Corona Daily 071: Dr Tomoaki Kato

Dr Tomoaki Kato, 56, was among the first Covid-19 patients in the USA. He had spent his entire adult life in hospitals, without ever being a patient there. He was fit and healthy, seven New York marathons to his credit. One day in March 2020, suddenly feeling breathless in the shower, oxygen level dangerously low, he reluctantly admitted himself to the same New York hospital where he worked. Once on the ventilator, he lost consciousness. Weeks passed without any signs of improvement or consciousness.

The doctors, his colleagues, were depressed. Even if Dr Kato were to survive, would he be a doctor again? There was a long waiting list of patients, and Dr Kato was irreplaceable.

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Dr Tomoaki Kato is the surgical director - adult and pediatric liver and intestinal transplantation. He is the innovator and practitioner of  “ex vivo” operations.

In his first year, Dr Kato and his team operated on Heather McNamara, a 7-year-old girl. She was told by several hospitals her abdominal cancer was inoperable.

As a transplant surgeon, Dr Kato knew organs can survive outside the human body for up to ten hours before going to a recipient.

He clamped the arteries of the little girl and removed her stomach, spleen, liver, small and large intestines and pancreas. The abdominal organs were put in a cold-preservation solution. Once out of the body, it becomes easier to reach and remove the tumours. Dr Kato cut out the tumour in the arteries, reconstructed her blood vessels using synthetic materials, replaced the organs and reconnected the arteries. It was like an organ transplant with the same person as donor and recipient.

When Dr Kato took out the organs, the anesthetized girl was lying on the table, with nothing in her body cavity. Though an empty abdomen was a familiar sight for Dr Kato, his colleagues found it unreal.

The organs were out for 19 minutes. It took an hour to sew them back. Another two hours to re-establish blood flow. The total surgery took fifteen hours. Heather went home in three weeks. She was the first child in the world to undergo multi-organ ex-vivo surgery. Ten years later, she is fine, studying in a college.

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 Over the years, Dr Kato had performed hundreds of complex operations. His operations were also marathons, requiring anywhere between 12 and 20 hours. While the team worked in rotation, Dr Kato stayed alert and in charge throughout. His surgical innovations, skilled hands and superhuman stamina had made the soft spoken surgeon a hero for his colleagues and god for his patients.

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In March, Dr Kato’s chest x-ray confirmed his covid was severe. Initially he had bacterial infections, then sepsis, followed by his kidneys failing, requiring dialysis. After four weeks of unconsciousness, he was put on ECMO, the machine that pumps oxygen into the patient, and sucks out CO2. This is the last resort.

Like many serious covid patients, he had frightening and vivid hallucinations and delusions. Scans found a blood clot and a brain hemorrhage. His hair had fallen out. Finally he woke up, a tube still feeding him. He had no strength and had lost 25 pounds.

It was two months before he could go home. When he left on a wheelchair, 200 staff members gathered around, chanting: Kato. Kato. Kato.

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In August, he started performing surgeries again. First few surgeries he performed sat in a wheelchair, with his sore shoulder wrapped in athletic tape. In two months time, he was performing liver transplants. By March this year, he completed over 40 transplants and 30 other operations.

Now he feels more driven to teach his art to other surgeons. If he died, and nobody else has picked up his magic, it will be a problem, he knows.

He also now understands better how patients feel. When he encouraged them to take a feeding tube, and said it might look like hell, he didn't know what hell meant. Now he does. He had experienced a near-death. “I was there”, are very powerful words for patients, he says.

Ravi