THE BOOK

I began writing my book more than ten years ago. I had just survived a very difficult and serious second liver transplant. It seemed like the appropriate time to seek closure from years of illness. The process of writing a book took much longer than I had anticipated. I had heard this cliche before and was sure it wouldn't apply to me. Yeah right...

I sat at the old graphics design table in the quietest room of our house one night, and began to write. Before connecting pen and paper, I asked myself, how am I going to do this when I've never written anything before, especially never in English? I spoke well enough, but did that mean I could write an entire book? Maybe I should write it in German.

I decided to write in English. The majority of my hospital stays had still been in Germany up to that point, but the transplants had taken place in the U.S., and therefore medical expressions and terminology were at the tip of my tongue. The first outline was done within a few days.

The words flowed out of my mind onto the keys of my computer and lit up its screen. A month after the outline, I had typed over 800 pages. For someone like me who is not particularly known for my memory, I was amazed that every detail was in my mind as if things had happened yesterday. It seems that traumatizing events stay with you. Once this first draft was finished, I put it away for several months. Although I had written a lot, I didn't have a conclusion to my story.

I picked up my manuscript much later and read it again. I couldn't believe what I had written. The story was fine, after all it was pretty much carved in cement since it was a faithful account of my life. But rather because I never realized how poorly I spoke English. The grammar was fine. My mother had seen to this growing up. However, expressions and wording of sentences, all of it was 'off'.

I began listening much more closely to the radio and television. Whenever a particular expression suited what I was writing about I used it. Little by little, the second and third drafts came together. Even though, I still didn't have a conclusion.

While my English was improving, my story wasn't. Not until I gave it to my husband to read did he point out the immense flaw. The solution might be simple, the execution of it, not so simple. I put the manuscript away for several more months still unsure how to fix it.

In my manuscript I had cast myself as a superhero defeating death. My story lacked honesty; honesty, first and foremost, towards myself. I had become so adept at burying my feelings in order to deal with my health issues, that I couldn't bring them to the surface anymore. I hadn't included them in my writing. The act of putting events on paper forced me to confront emotions I had never dared face before. Draft by draft I began removing layer after layer of thick skin. Like an onion, I peeled off a barrier at a time to get to the real story. I imagine this is the type of work therapists do.

By the time I reached draft number XXL, I felt as if I had spent years in therapy. The more I delved into my state of mind during my illness, the deeper the sense of relief. My manuscript was taking shape, but I still didn't have a conclusion.

Ten years flew by in a flash, but illness didn't let go of me. I wound up having a third liver transplant and a new kidney. This last physical trauma had to become my conclusion, the final chapter after twenty-eight years of roller-coaster health.

Finally, I felt confident enough to relinquish my finished manuscript to my most genuine critic. My husband's talent to take a story and find its heart proved invaluable. Once again I ended up under the knife...well, my manuscript did. He and I slashed the repetitive moments, carved out my sometimes harsh words, surgically removed all boring lengths and stitched my story together by keeping the best moments. Hopefully we succeeded.

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 THE BOOK IS AVAILABE FOR PURCHASE AT BARNES AND NOBLE

http://www.amazon.com/s/ref=nb_sb_noss/177-2814359-9266907?url=search-alias%3Daps&field-keywords=four+livers+and+no+funeral&x=0&y=0

OUCH!

I opened the tamper-proof bottle, poured the two white tablets in the palm of my hand and stared at them. Flashback to the gym. In the morning, my body had said, “I’m not anywhere near twenty years old, so go easy on me,” and my mind had replied, “fuck you, I’ve got energy, and I’ll do what I want.” So, I pumped too much iron, burned up the spin bike, and now, I was paying for it big time. If I didn’t want to walk like a zombie for the rest of the week, I’d have to swallow those two pills. I should take them, I thought hesitating. I need to get rid of this pain. In the past, before my third liver/kidney transplant, I’d relied on painkillers to make it through the day. That didn’t work out too well for me. One must learn from ones mistakes at some point in time…at least one would hope one does...

20 million Americans take prescription painkillers daily. Every year, 70 billion over-the-counter painkillers are sold. Advil, Aleve, Anaprox, Aspirin, Anacin, Ecotrin, Excedrin, Motrin, Nuprin, Voltaren, Celebrex, to name a few, are all NSAIDs or Non-Steroidal Anti-Inflammatory Drugs. There are more commercials for painkillers in the United State than in any other country in the world. Unless you live under a rock, you’ve heard of these drugs and have probably taken one or the other. Here’s what’s going on in your body when you do.  

