A Tale of Two Kidneys

Three years!

2010-10-31T14:59:00.004+01:00

For many people, today is Halloween. For Nancy and me it’s the third anniversary of the relocation of one of her kidney’s into my abdomen where it has dwelt happily an efficiently ever since. Three years! If I had a bottle of champagne in the house, this would be the right day to open it.

My first words today were addressed to the donor: “Thank you, Nancy.”

For nearly two years the backbone of my life in so many ways was the dialysis. Everything had to be arranged around those three weekly sessions of blood filtering. Normally this was at the local hospital, but, if I were traveling, sometimes in hospitals or clinics in other countries: Greece, Spain, Italy, England, France, Canada and the US.

Ever since the transplant, I have felt something like Lazarus after being brought back to life by his friend Jesus three days after being placed in his tomb. Of course I had no real death experience, but kidney illness is, even in these days, a close encounter with death.

In case you have never read it, I recommend something Nancy wrote about deciding to make that donation, “Saying Yes” -- see: http://www.jimandnancyforest.com/2009/07/29/saying_yes/

Jim

Remembering dialysis

2009-11-27T15:28:00.007+01:00

Today I happened to come upon the attached memo, something I routinely sent out to people who asked about my kidney illness before the transplant took place. The memo evolved during the two-year period I was on dialysis -- this may be the final form of it.

Jim

* * *

Kidney illness update (as revised June 28, 2007)

Here are some of the questions friends have asked and brief responses...

>> What is the illness you have?

The gradual failure of my kidneys. Mine still are working, but at only about 9 or 10 percent of normal function.

Since January 2006, I have required dialysis (the filtering of my blood with an artificial kidney).

>> How sick are you?

Quite sick, but I don't feel sick. I'm far from a "worst case" patient. I was fortunate to become aware of the illness much earlier than is the case for many others thanks to blood tests several years ago. Because of early treatment, my kidneys are still working, though at a reduced capacity. My situation is fortunate. For many patients, by the time kidney illness is recognized, kidney function is close to zero. When that happens, daily liquid intake has to be drastically reduced. Patients may feel they're on an endless roller-coaster -- energy one day, following dialysis, then exhausted the next.

>> Is kidney illness painful?

Not really, at least not in my case. The insertion of the two hollow needles into my left arm when I have dialysis is not pain free, but the pain is usually over quickly.

>> What caused the kidney damage?

It's not certain, but most likely it had to do with high blood pressure.

>> Is kidney illness fatal?

Without treatment, indeed. But with dialysis, one can go on for many years, though with gradual deterioration as dialysis doesn't equal having a fully functional kidney. (Not long ago I witnessed a death in the dialysis clinic -- an 83-year-old patient who simply faded out. It seemed he had fallen asleep. As is often the case with dialysis patients, kidney failure was only one of the problems he was facing.)

>> Is there any cure?

Though there is work going on to develop an artificial kidney that can be implanted in the body, none exists so far. Perhaps in another generation?

The only cure to date is a kidney transplant. After many tests, it has been decided that I'm a suitable candidate for a transplant. Unless one find a kidney donor, the average waiting time is 54 months, and it can be as long as 72 months. A transplant can occur much more quickly if a living donor offers a kidney.

>> Do you have a kidney donor in sight?

Nancy is exploring the possibility of donating a kidney. She has had quite a few tests these past half year. So far she appears to be a good match (same blood type, in good physical condition, heart fine, etc.). We know from a renogram that both of her kidneys are working equally well, so that a) she will still have a kidney capable of doing all that it needs to do and b) the one she gives me will also be up to its task in my body. More recently she has had a CAT scan and another round of tissue matching tests.

Here are two web pages about kidney transplants:

http://www.kidney.ab.ca/treatments/transplant.html

http://www.answers.com/topic/kidney-transplantation

>> Is kidney donation a risk to the donor?

While any surgery involves risks, the risks are regarded as slight for kidney donors. People who have given a kidney go on to live normal lives. (One of the early tests for potential donors is a scan to see if you do in fact have two kidneys. Not every one does. One healthy kidney, however, is all you need.)

>> What is hardest about dialysis?

For me, mainly the time it takes -- three sessions a week. Altogether dialysis involves approximately 50 hours a month or 600 hours per year -- about a quarter of my former working time. I normally leave the house about 2:30 and get back home about 6:30, traveling by bike. The hospital is only a kilometer away, so travel time isn't a big factor.

>> Can you travel outside Holland?

Yes, but not easily. I can't go anywhere for more than three days without first arranging dialysis care locally. This turns out to be a very time-consuming process. If the local dialysis clinic has too many patients already, as may easily be the case, they will not accept me. I had a great deal of trouble finding a clinic with space for me in London last May. I ended up in a private clinic that mainly serves wealthy patients from the Middle East. Later the same month, with the help of French friends, I was able to arrange five sessions of dialysis in Perpignan while taking part in a Merton conference in Prades. I've since been on lecture trips in Italy, Canada Spain, the USA, Greece, and -- most recently -- Memphis, Tennessee, for a conference on Thomas Merton.

>> What does a dialysis machine look like?

There's a photo of me hooked up to a dialysis machine at the Alkmaar hospital here:

http://www.flickr.com/photos/jimforest/91857028/in/set-151995/

>> How does a dialysis machine work?

There are drawings with brief explanations on these two web pages:

http://en.wikipedia.org/wiki/Hemodialysis

http://www.davita.com/article/dialysis/181

>> How are the people who take care of you?

I'm impressed with the nurses. All of them are extremely good at what they do and are, no less important, caring, good- humored people. The majority are women but there are also a number of male nurses.

>> Can you write during dialysis?

No. I really have effective use of only my right arm, though, with care, I can do a little with the left hand (the arm connected to the dialysis machine. I'm able to manage books and magazines. Dialysis has become mainly a time of reading. On the occasions when I'm too tired to read, I have a small DVD player and so cnn watch films.

>> Have you written anything about being ill?

I've written a chapter on "The Pilgrimage of Illness" for a book that Orbis will publish later this year ("The Road to Emmaus: Pilgrimage as a Way of Life"). The chapter is posted at:

http://incommunion.org/forest-flier/jimsessays/the-pilgrimage-of-illness/

Please keep us in your prayers.

Jim

* * *

photo: A maple leaf that was along my path in at the Antiochian Village in Pennsylvania last month, not quite two years after the kidney transplant.

* * *

Two years on...

2009-10-31T12:26:00.002+01:00

To celebrate the second anniversary of the kidney transplant (31 October 2007), at breakfast this morning I gave Nancy the new edition of the Van Gogh Letters. Given all the Van Gogh-related translation work that Nancy has done in the past two decades (currently she's working on a book about Van Gogh forgeries), it seemed doubly appropriate. Also the CD of the letters that comes with the set is likely to be a useful resource.

The book had a big launching at the Van Gogh Museum in Amsterdam the day before I flew to the US several weeks ago. Nancy went the next day with Diane Webb, one of the book's three English-language translators. Here's an extract from a letter Nancy sent me that evening:

"What a lovely day! Diane asked if I wanted to go with her to the Van Gogh Museum to see the new exhibition on the letters. She had been there the evening before for the opening (attended by the Queen), but so much else was happening that she didn't actually see the exhibition. She said all she saw was wine and canapes and lots of people. So we spent the rest of the day there. It was fabulous. The exhibition is definitely worth a visit. A selection of Van Gogh's letters are shown in glass cases, with the paintings and drawings he refers to on the walls. Breathtaking. You just can't believe what you're seeing. No catalogue, no matter how good the picture quality, comes close to being face to face with the real thing. And I saw the book -- or should I say books! Diane showed me the whole thing, including the part she did. I have a very serious book lust here. You wouldn't believe how beautiful the design and quality is. A six-volume boxed set. To get a glimpse, check out the museum site: http://www.vangoghmuseum.nl/vgm/index.jsp?page=200942

"The whole thing is copiously illustrated with everything that Vincent refers to in his letters -- his own paintings and sketches and paintings of other artists that he refers to. And the quality is superb. Each of the three translators is being given two copies. When you come back we really should try to see the exhibition."

It's an expensive set of books, but a substantial discount is offered by several online bookshops.

Two years on with Nancy's kidney, I seem more than ever aware of what a miracle it is to be really well, not to say no longer being a prisoner of dialysis.

There is a folder of transplant-related photos here:

http://www.flickr.com/photos/jimforest/sets/72157602782265033/

Jim

* * *

When you're smiling -- the transplant, one year on

2008-11-01T18:09:00.003+01:00

Yesterday it was one year since the transplant, and we went out to our favorite Alkmaar restaurant to celebrate. We began talking about what it had been like one year before -- coming out of the anesthesia, trying to eat a little bouillon -- and my strongest memory was of just lying there in my hospital room, fresh from the operation, with a smile on my face. There was a purity of happiness during those days that still makes me smile.

What was it about that happiness that was so pure and joyful? At first I thought it was simply a matter of coming out of major surgery and knowing that I was still alive and that nothing had gone wrong, that all the weeks and months of stress and anxiety were over. But it was more than that. I’ve been deeply relieved before (when the SATs were over, for instance, or when I got my driver’s license), but I didn’t find myself just lying in bed with a smile of pure happiness. Then I thought it had to do with the joy of giving, the feeling you have when you give someone a big present, when you make a grand gesture. I’ve done that before, too, and it does make you feel good. But if you examine your good feelings about making grand gestures, there’s always that nagging sense that you’ve done the thing partly out of a sense of egoism -- if I make this gesture, people will nod and say, “How generous she is.” Even if you don’t act from such a motivation, it’s always there, muddying up the waters.

But this was pure. There was no mud in the waters at all. I can’t remember when I’ve ever felt a happiness like this. And I think it has less to do with the gesture itself, the gift, than with happiness at having been given the opportunity to make the gesture in the first place. Before the operation I didn’t feel it so intensely. I remember at the beginning, when I first offered to give my kidney, how thrilled I was to learn that our blood types were the same, and with every test I was equally glad to learn that no problems or anomalies had been found. But there was a complexity of other feelings, too: anxiety about the operation, about how it would affect me to have only one kidney, about how long it would take to recover. I had crossed the threshold and had said my yes, but I still felt that I was moving relentlessly towards a great unknown.

Last night during dinner Jim and I talked about what it had been like the day before the operation, when we were being prepped in the hospital. Neither one of us was nervous. We remembered taking the early morning train to the AMC with our packed bags, traveling first class (which we rarely do), smiles all over our faces. At that point you’ve placed yourself into other hands -- the hospital is waiting for you, the bed is ready, the surgeon has you down on his list and all you have to do is show up. Early the next morning, just before the operation, the nurse asked if I would like a pill to calm me down, and even though I didn’t feel apprehensive, my legs were shaking uncontrollably and I said yes. It was half of a little blue pill, and it was very effective. I don’t remember being wheeled into the operating room at all. By the time I got there I was out cold. Several weeks after the operation, a translation colleague who also works as an OR nurse at the AMC sent me an e-mail in which she said she had seen my name on the daily operation roster. She told me she had come up to my bed in the recovery room and quietly said, “Nancy,” and that I had opened my eyes and given her a “lovely smile” and gone right back to sleep. I don’t remember this.

The happiness of having been given the opportunity to do something out of love. That’s what it is. It’s gratitude. It’s gratitude that everything just happened to turn out right: the right blood types, the right tissue matches, the right outcomes on all the tests. It’s gratitude that the medical people in Alkmaar and Amsterdam were all so kind and supportive, and so incredibly skilled. But it’s also gratitude for the strength to cross the line to yes. Freedom is a very mysterious thing. Acting in freedom is not acting in a vacuum. Every yes or no we utter is the product of a lifetime of being exposed to examples, of being taught certain things and of having been loved -- or not. Yet each yes or no is not predetermined by these things, and we’re responsible for every decision we make. We’re not doomed by our past to make decisions in a certain way, nor can we get away with taking the easy way out and pointing to our past as the rationale. Contexts are terribly important, and it’s important to give your children good examples and to tell them stories of courage and selflessness. Yet every yes or no we say is uttered, as it were, in eternity, and though it may be shaped by the past, it’s not inevitable. “Love without freedom is slavery,” said our friend Fr. Meletios Webber. Gestures of love must be made in freedom. And to be given the opportunity to make such a gesture is a great thing.

