Liver Transplant Operation: the deplorable end of struggle

" I recommend a liver transplant operation to him. Although he is a terminal liver cirrhosis patient, he is only 37 and was never in coma nor has he esophageal varicosity. Upon the recommendation from a physician in charge, my family headed for a well-known domestic general hospital for a liver transplant operation. After a series of test, doctors convinced us that the young, healthy patient would get better soon after a transplant operation. We were very fortunate to receive a donated liver in time and set a date for an operation. We signed on a number of agreements without any hesitation.

On February 21st, my son was carried into an operating room with a hopeful and cheerful smile on his face. When he was an outpatient last year, he was healthy enough to go to work on and off. This healthy condition seemed to promise a successful operation. After a 20 hour of long operation, the doctor came out totally-exhausted, saying that the patients narrower biliary tract prolonged the operation for two and a half more hours. As he added that a 475g of donated right lobe was transplanted, I thought my 87kg son might need a 600g of lobe. Anyway, the operation seemed to be a success and my son recovered consciousness one hour after he was moved to the intensive care unit (ICU). As my son showed a gesture of triumph, all family members and relatives were relieved and delighted.

On February 26th, my son was moved to an aseptic room from the ICU and was forced to start exercising. I believed his hard struggle was a due process and wished him a quick recovery. However, his condition deteriorated on the second day. An acute rejection set in with a high fever of 40 degrees. Although a rejection inhibitant lowered his fever, the resulting uremia substantially weakened kidney function, leaving him totally dependant on an artificial kidney 24 hours a day.

March 1st was Koreas national holiday and intestinal hemorrhage made my sons condition very critical that day. As nurses in chare all took a day off, only a number of assistant nurses were on duty three times a day. Few doctors were in hospital. Furthermore, remaining doctors had half-hearted, cold attitude. The day passed by with only a limited number of medical staff around my son. The successive 3rd and 4th were weekends that added to my impatience. My son continued to complain of great pain resulted from intestinal hemorrhage, but doctors and nurses neglected his pain, saying it was a common reaction. My daughter-in-law and I also asked him to stand it. Even when I heard my son burst into tears in front of CAT scanner, I could not imagine the immense pain that overwhelmed my son. I cannot but cry out and deplore when I think of the great pain that made a 37 year old man to weep bitterly. The intestinal hemorrhage continued and my son had to receive more than 10 units of blood transfusion. He finally lost consciousness and was moved to the ICU again. All available, state-of-the-art medical devices failed to find exact reason and spot of hemorrhage.

He recovered consciousness on the second day but discharged blood twice a day with a high fever. His consciousness was also on and off. The reason of this was still not clear after many tests. I started to get extremely uneasy and fretful. I begged doctors to save my son who was on a respirator with his arms and legs tightly tied to bed. He signaled his wife to come closer but she could not go any nearer as he was inside tightly sealed room that prevented possible infection. Visitors were allowed twice a day for 30 minutes. We could see him close only when he was carried to a testing room. I encouraged him and told him to cheer up each time, hiding my sadness.

After moved to the ICU, he suffered high fever nearly twice a day. Although the amount of hemorrhage was reduced, the reason and the spot were still unclear. I felt as if heavy stones were weighing on my chest. The doctor in charge was fretting as well because the hemorrhage could increase anytime. I went through long and gloomy days, feeling completely lost.

How could this happen and why to me? My uneasiness and worries turned into rages toward the hospital, as I believed the half-hearted attitude of doctors resulted in the failure of finding reasons of hemorrhage. However, this failure and indifference were nothing new to the doctors. As the hospital was well known for live transplant operations, some doctors performed five times of operation per week and sometimes three times a day. Doctors had only two to three hours of sleep per day. They definitely did not have time to look for new medical information or study new methods. Their patients were laboratory animals and doctors depended only on old, outdated knowledge losing sympathy and compassion. It was a scene of total despair.

