mad in pursuit journal

DISPATCHED FROM THE CROSSROADS, AT THE intersection OF urgency and waiting

When Cholesterol Is Good

We spent all day yesterday at the Liver Transplant Clinic. Jim's doctor believes in long-range planning, so this was the culmination of tests and assessments "just in case" things get ugly. Since Jim's health has been good, this enforced visit to Worst Case Scenario-ville was a little mondo bizarro. We like best-case scenarios.

We were greeted warmly in the waiting room by two volunteers — liver and kidney transplant recipients — who wanted to "be there for us" during the process. "But wait!" we kept wanting to say. "This is just a dry run — no transplants for us!" They gave us a list of Questions to Ask and a $1 coupon toward lunch.

Too quickly, we were whisked away to a chilly exam room, where we sat alone for an hour and a half, waiting for someone to show up, wondering what to expect. Last week Jim had an echo cardiogram, CT scan, pulmonary function test, a zillion lab tests — but no one actually explained what this full day was all about.

But by the end of the day we had seen a nutritionist, a financial reviewer, a social worker, a nurse transplant coordinator, a transplant nurse practitioner, a transplant surgeon, a hepatology nurse practitioner and a hepatologist. And we found out what a MELD Score is.

It felt like most of these people assumed the transplant was tomorrow. I was quizzed about my readiness to provide post-surgical care and Jim was lectured on every possible consequence of a life on immuno-suppressant drugs. That's the point where I thought I might faint and Jim changed the subject to research.

One of them left Jim's chart in the room. We grabbed it and pawed through it. Someone had written that Jim was "a pleasant elderly man." Elderly??? Geddoudahere!

Anyway, about the MELD Score. The creepy part is that it stands for "Model for End-stage Liver Disease." The good part is that, on a scale of 6 (least ill) to 40 (gravely ill), Jim scored a 7. Excellent.

But we wanted to know: how likely is it that a good score will deteriorate? What's the deal?

The surgeon was a hard-ass. His answer to all our questions seemed to be: no one knows. Like they say on Project Runway: "Today you're the Toast of the Town. But tomorrow, you could be Toast." But isn't that always the case? With life in general?

The hepatology team (the actual liver specialist and his NP) had apparently forgotten about us by 3:30. Did we still want to see them or did we want to re-schedule?

Jesus! Get them down here now!!!

They finally arrived about 4:15.


"I'll be surprised if you need a transplant 10 years from now. Look at these lab values," he boomed. "Better than mine!"


He pointed to the cholesterol level. It was high. That's good?

"High cholesterol!" he said. "That's great. Cholesterol is produced in the liver. Sick livers don't produce any. Your liver is producing cholesterol!!! And look here." He pointed elsewhere. "You are processing iron. Functioning livers process iron. Keep up the good work!!! No drinking and you'll stay healthy!!!"

On that note, the day was over. Acknowledging that life can always throw you into the toaster, we left the clinic giddy with relief.

Jim and I have travelled many roads together. But this is one journey l'm happy to postpone indefinitely.


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