I think that’s what the smile was all about.

Eight months later: launching a new blog

2008-07-01T15:35:00.004+02:00

Yesterday -- the last day of June -- marked the passage of eight months since one of Nancy’s kidneys made a journey from her body to Jim’s. All has gone amazingly well, as was confirmed just yesterday morning when Jim saw one of the nephrologists (a word which once upon a time meant absolutely nothing to either of us) at the Amsterdam Medical Center.

As it seems there only minor additions can be made to this blog that have something to do with kidney transplants, perhaps the moment has come to leave the old postings as they are and do our occasional journaling on a new one: On Pilgrimage at http://jimandnancyonpilgrimage.blogspot.com/.

We look forward to meeting you there!

[photo: This reproduction of an ancient sculpture of an owl was found while we were in Rome and now inhabits Nancy’s desk.]

Home from Rome

2008-06-19T14:51:00.010+02:00

Our blog postings are getting less and less frequent, and less and less focused on kidneys, but some brief account of our recent two-week stay in Rome deserves a place in this journal, as one of our reasons for going to Rome was to celebrate the kidney transplant. (That we were able to go to Rome or anywhere for so long was thanks to our daughter Anne, who moved into our house in our absence and gave a helping hand to Lorraine, Nancy’s 91-year-old mother.)

This was our first extended time away from home since May 2006, when we went to Prades, France, Thomas Merton’s birth place, to take part in a Merton conference. On that occasion, Nancy and I made many long drives from Prades to Perpignan, location of the nearest dialysis center. I am happy to say that, while in Rome, not a minute was spent at a hospital.

Merton again had a role in our going to Rome rather than various other places we might have been tempted to visit. As in Prades, we were participants in a pilgrimage group organized by the Canadian Merton Society. Rome had been chosen because it was there that Merton, then eighteen years old, first began to find his round-about way to Christianity, following the deep religious estrangement that surrounded his father’s death when he was seventeen.

In his autobiography, The Seven Storey Mountain, Merton vividly described the impact of his stay in Rome in 1933. It was not the usual tourist sights that moved him. He found much of the city’s ancient statuary and monuments “vapid and boring” and was equally unimpressed with the art and ecclesiastical monuments of the Renaissance and Counter-Reformation.

What truly astonished him were the city’s most ancient churches, in which so much of the iconography of Christianity’s first millennium was still to be seen.

“I was fascinated by these Byzantine mosaics,” he wrote. “I began to haunt the churches where they were to be found, and ... all the other churches [among them Saints Cosmas and Damian, Santa Maria Maggiore, Santa Sabina, San Giovanni in Laterano, San Prassede, Santa Constanza, Santa Agnese, Santa Cecilia and others] that were more or less of the same period.... Without knowing anything about it, I became a pilgrim.”

Eager to understand the iconography of the mosaics, he bought a Bible. “I read more and more of the Gospels, and my love for the old churches and their mosaics grew from day to day.”

On one memorable day, Merton climbed the Aventine Hill to visit Santa Sabina, one of Rome’s oldest and least modified churches. He decided it was time to pray and to do so on his knees, yet prayer in a public place was intensely embarrassing. “That day in Santa Sabina, although the church was almost empty, I walked across the stone floor mortally afraid that a poor devout old Italian woman was following me with suspicious eyes.” Despite his self-consciousness, he managed to cross himself with blessed water as he entered the church and then, kneeling at the communion rail, to recite the Our Father over and over again.

As you might expect, one of the first churches we visited was Santa Sabina, walking there from the hospice where we were staying a few kilometers away. (Another of the ancient churches we visited was San Teodoro, on the west edge of the Forum, not far from Santa Sabina, but probably this is one Merton didn’t enter, as I doubt it was open to visitors back in 1933. In the year 2000, Pope John Paul II gave it to the Orthodox Church. Following restoration, it was opened in 2004. Nancy and took part in the Liturgy there on our last Sunday in Rome.)

Happily, there was plenty of time for many unscheduled and unhurried walks, as the ten-day Merton Society program was light: breakfast together each day, lectures on four mornings either by Michael Higgins or Donald Grayston, a get-together every evening on the hospice roof, and two shared suppers. Together we also attended Pope Benedicts’s weekly audience, at which we were among the groups introduced to the pope (he waved at us and we waved back). We also went as a group to the Trappist Abbey of Tre Fontane (which stands where St Paul was beheaded in 67 AD), then to the catacomb of San Callisto, along the Appian Way to the southeast of Rome, and finally to San Paulo Fuori le Mura (St Paul’s Outside the Walls), where Paul was buried.

If you have an interest in seeing the photos taken during our time in Rome, they are here:

http://www.flickr.com/photos/jimforest/sets/72157605352157251/

There’s also an account of our visit to another of Rome’s best preserved ancient churches, the Basilica of San Lorenzo Fuori le Mura (St Laurence Outside the Walls):

http://incommunion.org/forest-flier/jimsessays/rome/

* * *
Photo: a view of the exterior of Santa Sabina.
* * *

One More Thing, part two

2008-05-26T16:14:00.008+02:00

In the last posting three weeks ago, I expressed relief that so far this spring I had not yet been battling hay fever and wondered aloud if this might not be another of the several positive unexpected by-products of the transplant. Since then, I’ve had two or three days of being aware that my hay fever has not altogether vacated the premises, though I’ve needed to use a nose spray only once so far. Several friends, one of them a physician, have suggested that the main factor is not Nancy's kidney but the anti-rejection medication I'm taking.

Patricia Burton in Canada put it this way: "I just checked out your latest kidney story, and I think there is an explanation for the lack of sneezes. The effects of allergies are really attacks by your immune system on something it considers an intruder (like pollen). In severe allergies, it goes overboard and sometimes can kill the person it's trying to protect (like kids severely allergic to peanuts). I know this from arthritis, which is also an auto-immune disease: for unknown reasons your system starts to attack and erode your joints. In severe cases they prescribe the same kinds of drugs as are used for anti-rejection purposes: anti-inflammatories and the like. So maybe your immune system is not bothering with pollen any more but is concentrating on protecting you without rejecting the kidney. Such a balance is in itself miraculous. That's my theeeeeeeeeeeeory anyway, but I ain't no doctah."

Our physician friend, Hans van der Deure, suggests my thanks may especially go to a drug called Prednisolon. As I’ve lately reduced the amount of Prednisolon I'm taking, this may explain why these last few days have found me a degree more vulnerable to pollens in the air. Happily, the condition is much less problematic this year than it has been in a long, long time.

Other news: I was back at the AMC this morning for blood and urine tests. Dr Bemelman called a little while ago with good news re the results: normal renal function, creatinine level 98, no protein or glucose in the urine, indeed all negative indications of any kind.

Off to Rome: We’re now gearing up for our first post-dialysis vacation. (In our absence, Anne will be taking care of Lorraine.) Wednesday morning we fly to Rome where we’ll be staying for two weeks in a hospice -- Domus Nova Bethlem -- run by a community of nuns, Suore Bambino Gesu (Sisters of the Child Jesus). During most of those days, we’ll be part of a pilgrimage arranged by the Thomas Merton Society of Canada, the same group with which we visited Prades in the south of France two years. The focus this time is on visiting churches where one finds the ancient mosaic icons that so profoundly impressed Merton during his stay in Rome when he was eighteen, soon after his father’s death. (For more about Merton and icons, you might look at this essay: “Thomas Merton’s Journey to the Undivided Church” -- http://incommunion.org/forest-flier/jimsessays/mertons-journey-to-the-undivided-church/.)

(photo: pollen under high magnification)

One More Thing

2008-05-07T16:46:00.008+02:00

Every now and then it seems to me that Nancy and I have said all that can possibly be said about the kidney transplant last Fall, only to realize there is One More Thing.

The One More Thing today is something that hasn’t happened so far this year: there has been no daily assault of hay fever.

A few weeks ago, when I was at the nearby pharmacy to pick up a fresh supply of anti-rejection drugs, I noticed that hay fever medications were very much on display and realized that any minute now I would be urgently in need of the nose spay that for years (how many I cannot recall -- 10? 15?) has helped me get through the waves of pollen that warm weather sets lose. I sensibly bought a small bottle of Prevalin.

Anyone reading this who suffers from hay fever needs no account of how unpleasant, at time exhausting, hay fever is. It’s no wonder that summer news reports often include the latest update about pollen levels.

Perhaps because we’re having such an early outbreak of summer this year in Holland, with cloudless skies and high temperatures, Dutch news reports in recent days have indicated especially high pollen levels.

But this year I have -- so far, fingers crossed -- needed not one application of the recently purchased nose spray.

The only explanation that occurs to me and Nancy is that for some mysterious reason, my kidney illness had considerable impact on my respiratory system. The decline of my kidneys may have begun much earlier than I had imagined. Perhaps hay fever was, in my case, the first indication of that event. But who would have thought?

This is not the only change in my health that followed the transplant. The day after the operation, I was amazed to discover on waking up that there was no longer a desperate need to clear my head or lungs -- my “nuclear sneezes,” as Nancy called them. No more need for nose drops before going to sleep. No more daily energy dips with the nonnegotiable need for a nap that such dips often occasioned...

I had no idea how much other seemingly autonomous systems in the human body are profoundly interconnected.

(See the more recent posting dated 26 May 2008 for an update on this topic.)

[Photo: Small flowers as seen earlier today in the park at the end of the street we live on.]

Saying Yes

2008-05-05T20:03:00.006+02:00

In my opinion, the best writing for this journal have been Nancy’s entries, especially those about the inner struggle that went into her deciding to be a kidney donor. Together we’ve edited these extracts from earlier postings for the spring issue of In Communion, the quarterly journal of the Orthodox Peace Fellowship. It seems worth adding them as a sequential unit to our kidney blog.

Jim

Note: The photo is the first sonogram of Nancy's kidney after the transplant.

* * *

Saying Yes

October 24: What goes into making a decision like this, to offer a vital organ to someone?

It took me a long time. Several years ago, when Jim first learned that dialysis was in his future, the idea of a kidney transplant didn’t really hit me. Each time he went to the hospital for tests, we were apprehensive, then relieved to hear that his kidneys were still on the positive side. Then about twenty-one months ago the doctor told Jim he had crossed the line. Dialysis began the next day. From that day onward, Jim was at the local hospital three times a week for three-hour sessions of dialysis.

At first I reasoned that I couldn’t even begin to consider myself a possible donor because, self-employed people that we are, we simply couldn’t afford for me to be unable to work for what might be an extended period. In my darker moments, I imagined the possibility of being bedridden for months, weakened by the loss of the kidney, unable to do any translation work.

In May of 2006, a Canadian woman we had met at a conference amazed us with the offer to donate a kidney to Jim. We were touched and thrilled. She made contact with the transplant people at our hospital in Amsterdam, and they approved her offer. But some months later other factors in her life made it impossible for her to go through with it.

At that point I began to rethink my hesitations. Doing a lot of internet investigation, I learned that kidney donation is only very rarely debilitating. In fact it was more than likely that I wouldn’t be out of commission for long.

Such research is helpful and the internet makes it easy. But research isn’t the same thing as saying yes. You have to reach a certain point when you sit down, open your mouth, and say the words, “I want to donate a kidney to you.”

Recently people have told me how brave I’m being, but believe me, the bravest part of this whole process is just saying those words, getting yourself to that point where you overcome all your excuses and fears.

I kept thinking of Frodo in The Lord of the Rings, who finally makes the decision to carry the ring in order to destroy it in Mount Doom. He must make this decision on his own, and when he finally says, “I’ll carry the ring,” he becomes the organizing principle for the entire story.

I have always believed that Tolkien was very deliberate in naming Frodo, and that his name could easily fit into the long etymological entry for the word “free” in the Oxford English Dictionary. Frodo – one who acts out of freedom.

