He was gainfully employed until very recently, despite 3 times weekly hemodialysis, which was done in the early evening, to allow him to continue working. The transplanted kidney worked for 34 years. He had been born with congenital abnormalities that caused urinary tract infections in very early childhood, and corrective urologic surgery was needed, but still a transplant was required, when he was 7 years of age.
He was short in stature, undoubtedly because of the early onset of kidney disease. The strain on his mother and his family were enormous, but they were there for him, and somehow, despite this enormous challenge, he received his education and assumed a very responsible position in a financial corporation. He was married and had an extremely supportive wife and son. His wife accompanied him to his dialysis treatments.
The anemia that accompanies renal disease required transfusions. Somewhere, along the way, before Hepatitis C could be detected in blood, he received a contaminated transfusion. The disease was diagnosed years ago, but therapy requiring interferon would have caused rejection of the transplant, and in consultation with gastrointestinal specialists, a decision was made not to treat the hepatitis with the hope of arresting the progress of cirrhosis, at the loss of the kidney.
So he continued to work and to enjoy his family. By 2010, he was having episodes of confusion due to ammonia accumulation related to his liver disease. This was treatable, and even as the transplanted kidney failed and he started dialysis, he continued to work. He was a fighter…. an indomitable spirit.
On dialysis with kidney failure, he suffered encephalopathy from liver failure, controllable by diet and by unpleasant medication that caused a therapeutic diarrhea, that interfered with his life… his ability to work. He didn't always take all of his medications the way the doctor ordered, but bright as he was, he controlled the diarrhea and the encephalopathy, and he continued to work.
He needed a transplant of a kidney and a liver. Our hospital, with a superb kidney transplant program, could only offer him a kidney, and that wasn't enough. So off he went to UCLA, and then to UC San Francisco, and off to UC San Diego. Records and phone calls, and still he worked.
Finally, Cedars-Sinai put him on the list. Then there was staying on the list, and working your way to the top of the list, the MELD score. There were the ups and downs of chemistry changes, lab values going up and down, and intervening events that landed him in a hospital ER, and threatened his hold on the number one spot on the liver-kidney transplant list. There was a moment during an alumni event that I recorded previously that will give me a belly laugh whenever I think of it. We got over the obstacle and finally he got his liver-kidney transplant, but things did not go well, or smoothly.
Many of the events following the second transplant occurred at CSMC or at his new dialysis unit, closer to his home, where he was attended by another nephrologist. His course was complicated and the last week or two, he was at Cedars. He underwent a laparotomy, and as his wife describes to me, "They found a recurrence of his hepatitis and said they could do nothing more for him. He went onto hospice, but he continued to want to live."
Well, that was the man I knew and respected. It wasn't easy to be his doctor, but it was an honor to try to help this great little fighter, and a special kindness to me that I wasn't there when his battle finally ended.
I extend my respect to his memory and honor his existential battle. I admire the constant support of his wife, son, mother and all of his family, who understood the events that made him such a determined fighter, if, often, a challenge in their lives, but one they willingly assumed. Sometimes its the patient who are the heroes and heroines. Often, it is their loved ones.
I assure you that I will never forget him. He died on the same day my oldest daughter was born, December 18. that day will never pass without his memory surfacing in my thoughts.