“There are only two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle.”-- Albert Einstein

What do you do when the career that you were singularly focused on for 16 years, actually focused on since you were about 5 years old is making you miserable.  What is your next step when every page, phone call, donor offer creates chest pain and anxiety and you just want to be left alone?  What do you do when the politics of the workplace have become the focus of your day, your thoughts, and are making it difficult to sleep at night.  What do you do when you have answered a calling to be the ultimate caretaker for people and it seems to be less appreciated, less valued (even though my debt to achieve this career isn't being lowered), and you are treated more like a factory worker by hospital administrators who sign your paycheck instead of being valued also for your role as a professional and for all those things that are a part of your job that cannot be counted.

 I don't know the answer for everyone but I will tell you what I did.  I cried, and then I tried to remember the very reason I navigated down this career path, which is actually more of a way of life than a career.  At the end of the day, the only thing that matters is my patients.  I believe that being a physician is a calling, as the sacrifices to your own life are too great to do this job for monetary success.  There are much easier ways to make the kind of money that surgeons and other physicians make.   There are much more lucrative jobs that don't deal in the currency of life and death.  Life and death are the very realities that we face everyday, especially in transplant.  At each transplant occurrence, outside of living donor transplants, we experience the reality of the very final moments of a life and the very exact moment when someone is given a second chance at life.  I view this as a gift and not a burden. Remembering this helped bring purpose back the the chaos of my everyday reality.

What happened next added to my resolve to remember exactly why I chose this career path.  Now, those of you that know me know that there is no way that would I believe that cleaning and organizing my office could be a cathartic event.  In fact, it wasn't my idea.  Chris, who is the yin to my yang in organization (and many other areas) decided that I needed some help. Now, before you scoff at the mental benefits of cleanliness and organization, let me reassure that although I did feel much better after my office was clean and organized. It was what happened during the cleaning that helped me to see through the fog of the everyday annoyances of my job and  remember that what I do is important and worthwhile and it is impossible to put a price on the rewards that are returned to me. While cleaning out my desk drawers, I found all of the cards, gifts, and letters written to me by my patients.  Also, while cleaning, I checked my office mailbox and there was a package from a patient who I had dropped by to visit about a month ago while she was in the hospital for something unrelated to her transplant.  These letters and gifts were not all from patients and families who necessarily had good outcomes or those who had no complications.  There were even gifts from family members whose family member had suffered the ultimate outcome......death.  Let me tell you about these patients, their families and their gifts to me and by gifts I do not mean the physical affects I found in my office and desk drawers but the gifts of love, encouragement, respect, kindness, and the reassurance that I have made the right choices in my life to answer the call of being responsible for the health and life of others.

Here are some of their stories.

Mrs. P-I found a piece of paper with her email address scrawled in my hen scratch.  Mrs P underwent a kidney and pancreas transplant when I was in fellowship.  I did her transplant and took care of her while she was in the hospital.  She had been described as difficult before I met her on the day of her transplant.  As patients who have been chronically often regress and act a bit like a spoiled child when they are sick, I was expecting the worse when I went in to meet her.  What I found was a woman who I connected with immediately and I could see that she seemed to feel the same way. Her transplant went well and she was discharged home.  A couple months later, she returned to the hospital with a bowel obstruction which is not terribly uncommon after having abdominal surgery.  I took her back to the operating room with my attending to investigate and relieve the bowel obstruction which is almost always due to adhesions (scarring from previous operations).  As I was untangling her bowel from around adhesions, I used the electrocautery to divide an adhesion but what I didn't realize is that her bowel had actually twisted around the artery to her transplanted kidney and I made a hole in the artery to her kidney.  I knew immediately what had happened and although my heart was in the pit of my stomach, I managed to get control of the artery, which stops the bleeding but at the same time, deprives the kidney of blood flow which can injure the kidney and cause her to lose the kidney that we had just transplanted a couple of months before.  I repaired the artery as quickly as I could and restored the blood flow to the kidney.  Even though there was a modicum of relief, I  still knew that her kidney was not out of the woods, we would have to see how much damage the kidney had sustained and there was also that  possibility that the artery would clot from the damage and she would lose the kidney or she would get a narrowing in the artery that would keep the kidney from blood flow and ultimately lose the kidney.  I knew that I had just done something, although not carelessly or not on purpose, but it could have devastating affects on this young lady not only physically (having to return to dialysis) but mentally as well.  My next task was to talk to her about what had happened after she woke up from anesthesia.  I remember that I stayed at work until early evening when she was awake enough to understand what I was telling her.  I sat down on her bed and told her exactly what happened and took full responsibility and said, "I'm sorry."  I talked to her about the potential devastating outcome.  I was prepared for her to be angry and specifically angry with me.  However, what happened was her first gift to me.  She was, of course, upset and scared but she said, those magic words, "it's ok".  She said that she knew it was an accident and that she believed that everything would be ok.  Forgiveness......the ultimate gift.  After a couple of days it was clear her kidney was going to make a full recovery.  I left fellowship, but never forgot her.  About 3 months ago, I received a call at my office from Mrs. P.  She is now about 3 years out from her transplant, has had another bowel obstruction but for the most part is living a normal life and working full-time.  She called because she wanted to tell me that she never forgot me and how good I was to her in the hospital.  I reminded her about the episode with her kidney and told her how she had helped me when I really needed it also.  

