When I first woke up in the ICU, I didn’t feel any different. I was still sore and groggy. It wasn’t until my nurse came in to check on me that I found out what had happened.
“Hi, Howie. It’s me, Jenny,” she said. I didn’t recognize her face behind the mask she was wearing, but I thought I remembered her voice. “Do you know where you are?”
Judging by all of the medical equipment around me, the hospital was a pretty safe bet. There was a tube in my throat that made it impossible to talk, so I nodded my head instead.
“That’s good. I’m glad to see you awake; you were out of it for a few days. Do you remember what happened?”
I wasn’t sure what she was referring to, so I shook my head, hoping she would elaborate.
“You had a liver transplant, Howie. The surgery went really well, and your vitals and labs are already starting to look a lot better. Hopefully we’ll be able to start taking some of these tubes out in the next few hours so you’ll be more comfortable. Are you in any pain right now?”
As I absorbed the startling revelation that I had undergone a liver transplant without having any awareness of it, I tried to assess my condition. I was definitely in some discomfort, but the ache in my stomach was no worse than it had been before surgery. I decided they must have put me on a drip of some pretty good drugs because I still felt like I was floating. I shook my head, letting the nurse know there was no need to up the dosage. In some ways, it was a relief to not have to feel, but I wanted to be back in my right frame of mind.
“Good. Well, here’s your call button, in case that changes and you need more pain meds,” said Jenny, placing the control in my hand. “Just try to relax and get some rest.”
She patted my arm and then went to work, fiddling with my IVs, checking bags and drains, jotting down information from the monitors around my bed. I lay back and watched her work for a little while, but my eyelids started getting heavier and heavier, and before she had finished, I’d fallen asleep again.
The next few days dragged by. At first, I just sort of drifted in and out of sleep, riding a wave of strong sedatives that were supposed to keep me calm so I wouldn’t start freaking out and fighting the ventilator that was still breathing for me. Once I was stable and able to breathe on my own, they took the tube out of my throat and started weaning me off the sedatives so that I was able to stay awake for more than a few minutes at a time.
After that, I was a lot more aware of my surroundings and what was going on with my body. In addition to short visits from my family, I had a steady stream of people coming in and out of my cubicle at all hours to check my vitals and my incision, change my bandages and IV bags, draw my blood, measure my urine output, listen to my bowel sounds, and so on. It was all pretty gross and intrusive, but also necessary. There’s no such thing as privacy or modesty in the ICU. I felt like a newborn baby - not just a newborn, but a preemie like James, hooked up to every machine imaginable and unable to do anything for myself.
There’s really not much to do in the ICU anyway, especially when you feel like shit, but after two days there, I was starting to feel better and stronger. Thanks to my shiny new liver, the swelling in my brain had gone down, and my kidneys had started functioning again. I was transferred to a private room in a different part of the hospital, where I was finally freed from most of the tubes and wires and able to move around more. Soon the nurses had me sitting up in a chair, then standing, then shuffling across the room to use the bathroom by myself. By the third day, I was taking slow walks up and down the hallway every few hours. That doesn’t sound too exciting, I know, but it sure beat lying in bed.
By that point, the boredom was really setting in, so I looked forward to anything that kept me from lying there alone and feeling sorry for myself. My brother and sisters brought my mom up to see me every day, and their visits were always uplifting. They offered me plenty of love and encouragement, assuring me that all I should be thinking about was getting better. But then the different members of my transplant team - not only doctors and nurses, but also a dietician, a social worker, and so on - started coming in to teach me about taking care of myself and my transplanted liver. That was when the reality of my situation sank in.
I had seriously screwed up my life, and it was never going to be the same. If I thought contracting HIV had made things complicated, it was nothing compared to this. I no longer had the luxury of popping one pill a day; I was now taking a dozen, and that didn’t even include my HIV medicine, which they’d taken me off of, at least temporarily, because it could damage my new liver or interact with the immunosuppressant drugs I’d be on for the rest of my life.
“Doesn’t that mean the disease will progress faster?” I asked, when I realized I wasn’t getting my HIV meds anymore.
