On my second day in the hospital, Brian and my brother John both flew in from the East Coast.
Johnny came straight from the airport to see me. “Thank God you’re alive,” he said, hugging me through the tangle of tubes and wires. “We’ve been so worried about you. What the hell were you thinking, little bro?”
It almost broke my heart to hear him call me that and imagine the pain I’d put my family through. “I’m sorry,” I whispered. “I guess I wasn’t thinking.” It wasn’t exactly the truth, but I couldn’t bring myself to tell him I had done what I thought was for the best. It sounded better to make my suicide attempt seem like a mistake, a mistake I was now paying for.
John shook his head. “Don’t ever do that again. Nothing is that bad, you hear me? Nothing.”
I sighed. “I know.”
“I wish you would have reached out to one of us. You know we’re here for you, no matter what.” He squeezed my shoulder. “Mom and Angie and Polly and everyone send their love. They would have all flown out, but we didn’t want to overwhelm you with visitors.”
I managed a smile. “I know. Thanks, bro.” I appreciated the support of my family, but I noticed he’d left out one important name. “Leigh isn’t coming either, is she?”
He hesitated, then shook his head again. “No. I talked to her yesterday, after Kevin called. She sounded pretty shaken up, but she said she doesn’t want to leave the kids again, and she doesn’t want to upset them by bringing them out here, either.”
I nodded. “They don’t need to see me like this.”
“Yeah…” John looked around at all the medical equipment. “So… what’s all this for, anyway?”
I shifted uncomfortably in my bed. “Well, they’re keeping a close eye on me, as you can imagine. My doctor thinks I might have done some damage to my liver.”
His eyes widened. “How much damage?”
“I don’t know yet. They ran some more tests this morning; I’m still waiting to hear the results.”
“I’ll stay until you find out, okay?” He sounded anxious.
I shook my head. “They won’t let you stay long. They’re pretty strict with the visitor policy in ICU. You should go drop your stuff off at my place and get settled in.” Sure enough, it was only a matter of time before my nurse came over and reminded John that I needed my rest. He seemed reluctant to leave me, but eventually he did.
Brian and the Boys came by that afternoon. Nick, I noticed, was not with them. “He wasn’t feeling well,” Kevin explained. “He said his meds have been making him sick.”
“You don’t have to make excuses for him,” I said. “I know why he’s not here. It’s okay.”
“He said to hang in there,” Brian added, giving me a grim smile. He reached out and took my hand, clasping it tightly. “How ya feelin’?”
I shrugged. “Not great… but not horrible either.”
“That’s good to hear. Listen, I’m sorry for what I said the other day at Q’s funeral.” Brian shifted his weight from foot to foot. “I didn’t mean to hurt your feelings. I was just upset.”
It took me a moment to figure out what he was talking about, but then I remembered the comment he’d made about me giving everyone AIDS. “I know. You don’t have to apologize for that. I’m the one that should be sorry. For what I did to Nicky… for what I did to myself… for everything.”
“It’s okay. We forgive you,” Brian said, and AJ and Kevin nodded in agreement. But it wasn’t their forgiveness I wanted.
“Have you heard from your doctor yet?” Kevin asked.
As if on cue, Dr. Stone stepped in before I could even answer. I thought he would kick them out, since I was only supposed to have one visitor at a time, but he didn’t say anything about the guys being there. He must have known I would need their support after hearing the news he’d come to deliver.
“Well, Howie, we got back your test results, and I’m afraid it isn’t good,” said the doctor, grim-faced and serious. “You’re in acute liver failure.”
“Failure?” I repeated faintly, my mind reeling from the word.
He nodded. “Your labs indicate a significant drop in liver function since you were first brought in. The combination of drugs and alcohol you ingested was enough to cause severe damage to your liver, and now it’s shutting down.”
“What do you do for that?” Kevin wanted to know right away. I was wondering the same thing.
Dr. Stone shook his head. “Unfortunately, there’s not much we can do. The damage has been done, and there’s no way, medically, to reverse it. Now, sometimes the liver does spontaneously recover on its own, but there’s no guarantee of that happening. At this point, all we can do is take supportive measures until your liver either recovers or gets replaced. Your best shot is a liver transplant.”
My mouth dropped open, as I struggled to wrap my mind around what he was telling me. A transplant?
Kevin, Brian, and AJ were all staring at the doctor in dismay, their reactions mirroring mine. We must have all been thinking the same thing. First I’d contracted HIV, and now I needed a liver transplant? It was unbelievable. How much bad news could one person handle? In a matter of weeks, I’d gone from loving life to feeling like the unluckiest guy in the world.