Mr B was a farmer and a horseman who had unfortunately been diagnosed with pancreatic cancer.  He was referred to me for a Whipple procedure.  I took him to the operating room and unfortunately he had developed a pancreatic pseudocyst from pancreatitis and I had to drain the pseudocyst because of all the inflammation, it was not possible to do the resection required to perform the Whipple procedure.  A very seasoned surgeon, Dr. D was helping me with the case and he and decided that the best thing to do was to drain the pseudocyst and put in a feeding tube into Mr. B's small intestine.  This way we could feed him liquid nutrition for a month while we let the pancreas rest and heal and then we would attempt the whipple procedure.  I had to go out and inform his family.  A month later we were able to do the whipple procedure and he recovered well from surgery.  He endured several months of chemotherapy and radiation. Unfortunately, he had a recurrence of the cancer and died a little over a year after his operation from metastatic cancer which is unfortunately the case for many pancreatic cancer patients.  I had become very close to the B family including Mr B's sister.  She continues to send me Christmas and birthday presents even two years after his death.  Right after Mr B died, she sent me a package with pictures of Mr. B and his brothers who all came to visit when it was clear that Mr B would not be well enough to visit and have fun with them for too much longer.  I get tears in my eyes, ok, I really cry each time I get something from her.  

DH is a young man who is 26 years old and on his third liver transplant.  After I had been out in practice for just a few months here in Dallas, my office gets a phone call from a mother who said her son who had been transplanted as a baby at the age of 3 at the University of Chicago, which is where I did my transplant surgery fellowship, was having problems with his liver.  The mother said that Dr M (who is the head of the txp department at U of C) stated his recently graduated fellow was in Dallas and would probably be willing to take care of her son.  DH ended up coming to our institution for care.  At first he didn't need a txp surgeon, but a hepatologist to take care of his failing transplanted liver. He actually had two liver txp as an infant because the first liver he received had a problem with the artery and he had to be re-transplanted on days after the first transplant.  He now needed a third liver at the age of 26.  We put him on our transplant list and I transplanted him. He is doing well and is back in college and working.  One funny side note is that his mother told everyone that I was involved in his first transplant at the University of Chicago which is numerically impossible as I would have been 16.  I never corrected her.  I think she believed that there was a more metaphysical reason for them finding someone in Texas who had been at the institution where he was first transplanted.  A framed poem which his mother wrote sits on my book shelf in my office.  Here is the poem copied exactly as written.

Her field of battle is close to her heart.

Her scapel, a sword, which busts death apart.

Biliary Atresia, hepatitis or virus…..

She’ll defend that liver, and be there beside us.

When your liver fails, and faith can’t be found,

She brings light to the darkness, and hope will abound.

She’ll fly to the donor, and bring back new life.

She never gives in, without a fight!

This organ is too fat and that one’s necrotic!

Oh wait, this one’s a match! Let’s get this fight started!

Bleeding,rejection, and just ole’ infection…

None will survive or get by her detection.

She’ll fight the good fight, and never give in.

Her battle is death, but she fights to win!

She’ll never forget the patients she has lost.

They live in her memory, nailed to the cross…

The hours are long, and the war is forever.

Everyday brings more patients and more storms to weather!

She never complains, or throws in the towel.

She believes in miracles, good health is her vow!

For she is a liver transplant surgeon,

Ordained by God, living with purpose.

The families line up, and shout out with Glee!!!

To the best of the best, Dr. Tiffany Anthony!!!!

Love you, doc!

KE, mother of DH, age 23

Triple Liver Transplant Survivor.

       I know there are days ahead of me which be long, difficult, and deprived of sleep, but I promised myself that when I set out on this career path, I wouldn't let it change who I was as a person (or the person my parents raised me to be).   When I read these things from my patients, it reminds me that someone sees me as having made a difference in their life.  It will be much harder to get upset, angry, and frustrated at the things that are clearly small when compared to the rewards I get back 100 fold from the people who matter most in this career…..the patients and their families.  

I will save the rest of their stories for another day.

