Take My Right Lobe… No, Really

A walkthrough of my recent living liver donor experience
By Keith Garcia
        Thirteen years ago I married my ex-girlfriend. It really is an awesome love story. One that has all the makings of a great “B” movie filled with mundane and under produced action sequences and excessive nude scenes. One of the side effects of being married, that I wasn’t altogether aware of, is the immediate gain of “family.” “Your brother, your sister, your niece” all of a sudden become, “My brother, my sister, my niece.” At the time it wasn’t truly recognized, there wasn’t a line in the sand that was clearly marked; in hindsight however it is a clear historical marker of a change in perspective. My wife is the third of four siblings and at the time her oldest sister was the only one with children. Out of respect for her privacy I’ll refer to her as Patrice for the length of this anecdote. Patrice worked full time. During the summer my wife would watch the kids from the time they got out of summer camps until just after dinner, when Patrice was able to pick them up. For a few summers our dinners were filled with the chatter of a six, three, and a two year old. Our weekend excursions often included trips to the Zoo, Sea World, Playgrounds, movies, etc… You get the picture. I had a new mortgage, a new wife, and was pushing a stroller, holding kids over railings so they could put a fish into a dolphin’s mouth, lifting up kids so they could get a better view of an Okapi, and making sure I brought at least one sandwich WITHOUT cheese. Like I said… at the time it wasn’t noticeable however, in hindsight it’s a pretty clear paradigm shift. So I got close to these kids, it was hard not to. They were my nieces and my nephew.

They were my nieces and my nephew.

Ashley surrounded by her siblings.

Emily Ray, Christian Garcia (my son), Ashley Ray, Aaron Ray

        Fast forward a few years and my own family has grown by two. House, wife, two kids – things were good. Family trips to the zoo morphed into longer June Lake / Yosemite / Mammoth excursions and my nieces were being groomed into a great tag team babysitting force; I had no complaints. Then my niece got sick, Ashley Ray, the eldest. It wasn’t an immediate, “OMG, her liver is failing.” She just got sick one day and then started getting sick more often. There were bouts of intermittent health issues with family members giving dissertations on what she could be allergic to or why she had a weakened immune system. It turned into months of tests and quite possibly years of parental worry until she was diagnosed with PSC and Ulcerative Colitis at Rady Children’s Hospital. She was fully diagnosed when she was eight and the prognosis was that she would likely need a liver transplant by the time she was sixteen. The news sucked. The uncomfortable road through puberty would be made even more uncomfortable. I focused on making family excursions better, more meaningful, and longer. We’d take Yosemite hikes to Vernal Falls or hidden natural granite slides out by Tuolumne Meadows. Each excursion we’d take would be accompanied by fugly whispers spat into my ear about how I may be pushing my niece too hard followed by a vulgar display of doting. I took the stance that she would fail when she failed and until then let’s push on like nothing is wrong. Of course this is a douchebaggery stance but in all honesty it was indicative of my thinking at the time. This went on for years. There was still fun to be had… I was even able to squeeze in a few family games of over the line, kick ball (pegging allowed), and wiffle ball. Then it happened. She failed or rather her liver failed. She was twenty, four years passed the original diagnosis, and she needed a liver. Extensive testing was done, a MELD score was derived, boards met, and she was on the California Liver Transplant List. That last sentence I am sure was read fairly fast if you’ve made it this far. Read it again. It held a lot of pain for my niece and her family. MELD stands for Model for End-Stage Liver Disease. Its essentially a scoring system, the higher the value the more likely you are going to die within the next 3 months. My nieces MELD score was 24. She approximately had a 20% chance of dying within the next 3 months. 15%-20% of transplant candidates die while on the list  (http://optn.transplant.hrsa.gov/converge/LatestData/rptData.asp). Once you step into this world… there are a lot of stats. There are specific stats on how the transplant recipients die: auto accident, fall, renal failure, heart failure, electrocution, hit by lightning, etc.. Its morbid. Its deflating. It’s absolutely spirit crushing. 20% likelihood of death in the next 3 months, 20% chance of death while on the list, 20% of recipients will need another transplant… It’s very easy to get caught up in the momentum of it. You may find yourself applying the stats you find to everyday occurrences: What if I had a 20% chance of getting into an accident each time I drove? Would I live differently knowing I had a 20% chance of dying in the next three months? I think I spiraled down this path until I came across a percentage that compared morbidity rates between live liver donors, live kidney donors, and census bureau mortality rates. I was surprised to learn that live liver donors fared better than others. I can’t source this comparison, however I do remember that the difference was insignificant. The significance was in the term: live liver donor.

