James and Lois Cowan's Blog

James and Lois Cowan

James and Lois Cowan
Key West, Florida, USA
July 07
The paramedic and writing team of James and Lois Cowan lives and works on a tramp steamer in Key West and in the summer off the coast of Maine. Advice columnists and authors of some dozen titles, they're at work on "Naked Love" and "The Fiend in the Cellar"—a nonfiction mystery that unfolded in Boston in 1849. They are the ghosts for Touchstone Press's book by Levi Johnston: "Deer in the Headlights: My Life in Sarah Palin's Crosshairs."


AUGUST 8, 2010 7:45AM

Congratulations! You're on the liver transplant list....

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by Lois Cowan 


My husband James—we call him Terry—is possessed. By a liver. His vintage 1943 organ was changed out for a shiny rosy model. I’m convinced this new one under his ribs and across his midriff is a female-liver.


She’s really quite close to his heart.


Terry admits he loves what his new liver does for him. He’s not wooing her. It’s more, he says, like an arranged marriage.


I’ve got issues with this feisty spirit invading the body of my man, an internal sassy friend with girl-genes and feminine attitude. The changes are subtle—maybe I’m obsessing, but I ‘m thinking Terry's a bit flighty, silly, chatty. I’ve not noticed him sitting down to pee yet, but it could happen. Hippocrates said moods, passions and behaviors emanate from the liver; will we have to deal with PMS? Two days after the procedure, as most were laid out in ICU punching their morphine pump, Terry was surfing the halls behind his I.V. pole. Before leaving his room, I caught him combing his hair.


His surgeon assured me the organ was a “very very good liver,...much younger than your husband.” Beyond that, confidentiality prohibited him from revealing more. He didn’t have to. I know this new spongy-smooth liver—a giant asymmetrical mushroom cap of a thing—began life as a little girl, then settled into a curvy bosomy adulthood.


Such a revelation changes one’s perspective about life and family, sort of like finding out you’re adopted.


This liver-odyssey began two decades ago, when Terry woke up one day head-to-toe yellow with a rare autoimmune bile duct disease. The jaundice subsided by evening and he’s been fine ever since. His liver wasn’t normal, it was doing 100%, completing assigned blood-filtering tasks. Except for errant tests results every year or so, and until we heard that Sweetness—footballer Walter Payton—died of the same primary sclerosing cholangitis my husband had, we didn’t waste much psychic energy on it.


Neither did the docs when, last November, Terry was in surgery for an unrelated issue. He picked up a nosocomial infection—from the hospital. He was discharged on antibiotics that turned out to be toxic to his not-so-wonderful liver. A week later the white sclera of his eyes was chartreuse. He began dropping pounds while eating like a horse. His liver stopped processing protein into muscle mass. In January, 2009, a skin-and-bones, bilious Terry was told he had end-stage liver disease. This ESLD was, we were informed, was almost to Stage 1...which googled to a forecast that he wouldn’t live more than a week without a transplant.


In the United States most of the thousands with ESLD—those too old, too sick—won’t receive the oddly congratulatory-letter Terry did, that ranked him on the national wait list as if the lottery had been won. Most of those 100,000 who do get listed wait months and years only to die in agony in hospital beds before their number comes up. This American tragedy will cease when the existing laws are upended. Now we must opt in to donate our organs. Instead our body parts should be automatically procurable—unless we go to the trouble of requesting in advance that they not be harvested. 


A gaunt mustard-colored Terry still seemed healthy, writing, playing tennis. He didn’t have the stabbing itchiness of liver disease, and none of the pain. The whole deal seemed less lifesaving and more outré. We packed a suitcase as if awaiting for labor to begin. Our seven grown kids from across the country and as far away as Ireland all wanted to show up, wait it out with us. It was scary, titillating, an adventure.


The activist-son pointed out it was the ultimate in recycling. 


Four days later we got the call.


In the twelve hours between that first alert and surgery, we deduced that the Organ Procurement Team was harvesting multiple body structures. Those unknown gracious people who mourned the original keeper of my husband’s liver also were, we guessed, bestowing gifts of life on others needing an ileum, heart, pancreas. Recipients born under the same lucky star as my spouse had to be pulled together at the University of Miami’s Jackson Memorial Hospital and, like Terry, prepped for the OR. 

Transplant teams, available 24/7, poured into the surgical suites as Terry was cooling his heels on a pre-op hit of the sedative Versed. I held his hand, scared to death, eavesdropping on chatter swirling around me, all focusing on him.


My handsome prince, fit to begin with, bounced right back after his day-long  surgery. He spent his post-op day in ICU contemplating ethics. What if each person in this unit now had anatomy from the same donor? Were he and the heart transplant across from him forever connected? Did Terry and this other patient, and the other two in the room—lungs and a kidney—have common DNA and maybe something deeper? When our spiritual cousin Hallie heard about Terry’s super-hero convalescence, she warned that, “Liverman must slow down so his new organ’s soul can catch up with him.” Is our essence in every cell of our being? Was my partner altered once his body’s largest gland, so high-priority that he could only live without it for 24 hours, was traded out? 


Who is this guy I curl up against in bed at night? Is it possible I’m hearing whining from the newest addition to the Cowan tribe, the sounds working their way through the staples of the inverted Y-incision? 


Can’t you envision her maybe twenty-four-year old? sloped self in there under a sagging diaphragm and an elderly pancreas, above a bladder dotted with cysts and, yes, a prostate!—not quite getting it, how she ended up where she is with her arteries and ducts stitched to structures old enough to be on Medicare. ‘What am I?’ she might be asking herself, with an irregular heart on her sleeve. ‘Chopped liver?’ I bet by now, two weeks down the road, this chick, used to kicking up her heels, now has to kick ass.


On Terry’s birthday last week, cousin Len wrote: “So glad you're celebrating your 66th and that organ inside is joining in on the festivities! May you two enjoy the beginning of the 67th together....” I placed 6-6 numeral-candles on Terry’s cake. Next to its three layers was a cupcake. I stuck 2-4 candles into its strawberry icing.


Terry ate both.


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This story is delightful: the moral considerations of the organ donation system are perfectly balanced with a smart sense of humor. A pleasure to read!

Great story - long on drama, but with little pathos. I hope the future is as handle-able as the past. Blessings to you both.
What lovely comments, ConnieMack and lolocat; thank you. I hope you'll enjoy as much coming posts by each of us—and some together—looking at other aspects of our lives together.
Congratulations on a successful transplant. May the 3 of you have many more years to enjoy!
What a wonderful uplifting story. Maybe transplant stories are the new genre. At least they should be. We need more donors.
Between your husband and mine, we're on our way. Thanks.