"Whoever Saves One Life, Saves the World Entire." -The Talmud

What would you give up for someone you love? On September 5, 2007, I witnessed a near ultimate sacrifice for love and I also learned I was far stronger than I ever thought possible. Let me tell you the story Terri and Ron Gonsiorowski. (They said it would be ok if I used their names.) I first met Terri and Ron at a clinic appointment where I learned that Ron would be donating part of his liver to his wife Terri. By part of his liver, I do not mean a small piece of liver, he would be donating more than half of his liver to his wife. Ron and Terri were at the clinic visit with their two sons, ages 10 and 15 at the time. I was charmed by the family immediately. Terri was clearly ill from her liver disease. (Terri suffered from PSC, an autoimmune disease of the liver which destroys the bile ducts and causes liver failure).  She is petite and was very thin from suffering for a decade with her chronic liver disease, however she had an easy smile and was quick to laugh despite being sick.  Ron had a wicked sense of humor. Tom and Eric were beautiful blonde headed boys. I became completely smitten with the family when Tom, the youngest son, asked me if I could come to lunch with them.

Now, Adult to Adult Living Donor Liver Transplants are done at only a few select transplant centers in the country and are by no means a routine procedure. Surgeons performing living donor liver transplants have a knowledge of liver anatomy and an operative skill set far and above your everyday transplant surgeon. I was incredibly lucky to be trained by Dr. G, a surgeon whose surgical skills are virtually unmatched. Living donor transplants are the only operative procedures there is a risk of having a 200% mortality. There is also a risk (albeit small) that you lose a patient who is perfectly healthy and didn't need an operation in the first place.  Living donors are the ultimate heros in my eyes.

The days we did living donor liver transplants were not my favorite days in fellowship. Although, I knew I was a part of something extraordinary, these days were extremely stressful and long. The long day in the operating room was followed by a long night of staying in the ICU taking care of the donor and recipient.....making sure no detail of their post operative care was overlooked. 

Terri and Ron's living donor liver transplant journey started at about 7 am when we took Ron back to the operating room. Once we did some preliminary dissection to make sure Ron's liver was indeed going to be suitable for transplant as indicated by the pre-operative imaging, Terri was taken back to another operating room by one of our other transplant colleagues who would begin process of removing Terri's old liver and preparing her to receive the right love (this was supposed to say lobe, but I thought the Freudian mistyping of love for lobe was appropriate) of Ron's liver.

Dr. G and I performed the resection of Ron's liver. Removing the right lobe of the liver in a fashion where it can then be transplanted into someone else is a daunting and tedious task......and for a surgeon, very rewarding. You must ensure that you have an appropriate length of the blood vessels and the bile duct so that it can be sutured into the recipient and at the same time and even more importantly you MUST make sure that you have left the donors remaining structures as unadulterated as possible to avoid complications in the donor.

Ron's operation went as planned and we had just removed the right lobe and placed it on the back table on ice and with preservation solution. The next step would be to suture the blood vessels on Ron's remaining liver. Before being sewn up, they are clamped temporarily. As we were about to suture the portal vein (the blood vessel that brings the majority of blood to the liver), the clamped slipped off the vein and massive hemorrhage ensued.....what we call "audible" bleeding. The type of bleeding that would unnerve any mere mortal transplant surgeon.....especially when you are operating on a living donor. Dr. G and I quickly got control of the bleeding portal vein and he sutured the place on the portal vein where we had removed the right portal vein to go with the right lobe for Terri. There was a brief moment of relief as the bleeding was stopped but then Dr. G and I noticed that the repair had narrowed the portal vein. Appropriate blood flow through the portal vein would be paramount to the healing and regeneration of Ron's remaining liver. (The blood from portal vein provides essential growth factors to the remaining liver that stimulate it to grow back to normal size) Dr. G knew that the portal vein would have to be repaired or Ron could progress to liver failure and require a transplant himself (if he lived) if his native liver did not get the appropriate signals for regrowth. At this point, we had two critical patients, a mother and father, a husband and wife in two different operating rooms. Ron needed a critical repair of major blood vessel and Terri was now ready to receive Ron's right lobe. Dr. G made several key decisions in a matter of minutes. He asked for one of the elder transplant surgeons to come down and help him in the operating room with Ron. I was for a brief second heart broken as I felt as if he thought I might not be able to give him the help he needed to repair Ron's portal vein. Then, as the other surgeon got scrubbed and stepped up to the table, Dr. G said, "Tiffany, I need you to take the liver and take it to Terri's room and put it in with Dr. B(the transplant surgeon who was removing Terri's diseased liver), you are the one who has done the most of these living donors with me and you know how I do it."  Dr. G had been traditionally been a little hard on me in the OR since I started my liver year with him.....accepting only the best technique from me. I knew at that moment why he had always been so hard on me, not because he thought I wasn't capable of being a good transplant surgeon, but because he knew I was. 