“Not necessarily,” was my transplant doctor’s answer. “Studies have shown that HIV-positive transplant recipients survive about as long as those without HIV. The main reason some recipients don’t survive long-term is that their immune systems attack and destroy the new organ. So that’s our first priority: preventing organ rejection.”
“But I don’t understand... If you’re shutting down my immune system, what’s to stop the virus from replicating? Won’t it just have free reign?”
“That’s a risk we’ll have to take for now, until we can ensure your new liver is functioning properly. Once we know the immunosuppressive regimen is working, we can talk about reintroducing antiretroviral therapy to target the HIV.”
I wasn’t completely comfortable with that, but I had enough other things to worry about, like watching for signs of rejection or infection. Even after I went home, I would have to weigh myself daily and take my temperature twice a day because a fever or fluid accumulation could mean complications. My medications were to be taken at all different times of day, some multiple times, some with food and others on an empty stomach. There were also certain dietary restrictions that came with the new meds: I couldn’t have grapefruit and was supposed to watch my sugar, sodium, and potassium, but increase my calcium intake because, apparently, my new meds could cause all kinds of other problems down the road, like diabetes, kidney failure, and heart disease. As someone who had always been pretty healthy without having to watch what I ate or take pills, I honestly didn’t know how I was going to keep track of it all.
“You don’t think we’re just gonna drop you off at home and let you deal with all of this by yourself, do you?” asked my sister Angie on the fourth day, when I admitted to her how overwhelmed I was feeling about all of it.
“Well... no, I guess not, but I don’t want any of you putting your lives on hold to stay out here and take care of me,” I replied. My transplant doctor had already told me I would need to stay in L.A. for at least another month after I left the hospital, so it wasn’t like I could just fly back to Florida with my family. They had already been out here for over a week, and I knew they wouldn’t leave as long as I was in the hospital. But what about afterwards? My brother and sisters all worked; I didn’t want any of them to have to take a leave of absence from their job just to take care of me, and I couldn’t expect my eighty-year-old mother to do it either.
“Howie, honey, don’t worry,” Angie said reassuringly. “We’re not. We got it all figured out while you were still in surgery. You’re gonna stay with Nick and Lauren for a while, until you’re ready to live on your own again.”
I nearly choked when I heard that. “Wh-what?” I coughed, which I was supposed to be doing anyway to keep my lungs clear, even though it hurt like hell. “Uh, does Nick know about this?”
Angie laughed. “Well, duh. Who do you think volunteered?”
I blinked incredulously. “Nick did??”
“Actually, it was Lauren’s idea, but Nick’s on board with it.”
“Really?” I raised my eyebrows, and Angie gave me a weird look.
“Yeah... why wouldn’t he be?”
I couldn’t bring myself to tell her the horrible truth, so I shrugged and said, “He and Lauren are busy planning their wedding, Angie. Why in the hell would they want to take on one more major responsibility?”
She frowned. “Because you’re Nick’s best friend. He’d do anything for you, Howie. When are you going to realize we’re not all going to up and leave you like Leigh?”
Leigh. My heart skipped a beat at the sound of my wife’s name. She had sent me a get well card, one of those recordable kind, with a cute message from the kids. It was wonderful to hear their voices, but that was all I’d heard from them since my surgery. It was more than I’d heard from Nick, though, which was telling. All of the other guys had called or texted, promising to come visit when they could, but not Nick.
“We’re here for you, Howie. Everyone just wants to help you,” Angie insisted. “Let us... please.”
I sighed. “I know, Ang. I’m sorry.”
“You don’t need to apologize for anything,” she said, squeezing my hand. “Just let us take care of you, and take care of yourself.”
I nodded, not wanting to upset her. Even though I’d put my family and friends through hell, they were still trying to help me, and I was grateful for their support. But still, I couldn’t help but wonder why Nick had agreed to let me live with him, if that had really even happened.
There was only one way to find out. After Angie left, I sent him a text.
Hey Nick. I know I’m probably the last person you want to see, but is there any way you could come to the hospital? I need to talk to you.