Freedom doesn’t mean doing whatever you feel like if it’s in your interest, because sometimes you do things that you think are in your interest only to discover later on that you did them under some kind of compulsion – peer group pressure, fear of rejection, fear of loss. Acting under compulsion isn’t freedom. But acting out of love, sometimes doing something that’s downright dangerous, is what freedom truly is. (Interestingly enough, the word “free” and the word “beloved” and “friend” are related, as the Oxford English Dictionary makes clear.)

So I said yes. And when I did, I suddenly felt as if all the winds were blowing in the right direction, as if I had made a free decision that was somehow in line with a kind of cosmic truth. I realized that for all the months that I had been saying I couldn’t donate a kidney due to economic worries, I had made myself responsible for a kind of self-wrought logical argument that had to be constantly reinforced with my own insistence in order to stay in place. But the yes floated freely. The yes was borne up by something beyond me and my own logical arguments.

This is not to say that the coming days will be easy or that I feel confident and fearless. I’m still apprehensive. When I think about the operation, now only a week away, I feel my heart beating faster and my breathing becoming shallower. But I wouldn’t go back on this decision for anything in the world.

October 29: Yesterday, directly after the Liturgy, Fr. Sergei anointed us in preparation for the surgery just two days away. The anointing reminded me of our marriage in the church, a similar sense of standing in a zone of pure grace.

November 3: Yesterday – two days after the kidney transplant – was our 25th anniversary, Jim’s 66th birthday.

Jim is going great guns. He was doing e-mail the day after the operation.

In the evening, Dan, Wendy, Cait and Björn came to celebrate both the anniversaries plus the transplant. Having just decorated it, they brought me by wheel-chair down to Jim’s room. Dan took pictures and Jim showed a sonogram of his new (my old) kidney. All the indications are that the transplant was a complete success. Jim’s godson Silouan came, too, with Leonidas chocolates to pass around. Wendy brought a huge fruit basket. We’ve never had a party quite like this before!

Now that I can walk, the nurse said I would be able to go home tomorrow.

November 6: The transplant was a week ago today. I’m not yet up to spending a lot of time behind the computer, but I’m home. The plan is to veg happily and watch movies with the kids, which I think I’ll be able to stand for about a week.

November 10: It’s ten days after the operation. I’m finally beginning to feel enough energy to write. What I hadn’t realized – and should have, of course – is that along with my kidney Jim now has truckloads of energy, whereas I have to be very conservative about everything I do so I don’t wear myself out. My operation took twice as long as Jim’s, and recovery takes longer. In fact I don’t mind gliding around the house in slow motion. I had planned beforehand to take all of November off, so I don’t feel compelled to get back to work. I’m deep into the Harry Potter novels, which I’d never been able to read until now.

The post-surgery pain is over. I can easily get in and out of bed, up and down stairs. It no longer hurts to laugh or cough or sneeze. If I lift a frying pan, I can feel a kind of pressure in the wound area, but no pain. But moving around too much makes me feel a little dizzy.

My project now is to recover my strength and to try to grasp what I’ve done. The spiritual, psychological and physical hurdle of deciding to donate a kidney – and then actually doing it – is something that requires an enormous effort. Maybe that’s also contributing to the fatigue. I never had any doubts before the operation, but I remember a lot of anxiety. I also remember telling myself, “You’ll be glad you did this, and if you don’t you’ll kick yourself forever.” The night before we left for Amsterdam, I jokingly said to Jim, “Me and my big mouth,” but that’s really it – me and my big mouth. When I see him so glowing with energy, and not troubled by the terrible morning coughs that used to exhaust him, “me and my big mouth” takes on a whole different meaning.

November 24: Yesterday we celebrated Thanksgiving. There were ten of us around the table. It was glorious. I wasn’t sure we’d be able to manage such a feast this year, so soon after the transplant. I’m not supposed to carry anything heavy, which includes the turkey, and I’m not supposed to overexert myself. But nobody wanted to skip it, especially not this year when we’ve just come through such an intense family experience and everyone has so much to be thankful for. Cait took a day off work and organized the dinner, Anne picked up the turkey from the butcher, and everybody pitched in with the cooking and clean-up.

My mother said grace. It was hard for her to get through the tears. We loaded up our plates and sat around the living room together. Dan kept everyone laughing, as usual, and Kylie read us a Maori children’s story.

Jim told me later he has never in his life felt such a prolonged and intense sense of gratitude as he had since the transplant.

I’m grateful he’s feeling so well, grateful to all the kids for their amazing support and help all through this, grateful to the medical community both in Amsterdam and Alkmaar, for their constant care, grateful to Dr. Idu (our surgeon, whose skill is something we’ll take with us all our lives), to our friends for their cards, e-mails, phone calls and visits, to the church, both in Amsterdam and all over the world, for praying for us, for Fr. Sergei and Fr. Mel for bringing us Holy Communion, and for my translation clients who have been so patient during all this. But mostly I’m grateful to the mysterious God who gave me the opportunity to give this gift. It was the most difficult thing I have ever been called to do, and it’s almost as if my whole life had served as a period of preparation.

I am daily discovering how the transplant is affecting my sense of who I am and where I’m going. It is immensely humbling.

December 3: At last yesterday we were able to return to church. The welcome was remarkable, even from people 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 us at length. We understood hardly a word, but felt showered in love. An Eritrean woman who also speaks very little Dutch did the same in her native language.

December 12: It’s six weeks since the transplant. 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 a thesis on George Orwell. The celebration went on until late at night. We got home at 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.

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…

And yet there was that thing I did. There was that yes. There was that “fiat.”

When we returned to church the Sunday before last, it happened to be a Sunday with a guest priest assisting in the sanctuary, Fr. Stephen Headley, archpriest of the Russian Orthodox church in Vezeley, 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 the Latin translation of 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 spent many hours of my recovery time reading all seven of the Harry Potter books. One of the main themes 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.

* * *

Lots to celebrate

2008-04-24T15:42:00.003+02:00

Following up on the entry made three days ago, let me summarize what I learned earlier today from Dr. Frederike Bemelman, a kidney specialist at the AMC.

The main item was more detail about the results of the kidney biopsy done last week: there is no indication of any degree of rejection; no toxicity (a possible consequence of using Neoral, one of the anti-rejection medications I’ve been taking); and no problems with the filters of the transplanted kidney.

Other results of recent tests: no indication of diabetes (those with kidney illness are more at risk of diabetes); creatinine level good (97); cholesterol okay (5.5); LDL level okay (3.2); liver function excellent; hemoglobin very good (8.5); and, finally, no warning signs in my urine (no trace of sugar, protein or abnormal cells ).

In brief, lots to celebrate!

One consequence of the various tests is that my medication can be changed. Instead of Neoral, I’ll switch to a new anti-rejection drug, Certican (Everolimus). At the same time, I’ll stop taking Myfortic, another anti-rejection drug that I’ve been on since the transplant. About a quarter of the patients using Certican experience some side effects the first few weeks, such as skin rash and slightly swollen feet. (If I am one such patient and negative side effects persist, I’ll be switched back to Neoral.) The medication changeover will start a week from Saturday. In mid-June I’m due back at the AMC for a checkup and the usual blood and urine tests.

This journal hasn’t been used to record much detail about medication, but on this one occasion it seems worth saying a little about this aspect of living with a transplanted kidney. It’s likely that the day is coming when other solutions will be found that will no long require a lifelong regimen of drugs for those who have organ transplants, but for now that’s not the case.

I made at stab at saying how grateful I was for the outstanding work she and her colleagues have done for me and Nancy, but tears prevented me from getting very far. Finally all I could do was kiss Dr. Bemelman on the cheek, a surprise for both of us.

Note: Instead of a photo, I’m posting with this the latest kidney-related cartoon from The New Yorker. A real-estate agent is telling prospective buyers of a house that there is one additional selling point. The present owners are “willing to throw in their kidneys.”

"Nothing to worry about..."

2008-04-21T17:36:00.003+02:00

News for this journal doesn’t come thick and fast at this point. It’s now three weeks since the last entry.

In ten days it will be exactly half a year since one of Nancy’s kidneys migrated to my body. Six months is a time, at least in Dutch medical practice, when a major evaluation of the transplant is in order.

One element of the process is a biopsy. But I had some doubts about this, having heard that a biopsy can cause some degree of damage to the organ being checked. As things seemed clearly to be going so well with the transplant, was a biopsy really needed, given that slight risk? I decided before agreeing to it to put my hesitations in writing.

I quickly got the attached response from one of the AMC kidney physicians, Dr. Frederike Bemelman:

“The biopsy is the most sensitive readout telling how your transplant is doing: We can judge your transplant for having a light form of rejection, which cannot be diagnosed either in your blood or urine. We can see whether your transplant is being harmed by the medication you are now taking. If your transplant looks good, we plan to taper the immune suppression medication, which would be a direct advantage for your whole body.

“As for your concerns about the procedure, taking a transplant biopsy is quite easy. The transplant is positioned much more superficially than native kidneys. It can easily be done at the bedside, and in renal patients is often more easy than drawing blood. The complication rate of the procedure is less than 1 in a 1000.

“In other academic medical centers in the Netherlands, such as in Leiden and Groningen, a six-month transplant biopsy is a routine procedure done with all transplant patients. The advantage of the information from the biopsy is considered to outweigh by far the annoyance of the biopsy.”

This was helpful information. Without further hesitation I agreed, and the biopsy was done six days ago, last Tuesday. It meant a long day at the hospital because there is the slight danger that bleeding might occur.

A scan was made -- see the above photo. Using it, Dr Bemelman was able to draw an outline of the kidney on my abdomen and choose the best point of entry for the procedure, meanwhile telling me stories of her two years as a student living in Oxford.

All went well -- no complications, no bleeding, just a quiet day of reading with a hospital breakfast and lunch thrown in. At the end of the day supper was also offered, but -- now free to leave -- I preferred to hasten back to Alkmaar.

But what were the results of the biopsy? Once it was done, I was very much hoping to learn that there is no indication of a “slight degree of rejection.”

Well, now comes the headline:

In the hospital today for several hours of blood tests, the nurse who was helping me told me she had asked about the biopsy and was told: "He has nothing to worry about."

Alleluia! This really made my day.

I will get more detail about the biopsy and other recent tests when I meet with Dr Bemelman three days from now.

What do we mean when we speak of God?

2008-03-31T19:47:00.005+02:00

I had a letter from a friend who confessed he was “annoyed at the Almighty ” because a person who had offered to donate a kidney was found, due to one of the many tests made before a donation can be okayed, to have a medical condition that precludes giving up one of her kidneys.

This letter promoted me to think once again about what we mean when we speak of God. What, in a particular person’s use of the word, is he/she talking about?

This has been on my mind for nearly half a century, since I read Maxim Gorki’s memoir of his early years, Childhood, in which the reader hears his vivid account of his grandparents in prayer in the icon corners of their adjacent rooms.

We find grandfather praying to a God whose everlasting work it is to punish people, a God who welcomes all updates that come his way regarding who is in need of punishing and appreciates advice about what form that punishment might take. Grandfather’s God is more the deity of hell than of heaven.

Meanwhile grandmother’s prayer reveals her as a person whose God is mercy beyond mercy, though she is alarmed enough by her husband’s volcanic god to think she may need to pray that God will please ignore her husband’s advice. Thus she sometimes brings into her prayers an explanation of what prompted this or that person to behave badly.

As I think about the donor who in the end can’t make the donation she wanted to, I find God in the midst of the prospective donor’s act of readiness to give away part of her body for the well-being of another. That in the end it turns out there is a medical reason why this action would not be prudent is not, for me, the heart of the story nor a revelation of the capriciousness of God, a creator who toys with us as cats toy with mice and birds before administering the fatal bite.

Neither have I an attraction to another popular image of God -- God the Divine Baby-Sitter, whose job it is to keep us from driving off the edge of road. For better and (not or) for worse, we bear the awful weight of having to hit the brakes ourselves. Often we fail to do so, and the results can be truly catastrophic.

Another way of putting it: God calls us to be peacemakers but never forces anyone to be peaceful.

(The photo for this posting is a stone carving of Christ with Adam found on the ceiling of the cathedral at Chartres. Double-click to see it in higher resolution.)

Biking again

2008-03-22T09:59:00.008+01:00

We haven’t done any recent postings about Nancy’s recovery from her playing the role of Magnet Lady last month, and being such a powerful magnet that she made a car collide with her, but just two days ago she was on her bike again for the first time since the accident.