MELD stands for Model for End-Stage Liver Disease. Its essentially a scoring system, the higher the value the more likely you are going to die within the next 3 months.

Shane Garcia (my youngest), Emily Ray, Ashley Ray, Aaron Ray, Christian Garcia (my eldest)

        There are other states where it’s more likely to receive a liver while on the transplant list. I won’t get into the reasons here, that subject alone is worth a few pages. However, after looking at the logistics and the cost of getting on these lists, the idea of a live liver donor was becoming more acceptable to Patrice and Ashley. So… I did the next indicated thing – I ordered a bunch of blood type tests on amazon.com and invited everyone over for pizza. I was a blood-thirsty lancing fool. My wife, Patrice, and myself were all matches… and the pizza was delicious. It was decided, we were all on board and up for further testing.
        Now up until recently Ash was going to Rady Children’s Hospital for treatment. They had to refer her to a different team since she was no longer a child. It was a slow process and the team was still fairly new to her. However… this team at UCSD Hillcrest Hospital was just starting their live liver donor program under the direction of Dr. Alan Hemming and Dr. Alexander KuoWhen Ash and Patrice asked about a live liver donor as a possible option it was confirmed not only as a possible option but a good one as well. Her MELD score determined she had a 20% chance of dying within the next three months and the percentage of successful live liver transplant was roughly the same. Opting for the surgery made sense. We were told we’d be in contact with a transplant coordinator and that we should select a candidate who would be tested first.
        So Ash, Patrice, my wife, and myself discussed who would be first. Having two people in one household recovering from surgery seemed like a less desired outcome, so Patrice was ruled out. She fought about it a little bit but it didn’t take her long to realize how much of a burden that would be on the rest of the household. So it was between my wife and I. My wife’s arguments were based on blood ties, she couldn’t expect me to risk my life for someone that isn’t blood related. I went over that in the earlier part… she is my niece. She was saying other stuff but it was muffled with tears and such so I discounted much of it. My argument was thus:

  • I work from home. I have enough vacation to cover the recovery time and expect to be back to work sooner rather than later.
  • I am in better shape and more likely to recover faster. I clock 20 miles of running per week, do 215 push-ups in 4 minutes three times a week, 100 pull-ups three times a week, do 3 sets of 225 three times a week, yadda yadda yadda, and practice Brazilian Jiu Jitsu twice a week (3 if i am lucky).
  • After 8 weeks the liver will be almost completely regenerated – I am great when it comes to short bursts of heroism. It’s the long sustained sacrifices that I fail at.
  • and the real reason… I don’t want to drive the kids back and forth to school, practices, play dates, or any other obligation that I have somehow agreed to pay for. I don’t want to cook breakfast, pack two lunches (and then get angry they didn’t eat it), and then cook a huge three course dinner. I don’t want to clean up after these 9 and 11 year old stink bombs and mess makers. I can’t do any of the above nearly as good as my wife and for the life of me I can’t figure out how she looks so damn good while she does it.

… and so I convinced my competitors that I was the best candidate. I opted to get cut open, give a lobe, and get doted on for a few weeks. Before I get into the details of the tests I just want to take the opportunity to state that live liver donation isn’t for everyone. It takes love and a certain amount of arrogance with the right mix of stupidity to even consider it. It requires the refusal and disbelief that you could be one of the tragic statistics. It takes optimism mixed with idiocy to think that you can be back to work in two weeks after someone crucifies you horizontally, cuts you open, expands your ribs with metal clasps, and removes half your liver. It’s not for the pragmatic, that road would be full of anxiety.

… live liver donation isn’t for everyone. It takes love and a certain amount of arrogance with the right mix of stupidity to even consider it.

This is obviously not the lancing pizza party but it was like it.. just imagine Santa isn’t in the pic.

