Cutting for Stone - Abraham Verghese [261]
Hema paced the waiting room, cursing Genet and bemoaning my stupidity in letting Genet get close to me again after everything she had put us through. Had Genet appeared just then, I would have feared for her life.
WHEN DEEPAK AND VINU made rounds together that afternoon they shared the latest lab results: my kidneys were failing; my liver, normally the source of clotting factors, wasn't producing any. If there were any viable liver cells left, they were showing no signs of recovering. There was not a bit of good news they could convey. They withdrew, Shiva following them. Thomas Stone and Hema stayed, silent around my immobile form. Now it was a watching game, a vigil to the end. There was no hope. The two of them as physicians knew it all too well, but if anything, experience made it even less palatable.
AT NOON, an ICU nurse paged both Deepak and Vinu to a Stone family conference. They came to find Hema and Shiva seated across from Thomas Stone in the small meeting room.
Hema, weary, head in her hands and elbows on the table, gazed up at the two young doctors in white coats, her son's peers. “You wanted to see us?” she said impatiently to Vinu and Deepak.
Deepak looked puzzled. “I didn't call this meeting.” He turned to Vinu, who shook his head.
“I did,” Shiva said. He had a stack of photocopied papers in front of him. A yellow legal pad was covered with notations in his careful script. Hema noticed an authority to his voice, a sense of action and energy and initiative that no one else seemed capable of displaying in the face of my terrible prognosis. “I called the meeting because I want to talk about a liver transplant.”
Deepak, who found it difficult to sit face-to-face with Shiva and not feel he was speaking to me, said, “We considered a transplant early on, Shiva. In fact, Dr. Stone and I talked about transferring Marion to Mecc—I mean to Boston General, Dr. Stone's hospital. Dr. Stone's team does more transplants than anyone on the East Coast. But we decided against it for two reasons. First of all, transplants are notoriously unsuccessful when the liver is being destroyed by fulminant hepatitis B. Even if we found a cadaver liver of the right blood group and size and we did the transplant successfully, we would have to use massive doses of steroids and other drugs that suppress the immune system to prevent rejection of the new liver. That would give the hepatitis B virus a field day and the new liver would be destroyed and we would be back to exactly where we are now.”
“Yes, I know,” Shiva said. “But what if the transplant is a perfect match? Not just the same blood group, but all six HLA antigens and other antigens you don't even measure—what if they all matched? Then no immune-suppressing drugs would be needed? Right? None. No steroids, no cyclosporine, nothing. Would you agree?”
“Theoretically, yes, but …,” Deepak said.
“A perfect match is what you would have if you took the liver from me,” Shiva said. “His body would see it as self, not as foreign in any way.”
The air had been sucked out of the room. No one spoke for a few seconds. Seeing Hema's expression, Shiva quickly explained, “I mean take a part of my liver, Ma. Leaving enough for me and taking out a lobe to give to Marion.”
“Shiva …” It was on Hema's lips to apologize for Shiva—this clearly was not his field, or hers for that matter. But then she changed her mind. She knew something about his tenacity when it came to medical situations that others thought impossible. “But, Shiva, has that ever been done—transplanting part of a liver?”
Shiva slid one of the articles over to her. “This is from last year. A review by Deepak Jesudass and Thomas Stone on the prospects for live donor liver transplant. It hasn't been done in humans, Ma, but before you say anything, read page three where I have underlined. They say, ‘Technically, the success in almost one hundred dogs, the ability to sustain life in the recipient and not jeopardize life in the donor, suggests that we are