I took Ron's partial liver over to Terri's operating room where Dr. B was just about to finish removing Terri's diseased liver. As Terri's liver was being removed, Dr. G came over to the room and said, "Tiffany, I need the portal vein from Terri's old liver." I took Terri's liver which was diseased but the blood vessels were still fine and dissected the remaining portal vein off Terri's liver and gave it to Dr. G who would then use it to repair Ron's portal vein. In an interesting and frightening turn of events, while Ron was saving Terri's life with his donated liver, Terri would now be helping to save his life with the portal vein from her liver which was moments away from being discarded and sent to pathology.


As Dr. G worked to repair Ron's portal vein in the next room, Dr. B and I transplanted Ron's right lobe into Terri.  Terri's transplant went well. We reconnected all of the blood vessels in and out of the liver and released the clamps and let Ron's liver fill with Terri's blood.  The liver looked good. It was a little swollen which is not unusual immediately after un-clamping the blood vessels. We worked on all the usual hemorrhage and then it was time to reconnect Ron's bile duct to a piece of Terri's intestine so the bile from the liver would enter the intestine as it should.  By this time it was about 8 pm and everyone involved was exhausted.  This was the only moment in an exceedingly long and mentally taxing day that I had a moment to actually catch my breath.....and go to the restroom.  Before connecting the bile duct, we decided to take a quick break.  Dr. B and I took turns staying with Terri while the other one headed to the restroom and and to get a quick drink.  As I write about this in a very matter of fact manner now, this was not the state of mind I was in at the time.  As long as I was operating, I was ok, but the moment I stepped out of the operating room and into the doctors lounge, I was reduced to sobbing.  It was like all of the stress of the day poured out of my tear ducts.  At that moment, this thought entered my mind, "I am getting on a plane in the morning and I am going home.  I cannot do this anymore." At this moment there was no guarantee that either Terri or Ron were going to do well after the days events.  This was the only moment in training that I considered quitting a career path that I had been since I was a girl of 5 years telling everyone I wanted to be a doctor.  Well, we all know how that turned out. Quitting is for losers.  I knew I had to gather my wits as there was still work left to do for Terri.  I washed my face, put back on my operating glasses and headed back to Terri's operating room.  We finished her bile duct, however, her liver still looked a little swollen and a little dusky, not quite the color the would have liked but at this point all the blood vessels were open, the liver was making bile which is a sign that the liver is working and Terri was critically ill but manageable.  It was time to close Terri's abdomen and take her to the ICU.  One problem.....Terri's intestines were so swollen from her portal vein being clamped for an extended period of time and from the massive amount of blood products she required during the very long operation that we could not possibly close her abdomen.  We had to cover her intestines, liver and rest of her abdominal organs with a clear, sterile plastic sheet and place drains and sterile towels to drain the fluid and blood that would normally be absorbed by her abdomen. We then took her to the ICU, stable but very far from walking out of the hospital.


In Ron's room, Dr G was finishing up with Ron and as in Terri's case, Ron's portal vein had been clamped for a long time and he has also suffered massive blood loss and transfusion.  Ron also went to the ICU with an open abdomen but with a repaired portal vein.  He was also fairly stable but not out of the woods.  A myriad of things could have gone wrong during the immediate post operative period with Ron and Terri.  Ron and Terri were both still sedated and on the ventilator, luckily not knowing what each of them had endured during the day.


At this point, it was 11 pm and we had been operating since 7 am.  Dr. G and I found an open late night restaurant not far from the hospital and grabbed a quick bite and decompressed from the days events. This moment cemented the friendship that Dr. G and I still have today.  At that moment he was still the mentor and I was still the student, but we were now friends.  After we ate, he headed home and I headed back to the ICU where I would spend the night with Terri and Ron.


Ron and Terri were fairly stable through night but there were some issues with Terri's morning labs.  Dr. G arrived in the ICU at 7:30 am as he always did and I updated him about Ron and Terri.  The very concerning issue was that Terri's liver enzymes were extremely elevated.  Normal liver enzymes are in the 30-40 range.  Terri's were in the 10,000's.  Something was VERY wrong.  These are the types of labs that would be seen in an entity in liver transplant called primary non-function where the transplant liver just does not work.....completely fails.  Primary non-function is unheard of in living donor liver transplant as all of these livers are near perfect.  We were afraid we were going to have to list her on the cadaver liver transplant list for an emergent re-transplant, something called Status 1A.  Status 1A means that the patient needs a liver as soon as possible or he/she will die.  It puts them at the top of the transplant list.


