Chapter 1: How it all started

Critical decisions

Can you imagine what it is like to have other people’s lives in your hands? Not in a generic sense, but in a literal sense; that is, if you don’t do your job well, a person dies.

And even worse, can you imagine that the life, not of a stranger, but of a loved one, your wife, your children, or your parents, depends on you? How far would you go to save their life? Sure, you would do everything you could, but if that wasn’t enough, how far would you go?

I know, all too well, because I have suffered it, and that is why my life has been turned upside down to where it is today.

It all started many months ago. I was then working as a surgeon in the transplant department of the hospital, the same hospital where my wife, Lucia, was responsible for the paediatric department.

Lucia was the love of my life. I had known her since we were small children and played with other children in our neighbourhood. Lucia was the daughter of an Italian father and a Spanish mother, whose families emigrated from their countries to mine. Although there is always something of a cliché and caricature about the character of those countries, in her case it was not an exaggeration. Lucia’s character was always volcanic and intense, both in passion and anger. When she was passionate, there was no one better in the world, but when she was angry, she was fearsome, and you wished you were miles away. More than one nurse had been fired for not doing the job to the standard Lucia expected and not taking good care of a child in the hospital.

Physically, her paternal grandfather, an Italian, said she looked a lot like the Italian actress Sophia Loren in her prime, while her maternal grandfather, a Spaniard, said she looked like the young Spanish actress Penélope Cruz. National pride fights aside, Lucia had always been a beauty: intense black eyes, full lips, a slightly large but characterful nose, long, black, shiny hair, and a curvy, sensual, feminine body with wide hips and incredible, large, shapely breasts.

The day it all started, I had just come home from work at the hospital. When I got home, Lucia had already started making dinner. She had learnt delicious recipes from her parents’ countries, and I could hardly compete with her. While she was cooking, I set the table and then cleared the dishwasher. Then Lucia’s mobile phone rang, a fateful call that I will always remember.

As she was busy and her hands were stained with food, I took it. It was a call from the hospital lab, a doctor named Grace, whom we knew well.

“Lucia?” asked Grace.

“It’s Tom; Lucia can’t come in right now,” I replied.

“It’s because of the tests.”

At the hospital we have an annual medical check-up for the staff, and last week Lucia and I had been tested. I figured that the results were already available, but I was surprised that they called so late. They usually left the envelope with all the results on the desk in our office.

“Yes, is there a problem?” I asked, starting to get anxious.

“I’d rather talk about it tomorrow. Please have Lucia come to see me first thing in the morning, or better still, both of you.”

“What’s the matter? Can’t you give me a head start?” I replied, growing increasingly uneasy.

“Better to talk about it in person. Good night, Tom, and say hello to Lucia,” Grace said and cut the call.

“Who was that?” Lucia asked.

“Grace, from the lab, wants to talk to you about the medical screening.”

“And why is she calling at this hour?”

“She just said she wants to talk to you first thing in the morning.”

“Maybe some test has failed and needs to be repeated,” Lucia said calmly.

“I hope that’s what it is,” I replied, “but I’m afraid it’s something more serious. She seemed worried,” I replied.

“Don’t worry; we’ll clear it up tomorrow. It won’t be anything major. Grace is very meticulous, and I’m sure she’s been worried because a test wasn’t done properly or a sample has been contaminated.”

I was not at all reassured; something told me there was some kind of problem. I had dinner without enjoying the delicious gnocchi with pesto that Lucia had cooked, and I slept badly. I began to think that she had been quite tired lately, and I sensed that it wasn’t just because of too much work, and we hadn’t made love for almost two weeks.

The next morning, we went to the hospital, and Grace gave us the bad news: tests seemed to indicate, with some certainty, that Lucia’s liver was not functioning well, and other indicators suggested that it might be due to liver cancer.

We stood there not knowing what to say. Being doctors, we both knew the seriousness of the diagnosis. In any case, Grace told us that the oncology department was the right one to carry out a thorough examination and that the tests should not be taken as conclusive.

From that moment on, we entered a whirlwind of check-ups, analyses, ultrasound scans and scans that only confirmed the diagnosis. We then went on to chemotherapy treatment which, apart from leaving Lucia totally exhausted and without her precious hair, did nothing more than slow down the growth.

We were fighting against time: if we did not manage to stop the growth of the tumour, Lucia’s liver would not only stop functioning completely, but the disease could start to spread and tumours could start to appear in other parts of her body, and it would be unstoppable, condemning my sweetheart to death.