        Before any of the tests could be scheduled you have to speak with the transplant coordinator and sign papers explicitly stating your intent to donate, that you are aware of the risks, and that you are not receiving any financial benefit. My transplant coordinator was Michael Chua, RN. When I first spoke to Michael he broached the subject of live liver donation with stating that there is a 25% chance of complications and a .5% possibility of death. Michael is a soft spoken man, it was as if I was speaking to a compassionate and knowledgeable Grim Reaper. I was thankful I spiraled into the world of stats weeks earlier. The stats no longer held shock value and I took comfort in the fact that it was time well spent. After the barrage of stats Michael ended the overview with the fact that at anytime I could back out. It’s how he ended every conversation with me, “you don’t have do this.” Once Michael covered all the risks and felt assured I comprehended all that was at stake he proceeded with scheduling the tests and getting the thumbs-up from Ashley and Patrice’s insurance company. Michael along with the rest of the team worked very hard to schedule my tests in a manner that required the least time off of work. They were super accommodating and I appreciate the effort it must have taken to coordinate with all the specialists I had to see. They tried to fit in all the tests in a span of three days. They had to separate a few of them due to the effect of the dyes and such.
        The first batch of tests were the blood, urine, stool, ultrasound, chest x-ray, arterial blood, and an EKG tests. For the blood tests they had to take 21 vials of blood to test for a variety of things. It took long enough to merit anecdotal stories about the technician’s children to avoid uncomfortable silence. When I was done with giving blood and other samples I quickly downed a power bar and a cup of coffee since I had to fast before the labs. After I got my caffeine fix I walked over to the imaging center and got felt up for approximately 30 minutes by the ultrasound machine. I got to see my abdominal cavity and its innards from a variety of angles. I then walked over to the imaging center, checked-in, got zapped and was done in less than 10 minutes. From there I took an elevator to the pulmonary department where I checked-in for my arterial blood gas test. It’s a test to see how well my lungs function and to check my acid / base balance. This one wasn’t as smooth. They had to take blood from arterial line in my arm and it was under a bit of muscle in my wrist, so it took a few times. All in all it was painless it just took a technician a few pokes under the watchful eye of his superior. Afterward I walked across the hall and had an EKG test done. Stickers on, “please relax”, stickers off, done. When all was said and done I was back at work after lunch. The first day of testing marked the first time I said to myself, “Oh Sh!t this happening.” I remember vividly the first time I had this jolting shock of reality, it was when I listened to my son’s heartbeat through the ultrasound machine. Never mind my wife’s belly growing all round and tight… it was the sound of his heartbeat that made it real. It was same thing when they started drawing blood, this was happening.

I can’t tell you how addicting Brazilian Jiu Jitsu is… So addicting that I had to schedule around it.