We discussed the issues with Terri with some of our other transplant colleagues and one of our very, very smart kidney transplant surgeons said maybe she is rejecting Ron's liver.  This type of early and rapid rejection is also basically unheard of in liver transplant.  We tested her for rejection.  It turns out that because she had bore Ron's children, she had developed anti-bodies to Ron and these anti-bodies were attacking his liver which now belonged to Terri.  We had to do a special type of dialysis called plasmapheresis which removes the antibodies attacking Ron's liver. After, several rounds of plasmapheresis, Terri's liver enzymes started to return towards normal.  We would now rely on immunosuppressive (anti-rejection) drugs to keep Terri's body from rejecting Ron's liver.  Let me be clear, we were very afraid for about 48 hours that Terri's new liver had been too damaged by the initial onslaught of anti-bodies and she would require a re-transplant (if a liver became available) or she would die.  At the same time we would have risked Ron's life for naught.  These are very hard realities to face. 


Now, as if the preceding day hadn't been enough (and I had barely slept overnight while in the ICU), during the middle of rounding in the ICU with Dr. G, I get a call from one the transplant coordinators letting me know we had an organ offer for Mr. M, a gentleman who needed a combined liver and a kidney transplant.  I would now be heading out to procure Mr. M's liver and kidney and returning to transplant them with Dr. G.  Needless to say, I was none to happy about the prospect of operating all day and evening and then staying up all night again in the ICU.  However, Mr. M (who you will hear about in another blog) and his wife would be come dear friends who treat me as if I was their own daughter.


While Terri and Ron spent the day sedated and on the ventilator in the ICU, I headed out to somewhere Illinois to a small hospital to procure the liver and kidney for Mr. M.  I returned to the hospital in the early evening and Dr. G and I did the liver transplant which was as uneventful as liver transplants go and then it was time to do the kidney transplant.  At the program where I did my transplant fellowship, there were liver transplant surgeons and there were kidney/pancreas transplant surgeons.  At some programs all the surgeons do everything as we do at my current job and at some programs they are completely separate.  Well, there was one kidney transplant surgeon that I did not particularly feel like "dealing" with for a number of reasons and he was looming around waiting for us to finish the liver to do Mr. M's kidney transplant.  He was not the kidney transplant surgeon on call as that surgeon was in another operating room taking part in a combined heart/kidney transplant and no one has asked him to stay.  I saw him looking through the small square glass window in the door.  As we finished up the liver, I got the feeling that Dr. G would like to leave and let this other surgeon do the kidney transplant with me.  By now, I had been up for nearly 48 hours on very little sleep and had experienced the most harrowing day in fellowship.  Dr. G and I obviously operated well together and I knew we could get this kidney done quickly.  I looked up Dr. G and said in a low voice, "If you leave me here to do this kidney with Dr. X, I will never speak to you again."  There was a moment of silence in the room and then he said,  "Tiffany, back table the kidney."  The other surgeon peaked in the door and Dr. G said, "Dr. X, I'm going to take care of this kidney with Tiffany, thanks."  He has saved me from undue pain at a time when I had really had more than my share and for that I will forever be thankful.


After Mr M's liver and kidney transplant, we moved him to the ICU and I spent the night again with Mr. M, Ron and Terri.  I did get 2-3 hours of sleep that night as everyone was fairly stable.  I knew I should try to get a few minutes of shut eye as both Ron and Terri needed to return to the operating room the next day.


Now I am on day 3 of staying in the hospital after only having left to procure and grab a midnight meal.  Terri and Ron both need to go back to the operating room to attempt to close their abdomens.  We were able to close Ron's abdomen, but Terri would require a little more time. We were able to close her a couple days later with the help of prosthetic mesh.  They were both stable now and would just need time to heal and recover. However, Dr. G and I knew of the potential complications that would lurking around for both Terri and Ron......and there would be some.  I stayed in the hospital again that night as I was too tired to drive home and by the end of the next day I had spent nearly all of 3 nights and four days in the hospital.  


After a couple of weeks, Ron was able to be discharged from the hospital but Terri was with us for almost a month.  Even when they were both at home, they were never far from my and Dr. G's mind.  We knew that there were several things that could potentially develop that would affect Terri's liver and Ron's liver.  Would Terri develop chronic rejection because of the anti-bodies to Ron and ultimately lose this liver?  Would Ron develop complications due to the dissection involved with very delicate structures during the portal vein repair?  Would the vein from Terri's liver be a durable repair for Ron's portal vein?


