The Blanco torso, two weeks after transplant, with 51 metal clips. What surgeons refer to admiringly as 'a beautiful scar'.

When I told people I was going to write about my experiences of liver disease and the transplant that followed my terminal diagnosis, it should not have come as a surprise that many readers were interested to hear about the process of the operation itself. So – with apologies to those of you who have already read ‘The Vagabond’s Breakfast’ – I am reproducing part of the section when I have been summoned to the hospital for the transplant.

Incidentally, I was recently asked to write a magazine article on the question of ‘presumed consent’ – whereby citizens are required to ‘opt out’ of the organ donor scheme, rather than the current system, where they ‘opt in’, by acquiring a donor card, thereby making known their availability as a potential donor. This is a fascinating and complex matter, with far-reaching ethical ramifications, and one that I will be addressing in this blog at a later date.

At this point in the narrative, I have been introduced to the anaesthetist and the surgeon who is to carry out the eight-hour operation, and I am being wheeled towards the theatre on a trolley bed:

Being manoeuvred down hospital corridors on a trolley bed has little to recommend it: you are now indisputably cast in the role of subject – you have become the one to whom things are done. This sense of utter helplessness is a challenge both to dignity and identity: you are simply the poor sod on the trolley whom passers-by will avoid looking at too closely. In the lift the other passengers stare at the ceiling, and I think of Hannibal Lecter. And then, the thought occurs to me that I spent ten years studying and writing about the subjectivity of the patient, that I have a PhD in the narrative construction of illness experience, have published in learned journals and even written a couple of books on the subject. None of this can help me now. I am in a post-discursive zone. I have reached the End of Theory.

Once inside the operating rooms, the situation becomes increasingly non-negotiable: the anaesthetist greets me by name but I have difficulty recognising him, transformed as he is by mask and surgical overalls. The surgeon too pops up with a consoling reminder: “I realise this is a big thing for you, but just remember that for us here, this is what we do every day.” He smiles. I do not panic. I am calm. I reason that if something does go wrong, I probably won’t know about it. Then the anaesthetist approaches once more, gives me an injection, and as he pulls away, the world goes with him.

I thought I had woken from a dream of the sea, but the waking was a part of the dream and instead I found myself upon a makeshift raft, the ocean swelling placidly around me, sharing tuna sandwiches with my dog. We rock unsteadily on the raft. I scour the horizon for any hint of land. Night is falling. I can hear nothing, and the gravity of silence makes me turn: a massive liner is bearing down, a million lights ablaze along the bows, lights that flicker into knowledge of something vast, unstoppable.

Coming to in Intensive Care, I nudge close to the surface several times before breaking through the last waves of sleep and opening my eyes. It is the afternoon of the next day. I am parched and my throat hurts, but I am evidently alive. I ask for water from the patient and fastidious Filipino male nurse who hovers at my bedside. My intake is restricted to occasional sips, which I swill around my mouth before swallowing for maximum lubrication, but I am impatient to drink, and inevitably take in more water than I am permitted. My nurse chides me gently, tells me again to take small sips.

I have often wondered, prior to the operation, how it would feel to be in a hospital bed immediately post-op, knowing that another person’s liver lies inside my body. At this same hospital, in February, I met successful, long-term transplant patients, and in spite of their apparent normality and good health, in spite of what I had been told about the advances made in transplant surgery, I could not help but regard these survivors as freakish cyborgs; insubstantial beings held together by pins and tape – and now I was one of them. Awkwardly, I pull back the bedclothes to look at my torso. Below the gauze bandage I follow the contours of a ridge that snakes across my stomach where the metal clips are planted (later, when the bandage is removed, I count fifty-one). Even more than during recent weeks, I feel at a remove from my own physical person, this immovable object to which I am attached and which now contains a large element of the not-me. The singularity of this sensation is perhaps due to the fact that nothing in my experience has been remotely similar: I have nothing to gauge it by. This lump inside my body is almost palpable otherness, and yet, if I did not know that I had received another man’s liver, would I feel any different? Would I know? Because of the drugs I am being fed, the only area of real discomfort in my body centres on my sore throat and the intolerable dryness of my mouth. Otherwise, it is too early for me to register any emotion other than relief that I have come through and am being told the operation has been a grand success.

I endure my thirst with a martial, dogged humour. Rose sits by my side, a warm and subtle presence, and I enjoy the visit of the surgeon, Professor W, and ask him when the monstrous battery of farts that issues forth from me might ease up. He tells me – and this is a little alarming – that the new liver was uncommonly large, coming in at 1.2 kilogrammes (the average liver weighs 0.7 kg). He says that with time it will shrink to accommodate to my body size, just as, if I had received a smaller organ – or half an organ, which is commonly the case – it would grow to fill the designated space. I have a sudden desire to mourn my old liver. It served me well, I think, sentimentally, before it finally gave up the ghost. Professor W says he had a hell of a job getting it out, which, quite apart from serving as a metaphor for the extinction of a past life, evokes some horrible imagery. I like the Prof – he has a nice sense of the macabre which he can’t quite keep in check, like his smile when discussing my prolific flatulence, marking him out as someone I might get along with well in civilian life.

At night, my temperature rises suddenly and I feel the onset of fear for the first time since entering the hospital; a dense fear, cloudy and dull, loitering, it seems, just to the back and to the left of me, like the devil. I am feverish. I fear I might have contracted some iatrogenic infection such as MRSA; I fear my body might be rejecting the new liver. I do not manage to sleep much that night, in spite of the medication, anxious in case my temperature continues to rise, putting me at threat of I know not what. There is a remote possibility of having to undergo more surgery if things go wrong, even a chance that I might require another new liver, for which an emergency, Europe-wide call would have to be sent out; but when my temperature is taken the next morning, it has fallen. I am off the critical list. That evening I am transferred to the Special Care unit, a half-way house between Intensive Care and the general ward. The following afternoon I manage to get out of bed and into an armchair. My father and sister visit, and they bring my daughters, Sioned and Rhiannon, who never take their eyes off me. I am tired and in considerable discomfort, but am overjoyed to see them.

Only a day later I am in a two-bed room on the liver ward and learning to walk with a Zimmer frame. That first night on the ward, I sleep a full eight hours, wake the next morning with a sense of levity and grace, and walk to the bathroom without assistance. A week to the day after surgery, I leave the hospital. The consultant who signs me out tells me this equals the record for turnaround on a liver transplant. I am irrepressible and quite barking: mad as a hatter, says the ward sister, Julie, approvingly. On leaving, I thank all the staff who have tended me. I vow to myself that I will never again complain about the National Health Service. As a parting gift they give me a blue plastic container for all my pills, with sections designating the days of the week. I take my pills four times a day. I swallow them down with water, tea or apple juice. They make me whole again. No, that’s a lie; they suppress my immune system in order to prevent me from rejecting the new liver. Before long I will have forgotten life without pills, but that is a small price to pay.

From ‘The Vagabond’s Breakfast’ (Alcemi, 2011)