Me @ BJJ Class 🙂 Just below the GB sign… making a jackass face 🙂

        A few days later I started the second portion of my evaluation as a donor candidate. It ended up spanning three days due to my scheduling conflicts… I can’t tell you how addicting Brazilian Jiu Jitsu is… So addicting that I had to schedule around it. The tests and evaluations consisted of a CT Scan followed by a surgical, hepatologist, and social worker consult. The CT Scan was a very unique experience. I had an IV put in to deliver the contrast dye. The dye is used to show greater detail in the imaging. The technician described certain sensations I could possibly experience. He said I would most likely feel a sensation of hot liquid going through my veins especially through the groin area. I quietly thought to myself, “I hope I don’t like this enough for it to turn into a weird fetish.” He also described the possibility of difficulty breathing especially since I was prescribed a double dose to produce better clarity. “Oh, by the way,” he says, “I’ll need you to hold your breath at times,” as he went back to the controls. “Great. In a few moments I will have the sensation of burning liquid in my junk followed by an anxiety attack brought on by asphyxiation. At the apex of these sensations I will be asked to hold my breath. This is a perfectly reasonable request you [email protected], “ I thought to myself.  I felt the heat pulsate through my body as the contrast made its way through my veins but I didn’t experience any sensation of asphyxiation. All in all it was easily tolerable, not nearly as bad as described, and to date I have not acquired a weird fetish that calls for burning liquid in my groin area.
        The next bullet points I had to check off were the consults. I met with the lead surgeon, Dr. Alan Hemming, a hepatologist, Dr. Yuko Kono, and a Social Worker named Michelle Morrison. I met with each individually. Each were well knowledgeable, passionate about their field of expertise, and concerned for my well being. They spent an extensive amount of time going over details about how the liver volume would be measured, how it would be extracted, how the recovery would be, what after care I could expect, and the possible financial strain recovery might create. I think of all of them fondly, they handled my niece’s plight with such compassion. That being said I couldn’t allow myself to take them for face value, after all they were going to cut me open. So I scoured the internet for some dirt… and found nothing but stellar reviews and anecdotes, a few mentions of their significant other’s involvement with a local farm to table group, publicized thank yous for some hefty donation dinner, and sporting highlights from a few of their kids. In short, I found nothing questionable… which is weird in itself.
        The penultimate test listed was an MRI of the area around my liver. If I am remembering correctly, it was ordered to to obtain finer details of the biliary ducts. I was prepared for the procedure by one of the transplant coordinators. I was going to be placed in a stretcher, strapped in, placed in a confined tube, have contrast dye injected into my arm that may or may not cause a severe reaction, have loud construction like sounds blasted around me, and be asked to hold my breath intermittently. Apparently I was going to have to endure this for an hour to an hour and a half. I was also told I could bring some music so I made a mix CD and brought it in with me. I felt horrible when I met the technician and found out that the he would have to listen to the music in the control room as well. You can call me out for making brash assumptions but I immediately assumed he wasn’t the type to appreciate the finer subtleties of death metal. The entire incident was an awkward mess. I would exhale and the tech would ask me to hold my breath for a thirty count. That is pretty much the gist except for one instance. He told me he had one shot to get a picture / video of when the dye first enters my organs and I needed to keep extra still and hold my breath extra long. Lovely, after that I didn’t feel so bad about the death metal.
Me and some of the doctors checking me out… Dr. Kono is on the right, she is awesome.