But no… this wasn’t just bad luck. This was my fault. I had done this to myself.
“So… basically, you’re telling me you guys saved my life for nothing,” I said flatly, staring at Dr. Stone. “I’m going to die anyway.” Beside me, I heard AJ draw in a sharp breath, but I wasn’t sure whether to feel devastated or relieved.
“I didn’t say that. With a new liver, you could live a long life. I know liver transplant recipients who have lived thirty years or more after their surgery.”
I shook my head. “Haven’t you read my medical history? I have HIV.” Even if a new liver would extend my life, I knew there was no way they would want to waste a healthy one on me. Why even bring it up? I wondered.
“HIV is not the death sentence it used to be, Howie,” said Dr. Stone. “Thanks to the advances in antiretroviral therapy over the last two decades, people with HIV are living a lot longer. There was a time when no transplant team in the world would even consider transplanting an organ into an HIV-positive patient, but those days are over. Studies show that HIV-positive transplant recipients have more or less the same survival rates as recipients without HIV. We’ve done several transplants in patients with HIV here at Cedars-Sinai.”
Kevin let out a low breath. “Thank God,” I heard him murmur.
“See, Howie?” said Brian, sounding relieved. “There’s still hope. All you need is a new liver, and you’ll be better. Everything will be better.” It seemed like he was trying to reassure himself as much as me.
But I wasn’t the only one not buying it. AJ snorted. “A new liver – no biggie, right?”
Brian and Kevin both glared at him, but I actually cracked a smile, appreciating his sarcasm. It didn’t make me feel any better, but at least AJ seemed to understand how overwhelming this was for me. Despite how simple Brian made it sound, this was a big deal.
Dr. Stone seemed to agree with AJ. “I’m afraid it’s not quite that easy,” he said, looking at Brian. “Before Howie can receive a new liver, he has to qualify as a suitable candidate for transplantation. There are certain criteria the transplant team takes into account when determining whether or not to recommend a patient to the program.”
Kevin frowned. “But you just said Howie needed a new liver. Correct me if I’m wrong, but you can’t live for long without a functioning liver, right?”
Dr. Stone nodded. “That’s correct.”
“So… what’s the problem? Why wouldn’t that need be enough to qualify him?”
Dr. Stone cleared his throat. “At any given time, there are somewhere around a hundred thousand people awaiting transplants in this country. The ratio of organ donors to would-be recipients is much smaller. Due to the shortage of organs, priority is given to patients who have the highest need, but who have also demonstrated a commitment to complying with treatment and living a healthy lifestyle post-transplant. In other words, we want to make sure these precious organs go to people who aren’t going to waste them.”
That was when I understood what he really meant. “People who don’t overdose on pills and try to drink themselves to death,” I added dully. It wasn’t the HIV, but my suicide attempt that would stand in the way of my receiving a life-saving transplant. Although it seemed sadly ironic that the hospital staff would save my life, only to let me die later of liver failure, I couldn’t deny that it made sense. Why would they waste a liver on someone who wasn’t going to take care of it, someone who didn’t even seem to care whether he lived or died?
“Your suicide attempt is something the transplant team will take into account,” Dr. Stone acknowledged. “Before we consider you as a candidate, you’re going to need to think long and hard about whether this is something you even want. A liver transplant could save your life, but life after a transplant isn’t easy. You would spend at least a couple of weeks in the hospital, after which you would come back for regular follow-up appointments. It can take six months or more to completely recover, and even after that, you would have to take medication for the rest of your life to prevent your body from rejecting the liver. As someone recently diagnosed with HIV, I’m sure you can imagine how overwhelming that might be. Most transplant recipients say it’s worth it, but if you feel it wouldn’t be, you have the right to refuse treatment. In that case, we could keep you comfortable and let nature take its course.” He looked me in the eye, and I understood that he meant let me die.
“How long?” I asked hoarsely. “I mean, how long would it take to-?” Seeing the stricken look on Brian’s face, I quickly rephrased my question. “How long could I live without a transplant?”
Dr. Stone’s expression was equally grim. “Even with the supportive measures I mentioned earlier, unless your liver function improved on its own, it’s unlikely you’d survive more than seven days.”
Seven days… I felt like I’d just gotten off the phone with the creepy little girl from that movie, The Ring, which Nick – who else? – had made me watch with him once. I couldn’t help but wonder what he would think when he found out that, without a new liver, I only had a week to live.