First, what’s pain? Pain is the result of chemical messengers (prostaglandins), which alter the make up of your cells wherever you hurt yourself, have physical damage, or develop a headache. This change in your cells alerts the nerves and spinal cord and they send an electrical signal to the brain. Voila! You’re in pain! Chances are, according to statistics, you’ll grab one of the above-mentioned pills, just like I had.  

Meet COX 1 and COX 2 (cyclooxygenase). These enzymes promote fever, inflammation and pain, which is a good thing because they’re our primary alert and defense systems. COX 1 can be found in most of our tissue. Besides bringing about the things we dread, this enzyme helps make mucus, which protects our digestive tract from its own (battery acid) juices, thus making sure the flora and fauna, so to speak, in our stomach and gut is healthy. COX 1 also manages blood flow in our kidneys, which keeps them working properly. COX 2 is responsible for inflammation (arthritis, menstrual cramps), but also manages our platelets so that they don’t clump together and cause high blood pressure or put us at risk of a stroke or heart attack.  

NSAIDs are COX blockers. Well, not exactly, but pretty close. They’re COX inhibitors. When you take a couple of Advil, it impairs all of the COX 1 functions. Much like bringing your little sister on a date, it stops you from having…pain. It also diminishes kidney function and mucus formation in your digestive tract. When you take Celebrex, currently the only COX 2 inhibitor still on the market (Vioxx and Bextra are no longer available), you’re targeting inflammation without impacting kidneys, stomach or gut. However, there is a potential for high blood pressure, stroke or heart attack because your platelet protection is suppressed right along with inflammation.

But fear not. If you only take NSAIDs when you really need them, none of the side effects matter. The astounding machine, which is our human body, bounces back. It continually seeks balance because that’s what it’s programmed to do. Take it from a pro that has unbalanced her body more often than I care to remember. Hell, I’m well acquainted with both my digestive tract juices and the effects of too many NSAIDs, but you’ll have to read the book (coming in September) for those stories. I’m not alone though, because every year over 100,000 people are hospitalized for NSAIDs related gastrointestinal problems.

Like all NSAIDs, Aspirin is harsh on the stomach, but it has stood the test of time. Probably one of the oldest medications ever, It’s been around since 400 BC. Hippocrates (you know, the one from the doctors’ oath) gave women willow leaf tea, a plant that carries the pain-killing component, after childbirth. Aspirin later became folk’s medicine, and then evolved to be a painkiller. In 1897 the German pharmaceutical company Bayer patented the current form of Aspirin (they added the component, which makes it less harsh on the stomach). Aspirin, among all NSAIDs, is unique because it’s the only one that keeps platelets nice and loose and prevents them from clumping together and causing a heart attack.

Back to the two pills in the palm of my hand. Tylenol (Acetaminophen). The only over-the-counter painkiller I can take. A wonder drug. No really, scientists wonder how it works. This one-of-a-kind pill isn’t a NSAID. It’s not a COX inhibitor either, and it doesn’t impact the kidneys or the stomach. They think it works with the central nervous system but the debate is ongoing. Tylenol has one drawback: it’s quite toxic for the liver.

I stood there, weighing the pros and cons of swallowing the pills in the palm of my hand. Yes, I’ll feel a lot better, but if I don’t absolutely need it, why bother? Then I realized: one had learned something after all. One had learned that one mustn’t turn to pills for ones own fault by overdoing workouts. I placed the pills back in the bottle, and walked over to my computer…like a zombie.  

EIGHT FOR EIGHT

What a wonderful article in the New York Times, this past Tuesday, May 17.  The Science Times section brought a story about Julio and Mirtala Garcia. The couple, naturalized Americans originally from Guatemala, saved the lives of seven people and restored the vision of an eighth. Theoretically speaking, instead of 110,000 people waiting for organs in the United States, there are now 103,000.

Mr. Garcia was at his plumbing job one day, when he felt ill. He was suffering from one of his much too frequent migraine headaches. This one was different than the others, because besides being in terrible pain, he also felt numb all over. He called his wife and asked her to come pick him up. Mrs. Garcia wanted to call an ambulance. Her husband, Julio, thought it unnecessary. They drove to the hospital where doctors diagnosed Julio with massive brain hemorrhaging. They were able to stabilize him; then they had him transported to another hospital better equipped to deal with his problem. By the time the ambulance dropped him off at the new facility, he was in a coma. A few hours later, and several attempts to drain the blood from his brain, he was declared brain dead. After the obligatory verification from two independent doctors, Mirtala was given the news. In this profound moment of grief, a hospital official asked her if she would donate his organs.