She has reached the point of being able to walk without worrying that, if she’s not careful, her right knee might “pop out.” This means that the bands that are part of the knee’s complex architecture have tightened up nicely.

Re the kidney-transplant: One of the surprising things has been how various comparatively minor health issues that I thought were unrelated to my kidney illness have cleared up since the transplant. I learned about the latest as result of my semi-annual dental check-up this week, the first since the transplant. Our dentist, Mario Voogt, took one look at my teeth and was astonished. “Your gums are really in better shape! Much firmer!” The only new factor in my life that accounts for the improvement is the kidney transplant.

(Photo: Two young women on one bike, one steering, the other peddling, seen as I was crossing the Canadaplein -- Canada Square -- adjacent to Alkmaar’s cathedral. Double click on the image to enlarge.)

on the road about a hundred years

2008-03-19T14:49:00.002+01:00

Nancy writes: "This fire truck came zooming down the Kanisstraat this morning, contained in a large box mailed to us from California by our brother-in-law, Charles Berrard, who had found it while clearing out my parents’ former house in Pacifica. Boy, does this bring back memories. My grandparents were Dutch immigrants, unlettered Ellis Island immigrants. My grandfather worked in Ridgewood, New Jersey, as an odd-job man, and one of his customers had given him this fire truck. It must be a hundred years old at least. They kept the fire truck in their basement, next to the coal chute. It was the only time I've ever seen a house that still had coal in it. I remember thinking that it was a very old toy when I was little, 50 years ago. I remember playing with it in my grandparent's house in Ridgewood. It had belonged to my father when he was a boy."

Saying "thank you" with an icon

2008-03-10T17:41:00.006+01:00

Yesterday was an important day in our kidney transplant saga -- a day for saying “thank you.” We did this by giving a newly-painted icon to our parish, St. Nicholas of Myra Russian Orthodox Church in Amsterdam, a community which in so many ways gave us support through the long period of my kidney illness. On the day of the actual transplant, the church organized a special service of prayer.

The icon is of four saints, all of whom died in Nazi concentration camps toward the end of World War II. They were involved in a work of dangerous hospitality during the occupation of Paris. They saved the lives of many people, especially Jews. How many were rescued, no one knows, but it is at least a number in the hundreds.

In the photo you see our rector, Fr. Sergei Ovsiannikov, presenting the icon after the liturgy. St. Maria Skobtsova, who founded the house of hospitality and is the best known of the four, stands on the left. On the right is Fr. Dimitri Klepinin, the priest who was her main partner in the community’s work. Also note, on the raised edge of the icon, the smaller figures of two other co-workers who also became martyrs: St. Ilya Fundaminsky, on the left, and St. George Skobtsov, on the right.

The icon is the work of John Reves, an American living in Austria. John has been our guest the last few days, having come to Holland to hand deliver the panel and to be present for its reception by the parish.

For detailed photos of the icon, see those just added to this folder of Mother Maria-related images on our Flick site:

http://www.flickr.com/photos/jimforest/sets/72157594152181792/

For an essay (“Saint of the Open Door”) summarizing the work started by Mother Maria Skobtsova, see:

http://incommunion.org/articles/resources/st-maria-skobtsova/saint-of-the-open-door

For links to other texts by and about her and this amazing community, see this page:

http://incommunion.org/contents/mother-maria

It happens that one of the grandchildren of St. Dimitri Klepinin, Tania, is married to one of the clergy of our parish, Deacon Hildo. Tania and Hildo have recently had their first child, named Maria, after Mother Maria Skobtsova.

The thanks we expressed in our church yesterday is not only to the members of our parish but to everyone who in some way, through prayer or caring thoughts or practical assistance, have helped carry Nancy and me through these last few years and especially through the transplant itself. I hope in time we can make a card of the icon and send it to all the people we want to thank.

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

A Donor Match Over Small Talk and Coffee

2008-03-05T12:58:00.003+01:00

It is always encouraging to discover new kidney donor stories. Here’s one that was in yesterday's New York Times [Photo: Annamarie Ausnes, left, will receive a kidney from Sandie Andersen, who works at the Starbucks coffee shop that Ms. Ausnes frequents.]

* * *

New York Times / www.nytimes.com / March 4, 2008

http://www.nytimes.com/2008/03/04/us/04barista.html?ex=1205298000&en=274e647622188980&ei=5070&emc=eta1

A Donor Match Over Small Talk and Coffee

By William Yardley

Tacoma, Wash. — Annamarie Ausnes is known for holding up the line at her favorite Starbucks here, carefully counting out her coins to pay for her "short drip, double-cupped" daily jolt. Over the years, Sandie Andersen, a friendly barista behind the counter, might have rolled her eyes once or twice but she has also taken these morning moments to make conversation, to make friends.

"She reached over the counter and said, 'I'm a blood match,' " Ms. Ausnes said last week, recalling the conversation.

Ms. Andersen said, "We both stood there and bawled."

Turns out, Ms. Andersen had made Ms. Ausnes a special offer, off menu. On March 11, the two women are scheduled to go into surgery at Virginia Mason Medical Center in Seattle. If all goes well, when they come out Ms. Ausnes, 55, who has polycystic kidney disease, will be the new owner of Ms. Andersen's left kidney.

Ms. Andersen, 51, has worked at Starbucks for more than four years. She said she had taken the job for the good corporate health benefits, which her husband's job does not provide. Her husband, Jeff, did not realize his wife would also be providing health benefits.

"My husband said, 'Next time someone comes in and says they don't feel good, don't give away another body part,' " Ms. Andersen said.

Ms. Ausnes, an administrative assistant for student government at the University of Puget Sound, said she had been buying her morning coffee at this Starbucks, at North Proctor and 26th Streets, for three years. She has known for nearly two decades that she has a kidney disease, but her kidney function has declined significantly recently.

Last year, after tests showed that family members could not provide her with a transplant, it became clear that dialysis and a wait of some years for a donor were inevitable. Ms. Ausnes never mentioned this during her daily exchanges with Ms. Andersen.

"It looked like dialysis was coming close and I just said, 'Annamarie, you never know where a donor's going to come from,' " recalled Wanda Ryan, the transplant coordinator at Virginia Mason who is handling her case. " 'Keep telling people your story.' "

In November, not long after that conversation, Ms. Ausnes stopped into Starbucks as usual, but this time Ms. Andersen noticed that her customer was glum. Ms. Ausnes finally told her the news, and the response was instantaneous.

"I'm going to get tested," Ms. Andersen said.

And she did. Blood type O? Yes, a match. Negative cross-match under the microscope? Yes, perfect. The six elusive DNA markers? One of six was alike, not ideal, but good enough.

So there they were that morning last fall, crying over the counter while the coffee line grew longer.

Both women expect to be in the hospital for about a week then to be out of work for up to six weeks. Howard D. Schultz, the chief executive of Starbucks, called both women and told Ms. Andersen "how proud I am to have someone like you working for our company."

She joked about Mr. Schultz's recent, well-publicized emphasis on having employees make a "human connection" with customers.

Ms. Andersen, who has done missionary work in Mexico and helped dig mud out of houses in New Orleans after Hurricane Katrina, said this latest gesture should not be viewed as unusually magnanimous. People should give freely of themselves, she said, and they do more often than is noticed.

Ms. Ausnes will undergo regular monitoring and testing and will need to take medication regularly for the rest of her life to prevent her body from rejecting Ms. Andersen's kidney, according to Ms. Ryan, of the hospital. Ms. Andersen, who was interviewed extensively by the hospital to make sure she was physically and mentally stable, should be recovered in six months, charged only with keeping a slightly sharper eye on her basic health and diet.

Ms. Andersen said, "I asked my surgeon, 'Will I be able to snowboard afterward?' He said, 'Do you snowboard now?' I said, 'No, but I'm hoping to.' "

I can walk!

2008-02-25T19:35:00.003+01:00

Take my word for it, donating a kidney is a thousand times easier than getting hit by a car -- less painful and much more gratifying. It’s nine days since I got clipped by a slow-moving vehicle while trying to defy traffic regulations and cross on a red light in Amsterdam. Jim has already described the accident in some detail. The first few days were pretty bad. I camped out on the living room couch for several days and could only get to the bathroom by swinging through the kitchen like Tarzan (this is the only time I’ve appreciated our tiny, narrow kitchen). Then came the dining room chair stage when I navigated by pushing a chair across the room, the way Dutch children learn to ice skate (back when we used to have ice). Then I moved on to a wooden cane. Today, for the first time, I walked from the bedroom to the upstairs bathroom without any assistance.

My knee is quite unstable, and until today I couldn’t trust it to hold me up. It sort of slipped out of the socket and splayed outwards, a weird feeling but painless. When I got up this morning I realized the knee felt stronger, and that I could actually walk on it. I went to the doctor this morning, who told me she didn’t think there was any tearing and that the knee was healing. Good news. Wednesday I start physical therapy.

I’m taking a strong painkiller, which forces me to nap a couple of times a day. I’ve had to simply stop doing everything I normally do, sit back and heal. Jim has been wonderful. He’s actually a very good cook, but I tended to monopolize the kitchen. This may change. I think I’ve been taking on way too much, and it may have taken a slow-moving car to get me to ponder the consequences of this. If it hadn’t been the car it would have been something else -- illness, perhaps.

Life is more than doing your best, or striving for excellence, or even being good. It’s not just a one-man operation. It’s about building community and friendships, sharing chores, learning how to delegate, admitting shortcomings and areas of weakness, and understanding there are some things you just can’t do yourself. In short, it’s all about learning humility. Some people know this instinctively. Others have to step in front of a car to find it out.

(The photo: a bouquet of tulips sent by our parish council.)

upward bound

2008-02-22T16:32:00.005+01:00

It’s going better with Nancy. Last night, for the first time since Saturday, she was able to climb the stairs -- very carefully, operating herself like a crane lifting fragile cargo -- and was rewarded by being able to sleep in our bed instead of downstairs on the couch. (This means I’m no longer hauling our guest mattress downstairs each night and camping out on the living room floor.)

Her knee was significantly less swollen this morning and the bruising much less in evidence. The mummy-like leg wrapping she had been given at the hospital on Saturday has now been replaced by a trim elasticized bandage, a type mainly meant for people with sports injuries, that I found at the local pharmacy.

After a few days of worry about long-term problems walking, we are daring to hope that her knee will heal without special treatment or surgery

She still tires easily.

Since late yesterday afternoon, she is on prescription pain medication that is working quite well.

For all those who have been keeping Nancy in their prayers, our thanks. If human beings had sails, prayer would be the wind.

Slowly mending

2008-02-21T11:41:00.005+01:00

It is not entirely a play on words to say that we are hard-hit. If a slow moving car can disrupt one’s life so significantly, what must it be like to have a more serious accident? Nancy’s main worry at present is that, although the x-rays taken Saturday showed no broken bones, damage may have been done to the soft tissues, something that can only be spotted with an MRI. She has an appointment to see our GP on Monday morning, by which times she hopes that walking will not be so painful. Unless things have taken a turn for the better, I expect he will refer her to the local hospital for a closer look at her knee.

Nancy wrote to a friend last night: “This morning Jim helped me take off the pressure bandage to take a much anticipated shower. We were startled to see how wretched my poor old knee looks -- all swollen, like a lumpy grapefruit, black and blue up and down the leg with a big nasty patch at the hip. As the pain level is pretty high, I'm switching from paracetamol to Aleve in hopes that this will help. I hate medication, but I also hate pain. It's much worse than the kidney transplant -- that was a piece of cake.”

The Aleve really helped, but only if she took more than the recommended dosage. This morning Nancy contacted our GP to see if he would prescribe something more effective.

As Nancy’s office is currently inaccessible because of the staircase that stands in the way, yesterday she and I set up a laptop computer for her with all the files and programs she needs. She is hoping today to work on a children’s book she is translating into English for a Dutch publisher.

There is truly such a thing as laugh therapy. Nancy has been hugely enjoying an anthology of short essays by S.J. Perelman, most of them originally published in The New Yorker, and also Bill Bryson’s memoir of growing up in the fifties, The Life and Times of the Thunderbolt Kid.