On March 21, the 21st day of inner hemorrhage, the doctor in charge left for an overseas medical conference. The reason of hemorrhage was still not clear and my son was in a very critical condition. How irresponsible the doctor was to leave his patient in a serious condition for an overseas trip! In addition, when her son was dying, throwing up blood, doctors were very impatient with a crying, angry mother. The doctor in charge came back four days later when my son got out of breath with severely swollen stomach. The doctor guessed that an abdominal operation of the previous day for liver biopsy, was the reason for swollen stomach. My son underwent a second abdominal operation at 1 AM on the 28th. After the operation, doctors found inflammation near the end of his pancreas. The doctors excused that they were unable to detect the inflammation as it was only a theoretical possibility and no such case had ever been reported. How can doctors think of this ridiculous excuse? If the inflammation was ever written in medical books, couldnt they find it earlier? What was the use of many tests that finally drove my son into death?
As the inflammation thickened digestive fluid in pancreas, the fluid damaged neighboring organs and made holes in large intestine. This was the reason of internal hemorrhage. It was difficult to understand that doctors were not able to find the reason out of a series of blood tests. Even when my son cried bitterly out of unbearable pains, doctors and nurses blamed my son, saying he was exaggerating. Now, I do not think I can ever forgive these doctors and nurses who were indifferent to my sons pains and suffering. I deeply deplore and regret that I gave him a record player, telling him to listen to music to forget those pains. My son just turned his face away. How silly and stupid I was to believe that his pain could be relieved with just music! But my beloved son did not even get angry with me and his wife. He just looked at us with sympathetic eyes without saying anything. During a month of hellish pains, my son may have rather wanted to die.

At 2 AM, three days after the second operation, all family hurried into the ICU upon a call from the doctor in charge. In fact, we had a last ray of hope. However, I was numb to see several doctors. They were doing cardiopulmonary resuscitation to bring back his weakening heartbeats into normal. Finally my son was pronounced dead. I just stood still in the room and could not do anything, not even crying. My sons body was so miserable with tangled dirty hair and long, cracked nails. I could not picture my sons healthy face from the swollen face. My beloved son was lying dead on bed with his body full of mars and bruises from numerous injection. His body looked like a worn-out, discarded blanket. I am so sorry, my beloved son. But I could not even have time to grieve over his death. The living, remaining people were too cruel. They asked my daughter-in-law and me to go out of the ICU as our time was up. We had to hold his still-warm body, wrap it with bed linen. We went down to a mortuary and put his body into a fridgers drawer.

<The 37 years life of my son>
He was the oldest son of my family and was a very playful and lovely kid. Although he was not academically outstanding to meet my snobbish expectation, he was the darling of his friends and neighbors as he had an excellent sense of humor. He majored in western paintings at college and ventured into the unexplored territory of animation after graduation. He did not smoke nor drink and was only deeply fallen into drawing. In his high school senior year, a blood test found that he was hepatitis b positive but I did not take the result seriously. However, the level of liver enzyme soared to around 700 to 800, and the color of urine turned into dark brown five years later. After hospitalized for a while, he came back home and was on interferon treatment for two years. Later he moved to Zeffix for another two years due to interferon resistance. As the physician in charge convinced us that hepatitis b positive patient can of course work, my son was very delighted and continued to work hard. As he developed resistance to Zeffix again from the fall of 1999, the level of liver GOT and GPT raised to nearly 200 to 300. To make matters worse, I happened to hear about a small, unproven health community and bought different kinds of health foods from it. But my son could not go on a normal diet after taking about 20 packs of so called health food. He had to be hospitalized again two weeks later and to take diuretics because of ascites. He underwent two to three times of operations to remove water near pleura. About 5g of protein came out of body as a result of renal failure and a small amount of blood came out with urine. However, he continued working on and off for another year as an outpatient because kidney function was still normal.