        Immediately after the MRI I had to speed walk to the psych department to get a quick evaluation done on my mental state. It was a definitely different vibe there. Diplomas and certificates were more abundant on the walls and the offices were adorned with darker non-institutional cherry wood accompanied by the staunch leather chair that one envisions all psychiatrists must have. I was asked approximately five questions and dismissed rather quickly. I get the notion if I made it to question eight I would have been denied as a possible candidate and if I progressed to question twelve I would have been admitted. This was the last step in a long checklist of tests, evaluations, and consults.
        In hindsight the next coming weeks were some of the most difficult. There wasn’t anything for me to do in regards to the transplant. I just had to wait until the transplant board met to discuss my candidacy. It was a looooong week and I started becoming a bit anxious in regards to the procedure. Not scared per se but I felt a little uneasy, nervous if you will. Quite a while back my sister-in-law gave me a “father’s manual.” It’s a prayer book that I keep at my desk and it’s been collecting dust for years. I picked it up, opened it, selected a few prayers, and read them aloud. A few moments later the phone rang. It was Michael Chua, the transplant coordinator, he called to tell me there were two tests that brought up some concerns. My stool test showed signs blood which could be symptoms of serious conditions such as colon cancer or something as benign as eating too much fiber. The other test that resulted in abnormal results was the EKG. It showed I had a low heart rate which was indicative of someone super active but it also showed signs of an infarction which is doctor speak for heart attack. Immediately after the call it was very clear to me what my primary concern was. I didn’t believe anything was wrong with me and I was most concerned about no longer being viewed as a viable candidate. All the anxiety regarding the surgery was replaced with concern with not being good enough. The next day I did the next indicated thing, on my way home from a run I chose a route i’ve been avoiding due to a long, huge mountain of an incline. It never looked fun and i’ve always felt I didn’t have the spirit to run up it without passing out, vomiting, or sharding. I ran up it without incident. I was definitely light headed and huffing for air; I may have even been on the verge of passing out but somehow my legs carried me. I was a bit more confident that the EKG threw a false positive. There was nothing definitive I could do to prove to myself that I didn’t have cancer of the ass… for that I just had to wait and the soonest they could schedule my EKG redo, cardiologist consult, and colonoscopy was in two weeks. So I sustained my normal activities and lifted, ran, and trained Brazilian Jiu Jitsu throughout the week. The thought of a possible past heart attack and cancer of the ass affected me. It was on my mind every time I did anything active especially practicing Brazilian Jiu Jitsu. There was one particular marine whom in the past I’ve had better luck training against but in the recent days since the news i’ve had to tap. Not due to blood chokes or armbars but as a result of lacking of air. It’s odd in Brazilian Jiu Jitsu, you normally tap to avoid someone breaking something or your vision tunneling because someone cut off the blood circulating to your brain. I haven’t been pushing myself during runs or when exercising in general. Self doubt seeps into the nooks and crannies of your being and brings about decay. Two weeks was a long time to fight that off.
        When the day finally came for the colonoscopy I was prescribed a healthy dose of a laxative called, “GoLytely.” There ain’t nothing “go lightly” about it, they should call it “Operation Shock and Awe II – Immediate Eradication.” I’ll spare you the details. In regards for the procedure I asked to be put into a twilight state so I could see what the camera was seeing. It looked like a new level of Doom II i’ve never seen (old video game reference.) I got to see the entrance of my appendix and one diverticula which in all honesty looked the same as the entrance to the appendix. Who knows what I was looking at, I was fairly lit. I saw nothing too weird and the team’s hepatologist / gi specialist (Dr. Yuko Kono) felt the same exact way. So after a congratulatory hug from Dr. Kono I was sent off to the recovery room, groggy, a bit nauseated, but happy.
        A few days later I had my EKG redo and a consult with a cardiologist. A technician came in performed the EKG test and the cardiologist came in and confirmed all look normal. The false positive was most likely due to placing the contact a centimeter or so off from the optimal spot. “However,” he says, ”just to be sure we should order an echocardiogram stress test.” Ugh… more waiting. So after another week of waiting I found myself running on a treadmill with electrodes placed all over my chest and getting ready to quickly jump on the gurney so a technician can take ultrasound pics of my heart in action. I had my running shorts on and my barefoot vibram five finger toe shoes on. I was dorked out in running gear…  for good luck.
        About a week later I heard from the transplant coordinator that I was approved by the transplant board that I am good viable candidate for the procedure. Ashley was going to get 52% of my liver. I was happy, my niece was happy, my sister in law was happy, my wife was scared sh!tless.
        I had about a month left before the surgery. I made sure my life insurance was in order, that my wife had a medical and durable power of attorney, and that I kept up my normal physical activity routines. I reached out to Michael Chua to see if was able to talk to a past living liver donor that has been through it. He said he would look into it but it would be up to them to contact me. Early on when we first began this endeavor, Michael would share small anecdotes of a living liver donor that was able to go backpacking three months after the surgery. He spoke of her recovery often and it became quasi legendary. For the sake of privacy i’ll call her KB. It seemed fitting that she was the one he chose to reach out to and she was kind enough to spend an hour on the phone with me going over the details of what to expect. To be honest the details she shared with me were much different than what the transplant team described what the recovery process was going to be like. In hindsight it may be because she lived it and was able to describe it in a way that only someone that has experienced can. It was honest description of the hardships, disappointments, and challenges. Her story ended successfully as I hoped mine would. She still reaches out via email once in awhile to see how I am recovering. She gave sound advice and I am truly grateful for the time and information she volunteered.
