acute liver failure

THE ER PART I by Nora Logan

I spent over 26 hours in the ER at Weill Cornell. They didn’t have a bed for me on any of the wards (and didn’t know what was causing my liver failure so were not sure where to put me). At that point they had yet to rule out an infectious disease. The 26 hours (not that I was counting) were a test of my patience, which at that point was a small thimble compared to the deep well I’ve had to dig since. If you think of a hospital in the way you would any hierarchy, the ER is at the very bottom rung (A&E for my UK people who never watched the extremely popular TV show ER - it's understandable if you missed it, it was only on for 15 years). No one really wants to be in the ER: the patients, the doctors, the nurses – it’s a hellfire like few others in the world. I may be exaggerating, but only slightly. In my extensive research on the ER, the only person I've met who didn’t mind it is a sweet friend of mine who was a volunteer at the hospital at the same time I was there (the second time round) and would come visit me when she had a shift. We would discuss the flaws in the system, and her reverence for being witness to the inner workings of the ER always struck me. There is something to be said for being in the thick of it, in the place people come when they're in dire straits Unfortunately in this country, where our healthcare is in such disarray, where we currently have 28 million uninsured people – people who go to the ER often as a last resort because it’s easier to walk away from the bill—or because they have no other options. 

If you're in a situation like mine, where you'd be very lucky if you even get to leave, your best bet is to hope that they want to get you out of there as soon as possible, and let it all wash over you. Before they really knew the full extent of my liver failure, they gave me morphine to take the edge off. I look back on that short-lived morphine moment as a warm bath of narcotic reverie. I remember, so vividly (well, I'll admit that it's not a crystal clear memory, but I have a fuzzy, opiate-laced general idea about what was happening), when they picked me up to transfer me on to a gurney and wheel me from my little bed to my first MRI. I looked up at the ceiling and had the distinct sensation that I was being rolled through a jungle. I could hear the sounds of the busy ER. The beeping of machines, the moaning of patients, the chatter of doctors, the nurses shouting back and forth to one another about bringing this piece of equipment or that syringe or this medication, it was all there in the background. But there were also more ethereal sounds triggered by the drugs (I believe they were a hallucination, although this can only be confirmed by my eardrums and imagination which unfortunately do not have their own spokespeople, so it's essentially up for debate). 

I was wheeled through a ward filled with murals, presumably for children (although I grew attached to them with each passing MRI or ultrasound), replete with cartoonish tall grass, butterflies and other animals. The pastel colours made me dream of a canopy of green, while the loud sounds of crickets and other high-octane noises bubbled up. A persistent buzzing—like a heart monitor flat lining—formed a helmet around my head. None of it was real, and yet there I sat. I associate my time in the ER with an escalating sense of panic, a similar experience to a comedown off drugs. And hey, it was. At a certain point, the offer of morphine stopped (just as the expression on just about everyone's face got more grim). The information increased in seriousness. New doctors kept coming, and although I kept the jokes going with my friends: 

"I'm never going to sleep it seems but that works out for me because you know I love to party. I am going for an MRI and hopefully having a blood transfusion cancelled because it's unnecessary [keep that dream alive, Nora of the past]. Sorry for the massive group chat but a lot of you are asking and since all the doctors love me so much and want to find out what this weird place called Bali is and where I picked up whatever the fuck this is it's easier to explain here rather than lots of texts. For now I basically know nothing but still have all the same symptoms and will hopefully know as some point in the next day or so. Love you bye. X".

Looking at the texts now, I'm amazed at my optimism, which would (sort of) last more or less all the way through to being listed for a transplant in the step-down unit on the 5th floor, when the grave reality of my situation set in (even then I was convinced I wasn't dying and kept saying things to the effect of "honestly everyone, I am definitely reversing this liver failure, don’t mind me! Is the F train running today? Need to get home later.")

When the silent stop order on the drugs went down it became all too clear that this was not a joke. But it was a lot easier to pretend like it was, especially since it's near impossible to get any sleep at all in the ER. They wouldn't even let me take an aspirin. Are you familiar with the feeling of your liver rapidly deteriorating at break-neck speed without pain or anxiety medication or anything whatsoever? It's sort of like nails scratching a chalkboard repeatedly 24/7 for 10 days. It's chill. The experience was so unbelievable, I was sure I'd be waking up from a low-rent badly-lit nightmare at any moment.  And If I hadn’t been the one who experienced it, I wouldn't actually think it bearable. 