Last night, at Anne's recommendation, we watched an excellent documentary called "The Architect" about the strange life of the American architect Louis Kahn. It was made by his son. Kahn had three parallel families who didn't know each other, and after his death his son decided to find out about his father's life. Very moving.

Spring is hard at work just outside our windows with its own news of healing. Crosuses and snow-drops are plentiful.

The day after

2008-02-17T20:38:00.005+01:00

Nancy has been home a full day and little by little is mending. For the time being, she has to live downstairs. Climbing stairs is currently not an option. She walks with difficulty and pain, doing so only to go to the bathroom in the back of the house. Every move she makes requires careful planning. To make it easier, I’ve placed a few wooden chairs in spots where Nancy can use them for support. Her blood pressure is low, though better than it was yesterday. She tires quickly and then has to nap; in the photo you see after waking up from a nap late this afternoon. She counts it as a major achievement that earlier today she was able to feed our cat, Beckett, while passing through the kitchen.

If one must get hit by a car, the results could have been far worse. No broken bones. No concussion. No damage to her kidney. The main impact area was her right knee. The only bleeding was from a wound in the back of her head.

I'm taking a crash course in home nursing. I would give myself mixed grades. At breakfast I managed to spill the freshly-squeezed orange juice (one of my normal morning chores) all over the living room carpet. On the other hand lunch and supper went well. I’ve also washed the blood off the canvas bag she was carrying -- it hasn’t been this clean in years -- and also off the wool sweater she was wearing.

Nancy has done a good deal of reading these past 24 hours, mainly the novel, Pillars of the Earth, but also an anthology of humorous pieces written by S.J. Perelman. It was a joy to hear her laughing.

She arranged this accident, several few members of our parish have suggested, in order not to have to attend the parish meeting that followed the liturgy today. Nonetheless she was elected secretary of the new parish council, to be installed in March.

An unexpected visit to the hospital

2008-02-16T22:16:00.006+01:00

It has been in our thoughts in recent days that it was about time -- about a hundred days after the transplant -- to add an entry to our kidney journal.

What had especially been in both Nancy’s thoughts and mine was a growing awareness that, since Nancy’s gift of a kidney, giving comes more easily than in the past. While neither of us are the tight-fisted sort, still -- self-employed people that we are, with income being far from predicable month to month -- we tend to watch expenses fairly carefully and sometimes think long and hard about gifts and donations to be made. Now we find it much easier making gifts.

Lesson: Once you have donated a kidney, or received such a gift, other donations come much easier.

There you have, in brief, what might have been a longer journal entry, but I make it brief to add the day’s main domestic headline -- that Nancy was hit by a car just after noon today when on her way to a lunch in Amsterdam with other translators. Crossing a street, she saw a green light on the far side of the street but failed to notice a red light for the lane closer to her. She stepped out into the street and was hit by a slow moving car making a turn. Knocked down, her right knee and the back of her head took most of the impact.

The distressed driver and a number of bystanders immediately did all they could to help her. They were really wonderful, Nancy reports. Should you ever want to get hit by a car, she recommends you do it in Amsterdam. Friendly strangers will rush to your assistance.

One of them called for an ambulance. Soon after, she was brought to the emergency section of the nearby Lucas Andreas Hospital.

The head wound, though bloody, was quickly closed -- no stitches were needed. Nancy’s gray air now includes a punkish pale purple halo.

After two x-rays were made, Nancy was given the good news that, though the right knee was painful, bruised and swollen, no bones had been broken. Her right knee was bandaged.

Nancy’s main worry was that her one kidney might have been injured. She was hugely relieved when a urine test showed no trace of bleeding or other indication of damage. (On Monday we’ll contact the kidney staff at the AMC to see if they want to do any further testing.)

Luckily, Nancy had our mobile phone with her. As soon as she was able, she called me. Dan happened to be at our house just then. As soon as I left for Amsterdam, he made calls to the rest of the family, at least those here in Holland. As a result, by the time I got to the hospital, Thom and his partner Kylie had already been there half an hour.

The worst part of the ordeal for Nancy was suddenly going into shock, something that happened just when she thought she was in the clear and had made a reassuring call to me. She found herself short of breath, covered with sweat, pale as a sheet, and shaking uncontrollably. Several staff in the emergency ward, immediately coming to her aid, found her blood pressure had plummeted. She was put in bed, covered with warm blankets, and given an IV. It took about half an hour for the trembling and sweating to stop.

About four hours after she had been admitted to the hospital, we returned to Alkmaar by taxi. Taking the train was not an option, as Nancy has difficulty taking even a single step, and will need help getting about for at least the next day or two. For the time being, she will be leading a downstairs life.

She is in good spirits, has talked to several people on the phone, taken a couple of naps, and is now reading a novel about life in twelfth-century England (The Pillars of the Earth).

Slaying the dragon

2008-01-28T21:55:00.000+01:00

Like a pregnancy, three months is the magic number in kidney transplants. During the first three months after the operation, everybody stands around waiting to make sure that the transplant “takes.” The doctors are alert to any sign of rejection. If after three months the kidney is still behaving itself and shows no signs of quitting, the doctors -- and the donor and recipient -- breathe a sigh of relief.

On Thursday it will be three months since the operation. Today (Monday) I went for my first check-up with the transplant team at the AMC in the person of Sylvia ter Meulen, the head of the live transplant team. Sylvia is one of those people with a big smile who just oozes positive energy and enthusiasm, and when I told her I felt great and had not a single complaint she just glowed with happiness and satisfaction.

One interesting development that we discussed was this peculiar feeling of energy and good health I’ve noticed -- peculiar because not only do I feel normal, but I feel better than normal. I find myself coming up with new ideas: things I want to change, such as the logo of the business and the whole computer operating system I’m working on. I want to send out a mailing to my clients to thank them for their patient kindness during my convalescence and to let them know I’m fully recovered. I’ve volunteered to join the parish council again, and have agreed to become the church secretary. But I also feel more awake then ever. I feel more spring in my step. I feel less beaten down, less overwhelmed, less frustrated by a lack of time or energy. I feel more capable, stronger.

Jim recently told Sylvia about this at one of his bi-weekly check-ups, and she replied in an e-mail, “I'm glad Nancy is doing so well, though it doesn’t really surprise me. In fact, some studies (I believe in Sweden) even show that living kidney donors experience a better quality of life after donation!” I found a scholarly article on the internet about the quality of life of kidney donors (“Impact on living kidney donors: quality of life, self-image and family dynamics,” Nephrology Nursing Journal, Sept-Oct, 2005 by Patricia A. Fisher, Denise J. Kropp, Eileen A. Fleming), and several paragraphs stood out:

Quality of life issues have been studied in regard to living kidney donors. According to Ciszek, Paczek, and Rowinski (2003), kidney donors have been reported to have enhanced life quality and self-esteem. Other quality of life studies (Corley et al., 2000, Gouge et al., 1990) have also shown that donors were generally positive overall about donation, but that it did not enhance their overall quality of life.

This article is a report of a study that was conducted with a group of live kidney donors from Akron City Hospital in Ohio (all the surviving live donors whose donation had occurred since the transplant program there began in 1967 and who could be located, or 119 individuals). As a result of the study:

Sixty-two percent of the donors in this sample rated their current health as very good to excellent. The average standardized physical component summary scale score of the SF12 for this sample was 51.5 with a standard deviation of 7.3, which is slightly higher than the norm of the general U.S. population average score of 50.12 (Ware, Kosinski, & Keller, 1998). The majority of the participants (75%) reported not being limited at all in physical functions, but 9% reported that bodily pain interfered with their normal work quite a bit of the time. The average standardized mental health component summary scale score for this group of donors was 50.6 with a standard deviation of 9.21, which again is slightly above the U.S. general population norm of 50.04. Only one person reported feeling downhearted and blue all of the time, while 71% reported feeling this way little to none of the time.
…

Overall, donors were satisfied with their decision to donate. Ninety-one percent of the donors reported that if they could go back, knowing what they know now, they would make the same decision to donate. Even those that ranked the negative factors of the decision-making process as important reported that they would encourage another person to donate (r = -0.24, p = .039).
…

Individuals who decided to donate of his or her own free will were generally very satisfied with the decision to donate. The majority of donors felt a continued sense of closeness with their recipients as well as an enhanced happiness and self-esteem.

Sylvia echoed these sentiments in her talk with me today. She said donors generally begin valuing life and their own health more. This is quite true. I’m deeply grateful that I was healthy enough to give Jim my kidney, and I’ll never again take my health for granted. I’m relieved the whole thing is behind us and relieved it all turned out so well. I guess “self esteem” has something to do with it, although I don’t go around feeling like a hero. The stress is gone. Someone at church yesterday pointed out that I had made the ultimate sacrifice, that I had done all that could be done, and this knowledge must have some kind of impact. We know that stress has an enormous impact on physical well-being. In the year since I began being tested as a possible donor I’ve lost 7 kilos, or 15.4 pounds! I’ve gone down a whole size. So the reverse must also be true: the impact is just as enormous when the stress is gone.

But I also wonder if it also doesn’t have something to do with the triumph over fear and the decision to act out of freedom. I told Jim yesterday that it was like fighting a dragon and winning. I think the reason I don’t go around feeling like a hero is that I know how difficult it was to say yes and to overcome my fears, and I have no more illusions about my own weaknesses. I know that the next challenge that presents itself is going to demand a brand new decision, that the dragon is never really slain, and that the best you can do is to sharpen your dragon-slaying skills. It’s worth the effort.

my first MRI

2008-01-17T13:00:00.000+01:00

In the hospital in Amsterdam the day before yesterday, I had the strange experience of my first MRI. This means being inserted into a narrow tubular space inside a massive science-fiction-like machine that manages to look, in high resolution detail, at the inside of the body as if it were a fish bowl. This is done with focused magnetic impulses, apparently very powerful. It’s an amazingly noisy machine. I had imagined eery silence. Instead I felt like I was spending half an hour in a crawl space beneath a street that was being attacked by pneumatic drills. I was provided with a pair of earphones so that I might listen to what was described as "easy listening" music, but the music was audible only in those brief intervals when the pneumatic drills took a break.

The MRI scan was requested by one of my doctors several weeks ago when I was having a lot of pain where my hips are joined to my legs -- almost certainly a side effect of the anti-rejection medication I'm taking daily.

Since the MRI was scheduled, probably due to changes in medication, my legs are back to normal. I can bike again, and walk without giving it a second thought. No need of a walking stick.

The results of the scan? I may find out tomorrow when I have my next appointment at the AMC's out-patient clinic for kidney patients.

A fireplace of welcome

2008-01-05T21:23:00.000+01:00

The photo is a view of the reception counter of the kidney illness unit of the AMC’s Polyclinic (for out-patient care). It's a very familiar sight. During the first few weeks following the transplant I was here twice a week. Now it’s once every one or two weeks. Nor are the visits ever brief. I get to do a lot of reading while I await my turn. These last few weeks it has been Tolstoy’s War and Peace in the new translation done by Richard Pevear and Larissa Volokhonsky. (If you have never read it, now’s the time. I doubt there will ever be a better translation in English.)

The woman behind the counter on the right, Ruthline, is always a fireplace of welcome, not only eager to know how I’m doing but certain to ask about Nancy as well. She loves speaking English, so we almost always converse in that language. Checking my blood pressure a week ago in an adjacent room, the word “God” entered our conversation. “I thank God,” she said, “that things have gone so well for Nancy and you. I have been praying for you.” “Believe me,” I assured her, “we thank God every day.” “You believe in God?” she asked. “Oh, yes,” I told her. “Isn’t it sad,” she said, “that so many people don’t? How is that possible?” I suggested it might have less to do with God than with negative experiences people have of churches, or the negative church experiences of others they have heard or read about. Also, for some, belief in God is just not fashionable. “That must be it,” she said. “Maybe all those things.”

We started laughing. In fact I laughed so hard that she had to take my blood pressure again as she thought the laughter would have thrown the reading off.