Now I constantly suffer from a heavy sense of guilt. I put my son into a cold, lifeless transplant factory, blinded by rootless rumors and unfaithful advertisement from TVs and newspapers. Waking up from the lies of excellent, world-famous, the level of Koreas transplant was still in its infancy. My son also was a devoted husband and faithfully supported his wife who studied abroad. He also comforted me when I was down. K.Sun, my beloved son, do you hear me and do you know how much I love you and miss you? My life must have ended when you left me.

The doctor in charged convinced us that he can live one more year if he did not go through a transplant operation. In fact, he lied to us by reducing the average life expectancy of patients with ascites, from 5 to one year. Now will the doctor take responsibilities of my sons death? I may also have contributed to reducing my sons life by agreeing to have an operation. Neither a doctor in charge nor family members were able to be sure of the right timing of operation then. I hope people will not be fooled by irresponsible remarks and decisions of doctors later on. They have such ridiculous, indifferent attitude of take it or leave it. Patients can only be articles of consumption that contribute to building doctors experiences.

If my son lived another year, he may have launched a new animation project in plan and may have finalized other animation works as a famous animator. He may have gone on a belated honeymoon and could have a baby. Or at least, he could have some time to say good bye to family members and friends.

Well, I cannot solely blame doctors who do not respect human dignity. The bad Korean education system gave birth to shallow doctors who prefer medical divisions with less-hard working. In line with this, many hospitals now suffer the lack of surgeons as the division requires a great deal of hard works.

Some general hospitals owned by private businesses are also prone to creating profits. These owners pay cheap for doctors in order to increase margins and this greedy attitude give doctors extremely hard times. As the number of doctors and nurses continue to decrease, medical staff cannot concentrate on their duties and grow indifferent to their patients. For example, the doctors in transplant team deal with outpatients, perform operations and take care of hospitalized patients who had already taken operations. As one person has the work loads of three persons, they understandably do not have enough time to study. Luxurious outlooks with poor facilities and this is the reality of Korean general hospitals. Those surgeons may be another victims of the inefficient, immoral medical and social structure.

Another problem is the receptive, complacent Korean media that presents hospitals with exaggerated, rootless hope and sentimental attitude. The media reported that the success rate of liver transplant operation is nearly 85%, while that of failure is only close to 15%. In this report, it failed to touch upon the sadness and despair of the failed 15%. It also neglected the fact that the 15% laid foundations for the 85%. Now the media should restore fair perspective and it should deal with the stories of failed cases along with the success stories of liver transplant operation. This unbiased attitude will certainly help viewers and readers to better understand the reality.

The Korean government also needs to establish a national hospital for organ transplants and care about organ transplant patients as much as they do for cancer patients. So far the government built Korea Cancer Center Hospital and National Cancer Center. A state-owned organ transplant hospital will provide good opportunities for independent medical specialists to treat transplant patients. This can contribute greatly to improving health of many patients and also to further educating Korean surgeons to be world-renowned doctors. Just like human history is the records of winners, the media also focuses on success stories. But now it is time to remember that any success came from numerous trial and error.

Mr. Hagiwara is a rather unknown Japanese comedian who was also diagnosed with terminal liver cancer. As Japanese doctors gave up on his treatment, his colleagues collected about 550 million won in order to send him to the U.S. for a better chance of operation. And he got recovered and came back on stage after one year. This story makes me pay great tribute to the Japanese medical society for their honest and sincere attitude toward patients. The level of Japanese medical care is far about than that of Korea, but they honestly accepted current status. Unfortunately, this is not the case of the Korean medical society. Even though one patient passes away, a hospital can still earn good money. The conservative, closed, authoritative Korean medical circle is also corrupted with bureaucratic red tapes. Members do not actively exchange information and are engaged in blind competition to enhance the meaningless success rates. In addition, many doctors do not have the courage and honesty to admit that they are unable to perform certain operations.

Can my son live longer if I took him to the U.S. for better operation? He had bright and promising future and now he lies under cold ground. Look at the saddened and dampened families, your wife and I. We desperately miss you, my son. Please forgive me. You are always in my heart and you know that, my dear son.