Poked, Pricked and Prodded

Things are moving fast, so I must pick up speed with my writing, while the memory is still vivid and sharp in my mind. My objective for doing this series is not to seek sympathy or appear altruistic, but be practical. Trained as a journalist, I must truthfully record a patient's perspective, as he swiftly turns into a dysfunctional entity, much like Gregor Samsa's change into a monstrous spider in  Franz Kafka's 1915 seminal work The Metamorphosis. I read the novella in college and its starkness still hits me like a bolt.

An optimist at the core, I cannot allow a fate like that to befall me - EVER. 

Taking my story forward, tomorrow morning, I am getting admitted into Kokilaben Hospital, Mumbai  for what surgeons there smartly refer to as 'work-up' to the transplant. The phrase is self-explanatory.

The main reason a major surgery like a liver transplant is so successful in India these days is that the multi-specialty team doesn't leave anything to chance. They don't want surprises in the Operation Theatre.

Therefore over the past one month, I may have been poked, pricked and prodded all over my body, and must have given at least 3 liters of blood, one liter of urine for numerous culture tests and submitted my body to a dozen-odd radiological examinations, sonographies, magnetic resonance imaging (MRI), performance tests (2-D Echo, Stress, Doppler's), dental and ophthalmological examinations, psychiatric evaluation, gynecological assessment (mamography, D&C), endoscopy, bone and positron emission tomography (PET) scans.

Other than the mandatory pathological tests recommended by the autonomous Zonal Transplant Co-ordination Centre (ZTCC), that are accepted at all hospitals, there are a few additional tests that each hospital can add to the pre-screening rigmarole. A few do so to run up their medical bills. Prices of these pathological tests vary across the board, so check the tag before you shop. The tab? Anything between Rs 2 to 2.5 lakhs, and there is bound to be some overlap and avoidable routine investigations.

Endoscopy is a non-invasive digestive track examination to check the presence of swollen veins (varices) that might rupture in the esophagus during a transplant, so have to be banded ahead of the surgery. Bone scan or a full-body positron emission tomography (PET) scan is done to check if the cancer has spread to the bones, in which case, transplant of any one organ may not be a viable option. Nor will it signify maximum use of a rare, donated organ. 

If these evaluations throw up some medical issues, such as a suspected calcification in any part of the body, a polyp or a lesion, those have to be dealt with first with biopsies and surgical removals. Even a blocked artery to the heart has to attended to first with an angioplasty. Individual medical clearances have to be sought from specialists in each domain, such as a  Cardiologist, Pulmonologist, Oncologist, Nephrologist, Radiologist, Diabetologist,  Hepatologist, Gynecologist and/or a Urologist to build a strong case for the recipient before the Hospital's Medical Ethics Committee.      

If the issues relating to any of these vital organs turn out to be bigger than the main liver issue, giving the patient a new leash of life in the form of a liver won't be an optimum use of the donated organ, that should ideally go to the next in the line-up.

Thankfully, in my case, while I have all vital clearances (heart, lungs, kidneys, bones etc.), two 'minor' issues have cropped up - a 'suspicious' calcification in my right breast, and a uterine polyp that could be benign or malignant. A biopsy will tell, so that's the first procedure I must undergo, followed by, if need be, surgical removal of the suspicious growth, under general anesthesia.

Next comes endoscopy. My memory of the last I underwent in 2007 is very traumatic. But doctors at Kokilaben Hospital, Mumbai have assured me that the procedure has now vastly improved, and I won't even feel the prick and soon everything would be over. "I'll have to show you pictures to prove we have done it," said my cheerful Hepatologist. This would be followed by TACE by the head of the radiology division that would buy me three months wait time on the cadaver list.

I know I have to work my way up on that list. But I also know I can't wish for someone else's death. I can imagine why doctors have coined the name "cadaver" for brain dead donors in order to make it sound less like an emotion-free, clinically-detached process, which it certainly is not.

Waiting at the other end of the life's spectrum, I can only imagine, what it must feel like to give up on a loved one. By no means, can it be an easy decision. Four years ago, I couldn't make that decision on behalf of my Mom during her 17 days on the vent. Therefore, my heart goes out to the 61-year-old mother, who recently signed a petition for passive euthanasia for her 36-year-old son, who has been lying in a comatose state for the past 15 years.

What I am fighting for pales in comparison to what this mother must have fought for and I draw immense strength and courage from such towering souls.