Just got back from this place.

Take a simple three seconds to guess where it is…. 3…. 2…. 1….

Now focus your eyes to the left on the person with the orange slippers. What your seeing are the pants of a patient, and this photo is one of the hospital.  This is the kind of hospital some lucky buggers get to work in, I say that with a grain of salt because I hated the general work atmosphere of the doctors here, but at least they don’t have to work in a place like this..

It’s so futuristic, the cranes over here work horizontally. (Legit photo – you can glimpse  Hayward Hall on the left which is where I lived during my first year).

Before I get side-tracked, let me continue on with the hospital. In case you feel bloated in the restaurants, there’s a park for you to take a jog in.

Fantastic.

Now for the part that looks like a hospital in this Korean hospital.

You need special permission to see the yellow people. I don’t mean that in a racist, you yellow Asian ching chong fucker! way. Literally yellow because of the poor liver function and failure to clear something called bilirubin (which happens to be yellow) from the body.

Now, my here’s a photo of my ex..

Hallway corridor which I walked a hundred times.

Plus for those waiting to see a photo of a liver donor’s scar, here it is – embossed upon a manly abdomen.

You even get a free pass at looking at my MRIs on the computer screen, and one of the liver transplant surgeons at the hospital. This will be the  only time you’ll see my abdomen, this pose is inappropriately wtf in every setting except the hospital where I got the scar from.

“Here, hold it, see how it feels.”

My hands were steady as the surgeon’s as my gloved hands took the scalpel where a slow ooze of the blood from the blade made itself down to my fingers. I was captivated by this man’s blood on my hands, lost in an unorthodox mixture of amazement and grotesque in my head. The resident surgeon looked at me with curious eyes, when just a moment ago I was looking at him with the same curiosity to try and understand what was going on behind his, wondering if it would’ve been the same as 2 weeks ago when he would’ve sliced me open.

“So?”

A flurry of stupendous blinks were all I could conjure up. I’ve been awake since 5 a.m. to get to the hospital by 7a.m. to observe everything about a liver transplant. The first surgeon I met was the resident (note: not the resident who handed me the scalpel)  who had admitted to not leaving the hospital for days at a time. Today seemed no exception, as his ruffled hair and barely open eyes were signs of someone who had just woken up from sleeping in some cold corner of this hospital. His eyes widened with shock as he saw me eagerly sitting and waiting in the preparation room. It quickly narrowed into a smile as he connected the dots and remembered that I had been given permission to observe a liver transplant by the head surgeon whilst I was in ICU. (What better time to ask a surgeon a favor?)

After a series of the introductions, I held up both my recently washed hands. A nurse draped a surgeon coat around the front, and prepared two gloves for me. I felt an unreasoned surge of power and could barely hold an urge to initiate the surgery… no, more like murder if I really did start cutting. The patient lay naked in front of me, fresh from having a tube inserted up his penis. I could feel a wince in my loins followed by the origination of momentary pure self-hatred of one body part to another. During the preparation of this patient, I felt connected with him. Everything done to the man formed itself into a phantom pain to my own body. The needle stabs into  the neck, shoving of tubes down the mouth, oranging of the body with iodine and of course the penis tube, all of it all made the same body part tingle.

Then the intern draped blue blankets all over this man’s body except his abdomen. I felt my connection with the man start to break and the surgery becoming what it is, the treatment of a disease or injury by operative procedures, not a reenactment of a personal experience. This time, I was the one holding the scalpel. Ah yes, the scalpel, the resident had a question for me that so far I’ve only blinked to answer.

“Uhhhh……” was how I showed the resident I was an up and coming med student, quick on my feet. The resident laughed at how speechless I was, instructed me to hand the scalpel to a nurse, as he picked up some high frequency vibrating knife that burned the flesh, cutting it with ease.  Smoke from this man filled up the room (I exaggerate) leaving a distinct smell of burnt meat with a hint of human in my nose. From the smoke, a prick rolled into the room, the lead surgeon for this man.

The atmosphere of the room completely changed. The previously joking resident greeted the surgeon with a solemn hello following it with silence. The intern and nurses shifted uncomfortably, with their eyes downcast, not wanting to catch an awkward glance. The surgery clearly belonged to this man, and depending on what he wanted and how he felt, the surgery will follow suit. For the next 7 hours, if he made a joke everyone would laugh, if he told someone to shut the hell up – everyone would, if he felt like a smoke he would leave the room with the patient’s abdomen spread open, if he swore at the particular difficulties of the surgery – everyone agreed, and if he wanted something done – it got done. Before the surgery, I had asked the resident surgeon how long he had been doing surgery for. “Surgery? What I do isn’t surgery, I just stand-by and help.” I get what he means now.