I had thought that a journal about a kidney transplant would surely end not long after the transplant, assuming all went well. In fact the transplant seems to have been entirely successful, and yet, even two months later, an occasional update seems in order, if only to share the post-transplant side of the event, as the AMC’s kidney staff keeps a very sharp eye on how things are going with all their transplant patients, intensively so the first few months.

Tests, tests and more tests. Last week’s laboratory visit at the AMC required filling twelve small vials for twelve specific blood tests. Happily it was only four vials yesterday.

The numbers continue to be good. My kidney function, as computed yesterday, is 88 percent -- a good deal better than is generally found in people four years short of seventy. The maximum might be found in a young person in excellent health.

The latest reading of my creatinine level is 118. Compare that to over 900, as it was on October 30, the day before the transplant.

Another welcome sign: Eight days ago, I had to use a walking stick in getting to the hospital. It was slow going. My left leg had been troubling me for days, which doctors at the AMC assumed was a side effect of the anti-rejection medication I’m taking. Yesterday I was able to make the journey on my own two legs, nor had I used the walking stick at all throughout the past week. Perhaps this has to with the reduced dosage of Neoral, one of the medications they watch most carefully, or the increased calcium I’ve been taking lately, or simply my body adjusting to medication. Still, in order to have a better idea of how the joints and surrounding muscle and tissue look in the area where my legs meet my hips, an MRI is scheduled for January 15.

A note that has nothing to do with kidneys or hospitals: for Russian Orthodox parishes, it’s almost Christmas. As we’re on the “old calendar,” Christmas comes thirteen days later than it does for most other Christians. By this reckoning, tomorrow is Christmas Eve. All this can be a bit confusing for those not living in Russia or part of a Russian parish in the west, but it can have its advantages. In our case it means a two-tiered Christmas celebration -- the days of December 24th through the 26th a time for family events, then a liturgical Christmas mainly centered at our parish in Amsterdam.

Merry Christmas!

The New Yorker strikes again

2007-12-27T15:35:00.000+01:00

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

2007-12-18T21:20:00.000+01:00

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!

2007-12-12T22:14:00.000+01:00

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...

2007-12-12T20:06:00.000+01:00

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

2007-12-04T23:00:00.000+01:00

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

2007-12-03T20:41:00.000+01:00

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

2007-12-01T16:56:00.000+01:00

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.

Good news

2007-11-27T11:34:00.000+01:00

Jim went to the AMC in Amsterdam for his semi-weekly check-up yesterday (he also goes on Fridays) and was told that he doesn't have to go back until next Monday! Super-K is doing just fine. The only side-effect of the many medicines he's taking are large, impressive-looking and (he says) painless bruises on his legs. He looks as if he's been kicked by hooligans. The doctor said this is because the dosage of the blood-thinning injections he's giving himself is too high, and she promptly lowered it. The injections are to prevent thrombosis and only have to be taken until December 2 anyway, so that's one less medication to think about (and the least pleasant to administer).

I'm finally feeling almost normal this week. Much less fatigue, and a renewed interest in getting back to work. Yesterday I worked my way through most of the bookkeeping that had mounted up since the operation and got back in touch with some of my translation clients. I'm expecting a rather large job next week as well as the corrections of a children's book I translated back in the summer. So here we go again.

It seems odd to be be getting back to the routine without the prospect of impending major surgery in the back of my mind and without the constant concern for Jim's failing kidneys. Certainly we'll never take our health for granted after this.

[Photo of Nancy at work; double-click top enlarge.]

Giving thanks

2007-11-24T12:27:00.001+01:00

Yesterday we celebrated Thanksgiving, one day later than the official day in America. We usually postpone Thanksgiving to Friday because obviously it’s not a holiday here and by doing so everybody can sleep late on Saturday. There were ten of us: Jim, Nancy and Lorraine plus seven kids. It was glorious.

I wasn’t sure we’d be able to manage such a feast this year, a little over three weeks since the transplant. I’m not supposed to carry anything heavy, which includes the turkey, and I’m not supposed to overexert myself. But nobody wanted to skip it, especially not this year when we’ve just come through such an intense family experience and everyone has so much to be thankful for. So Cait took a day off work and organized the dinner, Anne picked up the turkey from the poultry butcher (where I had ordered it a week before), and everybody else pitched in with the cooking and clean-up.

My mother said grace. It was hard for her to get through the tears, but she thanked the Lord for uniting her with her family after a year of such tragedy (my brother’s death in March). We loaded up our plates and sat around the living room together. Dan kept everyone laughing, as usual, and Kylie read us a New Zealand children’s story (she’s Maori, and the book is written in both Maori and English).

Jim told me later he has never in his life felt such a prolonged and intense sense of gratitude as he had since the transplant. Super K continues to work beautifully, although Jim does have some side effects from the immuno-suppressive medicines he’s taking. He keeps noticing other positive changes in his health, things he never would have related to kidney function before but now all seem to have been somehow connected to less than optimal renal function.

I’m grateful that he’s feeling so well, grateful to all the kids for their amazing support and help all through this, grateful to the medical community -- at the AMC and in Alkmaar -- for their constant care, grateful to Dr. Idu (the wonderful surgeon whom we met for only a few minutes but whose skill is something we’ll take with us all our lives), to our friends for their kind cards, e-mails, phone calls and visits, to the church, both in Amsterdam and all over the world, for praying for us, for Fr. Sergei and Fr. Mel for visiting us and bringing us Holy Communion and for my translation clients who have been so patient during all this. But mostly I’m grateful to the mysterious God who gave me the opportunity to give this gift. It was the most difficult thing I have ever been called to do, and it’s almost as if my whole life had served as a period of preparation.

Like Jim, who seems daily to be discovering how the transplant is affecting his total health, I am daily discovering how the transplant is affecting my sense of who I am and where I’m going. It is immensely humbling.

(Photo: Our two Thanksgiving pies. More photos of the celebration are on our Flickr site.)

Three joyful weeks

2007-11-20T22:36:00.000+01:00

Tomorrow it will be three weeks since the transplant. Three joyful weeks.

I was at the hospital in Amsterdam yesterday for the usual twice-a-week tests, plus a new echo scan, as Dr. van Donselaar wanted to make sure all was well with the kidney. She noticed a small cloud of lymphatic fluid that was left from the operation and so plans to take another look, possibly as soon as this Friday, to be sure this is putting no pressure on the kidney.

She also changed one of the prescriptions. All through November I am injecting myself with a blood thinner twice a day as a safe guard against blood clots. The medicine I was originally taking occasionally has the side effect of causing swelling and bruising in the area of the injections, originally my right and left legs. It happened to have this consequence for me, so I’ve now been switched to a different blood thinner which I’m injecting just above my abdomen. Meanwhile I must be patient as I wait for the swelling in the legs to recede. Given the muscles involved, it makes standing up, sitting down and climbing stairs mildly painful. Fortunately walking involves other muscles.

When one contemplates the long list of possible side-effects of all the medication I’m taking, this one problem hardly deserves mentioning.

Most aspects of domestic life at Kanisstraat 5 are now what they were before the transplant. We do our own shopping and are no longer eating microwave meals: spaghetti and meatballs last night, steak, potatoes and peas tonight.

This past Sunday, when ordinarily we would have been taking part in the liturgy in Amsterdam, we instead went for walk to the Alkmaarderhout -- the Alkmaar Woods -- part of which is a small zoo (farm animals, chickens, peacocks and some other exotic birds, plus a herd of deer and two llamas). It’s a walk as least at long as the one we ordinarily take in Amsterdam when going to our church and made us realize that we should be able to return to church next Sunday -- though I must ask at the AMC on Friday whether they’re ready to give the green light.

Almost a month ago, October 22nd, I wrote a brief refection for this journal about the original oneness of Adam and Eve. These past two days I’ve spent some hours working to develop this into a longer essay for possible use in the winter issue of In Communion. As part of the process, I’ve been reading commentaries on the Adam ands Eve narrative by those theologians of the first millennium who are known as the Church Fathers, due to the importance of their contributions to clarifying basic truths. I was especially impressed by a sentence from Gregory of Nyssa, a saint of the fourth century: “One who is made in the image of God has the task of becoming what he is.”

This links in my mind to something Merton said in a talk he gave in Calcutta not many weeks before he died: "What we have to be is what we are."

(Photo: A view of the Singel, the canal that encircles the center of Alkmaar, taken during our walk to the Alkmaar Woods on Sunday. The one windmill left in the town center, the Molen van Piet, is in the background.)

Wooing the donors

2007-11-18T11:08:00.000+01:00

Our niece Beth made a comment on my last posting regarding financial remuneration for kidney donation (Crossing the Line from No to Yes). I had said that for me, guaranteed health care for life wasn’t what pushed me from no to yes. Beth replied, “As someone who lives paycheck to paycheck, making a commitment such as this without knowing I was secure financially during the surgery and recuperation would be a big deal -- home care wouldn't be enough -- I'd need to know my bills were being paid, my rent covered.”

I had the same fear before I made my decision. What if the operation left me weak and unable to go back to work for several months? That would be a situation we could ill afford. This is why I suggested a publicity campaign -- to dispel that fear. Perhaps there are some people who really are debilitated by the donation of a kidney, but obviously the percentage isn't very high. A few months before the operation there was an information meeting on kidney transplants held at our local hospital in Alkmaar, where Jim was undergoing dialysis. The meeting was conducted by doctors and by the head of the transplant team at the AMC in Amsterdam. It was a very good, informative meeting, but I wonder how much better it would have been if a recent kidney donor had also taken part? We could have asked that person loads of questions: did it hurt much? How does it affect your quality of life today?

Beth is right, of course. You can’t go into something like this without knowing all your bases are covered. I realize the health care systems in the US and the Netherlands are very different, and there are more safety nets here -- but even so, people do donate kidneys in the US. How do they manage it? That would have to be part of the publicity campaign. The Dutch Kidney Foundation is a very powerful and helpful institution here, and the American Kidney Foundation is no different. Certainly they would have advice. The thing is: if particular societies want to encourage kidney donation, they have to woo the donors. Everybody’s got different needs. Some people need to have their bills paid, others need to have their small children cared for while recovering. And no one should lose his livelihood or his health insurance because he decided to donate a kidney!

Rip van Winkel

2007-11-17T15:32:00.000+01:00

(Today’s photo: While Nancy recovers from the surgery of eighteen days ago, she finds herself needing a nap or two each day. Our cat Beckett almost always volunteers to assist her in napping, one of his great talents. Double-click on the photo for a bigger version.)

Over the past five years, when the kidney illness was first detected thanks to a blood test, I’ve many times said to friends, “If I didn’t know I was sick, I wouldn’t know I was sick.” I was able to continue my usual work. I wasn’t in pain. I didn’t feel at all diminished. In most regards, life went on as normal. Writing seemed to take more time -- The Road to Emmaus: Pilgrimage as a Way of Life ended up being a three-year project rather than one, as I had imagined when I signed the contract with Orbis, but was a better book for all the time it took.

The most obvious major change came when dialysis became necessary a year ago January -- that took about a 60-hour bite out of my usual work schedule each month, but even then I was able to use the time for reading, which proved a god-send. Travel became far more complicated (it’s time-consuming and sometimes frustrating setting up dialysis in other countries), but even so I managed to get to quite a few places in response to lecture invitations: France, Italy, Spain, Greece, England, Canada, the USA.

Probably because the disease had been noticed at an early stage, I was one of the more fortunate people coping with renal failure. Treatment began earlier than is often the case. I was the one dialysis patient coming to the hospital by bike rather than taxi.

But now that I’m living with a healthy kidney, I suddenly realize just how much impact the illness had on me, though it came on so slowly that I was hardly aware of the changes. I feel a little like Rip van Winkel waking up from a multi-year nap. The world seems brighter, colors more intense, tastes more intense. I find myself looking at familiar things with a sense of surprise. A friend told me how her brother, after receiving a donated kidney, felt like he was seeing the sky for the first time in ages. Even though I’m still recovering from surgery, I find I tire much less easily than before. I was often sleeping eight-and-a-half hours a night before; now it’s typically seven-and-a-half.

The doctors at the AMC are pleased with how it’s going. I see them often -- two appointments per week the first three months following the transplant. I was there again yesterday.

