Last week, I was working the second half of a twenty four hour shift when I received a call about an incoming lung transplant surgery patient. Our institution is renowned for its transplant surgeries, specifically lung transplants. In 2025, according to a campus-wide email received on January 21st 2026, our institution performed 179 lung transplants—more than any health system in the country. One of the responsibilities of the overnight intern is to prepare lung transplant patients who come in overnight for their procedures. This involves admitting them into hospital, obtaining the necessary tests, and writing their History and Physical notes.

As I went through the motions of chart checking and note taking, I slowly realized I knew this patient. I looked at their notes and sure enough, there was a signed discharge summary I had written almost eight weeks earlier, while on my actual night float rotation. This was a patient who, on one of my very first night shifts, I had to deliver the news that they would not be getting the lung they had been admitted to obtain. It was a message I had to give to them and another patient, and it was only the second time I had done that. The other patient was gracious about it-they were no stranger to the disappointment of the process, they said, and they were grateful to me for coming to let them know so they could decide whether to stay admitted or go home.

This patient, however, was decidedly not happy about the news. She cursed me and all the doctors involved, turned her face away and refused to acknowledge anything else I said. Having now been the bearer of that specific piece of bad news news to more than five patients, I know that her reaction was justified, because for every successful transplant story cataloged, there are many more untold tales of denials, rejections, and postponements that these patients have to endure.

Transplant Surgery, from the little I have gleaned in my time as an intern, is a grueling beast for all involved. The process of organ transplantation is long, arduous and often fraught with disappointment. First of all, most major organs transplanted (heart, lungs and sometimes kidneys) are donated by dead donors at their passing. Meaning in these cases, the possibility of one person experiencing a new lease on life depends on another person or family navigating the fresh pangs of losing a loved one. Plans for organ procurement are made when a patient is nearing the end of their life, and recipients are asked to come into hospital in anticipation. The end of one’s life, however is never a fixed timeframe, and sometimes, as in the case of the patient I was now working on, the donor may not expire, and organ procurement and therefore transplantation would have to be deferred.

Secondly, the availability of organs for transplantation and the approval of patients to donate and receive organs does not always guarantee organ viability. Patients could go through the entire process of getting on the UNOS (https://unos.org/) list, be approved for organ transplant, make it to the hospital for their procedure, a donor and their family will generously offer organs, only for the surgeons to realize upon retrieval and inspection, that the organs are not viable. Organs are deemed suitable for transplantation by various means, one of them being imaging, such as CT scans. However there is no real way of knowing if an organ might be intrinsically or otherwise viable until one can examine them firsthand.

That was the case with two other patients I had to let know would not be getting organs as well. Imaging had confirmed the lungs were viable, and the procurement procedure had been successful, but upon closer inspection in the operating room there was intrinsic damage to the lung parenchyma that made them unsuitable for transplantation. This was about two weeks after I had met the first two patients I had to inform would not be getting lungs. I still struggled with how best to deliver the information, and how to deal with the aftermath, but I was now no longer a stranger to the actual doing of the thing. The first of these two patients was older, had been in the hospital waiting on organs for some time, and through sobs and sighs the family said they understood and would be staying as the patient was practically bed-bound from respiratory difficulty and they were going to be staying until he got new lungs.

When I went in to see the second patient I realized they were much younger than any of the other patients I had encountered previously. The were just a few years older than me. Their spouse sat on the chair next to them, packing a small overnight suitcase. I introduced myself and told them why I was there. They said the attending had already called, and they were aware. They were preparing to head home, but were unsure if it made sense for them to leave. It was the second day of the historic storm that hit the Southeast in January, and the snow had begun to fall heavily as they were leaving their hometown some two and a half hours away. As it happened, the couple was from the same city I was from, and we bonded for a few minutes over the joys and perils of living in our busy town. I mentioned to them they could stay and leave in the morning if they chose, which they gratefully accepted.

The next day I left for home as I usually did, all the while pondering how difficult it was to have these conversations, to speak with these patients, to try placing myself in their shoes, getting devastating information from a complete stranger and having to return to their lives in other to resume the waiting game over again. Every so often I would talk about my feelings on the subject, but gradually other commitments got in the way, and these five patients began to cede their place to other anxieties and duties in my life.

I had almost forgotten about this patient and their situation, until one day, three weeks ago, when I was on call again, and armed with lists of patients of all the various surgical specialties, I began to organize myself for the shift. As I ran through and sorted out important to-dos for the evening, I came across a name that gave me pause. It was the patient from a few weeks earlier, the one who with the spouse had not been able to leave the hospital due to the storm. I was worried what they might be doing here-was he ill? Had his condition worsened?

As I reviewed his chart, I saw the first line of the last note:

“Patient is post op day *** status-post double lung transplant…”

My breath caught in my throat. He had gotten them! After all that rejection, all that strife, all that anticipation, disappointment and back to waiting. He had gotten the life changing therapy, the new lease on life. The road to recovery would be arduous, and it will be a while before he is back at full tilt, but. He. Got. Them. The elation I felt for this man, this stranger, this patient whose only contact with me had been as bearer of bad news, is

The next morning I went by the patient’s room to say hello. I was worried they would not recognize me, as my face was obscured by the mandatory masks we have to wear in the rooms of lung transplant patients. As soon as I walked in, however, his spouse pointed me out to her sisters. “That is the doctor that let us stay overnight last time!” There were congratulations and proverbial high-fives all around, and after spending a few minutes with them I said my good lucks and Godspeeds and left for home.

It was two weeks later, on the heels of this good news, that, on my last call shift, I realized fortune was about to smile on someone I had crossed paths with once again. I went down to see the patient, introduced myself, and wished them luck as they went into surgery. I turned around to leave, but I was curious. I returned to the patient and asked if they remembered me.

“Of course I remember you!” She turned to her niece who was accompanying her and said “This is the doctor who came and told me the last time I wasn’t gonna get the lungs the last time ’cause they were bad.”

“And she cussed me out!”

“I did! Because y’all were trying to play with me! But I remember you. It was dark. and I didn’t have my glasses on cause you woke me up from sleep, but I know it was you.”

She was wheeled out of the waiting area to the operating room a few minutes after and I have not seen her since.

Two months ago, when I met these two patients for the first time, I reflected on how difficult these conversations had been for me, and how much more it must have been for them to hear and process. Having an opportunity to see them on the other side gave me something I had not thought I needed or expected to receive: relief. I did not want to be the face of a low point in their already difficult journey. Also, I was having a fairly difficult few weeks, and these two events felt like balm at the right time for the things I was going through.

Given where I am in my training I know there will be many more patients like these, many more days of delivering bad news, of difficult conversations, of things that will take a toll on both my patients and myself. But I also know that for every story of rejection, of disappointment, of returning to square one, there are stories like these: stories of patients where the outcome is positive, where the patients are treated, and in some cases, cured. These stories, these outcomes are what give the patients, doctors, and people in between like myself, a reason to get up in the morning.