With the surgery in full swing, this man’s abdomen was spread open by mechanical vices on each side revealing everything inside – an anatomical wonder that was so … alive. Everything responded to the surgeon’s incisions with a fresh squirt of blood and even the organs that were left alone made their presence felt, especially the heart that consistently beat upon the surgeon’s hands via the diaphragm. Lost in the inner anatomy of this person, it’s easy to forget there’s anything beyond it – not once did I think about the patient’s face, his expressions of emotions, his personality or his worried family members.

Who would you want doing your surgery? Someone who is completely distanced and mechanically approaches your body, or someone completely attached to you and heartedly deals with the consequence of each cut and the pressure of the possibility at each corner?

While I was dealing with a million thoughts, the intern doctor – whose job did not extend beyond holding things – found the boredom of the job greater than the value of the patient and started dozing off. First to go were his eyes, his blinks becoming longer and longer until his neck joins in and brings his head into a droop. I watched him with fascination, finding watching him with disapproval was followed by a pang of guilt. Every morning, my lectures start at 9, and almost every morning I would sleep a further hour in the comfortable seats of CQ lecture theatre. The stakes may be infinitely higher here, but the principle was essentially the same. Every bit of knowledge would make us better doctors but the repetition can eventually whittle anything mundane which coupled with sleep deprivation sends us to sleep.

“Hey, pull tighter…. I said pull tighter.” The lead surgeon looked up at the lack of tightness, “Fuck, are you serious? Your actually sleeping? Wake up you idiot.” The intern apologized profusely promising his full attention for the rest of the surgery. The rest of the surgery, if simplified, went more or less like this (most of this was explained in English by an observing doctor on a transfer programme to the hospital). Cholecystectomy (removal of the gall bladder, anything -ectomy means to cut/remove), followed by a hepatoduodenal ligament dissection, then after determining where to cut the bile duct with a radioactive marker, the actual cutting of the liver (hepatectomy). Associated arteries / veins and ducts are all sliced then tied up (suture ligitation).

When the liver is ready for removal, the donor plays the waiting game. Across the corridoor from this surgery room, was another room with the recipient being prepared to accept the liver. The recipient’s liver is removed completely, all the blood vessels and ducts prepared, and the great saphenous vein is cut out from the person’s leg to provide extra blood vessel length for connection.

The clock struck 3:47 p.m. when the call came in that both the donor and recipient were ready. It  had taken 8 gruesome hours to reach this point, and the transplant of the liver was about to go underway. After such careful procedures until now, the actual movement of the liver is a comparitively crude and primitive process. No fancy or high tech piece of machinery, just an ice box that the liver is carefully put into. To minimize ischaemic (due to no O2) damage, the movement of the box across surgery room is a somewhat panic striken shuffle across the corridoor.

That shuffle had made a part of me a part of my dad. Looks like I’ll always be there for him now. With a sly smile at everything I had seen today, I fell exhausted in the preparation room into a blissful nap.

After this major blind-siding, I thought back to how all the information and worry directed towards me had bounced off the shield of ‘knowledge’. One systematic review article had made me into an expert in liver transplants, that expertise was maintainable when the topic was of someone else. But, once I lay in the same bed I had scoffed at…. I really had no idea.

My abdomen feels exactly as it should. Like a surgeon cut open a wound, took out the right lobe of my liver, took out my gall bladder and reconnected the many blood vessels and ducts of my liver. I push the button to inject my body with more of some weak PVC crap instead of morphine that’s had minimal effect since this afternoon. A steady flow of it enters into my neck – I know because I can taste it along with my IV drips for nutrition. I know biologically I shouldn’t be able to, but I can’t escape the feeling like the insides of my mouth has been covered with an IV tasting layer of glad wrap.

My drained strength kept me from opening eyes to see and talk to the many visitors who had come in to wish a speedy recovery. Every visitor seemed to be compelled say those exact same words with a string of other cliché lines. They made no attempt to hide the repetition of the line, either because it was easier to slip into a role they’ve already seen or because it really best expressed how they feel.

Is it that we have lived long enough with the English language that everything has already been expressed? Our confessions of love, words of encouragement, jokes for the laughs, sympathetic phrases… How much of it was original? How much of it could be?

There seems to be another thing about pain, it makes me make half-hearted stabs at philosophy.

Day 2.
Today, I exceeded my limit. At 3 a.m. my body was drenched in the sweat of exasperation. I grasped at the bedrails and on my way up, ironically I snapped and fell way down in my head. Pain had been too much part of my life for too long, and I cried both out and literally. I shocked myself, I had been keeping everything under the lid just 5 minutes earlier, and with a short passage of time I was begging to be helped from it all.

Pain had become my Michael Jackson.