At first Mirtala hoped Julio would awake. But the doctor explained that this wasn’t possible because, essentially, he had already passed away. Machines were keeping his organs oxygenated. The next day, once again, she was asked if she would donate his organs. Julio had been a deeply religious man. He was the pastor at his church. Mirtala thought of her two friends from church suffering from kidney failure, and whose time was running out.

And she thought about the comments her husband had made after watching the movie Seven Pounds, starring Will Smith and Rosario Dawson. In the movie, Will Smith plays a man (Ben Thomas) filled with remorse for what he had done. He drove and was on his cell phone when he caused an accident that killed six people in a van and his passenger. Ben decides to ‘give back’ by donating his organs and thus saving seven people, the same number of lives he had taken. Personally, I don’t go for movies full of transplant flaws. You can’t transplant eyes (only cornea), and you can’t take organs from a dead man, even if he’s lying in a tub of ice water, waiting for his pet jellyfish to sting him (Helloooo!!). I don’t know how many times Hollywood has gotten this wrong, and will continue to do so as long as it makes for good drama, and, more importantly, good box office (the movie made 168 million worldwide. It cost 55 million to make. In Hollywood terms, including P&A coast, I’d say it barely broke even.) But I digress.

After seeing this movie, Julio had told his wife that he’d be happy to give life after his death. He said that if anyone got his heart, she should meet the recipient. Recalling that conversation, Mirtala knew she had to donate Julio’s organs. The article went on to say that she met five of the seven recipients: the heart, lung, two kidney and adult partial liver recipients. One, the pancreas recipient, chose to remain anonymous, the other, a one-year-old baby who received a portion of Julio’s liver, well, it’s pretty obvious. The cornea recipient was never at death’s doorstep and doesn’t count among the 103,000 remaining on the organ transplant waiting list.

The five recipients and Mirtala met at the New York headquarters of the liver distribution center. Such a gathering had never happened before. Perhaps one donor a year gets to meet his/her recipient. For five of them to come together with their single donor is highly unusual, as is one donor giving seven of his organs.  

I found this story quite touching for several reasons. A Guatemalan man who could barely speak English (Mirtala spoke through a translator) donated his organs to save American lives. This alone is praiseworthy. As much as we would like to think of ourselves as ‘color blind,’ there’s still plenty of racism in the United States. Does race affect organ donation? This is a question I can’t answer, but it is something to think about.

If all donors gave up to seven organs, perhaps the list would shrink a little. Why the average organ donation is only three I don’t know, but it’s something to think about.

I commend Mirtala Garcia for quickly deciding to donate. Her husband passed on Thursday, by Friday she had made up her mind. When you’ve just lost your loved one, it can’t be easy to think rationally. Time is of the essence when it comes to donors and recipients.

Let me end this story the way I began it. For a moment, there were 103,000 people on the waiting list thanks to Julio and Mirtala Garcia. By the time I finish this post, or probably even before, the number will have jumped right back where it was to 110,000. I wish no one the tragedy Mirtala and thousands of others experience when a loved one passes of brain death. Optimist that I am, the upside of such a death is giving life to others. We recipients welcome many, many more Mirtala Garcias. 

THE OTHER ME

       People often ask me if I feel any differently now that I have a new liver. With past livers I’ve always answered, “No. I feel the same as usual.” One could debate what “usual” means since I’ve been living with transplants for the last twenty-six years. Is "usual" the feeling after the transplant, or the one before? Or is it somewhere in between? I’ll go with the best of times of each transplant.

THE BEAUTY OF REPLACEMENT PARTS

REPLACEMENT PARTS

Recently I heard that a replaced knee only lasts fifteen years. I am in my tenth year with one of my knee replacements (the other is in it's eight year) and can't imagine that it will fail me at some point. I spin three times a week. I've been doing this since before receiving the new parts and have only intensified m y workouts after getting the new parts. Yes, I said parts since I have two knee replacement and two hip replacements. With all my fairly "new" parts, I have taken up road biking as well.

The beauty of having these metal instead of hips and knees, is that osteoarthritis has become an afterthought. I'd like to say that it has completely disappeared but unfortunately I can't. Why? Because, just like a used car, when you fix one thing, another goes haywire. My hips and knees might be fixed, but my ankles, elbows and wrists...well no comment.

Still, I’m thankful to live at a time when replacing bad parts with new ones is feasible. Forget about the hips and knees, I'm on my 4th liver. Yes, I have replaced that too...3 times. End of October it will be two years since the new replacement part (the newest liver and kidney...my first). Ugh! I'm exhausted just thinking about it.

If anyone has been wondering what life is like after replacement parts, well from personal experience I can say pretty damn good.