The New Yorker strikes again

The New Yorker seems to have taken a special interest in kidney transplants lately. Here is the second cartoon on the topic in recent issues. The caption reads: "Even though you gave the C.E.O. a kidney, this is a lot of sick days."

While posting this, let me mention that the only post-transplant problem I'm facing is adjustment to the anti-rejection medication. The most annoying aspect has been occasional pain in the joints where my legs connect with my hips. Nancy bought me a wooden walking stick just before Christmas and this has been helpful -- it's not always needed but has made longer walks much easier. When one thinks of all the side effects that are possible, a little pain in the legs is hardly worth mentioning. (An x-ray was recently made of the upper leg and hip area and, as the results were inconclusive, an MRI is scheduled for January 15.)

The main things is that the kidney Nancy donated, Super K, is working beautifully.

Meanwhile medication I'm taking continues to be adjusted. Last week there was a four-hour blood test at the AMC to see how one of my key medications, Neoral, is being absorbed into the blood stream. I had a call earlier today from one of the doctors in the AMC's kidney section reporting on that study. The result is that daily dosage of Neoral is being reduced immediately from 400 mg a day (200 in the morning, 200 at night) to 250 mg (125 mg twice a day). Whether this will have a positive effect on my legs remains to be seen, but I'm hopeful.

We've had a splendid Christmas. Because we belong to a Russian Orthodox parish, we actually get two Christmases. For us the first is mainly a period of family gatherings spread over three days, starting Christmas Eve. The "old calendar" church celebration occurs thirteen days later.

The only hitch yesterday -- Second Christmas, as the Dutch call it -- was the sudden demise of our seven-year-old electric oven just as Nancy was in the midst of preparing a complicated, labor-intensive moussaka. The moussaka sauce ended up being served with noodles -- not a bad plan B.

Coffee and a pecan pastry

I thought "Fiat!" would be the last posting, but I guess not. As they say, it ain't over till it's over.

I went back to the AMC in Amsterdam today for my six-week check-up with the surgeon, Dr. Idu. I have only one more check-up at the end of January, and that will be with the transplant team. After that I come in once a year to make sure that my single-cylinder engine is working properly.

Dr. Idu checked the incision scars (two tiny ones for the laparoscopic equipment, one eight centimeters long -- about 3.25 inches -- for the hand-assisted part). No problems. He said I can go back to the gym and even run the marathon if I am so inclined. Can't do any damage now, he said. He suspected I had probably lost some weight, which is normal, and he told me I'd probably gain some of it back. But in kidney transplants, he said, the expectation is that the donor will not suffer any permanent setbacks in any way -- complete recovery is the norm. And it's true. If I didn't know I only had one kidney I'd scarcely believe it.

I asked him exactly how long the operation had taken. He said it took them longer than usual to get the anesthesia right (about 45 minutes), but from the first incision to the sewing up was about three hours.

After the check-up in the out-patient section of the hospital I went to get a cup of coffee and a pecan pastry in the cafe located in the main part of the hospital. The cafe is in a large open plaza, brightly lit with natural light from the ceiling, which is essentially a huge skylight. Today it was filled with stands for a Christmas fair. I found a free table and ate my pecan bun as people milled around the stands and popular recorded Christmas music filled the plaza. I felt an odd nostalgia there. Despite the fact that the AMC is a huge complex, there's a kind of cozy warmth about it. I guess my fondness for the place has to do with the very positive experience we had there. All during this past year, every time I had another test in the long series of qualifying donor tests I would reward myself with coffee and a pecan bun in this cafe, hoping that the test result would be positive. And incredibly it always was.

(I did a little web research on Dr. Mirza Idu. He's an MD PhD -- a medical doctor with a PhD -- or, as medical students sometimes say, a Mudd-Fudd. These tend to be over-achieving doctors of amazing skill who are as interested in research as they are in their particular field of medicine. He has written quite a bit on donor nephrectomy.)

Fiat!

It’s six weeks since the transplant. Six weeks is the magic word. We were told that after six weeks we would be able to pick up heavy objects again and more or less return to our normal activities.

Most of the time I don’t even think about it any more. I can’t feel a thing, and the periods of fatigue have passed. Last Wednesday we went into Amsterdam to attend our daughter Wendy’s graduation from the University of Amsterdam, where she received her Master’s Degree with glowing praise for her thesis on George Orwell. We took a late morning train, attended the graduation at noon, went out to lunch with the rest of the family, walked to the new Stedelijk Museum in Amsterdam to see the Andy Warhol exhibition, and went to a special dinner with the family again that lasted until late in the evening. Got home at almost midnight. I don’t think we would have been any less tired if we hadn’t had the transplant.

I’m back at work. I’ve alerted my translation clients that all is well, and the assignments have started to come in. Today I finally mailed in the final papers required for my mother’s Dutch residence permit, which still hasn’t been issued after living here for six months.