Ron did indeed suffer a serious complication.  Ron developed a leak from his remaining bile duct.  Ron endured multiple bile duct stents that are placed by going down his stomach, into his small intestine and into his bile duct by a specialized scope by a gastroenterologist.  He also endured having a drain placed into his abdomen close to his liver to drain the bile that has leaked from his bile duct. He also had this drain replaced multiple times.  Ron NEVER once complained.  Never once.  He did whatever we asked of him and even though we struggled with our own feelings of inadequacy, he never made us feel as if what he was going through was our fault.  It was an honor to take care of him.  Multiple stent changes, drain removals and replacements and 9 months of enduring near constant pain and discomfort it became clear that non-surgical treatment was not going to work for Ron.


You might ask why it took us 9 months to decide to operate on Ron.  There are multiple reasons, not the least of which it that we were likely going to have only one shot at surgically fixing Ron's bile duct.  Second, this was going to be a re-operation in what we call in surgery, a "high rent district".  While attempting to repair Ron's bile duct we could potentially injure any number of structures vital to Ron's liver including his previously injured portal vein.  Dr. G actually enlisted the help of one his fellow Italian transplant surgeons who was at the time and still is a transplant surgeon in London.  Dr. G and his friend had performed many living donor liver transplants together when they were both working in Germany and had experienced many of the issues that can happen with living donor liver transplant.  On my last day of fellowship, we operated on Ron.  Actually, it was the day after my last day of fellowship, but there was no way I was going to miss being a part of Ron's operation.  The solution for the leak from Ron's bile leak is to resect the part of the bile duct that was leaking and connecting a piece of small intestine to his remaining bile duct.  The operation went well and Ron once again recovered like a champ.  


I am happy to report that 3 years later, Terri and Ron are alive and well.  Ron has had no further problems with his bile duct.  His liver lab tests are normal.  Terri has continued to do well with Ron's right lobe.  The are happy and living life to its absolute fullest.


Dr. G and I are still good friends.  I am the surgeon I am today in large part because of him.  He taught me that even though we take great risks as surgeons, our patients take the ultimate risks.


When I asked Terri and Ron if I could write about their story, the emphatically said yes.  I also asked them to tell me a little about their experience before the transplant because I didn't meet them until a few days before the surgery.   They free shared thoughts about this and about their feelings about the whole experience.  I  couldn't even on my best day write about their experience in a way that is more meaningful than their own words.  The have also allowed me to share their own thoughts and feelings that they sent to me in series of Facebook messages.


Needless to say, I was completely humbled and amazed by their recall of their experience.


Also, their words happen to be the best part of this blog.  They can teach us all something about love and how to live life even when life doesn't always go the way you had imagined.


From Terri:

Hi Tiffany! :)
Hope all is well with you! ♥
I think your blog is awesome! I would not mind at all if you used our story. If it helps someone else, by all means please do share. It was people like you that I drew my stength from. The moment that we met you I felt comfortable and knew everything would be ok. You have something very special inside of you. From a patient's point of view, you have a way of speaking that brings comfort to a very awful, stressful and frightening experience. I do not know how you do it, you go on a roller coaster of emotions every single day and still seem to maintain such a comforting way about you. I miss you lots and I am forever grateful for your compassion and thoughtfulness. We were lucky to have shared this experience with you. I will put together our story before the transplant and send it to you shortly.
Thanks so much Tiffany, God Bless!!
Love,Terri


Tiffany, Here are some of my thoughts and story before/after the transplant, hope it helps :)
Right after I gave birth to Eric I did not feel right. I went to the doctor thinking I had sinus issues, just to be told that my liver enzymes were elevated. After going to the University, I found out that I had PSC. I shared this with Ron and my best friend. We did not speak of it. I lived my life as if nothing was wrong and told no one. Ron was always there for me. In my darkest moments he was always goofing and making light of everything. Not a day went by that he didn’t tell me how much he loved me and how beautiful I was. I knew he was lying because I looked like jaundiced old lady. I could barely stay awake and always felt so sick. He would always rub my back, feet, etc. The itching was maddening. I would hate to get out of the shower every day, as soon as the air hit my wet skin it intensified the itching. One of the moments that I remember the most was the day that I was in Borders looking at information about PSC. I had seen the words death and transplant. It became a reality for me, I grabbed the boys, rushed home and cried for days. I spoke to no one about this. I never shared my feelings. I was on a need to know basis with the doctors. I just wanted to know what was absolutely necessary for that moment. Ron was there for me throughout this whole journey. Always joking, always encouraging. Probably the worst moment of my life was the day we told our boys. They never knew I was sick, we kept it from them. I wanted to keep their lives as normal as possible for as long as I could. The look in their eyes when Ron told them set me off into a very sad place. It all became a reality when the boys found out. Up to that point I was able to carry on this fake healthy life. As people found out they were quite shocked to know how sick I was all those years. A decade of my life, sick. When we walked out of the office from visiting Dr. G, Ron had made up his mind that he was going to be my donor. I was angry with him and did not want to chance anything. He kept telling me that he was my “incubation monkey” and he was meant to do this. Throughout the testing phases it seemed forever but yet it went so fast. Each stage we got a little more excited that it would become a reality. I would finally feel better. I don’t think that I would change a thing. The experience has made me who I am today. Ron and I are stronger because of it. We do not take a single moment of this life for granted. I feel like I am 20 again. I have never had so much energy!! We have shared a lot and will be married 21 years in May. The transplant seems like a lifetime ago, yet it so profoundly changed our lives. I am grateful for every single day, every single moment that I have. I do not take anything or anyone for granted. I am lucky to have such a wonderful husband…well, most days….hahaha We used to get into fights after the transplant asking for our parts back. I wanted my vein and Ron his liver. Of course, he HAD to make it known that I got the pristine organ and he got the piece of me that was dug out of the garbage with lint and cigarette butts on it. He was just saying the other day how good my liver was. Even Eric chimed in how great I should be because of the awesome organ I got from his dad. I just shook my head……




