Section 2 > Exercise 4 > Organ transplantation
Read the following personal essay "To whom it may concern" by Richard McCann, a liver transplant recipient, and answer the discussion questions.
"To Whom It May Concern"
Richard McCann
I have never dreamed about you, not even once. Not in a way in which you’ve had a face, that is.
I don’t know if you’ve died from a cerebral hemorrhage or a car crash or a dumdum bullet shattering your skull in a drive-by shooting. I don’t know if you listened to Prokofiev or wore dreadlocks or if you ever swam in the ocean, your body buoyed with saltwater.
I don’t know if you were a man or a woman.
I know only one fact about you, which I gleaned by accident, thumbing through a medical file: You were 20 when you died. When your organs were "harvested," as the transplant surgeon says.
I received the liver. The surgery took 14 hours and 33 units of blood.
And as for you? You can’t look back into this world, at least not in my thin system of belief, though if you could you’d find me sitting here at a desk cluttered with old letters and vials of medicine, recalling what a therapist once suggested when I told her there were things I still wanted to say to my brother who’d died of a drug overdose. "Write him a letter," she said, "and mail it by tucking it into the frame of his photo."
Oh sure, I thought. Talk about a dead letter office. But that night when I got home and saw my brother’s photo on my dresser, I yearned for him to have my words, even if I couldn’t bring myself to say them.
Dear donor, sometimes I feel I love you more than anyone in life. After all, you’re life itself to me. Other times I tell myself this: You’re someone who died, that’s all. It’s sad, it’s awful, really, but there’s no need to get all false and sentimental.
Dear dead zero. Dear no one at all. You died. But not for love of me.
Here’s a secret: I talk to you all the time.
This morning, for instance, walking through the park, past the widowers playing chess, past secretaries on breaks sitting on benches in the sun, smoking a few cigarettes. It’s a beautiful day. Look, the Bradford pears are almost flowering!
I’m headed to the gym, as I am most mornings, blue sports bag slung over my shoulder, so I can work on rebuilding the muscle tissue I lost while waiting for a liver, my skin jaundiced and my abdomen swollen with ascites: bench press, preacher curls, dumbbell flies and Gravitron. I want to let you know I’m taking good care of us. I’m eating right, I’m drinking bottled water, I’m doing my job, I’m working hard to make us stronger. It feels good, walking across the park like this, as if there are actually two of us, striding right into sunlight.
But the mood expires, as it always does, even before I get to the gym. I find myself stopped in the pedestrian crossing. Just what do I think I’m doing? What’s the point of this one-way conversation? Do I somehow think that I can pay the debt I owe you by keeping you alive, as if my life had been saved only so that I might serve as y6our living memorial? Please, if that’s the case, let’s just put a little tombstone on my hat.
It’s not as if I volunteered for the job, at least no more than you did. And it’s not as if the liver I received- your liver, your faultless liver- hasn’t now become infected with hepatitis C, the virus that devoured the liver I was born with and travels through my bloodstream still, endlessly replicating itself and ineradicable. According to my latest biopsy, my "new" liver- that’s how the doctor describes it, as if it were not pre-owned, a salvaged part- is already marred by active cirrhosis and chronic, progressive inflammation. Before too long, he says, we may need to consider retransplantation. In the end, as it turns out, I can save your life no better than my own.
In this mood, I make myself recall the first time I spoke to you with what felt even then like a kind of guilty, burdened love. It was a late afternoon, toward the end of my 11 th month on the transplant waiting list, a few months past my 46 th birthday. I was at the hospital clinic, sitting in a windowless exam room, while a nurse was drawing my blood. By then I knew I couldn’t wait much longer; I knew I was "end-stage," as one doctor put it. At home the week before, washing the dishes at the kitchen sink, I’d started hemorrhaging from my mouth, as I’d been warned could happen, from rupturing esophageal varices. The blood that poured down my chin was as black and thick as coffee grounds, mixed with a glossy spittle.
The clinic nurse finished her task, touching my arm as if to reassure me. "I’m sure you’ll get a new liver soon," she said. She said she could sense it because she had a lucky feeling about things. Then she started telling me, as I wish she had not, how most cadaveric organs come from those who’ve suffered sudden injuries to the heard and how teenage donors are often suicides. As soon as she said it I began praying: Please, don’t be a suicide.
For a moment, I wanted to protect you-or so I told myself then- for it seemed as if I knew with sudden certitude, as you could not have known, that you were marked to die. But how could I have been the one to protect you- I who wished so hard to keep on living but whose life required that someone die? Were you doomed because I dared imagine you, even if only for an instant? Did I unloose an awful wish into the world, a wish that grew powerful in the second I set it in motion, like one of those particles that a flaming meteor sheds- a dense, molten speck that could blow a hole right through you if it struck you while you were floating, eyes closed, through outer space?
In any case, a month later you were dead.
The transplant coordinator phoned after midnight, instructing me to report to the hospital at once. I don’t remember much after that. The room where I was taken for an enema. The gurney that took me to another room-cold, it was cold- where it all began to hurt. A man in blue scrubs inserting arterial lines, one beneath my collarbone and one in each of my wrists. You’re going to feel this, he said.