A question: Will this remain an approximately daily journal? Probably not. The recovery is coming along nicely for both of us. Nancy’s kidney, Super-K, is working with enthusiasm. There have been no signs of organ rejection, the primary worry of any transplant patient. I cannot even complain about side effects of the various medicines I take each day -- luckily so far they have given me a miss. It doesn’t make sense to make a daily posting that basically says “all is well.”

There’s the possibility of turning this it a journal that casts a wider net and in which the transplant is no longer the arch stone. We’ll have to think about it. What are your suggestions? The advice-needed sign is out.

Widening borders

2007-11-15T20:59:00.000+01:00

It’s now fifteen days since the transplant and we find ourselves steadily widening our borders. Yesterday we went for a long walk in the town (Nancy had to replace the watch that was stolen last week, while I was looking for a broad-brimmed hat). Later in the day we walked to the Alkmaar hospital, bringing flowers and a box of Belgian chocolates to the nurses who took such good care of me during my 21 months as a dialysis patient.

Today, in the late afternoon, we did our food shopping for the first time since coming home, walking to the supermarket we prefer -- the local Albert Heijn, on the far side of the North Holland Canal. In recent days this was a chore our daughter Anne had been doing it for us. Anne -- who had come over to vacuum the house and do laundry -- was anxious that we would carry the groceries home in sacks, exactly the kind of lifting we are under doctor’s orders not to do for six weeks, but we reassured her we would use our shopping cart on wheels. (The kids don’t trust us for a moment to take it easy.)

Nancy spent more time at her computer today than she had on any day since coming home. She wanted to do a little more work on yesterday’s posting to A Tale of Two Kidneys and submit it to the NCR Handelsblad for possible publication. She also wrote o the Dutch Kidney Foundation, the Dutch Minister of Health, and the Vice Premier of the Netherlands, André Rouvoet, in each case attaching “Crossing the Line from No to Yes.” Nancy has definitely slipped into campaigning mode.

Walking down the main street of central Alkmaar, the Langestraat, this afternoon, we both felt like people whose eyes had suddenly been widened. The sun was setting. What little sunlight there still was couldn’t reach the cobblestones but had gilded the thin spire of the town hall, one of Alkmaar’s oldest buildings. We stopped and stared like children dazzled by a Christmas tree.

Crossing the line from no to yes

2007-11-14T21:13:00.000+01:00

Since Jim has been told that his immuno-suppressive drugs make him more vulnerable to skin cancer and that he should put on strong sun screen whenever he is exposed to the sun, he decided to buy a broad-brimmed hat. We’ve also seen a couple of friends recently who were sporting such headgear, and they looked good. So we went downtown today to pick up a Stetson. I personally think this is just the thing. He is now referring to himself as Indiana Jim.

Just two weeks since the kidney transplant, and I find myself thinking less about my present medical condition and more about the bigger picture. This has partly been sparked by a discussion now taking place in the Dutch parliament, having to do with the dire need in the country for kidney donors. The problem is that the number of deceased donors is low here because of the relatively low number of traffic accidents, which I understand to be the main source of such kidneys. Good news with a twist. So the government is kicking around the idea of offering financial incentives.

It’s against the law here to buy a kidney, so the idea is to offer the donor other financial carrots such as free medical insurance for life. Another idea is to promise the donor a high place on the kidney waiting list if the donor himself should end up needing an organ. But financial rewards are controversial and lacking in public support. There is a strong feeling that such offers amount to exploitation of the poor -- that in the end it would be poor people who would be lining up to give their kidneys away, and the wealthy would be spared.

Amazingly, this discussion has coincided with our operation. So here I am, fresh from the operating table and with a clear memory of how difficult it was for me to decide to donate a kidney. I cast my mind back, and wonder whether it would have been easier for me to say “yes” if I had been told that I’d have free health insurance for the rest of my life. According to a recent article in one of the country’s leading newspapers (NRC Handelsblad), the Dutch Council for Public Health and Health Care reasons that “if living donors were given some kind of financial compensation, they would be more likely to donate a kidney and fewer patients would die of kidney disease. The chance that someone might donate an organ because they were in financial straits would be lower if they were offered free health insurance.”

In our particular situation, financial factors were certainly important. We are self-employed, I am the main breadwinner and we have no disability insurance. Yet I don’t think free health insurance would have done much to push me over the line from no to yes. After all, if you have to make a certain amount of income each month, and you’re afraid that such an operation would leave you bedridden for months -- or at least greatly weakened -- a few hundred euros a months isn’t going to make much difference. When I look back now, I think it would be nice if the government were to reward me with something like free health insurance, but I don’t think it would have weighed very strongly in my original decision.

My problem, and perhaps the problem of many people, is that I was afraid of how the operation would affect my quality of life. I was afraid that it would create insurmountable difficulties, in the days that immediately followed my release from the hospital and in the months and perhaps years that followed. What I needed, as it turned out, were two things: I needed the reassurance of post-operative home care, and I needed good, clear, realistic examples of people who had donated kidneys and had been able to pick up their lives where they had left off. I needed home care and I needed heroes.

The home care was a problem. My aged mother lives with us now, and we needed someone who would live in the house while we were in the hospital to prepare her meals. We also needed someone who would be here when we got home to cook for us, shop for us and do light housework. We belong to a Home Care organization, as many Dutch people do, and I called them to see if this could be arranged. I was told to call another authority, a Central Indication Board, which I did. They told me that I could not arrange home care myself before the operation; that I would have to tell the people in the hospital when I checked in that I would need post-operative home care, and that the hospital would arrange it based on their evaluation of my need. Then I called the head of the transplant team, whom we had come to know well. I asked her if this was true. She said actually it wasn’t. In fact, you check in to the hospital and tell them you’ll need post-operative home care, and they put you on a waiting list. You may get your home care in six months.

So I contacted all our kids -- five, all adults, plus two wonderful partners -- and asked them if they would be willing to sign onto a care schedule for the days during and following the operation. They were only too willing to do so. We quickly filled up the calendar, and it worked like a charm. All the kids were actively involved in the care of Grandma and of us, it was great for our peace of mind and it was great for the family. It turned out to be the best solution.

But what if we didn’t have such a strong family network? What if our kids lived far away, or didn’t like us very much? What if we didn’t have kids at all? Would this problem have been a factor in my deciding not to donate a kidney?

My second need was for strong, positive examples of real kidney donors. I had been told countless times that you can easily live with one kidney, that it doesn’t shorten your life and that it doesn’t even affect your quality of life. But I needed real stories. I checked web sites. I read blogs. I listened to friends and relatives talking about people they knew who had donated kidneys. I even watched an internet film of the operation -- a hand-assisted laparoscopic donor nephrectomy -- from Fargo, North Dakota. All these things helped convince me that it wasn’t going to be so bad. I probably wasn’t going to die or have to live a diminished life. In fact, I’d probably be back to my old self within a period of about six weeks.

And that’s what happened. It’s two weeks ago today since the operation took place. Most of the time I don’t even think about the wound in my stomach any more. It’s a bit sensitive on the surface, but there’s no pain at all. The pain in my shoulders is gone. I still tire easily, but I can stroll downtown at my normal pace. I took off the months of October and November (I worked very hard during the summer so I wouldn’t have to even think about work and deadlines until December), so I can nap when I’m tired.

If I could give the government my own personal advice, it would be this: provide high-quality home care to potential donors and make sure they know about it, and start a high-profile campaign with strong, positive images of real kidney donors. Maybe a documentary. Maybe short public service spots. But let people know that donating a kidney is not as terrifying as they might think. Not by a long shot. I have a feeling these are the things that would push many people over the line from no to yes.

But I’m speaking for myself. Perhaps the first thing to do is simply to talk to living kidney donors and ask them what it was that pushed them over the line. Ask them what the government could do to make it easier for others to do the same thing. How many people are there out there who are agonizing about this very thing? How many brothers and sisters, friends, cousins of kidney patients are lying awake at night, wondering what to do? What would it take to help them decide to donate?

“I’m beginning to feel my old self”

2007-11-13T21:12:00.000+01:00

Nancy is too much in the white water of her voyage with Harry Potter and company (she has started the next-to-last volume) to do a posting today, so let me try to fill her shoes.

When she got out of bed this morning, having stood up, she was astonished to realize that, for the first time since the transplant, she had done so without having to take her healing abdomen into account. “You know,” she said, “I think I’m beginning to feel my old self.”

She even decided to do a little administrative work, putting together some papers that needed sending to our health insurance company, and also working on getting some of the documents we still need to obtain from the US in our quest to arrange for Nancy’s mother, Lorraine, the right to live with us in Holland.

Nancy also wrote a posting to the web site discussion area of the country’s leading newspaper, the NCR Handelsblad, on the topic of what the country could do to increase the rate of live kidney donations. (I will leave it to Nancy to share her ideas, perhaps in her next blog posting.)

We’re still on a somewhat minimalistic kitchen setting. Breakfast and lunch present no great challenge. As for supper, Anne picks up ready-to-heat meals at a nearby supermarket. It’s not quite home cooking but not bad and surely it keeps us going.

Having used up the medicine kit the AMC provided me with on discharge so that I could make it through till Tuesday, I had the small drama this morning of discovering that one of the anti-rejection drugs I am supposed to take every day at 8 a.m. had not been included in the large package the pharmacy put together. As taking the drugs on time is a high priority for anyone living with a transplanted kidney, I hurried over to the nearly pharmacy. They checked their files, found that the drug in question had been left off the list the AMC had provided them with, called the AMC, and within a short time I was home again with the particular drug I needed. (Let me mention that in Holland one rarely has to pay for anything obtained at the pharmacy. No need to bring your wallet. Payment is made by one’s health insurance company.)

In addition to various pills, throughout the month of November I’m taking two injections of blood thinners each day. I didn’t do a very good job with this morning’s injection in my right leg and as a consequence spent a good part of the day finding walking painful. Largely confined to my living room chair, it became a day of concentrated effort to catch up with all the e-mail that piled up these last two weeks or so.

We had the good news today from St. Vladimir’s Seminary Press that my next children’s book is on their publication calendar for 2008. It’s about Saint George and the dragon, a legend that uses spectacular symbols to amplify what actually happened in the life of this martyr of the early third century. The signed contract will be in the mail tomorrow morning.

Best for last: Our beloved Beckett, a cat who looks like a miniature panther and who from time to goes off on great expeditions, returned last after a week in remote parts of darkest Alkmaar. We were overjoyed to see him. Throughout the day, he has been given us an excellent example of what real resting looks like.

(Photo taken last Friday morning at the AMC of my medicine list and schedule and their storage system.)

Nancy's Harry Potter Vacation

2007-11-12T18:06:00.000+01:00

It’s now my fourth day home. It’s been going well for both of us. Great to be in back to a life beginning to resemble “normal,” though we are under doctor’s orders to go very easy, no lifting anything that could cause some degree of strain, etc.

Nancy’s surgery went deeper and the operation was twice as long as mine (mine was only 90 minutes), so she still tires more easily than I do and naps several times a day. All this means we are enjoying a kind November holiday. Nancy calls it her “Harry Potter Vacation,” as she has more time to make her way through all seven volumes of Rowling’s epic tale about the power of self-giving love. Half an hour ago she finished the fifth volume, Harry Potter and the Order of the Phoenix, and has already gotten into the first chapter of Harry Potter and the Half-Blood Prince. At some point -- perhaps it will need to wait till she puts down the final volume -- my hope is that she’ll make some comments about what she takes away from these thousands of must-turn pages.

I was at the AMC today for the first of my twice-weekly control appointments. Adding in about three hours for round-trip travel by train, it took about five hours altogether. There was a meeting with one of the doctors of the kidney staff plus blood pressure and weight checks plus various tests. With two AMC appointments per week for the coming three months, significant travel will not be a possibility at least till the spring. But this has to be. For the AMC, the main thing is keeping a very close watch to make sure all is going well with the new kidney -- Super-K, as Nancy’s has christened it -- and to fine-tune the anti-rejection medication to the lowest safe level.

Anne has now taken over shopping for us and plans to do a round of house-cleaning on Thursday. Though simple breakfasts and lunches are no problem, we’re not yet cooking supper, but eating surprisingly good ready-prepared microwave meals that Anne picks up for us at a local supermarket.