No problem Tiffany :) You are a sweetheart and I am so VERY glad that it was you to have shared that time in our life. You made a terrifying experience better. Your truly do have a comforting way about you. I only have good memories of you :) I had an after thought today, I was thinking today of all the moments I got to be a part of because of my transplant....Eric's 11,12,13, and 14th birthdays. Thomas's 16, 17, 18th birthdays...Thomas's senior prom, Thomas's graduation. Eric is graduating 8th grade this spring and making his confirmation in 2 weeks. The numerous family vacations. My first trip to Hawaii. I got to turn 40, 41, 42 and 43. Our 20th wedding anniversary. So much more to look forward to and so many more stolen moments. The countless family dinners that we had together. Thank you for helping me remember how grateful I am to have the opportunity to have each and every one of these moments.
You are forever in my heart ♥




From Ron:


Hi Tif.  I read your blog and think it's great. You know I dont mind you telling our story.  You and Dr. G are my only 2 heroes.  You don't even have to change names. I dont give a damn. I'm so happy for you and proud to have gotten to know you. Anything you need is yours and you don't have to ask me.
Sorry, I dont have alot of time to keep in touch.  It's always good to hear from you.
Hope all is well with you and good luck in all your adventures. Thanks for not forgetting about us. I know you're a very busy person.
Love ya.


I will try to help ya,Tif. I live my life, even more now, with the saying "it is what it is". Not to say that I would ever give up on anything, but if I cant change it or fix it then I will deal with it. I live by fate, and "things" happen for a reason. Maybe to wake us up, slow us down or to tell us to change our ways. I don't talk alot about God, but I do believe he is real. He gives us the strength to get through the problems we think we have. I say think we have because there is always someone else who has it a lot worse. So, to me, having a sick wife is what was meant to be. I couldn't fix her or change the fact that she was sick.  All I could do was Love her. So I did and still do. Not to say it was easy all the time, alot of back rubs and back scratches because of the itching. Lot of heart breaks to see her suffer at times. But we never gave up and always lived for the moment.

Live for the moment.  Terri taught me that. I know alot of strong people (physically), but no one as strong as my wife. She gave everything she had for Tom and Eric, I dont think they even know how much. They didn't even know she was sick until it was time for the transplant. She was scared, I knew it, but no one else did.  She just moved forward and lived for the moment. Kept a lot of feelings to herself. Never complained, just tried to give her family the best she could.  When we found out about live donors I knew right then I would be the donor. At first Terri was against it, which ticked me off, but I knew it would be me. I wanted to fix her but couldnt, so God put us in touch with you and Dr. G and gave me a small role as well.  I figured he new I would be ticked as hell if I was left on the sidelines, haha. Never once was I worried about myself. My boys needed their mom and if it meant giving my life for hers....NO PROBLEM. I almost told you before the operation that if it came down to me or her it's her to keep. Didn't want to sound like a harda** though. I look back now at the whole thing and it seems like nothing. I would do it ALL over again. To have people like Dr.G, Jeanine, family, friends and especially you made it a piece of cake. But most of all I have my wife.


So without writting a freaking book,  it all was pretty easy to get through. All I had to do was show up, go to sleep and wake up with a healthy wife. Some time off of work. Simple. God wanted me to take a vacation from working crazy hours and knew he had to really kick me in the butt, hard. He also wanted to show you and Dr. G that you two are the best of the best. So we had a complication, no big deal, you guys knocked it out of the park. Throught out all of this, you two never gave up. Thanks. You never let it go to your heads either, the amazing, unbelievable, job you guys did. I tell people the story and they look at me like I'm crazy. (Portal vein, right..). Well, we know the truth, right?
You're an amaizing person,  Tif. I can't put to words how much you mean to me. Any person who gets to just meet you is a very lucky person. To have you be in charge of their care, well God's on their side.
Hope that this helps. Love you and good luck.