During my time in the ER, I saw all manner of bizarre sights reserved only for the preternatural setting of a room that is essentially a holding area for any and all manner of illness. Think about it. Whether you’re coming in for stepping on a nail in a warehouse party or a building site, your kid fell down in the park and split their lip, you’re a drunk who comes in weekly, you’re an elderly person who lives alone and you’re scared because you don’t feel well and don’t know where else to go, you’re seeking pain medication for some phantom back problem, you just had a brain hemorrhage, you got into a fender bender, you have food poisoning or, like me, your liver is failing (the list goes on, and on), it all exists together, in this ground floor vacuum. You can witness the best and worst of humanity in an ER. The stakes can be really high so everyone is tense—from the patients to the nurses to the doctors to the aides to the janitors. Everyone reacts differently—someone could be completely distraught over a sprained ankle or worryingly calm about a massive heart attack or vice versa. On top of that there are so many variables to everything. It's hard to keep your head above water as a patient. I can only begin to imagine what it must be like as a health professional.

The really weird stuff happens either very early in the morning or very late at night—it’s when the zombies come out to play (or nervous parents come in with toddlers with temperatures). I clearly remember a wasted guy in his 40s come in around 3am screaming at the top of his lungs (which isn't so out of the ordinary, we've all heard a story like this), the staff at once wearily pleading with him to settle down but also completely ignoring him, because they've seen it all before. He would not leave and he would not shut the hell up. The woman next to me was wailing in pain and she would also not shut up—she wanted to be seen by someone—anyone. She was indignant that she was so willfully ignored (and probably disgruntled that I was fast becoming the It Girl of the ER). She was being ignored. That's what happens in the ER. Once that morphine wore off and I no longer felt like I was a panther in human form in the Amazon, it was interminable. I had so many doctors come in and out of our little room, the only thing separating us a tiny, thin piece of material that passed as a curtain to come see me, asking me questions - doing their work, trying to solve the case of the mystery liver failure, which only increased her loud frustration (understandably). Even with the constant flurry of people, I felt ignored too—that’s just what it is to be in the ER. The moral of this particular ER story is to get as much morphine as possible when you're spending 26 hours in the vortex. Failing that, keep your phone nearby for jokes from friends and keep your interactions with the drunk guy at 3am to a minimum. Oh yes, and find the least used bathroom and use it exclusively.

TELL THE TRUTH + TRY NOT TO SMOKE by Nora Logan

On the very last day as a civilian before my first hospitalization in July 2015, I remember getting a banana from a fruit stand on the corner of East 15th Street and Park Avenue South and smoking half a cigarette. I was with my mother. We hailed a cab. We called my dad to tell him where we were going. We got to the ER on the Upper East Side. That would be my last cigarette ever. I spent the majority of my misspent youth in London, where cigarettes were widely available, and during my adolescence and early 20s we all smoked. We smoked at break time, at lunch, next to school, after school, on the way home, waiting for the bus, in cafes, at restaurants, in clubs. You could smoke everywhere, and we did. It was a different world (a smellier world). Cigarettes were cheap as chips. I loved smoking. I had a deep love affair with it. I am really much happier now that I no longer smoke. Things are much less complicated when you don't have to constantly interrupt your day to have a cigarette. But it doesn't change anything about how I remember it. I love how it made me feel, I loved the act of having a coffee and a cigarette or a glass of wine and a cigarette, I loved having a chat with a friend over a cigarette, I loved having that oral fixation, I loved having a secret. I can't believe I thought I was tricking anyone into thinking I didn't smoke when I was a teenager. A friendly word of warning to anyone who thinks they don't smell like smoke YOU FUCKING DO AND EVERYONE KNOWS IT AND YOU'RE NOT AS CLEVER AS YOU THINK, 15 YEAR OLD NORA. We all know all the many reasons why one shouldn't smoke, and in a twisted way, I'm grateful for having an emergency liver transplant because it was a great and ultimately very effective way to get me to finally quit. For anyone out there looking to quit, may I politely suggest not using my tried and true technique and just buying patches or that Allen Carr book everyone loves so much. I can tell you now that it's a lot easier, less fraught and decidedly less time consuming than a liver transplant. I like that I know exactly where and when I smoked my very last one, it was a nice little bookend to a years long torrid affair.

