Reality Hits You Hard, Bro.

Logan posted our schedules for yesterday’s Lahey meetings, and did a good job of making it sound like it would be all Sunshine and Rainbows. Remember it went something like this?

AM: General poking and prodding, blood work, with some chit chat and head nodding, plus mmmhmmm’s thrown in for good measure.

PM: Ooo! More poking and prodding, more chit chat, some scans and some beep beep BOOP boops.

If you want to believe that the transplant is a magical process and everything will turn out fine, than yesterday’s meetings were just a formality.

If you want to hear the harsh reality, you can read on after the video. There aren’t any gory photos, but there also aren’t any unicorn stories. I’m going to be honest with you, because the people in charge of my care were honest with me.

My first step was the removal of 12 vials of blood at 8:00am. Unfortunately, I was also fasting for an MRI later in the day, so I became very hungry before my other meetings and appointments. I learned that during the transplant, the pathology lab will constantly monitor my blood levels with a 5 minute turn around time. If anyone has been to a phlebotomist lately, you know how fast 5 minutes is!

The second meeting was with the pre-op department and the anesthesiologist. This is where the harsh reality began to set in. Up until this point, I thought the worst part would be the surgeons making a huge incision in my abdomen and rooting around in there. How wrong I was. I learned that I’ll probably have one IV inserted and be knocked out before entering the operating room. When I emerge, I’ll be hooked up to a lot more tubes and machines. A couple  of drainage tubes, a port into my neck, a ventilator, an IV near my clavicle, a catheter, and a tube down my nose are all to be expected.

Basically, they replace a vital organ, put me on life support, and then slowly and very carefully take me off the machines once they know things are working properly.

I’m not too excited about any of the tubes and ventilators. I did tell the anesthesiologist that they may have to restrain my hands when I wake up to ensure I don’t do something stupid like try to take out the ventilator myself. They did a good job of opening my eyes to the immediate post-transplant, rude awakening–literally–that I will be subjected to.

The third meeting was with my surgeon, Dr. Pomposelli. It was my first time meeting him, and some of his first words were: “So, we have a busy day next Monday.”  Yes, yes we do. My life will be in his hands. And so, he went on to explain the procedure; how Logan’s liver was perfect – he did actually say that – and how all the connections would be made once her liver is inside of my abdomen. He also went over some risks, such as hepatic artery thrombosis or HAT. Basically, the hepatic artery is finicky and only 2mm in diameter. The surgeon has to sew this small tube from Logan’s liver into my plumbing. If there’s a puncture or mistake, it could render the artery and potentially the liver graft useless. The risk is low, about 5% or less, and about half of those turn out ok. The other half, or 2.5%, would result in potential re-listing on the transplant list and all sorts of complications. After taking it all in, I repeated the message back to the surgeon to make sure I understood what he was saying:  Four possible outcomes from worst to first (and the success is most likely, about 93% of the time): (1) Die on the operating table – “crash on takeoff” (2) HAT, and need a new liver – “skimming the treetops, and clip a wing” (3) HAT, but graft is ultimately successful – “skimming the treetops but gain altitude”, and (4) Successful graft – “graceful takeoff”. Again, the harsh reality is that successful organ replacement may hinge on the surgeon’s ability to sew tiny tubes together and nothing about this process is guaranteed.

My fourth meeting was getting an updated chest X-Ray and MRI. These are known entities and didn’t phase me. The one thing I did learn about the MRI is that when they say you can wear a wedding set, don’t believe them. Especially if your wife is a jeweler. A silver ring filled with epoxy resin does have a resonance in the MRI machine – I could feel it buzz every time the machine turned on. Oops!

The fifth meeting of the day was with the nurse for a family meeting. I was running late, so the nurse went  through the transplant process very quickly and covered similar information about tubes/drains, as described above. In addition, I’ve highlighted some of the more salient points:

• I’ll have a drainage / access tube in my abdomen for 6-8 weeks after surgery
• I’ll be in specialized Care unit for 24 hours after surgery, and it’s not uncommon to go back into surgery for some reason.
• Don’t expect me to be cognizant until Tuesday evening.
• There’s over a 50% chance that within the first 30 days I’ll be hospitalized for any number of potential complications.
• I won’t be going home until I’m independent – walking about, eating solid foods, and understanding my medication schedule.
• Average stay in the hospital for this type of procedure is 13 days.
• I’ll have a visiting nurse after I get home to help with wound dressing.

Logan and I are both having surgery involving the liver, but they’re vastly different procedures and recovery times; I’m no longer under the illusion that I might leave the hospital before Logan. Today was a glimpse behind the surgical curtain – there’s a reason you don’t usually hear what goes on in surgery; it’s not pretty. It’s also incredibly scary and makes you realize that yes, in fact you are putting your life in someone else’s hands, and you hope they have the confidence and experience to do the job.