        I felt that I was prepared for the coming challenge and that I had all my ducks in a row. I was oddly at peace with all of it. One thing I wasn’t prepared for was the enormous amount of support my family received from friends, neighbors, church parishioners, school families, and the community. There was an unprecedented amount of well wishes, prayers, and good vibes thrusted in our direction. It was like a firehose of love. A family friend set up a “meal train” which is basically a long list of families who volunteered to bring us home cooked meals while I was recovering. We had school families sign up to make lunches for our kids. We had children’s friend’s parents offering to take our kids on playdates and sleepovers during the surgery and recovery period. I had accolades and praise being thrown at me for such a show of bravery. I accepted them as graciously as I could. I wanted to explain that it really was a family decision but I generally felt it would be too difficult to convey in a timely manner. So I smiled and accepted the compliments and quietly thought to myself… there isn’t any going back now 🙂 Nothing seals the deal quite like a receiving a trophy for something you have yet to accomplish. This sh!t better happen.
        The remaining few weeks blew by and before I knew it my surgery was coming up bright and early the next day. I took the day off and the plan was to remain low key with the family. The waiting period was harder on my wife than on me. She was becoming somewhat anxious and rightly so, she had to worry about both her niece and her husband. The surgery was going to take roughly six hours to perform but that was just for me. They had to stagger the procedures due to logistics and that meant my wife would be waiting roughly ten hours until she was to know both of us were ok. It was going to be a loooooong day for the family but just a quick count backwards from five for me. So after a night of relatively little sleep we headed out to the hospital and met my niece and her entourage. I had a small wait before I was asked to slip into something more comfortable. I had to apply another round of cleanser on and around my abdomen and shimmy into an odd light purple gown. Within thirty minutes I was in a bed with a warm blanket over my legs and a shower cap. My niece was in the bed next to me. We were surrounded by a staff of at least twenty five transplant surgeons, nurses, anesthesiologists, other highly important dressed people in scrubs, and an observer from an organ donation non-profit organization. They all oozed proficiency and reeked of confidence; I was soooo thankful for that. My wife had been teary eyed on and off since we checked in. I was able to hold off partaking in the teary festivities and offered support and reassurance, I love my wife and I hated seeing her upset. Then my niece got involved… it became two against one. She got out of her bed and started hugging, crying, and thanking me for saving her life. It was at this point that I started making the fugly cry face. My tear ducts don’t work, most likely due to being dry for so long, but even though I didn’t drop a tear it was legit crying. Thank goodness the anesthesiologist interceded and began dosing me with something that would make me feel, “at ease.” I haven’t been that, “at ease” since a few legendary weekends in high school. I was lit and the mood in the room immediately became a light hearted. Since I was the first to go back, I said my quick goodbyes and mentioned something about a hidden bank account to my wife. Since that little joke my wife MUST be the one to get the mail… like I would send my hidden bank statements to my primary address… c’mon. I honestly don’t remember much after that. I was told I said a few choice gems and one nurse looked at me a bit cockeyed when I saw her again quite a bit after the surgery. Whatever was said I am sure she deserves an apology.
        When I started to come out of the anesthesia there were a few sensations that I remember quite vividly. The strongest of the sensations I remember was hunger; I was ravenous. I immediately asked to eat something but was told I could not eat for some time. I was in the surgical intensive care unit (SICU) and there was a nurse that was literally watching over me every minute. She was super compassionate and bent the rules by feeding me ice chips. I am forever grateful for that… It was enough to keep the hunger pains at bay. For those that don’t know me… I am a gluttonous pig when it comes to ALL things and I am use to consuming a good quantity of food at the slightest twinge of hunger. I was not prepared for that feeling… I was prepared for pain, not hunger. Which brings me to the next sensation, pain. It was not what I expected. I was expecting pain in my abdomen; as the anesthesia wore off I felt like I overworked my core but didn’t feel like I was split open. I was expecting acute pain at the incision site. What was weird is that it was my biceps that were throbbing in pain; it felt like I was fighting simultaneous armbars for hours. I also felt an ache in my back directly opposite of my sternum. The pain was not a sharp acute kind of pain, it was a dull ever present pain. It’s not the kind of pain that will make you yelp but rather the kind of pain that prevents you from EVER getting into a comfortable position. At a later time during one of my checkups I asked about that pain the first day… the nurse practitioner I was seeing said, “Yeah… we did that to you. That is from being in an airplane position and we had you bent pretty good.” Yeah… in that case the pain makes perfect sense, I guess being crucified horizontally for several hours would cause that type of discomfort. The last sensation I vividly remember while coming out of sedation was my sleepy fingers. It’s the same sensation of your leg going to sleep and coming back to. The prickly needles sensation, the inability to feel fine detail, and the lack of general motor skills. It lasted quite awhile and was such an odd sensation.
        I started coming out of the sedation around 2:30pm and at that time my wife came in super happy to see that I was alive and doing well. Since I am coming out of major surgery pain is to be expected and they mitigate this known side effect by providing drugs. The pain medication that was provided to me was a morphine based saline that is administered directly into the IV. This drug is self administered and is to be used to keep your pain threshold down to a reasonable level. Now unbeknownst to me, my wife told my nurse that I get all loopy and weird when on certain medication. Well, loopy and weird to my wife and loopy and weird to a night SICU nurse mean two completely different things. When the nurse suggested I use the button for the hunger pains she said it with a disclaimer, “but… your wife says you get weird so don’t use it unless you really need to,” followed by, “soo… like she doesn’t mean you get violent weird does she?” Needless to say I didn’t push the f&(*kng button until 2:30AM and mind you that was just to be able to sleep.

