hope. A collaboration: Sarah Hildebrand (photographs); Gerhild Perl; Julia Rehsmann; Veronika Siegl (essays). Translated from German into English by Alexandra Cox.
©2018 Christoph Merian Verlag, photographer, authors, translator. ISBN 978-3-85616-860-5
Organism, by Julia Rehsmann (extracts)
The liver is a silent organ. Whereas the lungs cause our ribcage to rise and fall with every breath and our heart beats constantly, the liver works away soundlessly. Rarely are we aware of its functioning; we do not feel and hear the liver. It is the largest of the internal organs and pivotal for the whole metabolic process. The liver produces vital proteins, serves as an energy store, breaks down harmful substances. No liver – no life. Its function is so complex that no substitute has been found for it yet. If the kidneys’ function is impaired, there is the possibility of dialysis, but for the liver, so far there is no comparable procedure. One of its specificities lies in its ability to reconstruct healthy tissue. It is able to form a whole liver out of one half. But when the strain gets too great and things become too much for it, the consequences can be life-threatening. Its failure, whether insidious or sudden, can be felt throughout the body: from states of confusion through to coma; forgetfulness; tiredness; water retention in the abdominal cavity, arms and legs; itchiness all over the body; jaundicing of skin and eyes. Liver failure. The liver works silently and screams when it fails. Failure means refusal, and when it refuses, the liver puts across its message loud and clear.
No patients today again. I wait, wait, wait.
The silence here is only occasionally broken by the calling out of names and the sound of the automatic doors, their opening and closing, and the rapid steps of the hospital staff, who criss-cross the clinic’s hallways with an apparent purpose and always in a hurry. Now and then a diffident whispering among those waiting – partners, brothers and sisters, children and parents, friends – underscored by the quiet background noise of this morning’s television. Cookery shows, soap operas, news magazines. All seats directed towards the television mounted high up on the wall, its channel never getting changed. An arrangement of places that was explicitly desired by the patients, so that all of them if possible can keep their eye on the TV. Distraction from waiting and uncertainty.
MELD – Model of End-Stage Liver Disease. A value, an algorithm, calculated from laboratory findings. The number that decides on the patient’s prospects of getting an organ. An estimate of how likely a demise is in the next 3 months without a transplant. But it is not uncontroversial, this MELD score, explains the transplant surgeon in a calm voice. It is not objective, because numbers are not objective, she says. They depend on muscle mass, on the laboratory, and many things, she tells me, are simply not covered by this MELD; abdominal water retention, for instance. And so, unfortunately, many of her patients who need a liver and, from a medical point of view, would have good prospects of surviving the transplant, do not receive an organ. The doctor should know this. It is her craft. She is the one who transplants the livers, cuts up bodies, inserts organs, sews up blood vessels and tissues, works with precision to make one body out of two. Only the really sick receive an organ; she does not approve of this. Yet she has no better proposal for distribution and allocation, she says; the problem is simply the lack of organs. And when they are managing a shortfall, when there is too little to go around for all who want this something, the disadvantaging of some groups is unavoidable, she tells me. At the end of 2016, in Germany, 1,157 people were on the waiting list for a liver transplant. Not all of them will receive an organ in time.
The transplant centre office is bustling like a beehive. Nursing staff flying out, in order to gather blood and urine samples in surrounding rooms; doctors who come by briefly and purposefully, in order to pick up patient files; patients who enter cautiously in order to sign in and collect prescriptions. The permanent buzzing of the telephone, the droning of the carers about patients and doctors. And, at the heart of the events, a box filled with chocolates, around which everybody whirs, reversing their steps after a quick glance round and taking a chocolate or two. One of the many gifts from grateful patients, shelves full of chocolate, coffee and alcoholic drinks. How wonderfully absurd the fact that some people with a liver disease, which not uncommonly is attributable to excessive alcohol consumption, thank the hospital staff with wine, bubbly and homemade eggnog.