You know the rest of the story, if it might be said you know anything at all. You know whether you were hooked to a ventilator, as the brain-dead often are, so your chest kept rising and falling for hours, though with mechanical breath. Whether you were incised from the sternal notch to pubis; your sternum cracked and retracted; your organs cut loose, one after another, first the heart, then the lungs, liver, pancreas and kidneys, in that exact order, and then set in sterile bowls and perfused with cold preserving liquids before being triple-bagged in ice. Then bone, if bone was taken. Then corneas, if corneas. Then small strips of skin, if skin-skin, the last thing, a fine layer, that’s all, like the peeling after a sunburn. As for the rest of you, I don’t know if there’s a grave site that people visit on Sundays, bearing their armloads of fresh flowers.
I’m sorry, I want to tell you.
For what? you might ask.
For the nights I spent at the window that winter, watching as black ice glossed the highway and hoping with at least half my heart that I’d see a car skidding across the lanes and into the guardrail, then the red lights of an ambulance arriving. For the jokes I made with the other pre-transplant candidates as we sat in the clinic for hours, awaiting our EKGs and CAT scans and pulmonary function tests- Who’s got a rifle? Let’s go to the roof and pick off some strangers for their organs.
I am sorry, in fact, for our ever having had to meet at all, whether it was by fate or chance- or even luck, as some might say, although of course it’s brutal for me to say that to you.
I had wanted to write you a love letter. Something simple and unambiguous, I thought, thanking you for having saved my life and telling you how much I need you still, in sickness and in health, 'til death do us part.
I wanted to tell you the terrific joy I felt the morning I was wheeled to Radiology for a sonogram, only a few days after the transplant, and saw for the first time our liver-not quite yours, but not yet mine- as imaged by echoing sound: at first a vague motion among watery shadows, and then the sudden oceanic rush of my own blood pulsing loudly through the hepatic vein toward the vena cava. This must be how a pregnant woman feels, I thought, as she catches the first sight of her fetus and hears its pounding heart, though I was also the one being born, or born again, so jubilantly resurrected! I wanted to tell you how each morning I ride the bus across town looking into the faces of my fellow passengers- the Latina across the aisle, combing her hair in a pocket mirror, or the Pakistani two seats away, reading his tattered guide to English verbs-because any one of them might now be related to me as your sister or uncle or niece or brother or wife. I wanted to tell you all the small, good things, dozens of them, maybe more, if only because I now know, as I never did before, that I’m alive. Alive.
These things are true. But so is too much else.
The love letter I had hoped to write could never have served as a vessel deep or strong enough to contain the complexities I feel toward you, at least not if it had been the kind that’s all gratitude and praise and avowals, the kind one rights in eager, hopeful courtship. And how could it have been, if only because the bond between us was sealed at the start of at least as much in death as life? Even if this were that letter- as perhaps it is, in the end- it’s a love letter stained, as it must be, by grief and guilt and trauma. It’s marital.
We will never resolve the differences between us.
We will never become fully compatible or settle our bickering quarrel of rejection. For the rest of our life together. I’ll take a capsule of FK-506 in the morning and another at night to reduce my immune system’s ability to attack the organ-still yours? or now mine?- it will forever perceive as foreign. You will never be flesh of my flesh.
Perhaps it would be easier, I sometimes imagine, if I were to learn who you’d been in life. Some nights, I sit at my computer, scrolling through a transplant Web site maintained by grieving families who wish to post online memorials, whether photos or poems or intimate letters, to their beloved dead whose organs have been donated. The memorials seldom mention dates of death, but I persist, searching for the names of people who died the same day I was transplanted, as if I might somehow recognize you among them. For a moment, I imagine you were April Jones, whose husband recalls her "hazel-green eyes" and "beautiful brown hair"; or Richard Hall, a motorcyclist, bearded and tall, commemorated by a photo of him standing in his black leather jacket and chaps, squinting into the sun; or Dave Kuroko, who loved basketball and whose father wants him to know he is "proud to be a donor parent"; or Luz Maria Paniagua, "querida hijita" of Maria Gomez and namesake of "nuestra santisima Virgen Maria, y la de nuestra Senora de la Luz"; or Bertha Rangel, whose snapshot shows her dancing atop a mountain, her arms flung open as if to hold the whole living world.
Afterward, I lie in bed, slowly massaging my right side, from diaphragm to abdomen, gently passing my hand back and forth and over the liver. I trace my scar, slowly following the long furrow of puckered, hypertrophic tissue, remembering how once I could barely stand to even look at it, back when it was an open wound measuring 22 inches, almost as long as the incision the surgeons must have cut into you. For a moment, I imagine I can feel your presence, so close beneath the surface of my own warm skin, inside this body that will forever be both your living home and shallow grave. Who are you? I find myself whispering.
Discussion Questions:
1. What are the contradictory feelings the author confronts in himself? What in this story echoes the contradictions you just worked through? (See exercise 1)
2. If your perspective is that of the health care professional, McCann's is that of the patient. The physician often relates to his patient in terms of his disease, rather than as a person. Now it is the patient's turn to view his donor as a clinical object. Find examples of this in the text. McCann also apologizes to his donor. How does he reestablish a human relationship with his donor? Point to specifics in the essay. |
