The drain-tube-straightening procedure worked fine, but did not alleviate the symptoms. LFT numbers continued to rise, and there were digestive problems with the first solid food, but steady physical improvement continued - leading to the complete removal of lines and drips yesterday and an unaided walk today.
After culturing and identifying everything that could be drained, extracted, X-rayed or swabbed the microbiologists eventually advised "normal" quantities of infective bacteria, "not unusual" quantities of fluid in the lungs and so it was time for a liver biopsy, left until last not only because it is invasive and carries some risk, but also because it is apparently unusual to find rejection in less than a week or so.
Sure enough, by day 6 (today) Joc's ferocious immune system is attacking the new liver, leading to what is described as 'moderate to severe rejection'. Having dutifully attended 15 months of pre-transplant lectures, we are perhaps less alarmed by this than many a reader. Joc's particular liver disease was in fact characterised by inappropriate immune activity directed at her liver.
This activity however *is* appropriate, being directed at a genuine foreign invader, rather than her own tissue. To this extent then, it is a Good Thing(tm) as it shows that the body is returning to normal. This of course we do not want. Joc's anti-rejection drugs have been adjusted, and a course of high doses of intravenous corticosteroids prescribed over the next five days, starting this evening.
One of the side effects of this medication is much teariness and depression, so I have returned home early in the hope of getting a little sleep before Joc perhaps calls me for a chat and moral support in the wee small hours. At least until the shift change around 11.30pm, she has a particularly friendly nurse who will look after her well and keep an eye on her mood.
Not that we have any complaints about the staff. It has been said to us many times that if you have to have a liver disease, PBC is the one to have and Australia is the place to have it. Readers from other lands may substitute their own. Joc's surgeon is the numero uno, and the whole transplant team is fantastic.
Minutes from being wheeled away to have her liver ripped out, dearest fusspot Joc became concerned that she would wake up without her glasses, and asked a theatre nurse to tuck them down the front of her gown. Many a person in this profession would have callously told her she wouldn't be needing them, but this sweet lady made a neat sticky label with Joc's name and clipped them firmly to her neckband. Another had allowed Joc to rummage through the CD collection and choose the music to which the transplant team would work, and we are sure they did; they are that sort of people.
So when they say that they have a low threshold for anxiety where their transplant patients are concerned, and that the current hiccups are not at this stage alarming, then we will believe them and we will try to sleep soundly, though these things are surely relative.
Most of these wretched procedures require fasting for eight hours, and given
that the food J has eaten over the past six days would fit in my eye, she
has not exactly been delirious with joy today. A scan of today's pictures
yields few that she would be happy with, but I have attached, as has become
the custom, a small image of Joc agonising over the choice between the fine
cuisine of a Public Hospital and a box of fruit and chocolates left by an
admirer.
(I took the opportunity to devour her lunch, on the grounds that I could hardly then be accused of wilful malnutrition.)
One more thing: to those importuning me for telephone numbers, addresses to send flowers etc. (you know who you are :]), please understand that Joc's telephone cannot receive incoming calls. This is not a technological malfunction. There are also very few horizontal surfaces in Joc's room, and such as there are, now resemble parts of Costa Rica. I am far from ungrateful, but unsentimental and if forced to play musical flowers will probably throw the exchanged ones out of the car window whilst lying to Joc about watering them at home.
For the record, this has been an executive decision, entirely unauthorised by Joc.
Love, JH.