Life goes on. The big event, which I had been awaiting with quite some apprehension, is passed. All is well. Even the scars are barely visible. And yet…

There was that thing I did. There was that yes. There was that “fiat.” We went back to church the Sunday before last for the first time since just before the operation. It happened to be a Sunday with a guest priest assisting in the sanctuary, a friend of ours originally from America, Fr. Stephen Headley, now archpriest of the Russian Orthodox church in Vezelay, France. He preached a sermon on the Mother of God, and he told us that her life is the model of how we should live out the gospel. “Fiat” is what she said at the Annunciation when the angel Gabriel came to her -- let it be done according to your word. She was not a deus ex machina, handily inserted at the right moment to make sure the prophecies were fulfilled. No one said a word to her about prophecies. Gabriel simply explained the situation to her, and she said yes.

I’ve been spending the past several months reading the Harry Potter books, and one of the main themes in the series is the futility of prophecies. In her creation of a world of witches and wizards, Rowling wanted to make it clear that she was not interested in having her plot hinge on the magical fulfillment of a prophecy. She has little patience with fortune-telling. The one teacher at Hogwarts School of Wizardry and Witchcraft who is responsible for teaching the prophetic arts is depicted as a well-meaning but ridiculous fraud whom no one takes seriously. In the end, Harry is not the victim of a prophecy but the hero of his own freely made decision to act out of love.

Before the transplant, during the early stages of the selection process when I was still undergoing test after test to see if I was a worthy donor candidate, I was asked to meet with the hospital social worker. We talked for about a half hour, maybe longer, and basically what she wanted to know was whether I was being coerced or guilt-tripped into offering my kidney. Donations made under pressure are not accepted. Only those who offer their kidney freely can get past the AMC social worker. This is as it should be.

After having said her yes, the Mother of God -- as St. Luke relates it -- sings a hymn of thanksgiving, the Magnificat. “My soul magnifies the Lord, and my spirit rejoices in God my Savior.” What is she giving thanks for? For the fact that “henceforth all generations will call me blessed,” that her future reputation is secured? For having been chosen to be the Birthgiver of the Savior, for having won a cosmic sweepstakes? Or was she thankful for having been given the opportunity to make the decision in the first place, thankful for having been so fully challenged, thankful that God drew forth from her the full strength of her humanness, thankful that God put her in a place where she was required to fight her fears and to make a decision that was not based on what her friends might do, or what her parents might want, or what “common sense” informed by popular culture might instruct. Her yes was uttered from a deep trust that God would be with her, that her will and God’s will were aligned. This is really beyond obedience, because she didn’t surrender her will to God. She was not a victim of some almighty and unavoidable power. She decided to sing in God’s key, as it were, because she knew that it was the key of truth and love.

When you sing in that key, even if only for a moment, things can never be the same. That’s what I feel right now, even as the scars are fading.

(The Annunciation icon was painted in Russia in the 12th century. Double-click to see it enlarged.)

* * *

Still reading after all these years...

There is the scent of Christmas in the air. Yesterday we set up the Nativity creche on our icon shelf in the living room.

Six weeks ago -- 42 days -- the translation of Nancy’s kidney to my body had just happened and we both in the recovery room. At least I think Nancy was still there, but at 6 pm that Wednesday, I hadn’t yet regained consciousness. Finally, perhaps at 7 or 8, there came a dream-like period when I became blurrily aware that Wendy and Anne were sitting quietly at the side my bed in that faintly lit room, and noticed other post-operative patients in other beds and a nurse or two quietly making the rounds. I know that somehow we had a conversation, though I have no memory of what they said or my responses.

Six weeks marks another border-crossing moment. As we were told beforehand, normally it takes six weeks to get the point where one has a green light to do ordinary lifting. If all has gone well, the healing of tissue and muscle that was needed has happened. While you may have thought you were back to normal life days or even weeks earlier, now it’s official. It seems to me I ought to look around for something heavier than my bike to pick up, but I think I’ll let that remain a theoretical possibility for the moment.

Nancy has returned to the kind of work she was doing before the operation. At the moment it’s a lengthy text that she’s translating for the Anne Frank House in Amsterdam: an annual report on extreme right-wing activity in the Netherlands. (Yes, even the sensible Dutch are not without extremists -- violence-prone skin-heads, assaults on vulnerable people from minority groups, etc.) The report also surveys evidence of systemic discrimination in jobs and housing.

Apart from the short essay on the oneness of Adam and Eve, which will be part of the winter issue of In Communion (a special issue on walls being guest-editing by Alex Patico), the main work I’ve mainly been doing lately, apart from correspondence, is to gather pieces for an issue of In Communion that, if all goes well, will be issued in the spring. The theme is Christian (especially Orthodox Christian) dialogue with Muslims.