At that point the ball was in my court, or rather in the court of the transplant department where I worked. The only solution was a liver transplant to replace Lucia’s damaged liver with a healthy one, removing the source of the problem from her body.

The problem in these cases is finding a donor. Unlike other organs, such as kidneys, where having two in the human body means that one can be donated without any problems, in the case of the liver, we needed someone to die in order to use their organs.

But there is also another problem, common to all transplants: to avoid manipulation or sale of organs, there are waiting lists that are rigidly controlled and assigned according to criteria of entry on the list, probability of success, donor-recipient compatibility, etc.

I checked the waiting list for liver transplants, and ahead of Lucia was a teenager, Salif, a refugee from one of the endless wars that sadly ravage Africa. Lucia and I knew him well, as for several years, until last year, he had been Lucia’s patient in the paediatric ward, and Lucia had grown very fond of him and his parents.

I went through Salif’s file; I don’t know if I was trying to find out why he could live and my wife could not, but I found some information that caught my attention. My boss, the head of the department, had just retired and had gone on holiday abroad, so I couldn’t talk to him. In fact, I was temporarily taking his place until the arrival of his replacement. But I thought of my former professor at the university, a luminary in his field with many, many years of experience.

I called him and gave him all the details of both files, without mentioning names or other details. He confirmed what I sensed, or perhaps what I wished for: in his experience, Salif’s transplant would be rejected and it would be useless to do it. There was no point in giving him a transplant. His body was very weak and unbalanced due to the malnutrition he had suffered, and it would be difficult for him to accept a transplant.

When I told him that this case was ahead of the other on the transplant list, he went on a rant about ‘the absurd criteria of the lists’ and ‘the nonsense the bureaucrats were doing’.

I thanked him for his help, and after hanging up, I thought to myself. Even if the best expert on the subject said so, there were criteria set by the medical association that had to be respected; I could not put my wife first, even if I was sure that this would save her life and that giving Salif a transplant would be useless.

For several days I tortured myself with the thought that I would soon have to perform an operation that I was sure would be useless and, on top of that, probably condemn my wife to death, as it was unusual to be able to find a liver that we could transplant. In the evenings, I would sit next to Lucia, enjoying her company and trying to cheer her up, although I myself felt terrible, watching her slowly wasting away.

Finally, one morning, I was told that there had been a car accident and the driver had died. He was an organ donor, so his death meant life, or at least a better life, for several people. That very afternoon, his organs were to be transplanted into all the waiting people.

When the moment of truth arrived, I couldn’t resist thinking that it might be the last chance to save Lucia. I logged into the application that managed the waiting lists and modified some of Salif’s details so that Lucia now appeared as the most suitable recipient for a liver transplant.

When the transplant team met to plan the work, a colleague took care of Lucia’s liver transplant (it is never recommended that the operation be done by a relative of the patient), I took care of a kidney transplant, a female surgeon took care of a heart transplant, and another kidney was sent to a hospital in the nearest city to be transplanted there. The recipients were summoned to the hospital on an emergency basis, and all of them were operated on.

When I visited Lucia in her hospital room that night, I was happy, and she seemed cheerful.

When I left her room, I went up to my office and changed Salif’s details in the application file. I didn’t want anyone to notice the manipulation, and besides, Salif would be first again if, for any reason, there was another chance for a transplant soon. On the one hand, I felt very bad about what I had done; I had somehow chosen to save my wife over someone else, and I had also violated medical regulations, which, if discovered, would mean my immediate expulsion, but it was reassuring to think that Salif really had no chance and that it would have been useless to try to transplant him. But in medicine there are not always certainties. I was playing with possibilities, and the fact was that Salif could have been saved, and I might have condemned him since he needed a liver as much as my wife did.

Lucia gradually recovered and was able to go home. She had to take multiple medications to facilitate her recovery and to avoid rejection of the transplant, but her body was very strong, as was her character, and her recovery was good.

Three weeks after Lucia’s transplant, Salif died without a transplant. I felt awful that day, although I took some comfort in the diagnosis I had shared with my former teacher that Salif would surely have been rejected if he had had a transplant.

The next day, the secretary of the transplant department called me and said, “The new director of the department has arrived and wants to meet all the doctors. He wants to see you this afternoon, when you finish your workday.”

“OK,” I replied.

Although I was leaving every afternoon as early as possible to be with Lucia, who was already doing quite well, that afternoon I went up to the floor where the department heads’ offices were located.

I knocked on the door and went in.

“Hello, Tom,” said the man sitting behind the desk.

“Hello, Stephen,” I replied. When I saw who was sitting at the desk, a lot of childhood and teenage memories suddenly came flooding into my head.