END STAGE LIVER FAILURE

First you take a drink.

Then the drink takes a drink.

Then the drink takes you.

In the early afternoon the emergency room supervising physician came into my Mom’s room and shut the sliding glass door behind him. I’ll never forget this doctor as long as I live. His name was Dr. Nathanson. When he introduced himself and who he was to my Dad, my Aunt Marie and myself, I couldn’t help but tear up again. In the back of my mind I knew that typically hospitals don’t send supervising doctors into patient rooms for minor things or even for serious issues. If you get a personal visit from a supervising MD, there’s a reason. The look on his face and in his eyes behind his glasses said it all. I knew where the conversation was going before it even started.

The doctor explained some of my Mom’s lab levels to my Dad and to my Aunt Marie. Being a nurse in that situation was absolutely awful. The worst part was that I didn’t need any explaining, all he needed to say was a level, and I immediately knew the meaning behind it. Her blood counts including her hemoglobin, hematocrit and platelets were at an all time low. Dr. Nathanson explained that her golden color and her yellowed eyes were directly correlated to her bilirubin levels. He proceeded to explain that because my Mom’s liver was failing her, the toxins that would normally be cleaned from her blood, were compiling and thus made her disturbingly confused. He also informed us that he had reason to believe that her body was destroying or lysing red blood cells and that her body was working incredibly hard to make new ones.  Her heavy drinking after many years had likely caused a change in cells and that it was likely that she now also had liver cancer.  He would have to consult a the hematology and oncology physicians and gain their insight.  He concluded by telling us that her liver enzyme levels were very high and that he was aware of the recent abdominal ultrasound that showed she had liver cirrhosis.

My Mom had that particular ultrasound a few weeks prior just after she crashed her car into our house. That ultrasound was done on August 4th. And once she had the results from it, she promptly signed herself out of the hospital against medical advice. Now we were back at the hospital on August 27, 2015. This was what full-blown alcohol related liver failure looked like.

“We’re going to treat her the very best we can, we are going to need to give her a lot of blood and if we see improvement that would be great. However, we can’t fix her problem without a new organ. Her liver is completely failing her. She needs a liver transplant.”

I heard my Dad start to choke up. I hated seeing him distraught. I very rarely saw him cry. In fact, the truth is, I couldn’t really bare it and I still can’t. I couldn’t even turn his direction. There is something profoundly sorrowful about watching one’s Dad weep. It creates within you this inexplicable painful void that floods with desperation. I held my attention on the Doctor Nathanson.

“A liver transplant,” I thought. My next thought, “how long does one have to be sober in Rhode Island before even getting on the liver transplant list?” And then I realized it wasn’t a thought. I actually just blurted out the question.

“Six months.” Dr. Nathanson said.

My Mom had been sober for a grand total of ten days. He must have known by the look on both my face and my Dad’s that six months seemed like an eternity.  Dr. Nathanson’s sincerity and concern was palpable.

I stepped toward the stretcher. And my Mom’s confusion interrupted what I was about to say.  She readjusted herself on the emergency room stretcher and turned to Dr. Nathanson.

“Can I help you?” she asked in slurred and garbled words. “Can you help me!” she exclaimed as she squirmed her legs around the railings of the stretcher. She did not know, nor have the capacity to know what he just informed her family.

I looked at Dr. Nathanson and he simply gazed back at me. It was a gaze I was no stranger to. It was a gaze I had received from doctors before, the kind of look you give one another when you’re both working tirelessly on a patient whose prognosis is grave. In that moment, all the patients that I’ve taken care of flooded back to me, but especially the ones that pass from this life to the next on my time. I thought of the patients who were made DNR/DNI or do not resuscitate/do not intubate, the ones who only received comfort measures only.

One patient in particular stood above the rest, a man I cared for while working as a new graduate.  His golden color, as I recalled, was not nearly as profound as my mother’s was.  I thought of a professor I admired so very much in college and the Holistic Nursing course she taught. For a brief moment I felt like I was back in my Medical Ethics course and I could picture Professor Daly explaining the term active benevolence.

“To actively choose the good for someone else,” I recalled him saying this as he simultaneously underlined the term benevolence during a lecture at the top of oldest building on campus. The essence of terms like “quality of life” and words like “dignity” resonated in my consciousness.

I again became aware of the emergency room, the fruity smell to my Mom’s breath, the distress on her face, the bulging in her abdomen; the physical ramifications of her debilitating disease. She was yellow, and glowing, her eyes soaked in the golden toxins that had built up in her system.

“So she’ll be admitted to ICU I’m guessing. And we’ll try, but what you’re essentially saying to myself and my Dad especially,” I reached back and motioned him to stand as close to his wife as he could. “You’re saying that palliative care and hospice are a really good option.”

“Yes, that’s exactly what I’m saying.” Dr. Nathanson concluded.

He confirmed for me what I already knew would be the best for my Mom. But the decision to pursue comfort would ultimately land in my Dad’s hands.

I turned to my Dad unable to hold my tears back any longer. Silently streams of salty water fell down my face and turned the curves of my jaw line. I wiped them away.  Rooted only in strength that I had not yet known was blessed to me by God.  I gained my composure with ease.

I thought of my sister. We had not spoken in over a year and a half. “We should call Justine,” I whispered.

 

 

“Your eye is like a lamp that provides light for your body.  When your eye is healthy, your whole body is filled with light.”—Matthew 6:22