More Questions Answered

On Friday, when we were sitting in the doctor’s office at Lahey, Derek and I were both trying to remember some of the questions that have been rattling around in our brains the last few weeks. We remembered a couple.

Will Derek and I get to share a room to recover?

The answer is no, but only because the floor we’ll be on at Lahey only has single rooms. We will be in recovery at different times and then once we move to our floor, we’ll be in different rooms. I was a little disappointed at first, and then I realized it will be nice for both of us to have a place to go and visit! It’s kind of a relief actually. When Derek was at CMC back in October he had a roommate. He was very nice, but both Derek and I felt like we should be quiet so as not to disturb him. Plus when you have a roommate there’s additional opportunity for middle of the night disturbances, and we’re both going to need as much rest as we can get! I mentioned that we can always Skype with each other and both the doctor and the nurse thought that was very funny and very adorable. Because let’s face it, it is!

What really happens to Derek’s DNA once my DNA sets up shop in his abdomen?

According to Derek’s doctor, chimerism, which we discussed in a different FAQ, occurs in about 25-33% of all transplant patients. Essentially, when the new organ is introduced, in some cases, the recipient’s DNA and the donor’s DNA ‘play nice’. This means that, ostensibly, those patients don’t really need anti-rejection drugs, because the recipient’s body accepts the donor’s DNA as its own. Whoa! But here’s the catch, there’s no way to test for chimerism without putting the patient at risk. In other words, to test it, you have to take the patient off the immunosupressants. Guess wrong and now the recipient needs another transplant. Derek’s doctor mentioned that there was a study done where they took bone marrow from the donor at the same time they took the liver and then transplanted both into the recipient. It worked, but there’s a lot more testing to be done to see if that will actually be a solution to anti-rejection meds.

Can we look at the 3-D models of Logan’s liver?

Derek is understandably super keen on getting his hands on the 3-D image files of my liver. I don’t blame him, it seems like a very fun idea to do something with that data. They couldn’t give us a copy of the files right then, but Derek’s doctor agreed to show us the images. Here’s a transcript of the conversation as I remember it:

Doctor: Ok, I found the files, let me just pull them up here.

Logan: Wait a second, are we going to look at the images on an iPad Mini?

Doctor: Yes, there’s an app for that.

[He was pretty pleased with himself when he said that, and lo and behold there totally is an app for looking at livers. Why this blows my mind, I do not know.]

Logan: Can I take pictures of this???

Doctor: Yeah, sure, why not?

Logan: Where’s my gallbladder?

Doctor: It’s right here…no wait, that’s not it, that’s the vena cava. The gallbladder is over here.

[To be fair, the images are all color coded in a non-intuitive way and this was his first time using the app.]

Derek: I’m a little uncomfortable that my doctor doesn’t know where the gallbladder is.

Logan: Settle down, he’s not the one doing the surgery.

[Then there’s a lot of spinning the 3D image around, pointing out the portal vein, and the line where they can safely sever the two lobes. I can’t remember everything he said, I was mostly in awe of how pretty my liver is.]

Logan: It’s so pretty! You’re impressed, aren’t you? I mean, let’s face it, you usually have to look at some pretty ugly livers, it must be a treat to look at mine.

Doctor: Yep. This is what a normal liver looks like.

Logan: Normal? Did you just say, normal? Don’t you mean, magnificent?

[Lucky for me, I’ve known this man for many years and he understands me, at least partially.]

Doctor: Uh, yeah, it’s really nice. [Pats me on the shoulder.]

There was a moment when the doctor was explaining something to Derek and then he paused for a moment, searching for an analogy. Derek piped in with, “So it’s like a traffic jam?” Dr. Gordon smiled and there was, what appeared to be, a real moment of pride. “Huh. I guess I’ve taught you pretty well.” If nothing else, Derek and I have been his students for the past few years, sitting in rapt attention while he explains the inner workings of the liver. It’s sometimes easier to think about all this if we pretend we’re just a couple of medical students learning about the largest organ inside the human body, instead of a couple terrified of having impending–dueling–abdominal surgeries.