Those kids who went to Neverland, would’ve laughed at the aspect that he liked his kids a little too much. When they get there, they find that the giraffe’s neck is not the only stiff rod in the zoo of a house, and after the consequential relief of the stiffness to the horror of the children, they will be rewarded with a multi-million dollar lawsuit. False expectations – harsh reality – great reward.

So, going back to the crumbling me, my mother ran out to yell for a nurse. They arrived with a painkiller, and injected a large dose into my veins. The relief was almost instantaneous, and just as I was thinking medicine was a miracle, the catch of medicine kicked the wind out of me, literally. It felt as if some douchebag smashed me over the head then stuck two fingers down my throat making me nauseous, vomittus (wanting to vomit – don’t look this term up in the dictionary though… I made it up) and unable to breathe.

A hurried oxygen tank ended the day for me. It’s actually worth it to have the douchebag do what he did, because it relieved me from what the surgeon did. The side-effects of the opioids wore off in less than 30 minutes, giving me hours of doped-up joy and sleep.

Day 3.
Did you notice the lack of the mentioning of the person who all of this is for? I couldn’t escape the self-absorption of this particular suffering to muster a sustaining concern for my dad. The resident surgeon had told me earlier that the liver donor hurts more than the liver recipient – not because we really hurt more than the receiver, but because the amount of pain relief medication is just that comparably different.

The nurses here have 3 different pain medication at their disposal at this hospital. My body had side-effected to the one yesterday, and it decided to reject the other 2 with a worse reaction to one, and a loss of the relief to the other that had successfully worked on Day 1.

I had done my summer studentship (a research project) on pain. During the literature review, research revealed the harm of pain and exposed some dire long-term consequences – it was no longer about toughing out the moment and believing in the benefits of getting better on your own. My brain had been the only one absorbing all this information whereas my body still seemed to believe one thing. “Harden up mate.”

Fine, no more pain medication. No more blogging about it either. Instead I’ll make the rest of my stay at the hospital into a list.

Days spent at the hospital: 11
Days I wished I wasn’t at the hospital: 3 (Hospital intrigue could only take me so far, plus by Day 8 I had explored every nook and cranny of the 3 building complex available to the public).
Days I was promised discharge but stayed with fluid leakage from the liver: 1
Days with a lot of pain: 3
Times I wake up at night sweating from the discomfort since Day 4: 3
Injection holes in my arm: 14
Injection holes in my neck: 3
8x4cm bruise from poor injecting skills: 1
Loss of reserve inspiratory capacity (Max volume of air inspirable after maximum expiration): 1200mL
Regain of that loss: 900mL (With exercise)
IV fluid entered into my body: 5L
Peak no. of IV drips simultaneously: 4
Dad’s peak no. of IV drips simultaneously: 9
Staple holes in my abdomen: 48
Staples pulled out of my abdomen with me looking: 24
Blood pouches draining my abdomen: 2
cm of tube pulled out of my abdomen: 50
cm of tube I wanted to watch getting pulled out of my abdomen: 50
cm of tube I actually watched: 15
cm of tube pulled out of my nose: 10-15
No. of CT scans: 1
No. of Hepatobiliary scans: 1
No. of X-rays: 4
Kilometres walked: 25 (Exercise is recommended from Day 2 onwards, becoming especially important from Day 4 onwards to reactivate the GI tract)
Times those kilometres got me in trouble: 2 (Both times from venturing into ICU)
Kilometres walked wishing that I had a Mp3 player : 24.9
Minutes spent with a Doctor: 20 (That’s over the 10 day span, including a 10 minute session obtaining consent before surgery. This did change somewhat on the last day when the resident doctor opened up a little bit.)
Days spent by my resident surgeon in the hospital: 5
Metres walked by that doctor on his venture into fresh air: 10
Hours slept on a daily basis by the same doc: 1 (Completely ridiculous the workload the doctors are under over here.)
Words I wish I had the opportunity to say to a Doctor: A summarised 200
Number of verbal consent asked by the Doctor: 0 (I remember a time when a doctor shook me awake, and before I could shake off the grog, she was already busy removing my IV drip needles from my neck)
Times spent bent forwards washing my hair wishing I was having a shower instead: 6
Times I had a shower: 0
No. of beautiful of nurses: 6
No. of beautiful radiologists: 1

So concludes the mind of a liver donor.

Let’s take it back 156 hours, it was hammer time. There was no blue pill or red pill to choose from anymore, just a white one they told me to take to relax. All I remember after that is, waving the V sign to my mum and brother who had these eyes that cried so much worry that I felt I ought to give them a lift-me-up of some kind.

