in this stage where the the heart has been transplanted successfully? how long did that take? >> it typically takes about -- depending on the case, a few hours. >> how many people total are involved? >> it is a huge undertaking. it is a big team effort. no one person is the single person that is doing the whole job. we have nurses, anesthesiologists on both sides, two teams typically. this is just the heart team. on the recipient side, we have the same cadre of individuals there. that is just the hospital team. you take all of the other folks involved, the transplant coordinators, the ambulance drivers, the pilots. it is a huge effort.

one that is taken very seriously by a number of very dedicated individuals. they typically work through the night and overnight and on weekends and holidays because unfortunately that is often times when a lot of these tragedies occur. trauma is never really something predictable. it never really happens during banking hours unfortunately. >> how much sleep have you had since you were with your son last night right before you took off? >> intermittent snoozing on the flight and about an hour afterwards. >> how often do you do this a month? >> it depends. there could be some months where it is twice or three times. there could be months where it is four or five times in succession over days. sometimes, holidays are busier than other times of the year. >> are you on the other end ever were you are putting the heart in? >> yes, i am occasionally. sometimes when you come back, the team and need some help and

i will come in and help out. >> so we can get to your background now. i do have one quick question. do you ever put a female heart into a mail? >> it does happen. and vice versa. the criteria are natalie with blood but you raise a very interesting question. the other thing that we take into account is the size. large individuals or small individuals. you want to make sure that the size is compatible. typically, female hearts are considered a smaller kind of heart for a male. you would want to put a female heart and maybe a smaller male. >> any idea how much all of this costs? >> you know, there are definitely dollar amounts that

are ascribed to them. pretty much, it is a lot. cost is very hard to measure. i have done studies on transplants and tried to assess cost. it is difficult to quantify because of a number of things. different hospitals have different costs for different items that they use. different transplants, depending on where you are going whether it is local or out of state, those incurred different costs. for local, we are just going to another hospital. we are not going to take a jet and incur those costs. >> are we talking a million dollars? >> i don't think it is that much. >> several hundred thousand? >> probably not that expensive, but certainly up in the six- figure and under range. >> i have in my hand, a novel

called "gifts of the heart." are you the doctor in this book? >> no, i am not. i think at times when i read my characters' attributes and qualities, i wish i could be like him at times. there are certain things that i had the privilege in my career to have the opportunity to rise to the occasion of some of his feats. >> who is he in the book and how close does that come to your story? >> it comes fairly close. i relied on a lot of my experience from my practice, my experiences in the hospital, life experience as well to come up with the character. there are definitely some

parallels, but there are some differences as well. my mom is still alive fortunately. my dad has passed away. >> was he from ghana? >> yes. >> was your mother from sierra leone? >> yes, she was. >> what measure of ancestry got into that? >> it was fairly accurate. he was a lebanese businessman that had migrated or done some business in sierra leone. >> your name is hassan tetteh, but you say you started out as a roman catholic. where does the name come from? >> my grandfather. >> it was his name? so you were born in brooklyn, where did you go to school along the way? >> my parents were both born in west africa as you mentioned. my dad would always muse and say that i was made in the usa. i like to specifically pledge

allegiance to brooklyn. i think it is a very interesting place to grow up and one that builds a lot of character. it makes a lot of characters. [laughter] i went to catholic school for most of elementary. i transferred in middle school to a public system. i went to brooklyn technical high school. it was an amazing experience, great high school. i recently went back for career day. we have a huge alumni network, we graduate over 1000 individuals every year. great friends from that experience in high school. we still to this day keep in touch. then i went to a small arts and sciences college. the background behind that is interesting because i, like many

of my brooklyn tech students, we thought we were fairly bright. in my case, i thought that i would do well in one of the big schools, the iv schools so to speak. i went to my college counselor and i wasn't valedictorian -- i was an ok student. i probably should have applied myself a little bit more. i went in with these grand ideas of wanting to apply to ivy schools and he suggested that maybe i should lower my expectations of little bit. apply to some of the schools. i applied to some other schools out of state because like most kids in my era, we wanted to get far away from our parents. i applied to florida and virginia and alabama. i got accepted to all my schools. i always thought to myself, i should have just applied a

little higher. i probably would have got in. it turns out that i don't have the money to go. they sent a financial aid package and the school i was supposed to go to was morehouse. i got accepted to morehouse, we were going to go. it was going to be very exciting. i was so happy to go. when the financial aid package came, it wasn't much of a package. even with loans and subsidies and everything else, my mom simply said, i can't afford to send you. in fact, if i have you go to the school, i don't think i could even play for the plane ticket. i found myself without a university. my mother told me, you can't stay here. you need to go to school. i had not applied to any of the city schools in new york. i went back to my high school, they couldn't do much for me other than direct me to the

