Dr. Howell wasn’t fazed by Yoss’s attitude. The older doctor read over the results and then cleared his throat. When he looked at Yoss again, his eyes were kind and compassionate, his expression concerned and serious.
“Your biopsy confirmed that you have end stage liver disease. Your liver function is very low and you are at significant risk for acute liver failure,” Dr. Howell said succinctly. Carefully. Gently. His words falling between us like shrapnel.
This was my cue to say something supportive, just as I would have done for any of my other patients. But this was Yoss. And I felt the reality of his situation hit me square in the chest.
Yoss began to pick at his stitches. “Okay. You had mentioned liver failure before. I think I got that part.”
“I’m going to be frank with you, Yoss, your condition is very serious. Hepatitis B is a tricky disease because of how long it can take to show symptoms. The longer it goes untreated, the more likely you are to suffer from liver damage. That however, isn’t insurmountable. A strong course of antibiotics as well as treatment with medication and we can significantly slow down the progress of the disease and the impact on the liver. However—” Dr. Howell stopped for a moment and gave Yoss and long and penetrating look. “Your situation, Yoss is a bit more complicated.”
“Isn’t it always?” he muttered. He was biting on his lower lip, his knuckles white as he clenched the sheet in his fist.
“To put it simply, your best chance is to have a liver transplant and the results from your biopsy show that you are a prime candidate. The good news, Yoss, is that there is no indication of vascular invasion. That means that the areas around the liver don’t appear to be affected. Yet. That increases the likelihood of a successful transplant, ” Dr. Howell concluded.
I finally found my voice. “That’s great.” I turned to Yoss and gave him a smile. “See, some good news.” He didn’t return my enthusiasm, so I spoke again to Dr. Howell. “Okay, well didn’t you say that he’d be high on the list? That he’d be given priority if the health impact was significant enough?”
“His MELD scoreishigh, which means the wait time is significantly less. However, I want you to be aware, Yoss, that even with high priority, you could be waiting for several weeks, even months, before a transplant is made available.”
Yoss’s face had gone grim. His green eyes dull.
“Let’s be straight here, Dr. Howell, what you’re saying is that I could quite possibly die before I get a new liver?” Yoss was angry. Really angry. And I could understand why.
How else were you supposed to feel about the idea that you could die? Even though Yoss had been reckless in his choices, the realization that death was a possibility would knock anyone down.
“Your condition is potentially fatal, yes, but so is walking across the street during rush hour,” Dr. Howell pointed out and Yoss snorted.
“I don’t think you can compare playing Frogger across the road with my liver giving out, but nice try,” he remarked dryly.
Dr. Howell closed the chart in his lap, his face set in severe sternness. “Yoss, you are a very sick man. I will always give you the facts as I have them. But you have many options. There are treatments available that cannot only slow down the disease’s progression until a transplant becomes available, but can also make you feel better. To give you back your quality of life. But mental outlook impacts every part of this process. I spoke with Imogen about getting you some counseling. The medication you are taking can cause an increase in depression and suicidal thoughts. It’s incredibly important that you talk to someone. They can help you process what you’ve been through. Help you with coping skills.”
“Dr. Howell’s right, Yoss. Speaking to someone, even informally, could help you tremendously. I know a number of wonderful therapists who could come to talk to you—”
“So how long do I have to stay here then?” Yoss interrupted, not acknowledging that I had spoken at all. “I can’t hole up in the hospital for months while I wait for a possible transplant that may never come. I don’t have insurance. And I sure as shit know that the hospital won’t keep me here indefinitely if they’re not getting paid.”
“As I said earlier, you will be moved out of the ICU later today. I am recommending that you remain in hospital, for at least a few more days. Your injuries sustained from your attack have healed nicely. And if you remain vigilant about taking your anti-viral medication, you can go about your life. However, you would have to come back for frequent follow-ups to monitor your symptoms and your viral counts. This would mean routine blood work and tests. While you are physically stronger, given your situation, I have serious concerns about your health once you leave. I’m assuming you and Imogen have talked about where you will go once you are discharged?” Dr. Howell looked at me and I nodded.
“Yes, Dr. Howell, we’ve talked about the Salvation Army downtown. Tracey Higgins says they have available beds. But Yoss and I are still discussing it.”
Yoss gritted his teeth and I anticipated an outburst at the mention of the shelter. I was relieved when there wasn’t one.
“I would strongly encourage you to find suitable accommodation. Somewhere safe, clean, and warm. I don’t feel comfortable signing off on your discharge until we know you can properly look after yourself.”
“I’m not a child, Doc. I’ve beenproperly looking after myselfsince I was twelve,” Yoss spat out.
I reached over and put my hand on his arm, not caring that Dr. Howell was in the room. “He only means that with your diagnosis, you have to be somewhere clean. Somewhere that lowers the risk of a possible infection. We don’t want anything to happen to you, Yoss,” I said softly.
Yoss met my eyes. He wasn’t just angry.
He was terrified.
“But again, I want you to stay in hospital for another two to three days at the very least. You still need some rest and until you secure housing, I think it’s best to keep you here. Okay?” Dr. Howell said, his eyes flitting from Yoss to me and then back again.
Yoss nodded, his gaze drifting to the window. The sun was dipping below the horizon and it was mostly dark. His chest was rising and falling rapidly, his face drawn.
“All right, we will talk more about this tomorrow. It’s almost dinnertime; make sure you’re eating as much as you’re able to. Especially now that the nausea is subsiding.” Dr. Howell stood up. “Imogen, a word.”
I let go of Yoss’s arm and just as I was about to move away, he grabbed my hand and held it tightly.
I squeezed his fingers.