Strange to admit, but one thing I miss from dialysis is the amount of time -- nine hours each week -- that I spent reading while hooked up to an artificial kidney. Not that I have given up books, far from it, but now, when there are so many options, I have to remind myself that unhurried reading is important in my life and is not to squeezed into train rides or patches of time at the end of the day after my laptop has been turned off.

The book I’m reading -- now nearly half way through -- is the new translation done by Richard Pevear and Larissa Volokhonsky of Tolstoy’s novel, War and Peace. (I last read it in 1969 or 1970 while in prison for disturbing the Vietnam war.) It had been my intention to start reading it while recovering at the hospital, but in those ten days the book -- about the weight of a cinder block -- was too heavy an object.

These last few days I’ve also read Wendy’s master’s degree thesis about George Orwell, which in turn has made me want to read his Homage to Catalonia, an anthology of his essays, and to reread 1984.

Just today, inspired by a review of a new translation of Paradiso, I began taking a fresh look at Dante’s Divine Comedy.

Now that I note all that I’ve been reading, I can see that, while the hours of reading may not quite equal what I was doing as a dialysis patient, still I am yet among the post-literate. Still reading after all these years...

(Double-click on the Nativity creche photo to see it enlarged.)

Frankenstein's kidneys

Several years ago a vegetarian friend of ours visited America and came back to Holland exclaiming that America was bursting with vegetarians.

It must be that the passionate interest Nancy and I have developed about kidney donation has made it seem to us that more people than ever have that topic on their minds. Thus we even find cartoons on kidney transplants even in The New Yorker... The caption reads: "He goes to the bathroom a lot. Where did you get the kidneys?"

(Double-clock on the cartoon to enlarge it.)

Back in church

One of the early entries in this journal had to do with our being prayed for and anointed by the rector of our parish, Fr. Sergei Ovsiannikov, the Sunday before the transplant operation. Since that Sunday -- the 28th of October, five weeks ago -- we’ve not been able to attend the liturgy, though in various ways the parish has come to us: a special prayer service in the church the day of the operations, communion brought to us twice, visits at both hospital and home from parishioners, plus cards and notes beyond counting.

At last yesterday we were able to return to church. The welcome was remarkable, including from people in the parish whom we had never had occasion to speak with in the past (keep in mind that in recent years ours has become a large parish, with several hundred people present each Sunday). One of the women who speaks only Russian embraced us and, with many joyful exclamations, spoke to each of us at length. We understood hardly a word, but felt showered in love. One of the Eritrean woman who speaks very little Dutch did the same in her native language.

There was another event to celebrate -- the news of the birth on Wednesday of a daughter, Maria, to Tanya and Deacon Hildo Bos. After more than a decade of hoping for a child, they had begun exploring the possibilities of adoption when Tanya realized she was pregnant.

After the coffee hour, our friend of many years, Fr. Stephen Headley, rector of the Orthodox parish in Vezeley, France, gave a lecture on the late Metropolitan Anthony, longtime leader of the Russian Orthodox Church in Britain and one of the prime movers in the foundation of our parish nearly thirty years ago. (Photos are in the parish set on our Flickr site.)

A long day in Amsterdam ended with a housewarming celebration at Wendy’s new apartment.

It was nearly eight at night when at last we were back in Alkmaar.

(Photo: During the coffee hour after the liturgy, Jim in conversation with Marina van der Kamp, Nancy with Ann Headley. Photo by Vlad Dobrovinski. Double-click to enlarge.)

First day of December

It’s the first day of December. A month ago, Nancy’s kidney had been in me less than a full day. That morning, with some difficulty but a sense of triumph, I managed to type a short entry about the operations having gone well for both of us.

It has been impressive in recent weeks to see a good deal in Dutch newspapers about kidney donation. It has become a much-discussed topic in Holland. Here is a drawing that appeared a few days ago in one of the main dailies, Volkskrant, that reminds me a bit of the 13th century Adam and Eve illumination I posted on this site a few days after the blog started -- see the entry for October 22. In this case, it’s a contemporary image of the possibility of oneness of man and woman. Not that one so easily finds evidence, in this fear-driven world, of human divisions being overcome, but every living organ donor gives a sign of the communion that is within our reach. (Double-click on the image to see it enlarged.)

Every day we get notes asking how we’re doing. We’re in great shape, recovering at a brisk pace. This week Nancy let her translation clients know she is ready to resume work, while I’m biking once again and in general carrying on life as usual, also getting back to work. The main result so far is an expanded version of Adam and Eve blog entry, “The Original Oneness of Adam and Eve.”

Some hours have been spent the last week or two laying the foundation for a special issue of In Communion, the quarterly journal of the Orthodox Peace Fellowship, on the theme of Orthodox-Muslim dialogue. If the puzzle pieces come together in time, it should become our spring issue. Meanwhile the winter issue -- on the theme of walls -- is being guest-edited by Alex Patico, the new OPF secretary for North America.