state university of new york office in manhattan. i went there and with my transcript in hand, sat there with a woman who i will never forget. she made a phone call to almost every single one of the suny schools. school was about to start in a couple of weeks. she pitched my application to a number of the schools, the big university schools like binghamton and so forth. none of them had room. they simply were filled to capacity. the two schools that did have a place for me were suny purchase and the other one was suny college at plattsburgh. i looked on a map and the map showed plattsburgh was up by the canadian border. it look far away from home so i chose that one. >> where did you get your

medical degree? >> suny downstate. >> when did you join the navy? are you still in the navy? >> are you in the navy full- time? >> yes. >> howdy do the navy full-time and the private hospital? >> we have a memorandum of understanding joined the fairfax hospital and the navy hospital. since coming to this area, i have been working with the nova group primarily because of my transplants training and wanting to eat those skills fresh and current. also, based on this agreement that we have to be able to cooperatively work with each other, they help us with our cases at our institution and vice versa. >> when you are in the navy, working, you are located where?

>> correct. >> take us to the time you were in afghanistan. when was that? >> that was in the summer of 2011. >> how long were you there? >> approximately six months. >> what was your purpose for being there? >> i was deployed to support the second marine expeditionary forces. in my case, i was there to provide medical support, specifically surgical support. typically, when physicians and surgeons deploy, we go primarily as physicians so we are just docs and we are always that and surgeons -- despite your specialty, whether it be plastics or cardiac, your main role is to serve as a combat trauma surgeon. >> where were you located? >> in the southwest portion of

afghanistan. >> what were the circumstances? were you in a city, out in the country? >> we were out in the desert valley, very austere base. role two means that it is special on the care. we are supporting the marines so we are there to help them when they get injured. there are about five echelons of care. roll 1 is right at the time of injury. usually it is a corpsman putting a bandage on a wound or a turning kit. that is real-time, gunshot wound happens, we call that roll 1 care. roll 2 is usually away from the activity although sometimes the activity can occur right there as well. that is where i was.

what we do there is stabilize a patient, try to get them to a point where we can arrest the bleeding and get them to a roll 3 and that is usually still within the country. it is a larger facility, bastion in our case. they cooperate with the brits. these hospitals that are quite visible. then there is roll 4. in each of these stages of care, the injured member is getting more and more acuity of care. finally, roll 5 would be one of the big hospitals back stateside, like bethesda, san diego. >> had you seen combat before this six months? >> in some sense, yes.

i spent two years on an aircraft carrier earlier, 2003-2005. uss carl vinson, that was my first deployment if you will. after some years in the navy. my last six months on this ship, we were deployed to the persian gulf. we supported operation iraqi freedom during that time. combat, but different kind of combat. on an aircraft carrier, we are launching and recovering the air raft that are flying to support the mission. >> 2002 in afghanistan, you're out in the field, in the field hospital. how many people are medical in that area? >> in our case, we deployed with almost 200 medical people altogether to support our contingent. we were distributed to different areas within the region.

my specific area, we had about 30 medical folks with us. >> is the story in this novel pretty close to what happened in afghanistan? >> there is some parallels, not exactly the same way but there are some parallels and some similarities. >> when do you remember the first time that battle wounds, injury, came to you? what were the circumstances? >> the most vivid was our first day. arriving at our final location, roll 2, the transport there took some time between combination commercial aircraft, military aircraft, going to be staged at the big base at leatherneck and going to our respective places. the day we arrive at the forward operating base, the day we

arrive as the new surgical team to take over and our colleagues that are going to be there, we saw our first real casualty. >> what was it? who was it? >> it was a young marine who had been injured by an ied, and improvised explosive device. the young man -- i should take one quick step back and say, i wasn't kidding when i said brooklyn was a formative place to grow up. it was also a formative place to train. i thought that i have seen every trauma possible, gunshot wounds, stab wounds, explosive injuries even. motor vehicle accidents -- anything. i felt very comfortable with my

level of experience with trauma based on my brooklyn experience. what i saw that day, the first day that we were there -- it is so hard to describe because even though i had been years before deploying, seeing individuals with extremity injuries, some of them still undergoing the surgery they need, i hadn't seen it raw, in real-time right after it occurred. that was what i saw upon arriving. there was no delay. some of our colleagues went to other areas where they didn't see a casualty for weeks or even months after being on station. we saw it the first day. it just continued. what we saw in this individual was someone who almost 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? >> nine, my son and seven, 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 give us your comments about this program, visit us at q-and- a.org. "q&a" programs are also available as c-span podcasts.

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