I was told I said a few choice gems and one nurse looked at me a bit cockeyed when I saw her again quite a bit after the surgery. Whatever was said I am sure she deserves an apology.

My wife and I during surgery prep… I look much calmer and collected than I actually am.

Just before wheeling me back…

… after surgery, Ashley was all teary eyed.

My family coming to visit me… either they got gussied up to come see me or they just got back from church.

The day I got back home from the hospital. I lost a ton of weight… look at those puny arms. No stitches or staples… just glue 🙂

        The next morning, immediately after waking, I wanted to get up and walk around. Before I was allowed to get up and about they wanted to remove a number of IVs that were no longer needed. I had a CVC (Central Venous Catheter) that they wanted to remove. Now… mind you I was told it was an IV of some sort but the look on their faces seem to indicate it was quite more than that. My wife was present when they took it out and I was very aware of the care and concentration that was being used by the nurses around me. I didn’t feel much at all but I wasn’t expecting what seemed to be a two foot long quarter inch tube being pulled gingerly from my jugular. My wife’s face was stark white when they pulled it out… Everything else they removed afterward was far less dramatic; even the removal of the urinary catheter was less shocking (to me, can’t speak for the nurse). I was able to move about around the bed without too much trouble (one of those benefits of Brazilian Jiu Jitsu hip escaping my way around the bed). So as soon I was no longer tethered I stood up and walked a lap around the SICU with my entourage (my nurses and my wife in tow). I ended my lap by visiting my niece. I was greeted by a 96 lb, no longer jaundice girl who was tearing up with an authentic gratitude I have not had the honor of seeing until now. I hovered about her room for as long as I was allowed to and then headed back to my room. After the walk I was looking forward to getting into my bed. I had it adjusted to the perfect angle of repose for a human body.  Instead of a bed I was greeted with an odd looking wheelchair and a smiling nurse who was about to take me to an 11th floor room with a view… and jello… lots of [email protected](#&$ jello.

I was greeted by a 96 lb, no longer jaundice girl who was tearing up with an authentic gratitude I have not had the honor of seeing until now.

He liver they took out… all janky and such.

My right lobe… all sexy and such.

Three Year Update:
        I am still alive. My niece is also still alive. Not only is she alive, she is thriving 🙂 She just graduated from California State University San Marcos with a degree in underwater basket weaving! Just joking… she has a bachelors in Molecular and Cellular Biological Sciences. Her liver numbers are great and she is healthy, somewhat happy, and chasing boys. I think that is what she is supposed to be doing at her age.
        I am still hitting the same exercise regiment. It’s is more focused on bodyweight. I do lift still just more weight less reps and run considerably less; I am lucky if I clock 10mi a week as opposed to the 20 I used to clock. I do run faster… so I have that going for me. I also hit Brazilian Jiu Jitsu 3 days a week. So all in all my physical health is pretty much the same. The only side affects that I can without a doubt attribute to the surgery are – I am considerably less pliant in my core and I am more gassy. Now… each of those complaints can be rectified if some action was taken but in therein lies the problem, I would have to do something. Doing something isn’t exactly my strong suit. I could stretch and eat in a manner takes into an account that I do not have a gallbladder… but that would be doing something. All in all I am well and am more focused on contending with bad investments and figuring out how to pay for my kids’ education rather than worried about impending death.
… maybe i’ll write another post about the recovery. This was getting too long 😉
Two years and 20lbs later…

… and everything is back to a new normal 🙂

She graduated and is thriving!!!

        I can’t thank the staff at UCSD enough. The expertise and high level knowledge that Dr. Alan Hemming possesses has granted my niece a second chance and allowed me to carry on as if nothing happened. I’ve recently heard that Dr. Alan Hemming is no longer the head of the transplantation team at UCSD. I am going to miss his abrasive, arrogant bedside manner. If I ever end up in the hospital again I would send off a text to Dr. Hemming with the hopes he would check-in on me. I trust his medical opinion and expertise more so than anyone else’s. In the end, I think that is how one should measure someone’s medical certificates, degrees, doctorates, bedside manner, etc… who would you call when sh!t hits the fan.     
Thank you for reading… consider being a hero, consider being an organ donor. https://www.donatelife.net/
1 year later during a radio interview…