Next time I wake up, I am being rushed out of the operating room into the ICU. 8 hours and a half had passed since I went into surgery into 7:30a.m., making it 4:00p.m. My eyes are trying to focus the blur overwhelming my sight, but before clarity, my first conscious thought merges from the blur- my most instinctive, animalistic thought, defining who I really am.

“What the hell…?” ……… I’m not proud of the thought, it could’ve had more depth, but dealing with the brightness, disorientation, pain– it leaves little room for thought. Then my eyes finally focused on something. My brother and my mother. The warmth of a CT scan dye flushed through my body – except this time, it wasn’t a kid pissing in my body, it was someone really high up.

I waved them the same V sign as over 8 hours ago, and my brother took my hand into his. He’s never been an expressive brother, wanting to maintain his cool, mysterious cloud – in fact, coming out of his surgery (no, not a liver transplant – it’s not like its a family tradition), he pushed away my exact same attempt to hold his hands a week earlier. Yet, here he was, my hand in his, and telling me “I look awful” as open tears formed on his eyes. What a pleasant surprise.

I thank those 2 so much for giving me the sense of security and strength to come out of the surgery stupidly warm with the feeling of elation even if I felt the most pain in my life at the same time.

All of that happened fairly quickly, and my mind shifted to how my dad was. Nonetheless, I felt a pang of guilt with my dad’s surgery not being my first venture into awareness. “Surgery’s still going underway, and isn’t expected to finish for at least 5 hours from now” some masked man told me. Thinking it a pathetic attempt at reassurance, he further told me my “surgery had gone successfully without any complications”

I lose complete sense of time from then on, and everything becomes a mixture of pain, pain medication, high-pitch screaming from pain (not by me, but by some dude in the room next to mine, if it were mine it would be a manly low-pitch scream), the sight of my two caregivers outside a big glass window, and drifting in and out of sleep.

At 11:24p.m., my father came out of his surgery, him taking an extra 7 hours and half, for a total of 16 hours. 

Ah… It’s over’ was my last thought giving up completely to remain alert for a easier rest.

Now I know, No it wasn’t. Not even close.

Footnote: I had originally written this on my laptop on the 2nd of Feb – thus it being the 5th day after my surgery. Didn’t want to re-type it on the hospital public computers (the only ones with internet) so it didn’t get posted til now.
The reason I’m telling you is to maintain a sense of time – the post dates are way jumbled.

3 metres to my right is a 41 year old man who had undergone a liver transplant 4 days ago. There’s a low hum of bubbles of oxygen in its tank with a tube sliding down from it into his nose where the neighbouring mouth lets out groans of this man’s own sleepless night. His overly pink wife sleeps at his side, wearing her pink scarf, pink top and pink blanket with her pink bags close by.

What a fitting image to our conversation earlier on in the afternoon. The 41 year old man started off the conversation light, but soon focused the attention to pain. “How are you?” Pain.  “How did you feel going into surgery?” Pain. “What’re your first thoughts when you wake up from the surgery?” Pain. Just like his wife had only pink in mind, this man had only pain in mind. And just like this woman has her jet black hair and eyes to offset the pink, the man has something to offset the pain, he has the words “I’m the donor for my son.”

How strange it is to see a man prophesising my own bodily fate yet be in the opposite situation to I. His son is a baby 4 years old, only getting comfortable with the life born between this man and his wife. Yet, before he even goes to kindergarten, he requires his dad to give him his second life from the malignancy growing in his liver. “What’s the kid going to know what I’ve done” is what this life-giving man claimed to be the benefit of his deed.” All we get as a liver donor is pain, pain and a scar *this big*” stretching his arms to an exaggerated length.

I wonder if this man is that uncaring, that he begrudgingly underwent a surgery to escape the guilt had he not. Worried that the eyes of his wife would become too heavy to look into and eventually his own reflection in the mirror with its familiar resemblance to his son’s. I want to believe that it’s all a front, but I can’t find an answer to why he would be acting this way for the only two people in the room with him, his wife and I. Maybe it’s a short-term defeat to that pain he’s so concentrated on, and with the easing of the pain, so will his cynicism. I hope he gets over it, and goes to visit his son downstairs in ICU, even if he has to remain on the other side of a glass window.

So here I am, down with a harsh possibility sleeping 3 metres to my right. Then again, I’m up with the possibility that my dad and I be blessed with a successful surgery such as theirs that only took 7 hours for him, and 12 hours for his son. That and to my left, I can see a reflection of myself, and slightly lifting my shirt, my recently shaved abdomen has never looked so ready to be cut,  my liver has never felt so big, and my intestines so empty from the laxatives shoved down both my orifices. Maybe this post is my remote, because I feel light and ready for bed.

Good night.

Footnote : This was written on the actual day before the surgery. You’ll find out soon enough where I’ve been, and my posting this at least shows that I made it out of their alive to continue on