I think when I first started writing this blog I downplayed this aspect of myself -- I felt the need to be infallible and perfect once I was given the gift of a new liver. Somewhere in the deep dark depths of my own mind, I'm sure I thought they'd take it away if I was too honest (despite always striving to be as honest as I'd let myself be, in the moment). I'm not sure who they are or how they would go about extracting a liver from me, but I was indebted to 'them' and so it felt important to be the ever obedient patient. As if I'd get a medal at the end of it, or something. Newsflash: there are no commendations in hospital, there are no awards for 'most obedient patient'. The award for 'perfect patient' does not go to anyone, ever. You don't even get an award for 'did her best not to fuck up'. The main objective for doctors, your family, the hospital, society at large (if you're lucky)--is getting you to a point where you're basically alive and they can politely kick you out is best case. 

I've made a bunch of mistakes pre-LT and post-LT and future-LT-me will make some, too. We all make so many mistakes that sometimes it feels like the only thing you're doing is messing shit up. I smoked for basically 15 years straight, and I never once tried to quit. I can't even be one of those people who say 'I mean, I smoked on and off for 15 years' or 'You know, I quit for about 8 months' or 'I tried this really great hypnotist--she's amazing--you really must go to her, she cured everything I've ever done and now when I have a pee it is flaked with actual gold.'  I'm really not ashamed of having smoked for so long. I mean, of course, I sometimes regret all that money that went down the drain or the time-wasting or the standing in the freezing cold getting frost-bite. But I don’t feel the need to qualify saying that I smoked with anything like 'Oh, how I wish I hadn’t.' or 'God, how could I be so stupid.' I loved smoking. I loved that part of me. I didn't think it was gross at the time (which I have come to realize it is); I thought it was sexy (only if Kate Moss is doing it); I thought it was fun (it’s really, really fun). 

I don't admonish anyone else for smoking, because that would be beyond hypocritical. My friends can tell you how much. I can't really be around smoke anymore because it makes me feel sick and gives me a headache (although if I am conveniently placed in a wind tunnel which does happen more often than one would think I've been known to ask friends of mine to smoke near me -- cheap thrills where you can get them). Also, if I’m around smoke, I’ve been told, it can increase the chances of me getting a cold because of my suppressed immune system. So I'm really 'supposed' to ask people to slowly step away from me if they're smoking. 

The point is that we are only human, and whatever blows your skirt up blows your skirt up: everyone has their vices. To ask that I suddenly shut off that part of me because I've been told I can never smoke again would be dishonest. It's the same as expecting that sick people never have sex, or that they don't have a desire to have sex, purely because they are sick. A calamity happened to show up in my life and turn it all upside down and gave it a nice little shake. That doesn't mean I didn't engage in a bunch of crazy adolescent proclivities before the calamity appeared. Just because we are patients or we have a medical condition of some sort does not make us inhuman or devoid of basic human impulse. It does not mean I do not long for the sweet smell of tobacco on a summer night. It does not mean we do not remember when life was just a languid afternoon down the pub, with not a teenage care in the world. There would be nothing more joyful than throwing caution to the wind and doing something entirely spontaneous. It’s so beyond boring to build your life around when you have to take your medication, or when your next doctor’s appointment is. And even if you are not a patient, the same things might ring true: building your life around your kid's schedule, or your job's schedule, or your bills' schedule -- or whatever boring schedule life demands of you. The way I get my kicks now is meditation. I actually can't even believe that that's what I think is the most fun thing to do. But all those selves that came before me, I see them. I am so different now. I see the other selves of mine. I still like those previous incarnations of myself. I won't apologize for them, ever. 

Sometimes, I have been very reactionary and defensive when the doctors ask me leading questions about whether I have smoked. As if they are waiting for me to trip up, to make a wrong move or do something irresponsible. Which, by the way I might, at some point. I'm only human. At the beginning of all this, I would get defensive when they asked me if I had smoked. They'd say: 'Any smoking?' And I'd look at them, speechless. Then irritated. I'd curtly reply: 'Nope.' How could they possibly think that I would do that when I was so ill? How could they possibly think I'd be that disrespectful? But 'they' are not waiting for me to make a wrong move, what could possibly be the upside of that? I suppose they have to ask, in order to help. I’m not sure why they ask. I would love nothing more than to do something completely irresponsible. But illness and aging, they teach you it’s not worth it. And by the way, life is long, and people change. I cannot say that I won't feel differently in 10 years time. That I won't do something like smoke a cigarette. I don't want to, I don't have any desire to and I have committed to strive to never smoke again. But again, I use this as an example to remind ourselves that we are only human and as people and patients we are asked to do a hell of lot to just get through the day. Which is tiring and very dull, let's be real. The blame game is one we'll never win and the enormous pressure of being responsible for oneself in life can sometimes be overwhelming. It helps to tell the truth and try not to smoke.