I will never forget Ron and Terri and what they have taught me and what the experience taught me.  I am forever changed, for the better.

In Between Two Worlds

Death is a part of what I do. Transplant surgeons take care of incredibly ill patients before and after their transplant. I like to say we win most of them, but we don't win them all. I am comfortable with death and I have been as long as I can remember. I do not take it as a personal defeat and I do not feel I can take all of the credit when someone does well. I do not mean I am comfortable with death in that I am unaffected by the death of a patient. I am deeply affected by the death of my patients and I am even more affected by the pain their families endure. I am comfortable with talking about end of life issues with families and I am comfortable in the role of being a healer in the non surgical sense. In fact, some of my best moments as a surgeon have been helping a family with the moments at the end of the life of their loved one. I learned a very valuable lesson about death and grieving when I was in college. I took an EMT course and worked in a hospital operating room while in college at UT to get some exposure to medicine. A very wise and seasoned paramedic instructor told the class, when discussing how to deal with the stress of being exposed to tragedy on a regular basis that the grief surrounding the tragedy we see belongs to the families of the patients and it is not our grief to steal. The statement "not our grief to steal" has stuck with me for over two decades now. She made it clear that empathy and sympathy for the families was acceptable and a normal process for caregivers, but the grief and the process of grieving belonged to the families. I believe this to be true. I cry with my patients in times of joy and in times of sorrow. It is part of who I am, and I can continue to do this job because even though I am at times sad, I know that I cannot and should not "grieve" for each patient we lose. There are others who need our care. All of this being said, even I can be rattled by death.

Last Saturday morning, I was awakened by a page at about 6 am. I called the ICU and I knew the phone call would be about Mrs. C. Mrs. C had a liver transplant about three months prior, but had been in the ICU and very sick for about a month now and it was clear she was not going to make it out of the ICU. I had been talking with her family for the prior two days and we knew her days were numbered, however, we had been treating her with the normal medications to keep her blood pressure stable until the family was comfortable with the decision to cease all resuscitative efforts. The family, especially her daughter and husband were obviously having a difficult time emotionally. I felt especially sad for her daughter who is close to my age and losing her mother. She is an only child. I was not so much surprised by what the ICU nurse said when I returned the page, "Dr. Anthony, this is Manu, I am calling about Mrs. C. She expired." (I had not been aware that one of my medicine colleagues had talked with the families late in the evening the night before and decided not to accelerate any care....so I actually expected to get some type of warning that her death was emiment....ie her blood pressure was low, heart rate falling) So, actually, I was startled by the call not so much by the fact that she had died but by the fact that I didn't get any warming as ideally I would have like to have arrived at the hospital and had her family come in and be with them when she passed.

I was particularly unnerved by the timing of Mrs. C's death because the page from the nurse woke me from a dream about her and her family. I have not had this experience before. I was having the dream during the exact hour she was dying and leaving this world for another. In my dream, the family was sitting in the family room at the hospital. They were seated at a long picnic table and there was food and laughter and they were reminiscing about the good parts of Mrs. C's life. I was seeing that moment in a family's grief when they are using good memories and laughter as a coping mechanism for some relief from their grief. We have all had these moments with our families when we have had a loved one pass. In my dream, I was comforted. I then went into the hospital room of Mrs. C and someone had taken out her breathing tube. She was talking (which is not possible when someone as sick as Mrs. C). In the dream, I knew this wouldn't last long because I know the real consequences of removing someone from life support. I quickly went to the family and asked them to go in and speak with her as she would not be able to do this much longer. In the next scene in my dream, she was laying peacefully in her hospital bed, then the beep, beep, beep of the pager.

I got out of bed, threw on some scrubs and drove into the hospital to pronounce her dead. I waited for her husband arrive. I did my best to console him. I talked to her daughter on the phone while Mr. C spent some time in the room with his wife. I told his daughter about my dream. I wasn't sure if it was the appropriate thing to do, but she said she was glad I told her. I also told her husband a little later. He said, "You have described exactly what we did last night after we left the hospital." He stated the family left the hospital the previous evening, after deciding not to continue to accelerate her, and went to dinner. He said the laughed and talked until midnight about good memories. I guess even if my conscious mind wasn't aware that she would be making the passage from this world to the next.....my unconscious mind was fully aware and knew I, too, needed some comforting about her impending death.

The names/initials have been changed for privacy reasons.