Fr. Meletios, one of our parish priests, came up after the Liturgy yesterday to bring us communion, to congratulate Nancy on her name day (St. Anastasia of Rome), and -- along with my god-son Silouan, to join us for a microwave repast.

We continue floating on a cloud of gratitude.

Every day in every way...

2007-11-10T12:51:00.001+01:00

It’s ten days after the operation and I’m finally beginning to feel enough energy to start making contributions to the blog. What I hadn’t realized -- and should have, of course -- is that along with my kidney Jim now has truckloads of energy, whereas I have to be very conservative about everything I do so I don’t wear myself out.

Jim used to start every morning with a long session of violent coughing to clear out his lungs. Sometimes this would make him feel faint or nauseated, and he’d have to lie down again to recover, drenched in sweat. He was wondering if the transplant would have any effect on this. Answer: it does. The very first thing we noticed after the operation was that the coughing disappeared. Obviously the coughing was just one more desperate effort that Jim’s body was making to clear out the impurities, but now the new kidney has taken on the full task of keeping his body toxin-free and spinning like a top.

Caitlan suggested that we give the new kidney a name. I’m tempted to call it Super-K. It impresses me all to pieces. I have an image in my mind of a little kidney in a cute little spandex suit with a big K on the front, beaming broadly with a big American smile and absolutely radiating strength and good will. I’m quite proud of Super-K, actually. I didn’t know I had it in me!

I can only assume that its twin is just as efficient, so I should eventually return to my former level of activity. But it’s taking a long time. Ten days -- I should complain! My operation took twice as long as Jim’s, and the impact of having one less vital organ is naturally going to be significant. Frankly, I don’t mind gliding around the house in slow motion. I’ve taken the rest of November off, so I don’t feel compelled to get back to work. I’m deep into Harry Potter (which I’d never been able to read until now). All I really have to do is the paperwork for the insurance after the wretched break-in on Monday night. And maybe go window-shopping for a new watch to replace the one that the perpetrator kindly relieved me of.

I should also note that today I don’t feel any pain in the wound for the first time. I can easily get in and out of bed, in and out of chairs, up and down stairs. It no longer hurts to laugh, or cough, or sneeze, or blow my nose. If I lift anything of any weight (like a frying pan) I can feel a kind of pressure in the wound area, but no pain. But moving around too much makes me feel a little dizzy and I have to sit down and wait for the energy to return.

Jim goes back to Amsterdam on Monday for a careful check-up. He’ll be a regular visitor to the AMC twice a week for three months, then at longer intervals. I don’t have to go back for six weeks. My project now is to recover my strength and to try to grasp what I’ve done. The spiritual, psychological and physical hurdle of deciding to donate a kidney -- and then actually doing it -- is something that requires an enormous effort, I now realize. Maybe that’s also contributing to the fatigue. I never had any doubts before the operation, but I remember a lot of anxiety. I also remember telling myself, “You’ll be glad you did this, and if you don’t you’ll kick yourself forever.” The night before we left for Amsterdam, I jokingly said to Jim, “Me and my big mouth,” but that’s really it -- me and my big mouth. When I see him so glowing with energy, and not coughing, “me and my big mouth” takes on a whole different meaning.

Back home!

2007-11-09T17:27:00.000+01:00

Or as Nancy just put it, "Back home with these wretched people." Well, in fact that aren't so bad. Not actually wretched.

Wendy brought me back, leaving the AMC at 2. The social worker in the kidney transplant unit, Jacintha, had earlier in the day arranged for a taxi so we returned to Alkmaar in comfort, arriving at 2:40. She had also gotten approval from our health insurance provider to cover all my travel costs to the AMC for at least the coming year. Not normally by taxi -- it's an easy trip to make by train from Alkmaar.

Another kidney echo scan this morning (the new kidney is thriving) and more blood tests, then a visit from Michael Jacobs, a photographer whose work I much admire and a deeply thoughtful person, dare I say a mystic. You might take a look at his Flickr site.

The northwesterly storm that battered the Dutch coast during the early hours today caused the sea level to rise nearly four meters but no dikes were broken and the wind did little serious damage -- just fallen tree limbs and roof tiles blown away. Near the Fresian town of Fryske thousands of mice drowned because they were nesting on land outside the dykes.

The heavy weather continued till the late morning -- massive clouds but also islands of blue sky alternating showers and sunlight. Watching from my AMC room, I counted five rainbows appearing in about a three hour period. Never had a day of five rainbows.

(The photo: Before discharging me, the doctors wanted to take one last look at Nancy's kidney at its new address. It looks a bit like a donut. They were pleased that there was no indication of swelling.)

First long walk with the new kidney

2007-11-09T06:29:00.000+01:00

I was the beneficiary yesterday of a newly installed machine, possibly borrowed from the sets of Star Wars, that -- among other things -- can unobtrusively look at a bladder and see if there are any damaged or unhealed areas. Happily all is well. Thus the longed for moment of being released from the catheter happened on the spot, alleluia, alleluia. I felt a little like Pinocchio at the moment the angel freed him from his strings.

I had been told that, assuming my bladder passed inspection, I would be released and was avidly looking forward to a homecoming in Wendy’s company and a nice meal at Kanisstraat 5 in Alkmaar, but soon after getting back to my room the doctors paid a visit and let me know they had decided to keep me one more night. They want to do another round of blood tests tomorrow and meanwhile want to be sure my kidney doesn’t just look good under high-tech inspection but is functioning well in actual life (which happily it seems to be doing quite well).

I also learned that my creatinine level, for the first time in about five years, is now “normal,” normal signifying anything between 80 and 120. It was 900 when it was checked last week on our arrival at the AMC and was 110 the day before yesterday.

The delay in going home was disappointing, but, on the plus side, no longer hobbled by the catheter, I was free to go for a walk and eager to take a closer look at the hospital, inside and out. I put on my street clothes (trousers tighter than they were ten days ago) and set off.

I’ve never been in a hospital anything like the AMC. The view of the complex from the outside suggests no-frills efficiency. Indeed the efficiency is there -- the hospital seems to operate like a Swiss watch -- but once inside the main entrance one enters a corridor that leads to a large glass-roofed plaza dominated on the ground level by a café and bookshop (where I bought a copy of Khaled Hosseini’s novel, A Thousand Splendid Suns). The plaza serves as a kind of public living room -- lots of places to sit, have a cup of coffee and read a book or newspaper. An adjacent corridor leads to a similar plaza which is home to a cafeteria, a café and an upmarket restaurant with the elegant name Basilico, plus a row of shops: a small supermarket (I came away with a bottle of strawberry smoothie), a gift shop (I bought an anniversary gift for Nancy: a music box), a barber shop (but Nancy is my barber), etc.

Photos I took during my walk are now on our Flickr site in the set of kidney transplant related images: http://www.flickr.com/photos/jimforest/sets/72157602782265033/.

As night fell, it was no longer walking weather outside the hospital. It was suddenly raining with a passion. On the evening news I heard that the entire Dutch coastline were being closely monitored for the first time in thirty years because of a severe storm in the North Sea coupled with exceptionally high tides and waves expected of up to ten meters. Coastal areas were preparing for a possible four-meter rise in water levels. Ferry services to the Wadden islands were cancelled while the islanders themselves were hurriedly laying down sand bags at vulnerable locations. Similar conditions in 1953 caused dike-breaking floods in the province of Zeeland which cost more a thousand lives.

It may be a sign of healing that what is happening outside my hospital window isn’t overshadowed by the kind of myopia that illness can occasion.

The tenth day

2007-11-08T08:17:00.001+01:00

Eight days since the transplant, plus one day in the hospital for pre-op tests and the actual day of the transplant. Ten days in hospital (ten days in dry dock), not to mention all the time spent in the Alkmaar hospital these past few years. Being in the world of illness and those who care for the ill has become a major part of my life, a pilgrimage that continues.

One of the night nurses in this ward, a young woman with close-cropped silver blond air wearing bright blue running shoes, dropped in a few minutes ago to say goodbye, adding that of course in the future she will be seeing me again from time to time.

In fact it’s not definite I will be leaving today, but so far the signs seem to point in that direction. There is one more major test, the bladder examination, at 11 this morning. If that goes well, I should be in Alkmaar in time for supper.

There was another round of blood tests yesterday morning -- about a dozen small vials to be filled. What’s not know about my blood cannot be much.

Later in the day a nurse came to talk about living with the factor of a reduced resistance to illness, a consequence of the immuno-suppressive drug regime I will be on for the rest of my life. For example, I’m significantly more at risk of skin cancer and will need to use sun screen every day and have to avoid being in the sun for prolonged periods from the late morning till 3 or 4 in the afternoon -- no sun bathing. She also briefed me on the kidney clinic here, in an adjacent building that houses the AMC’s Polyclinic. In the coming months I will be there quite a lot -- twice a week for the first month or two.

I spent hours yesterday reading Ken Follitt’s fine novel of 13th century England, “The Pillars of the Earth.” It’s the next best thing to traveling into that period by time machine. At the center of the narrative is the construction of a cathedral.

Also I had time to do some searching on the web for texts about the iconographer Archimandrite Zinon (sometimes spelled Zenon) and came upon an excellent essay by Aidan Hart on how traditional iconography has been revived in the past century following a long period of decadence when icons became second rate imitations of third rate western paintings. In Russia, Zinon has been an especially important figure in the recovery process.

Using Google Earth, I searched the south of Amsterdam so that I might have a better grasp of just where the AMC is and see what it looks like from the air. (Double-click to enlarge the image.)

There was a nice visit at supper time with my godson, Silouan.

Then in the evening watching Dennis Potter’s long television film, “Lipstick on Your Collar.”

The sun has just risen, not yet touching the ground but lighting up the upper floors of the nearby building. A new day begins.

(Five hours later: Bladder examination over -- all is well with that part of my anatomy. No more catheter, alleluia. But the doctors have decided to keep me one more night for a final round of tests tomorrow morning. And then I head home, accompanied by Wendy.)

Day with a rainbow

2007-11-07T06:52:00.000+01:00

It’s just past six in the morning. Not a long sleep but solid. Still dark as midnight outside, but the trains and buses have begun running and there are a few cars on the nearby streets. From this height -- the fifth level above the ground floor -- the south of Amsterdam looks like a very tidy model train layout.

In the mid-morning yesterday, shortly after dark grey clouds produced a brief shower, I watched a rainbow rise from the right side of the window and then slowly complete its arc. The nurse who was doing the first of a series of seven hourly blood tests to see how the medication I’m taking was being accepted, suggested we ought to forget about all that and instead make our way to the nearby pot of gold. Surely it wouldn’t be hard to find. But instead we kept at the blood tests.

Rainbows are not rare in Holland, especially in the rainy season that Fall is, but somehow I was more vulnerable to its astonishing beauty and experienced it as signal from heaven, a reminder of God’s love for us and our hard-pressed world.

I had the news yesterday that my creatinine level -- 900 before the transplant -- is now 110. But the examination of my bladder that I had hoped might happen yesterday is delayed until Thursday, at which point, assuming no unpleasant discovery is made, I will be free to return home. Instead a sonar scan -- an echo -- was made to take a very close look at the veins and arteries in my neck. The purpose is to create a base line to see how the anti-rejection medication I am taking daily for the rest of my life affects my circulatory system. (I’ve agreed to be part of a kidney transplant study that the AMC is conducting.)

There was distressing news from Nancy yesterday. The night following her return to Alkmaar a thief had broken into the house. Sometime after midnight, the back gate had been forced open as well as the back door. Not much was taken: Cait’s laptop, camera and wallet and Nancy’s watch, all of which were on the coffee table in the living room. (Cait was staying at the house taking care of Nancy and Lorraine.) The police quickly came to the house followed by two detectives. By the early evening the back gate and door had been repaired. The worst loss was not the things taken but the theft of time involved in coping with the theft, and the sense of violated space.

A note from Nancy

2007-11-06T19:48:00.001+01:00

Dear all,

I'm not going to spend a lot of time behind the computer today, but just to let you all know that I'm home from the hospital and everything is fine. I haven't even read any of my accumulated e-mail yet (unlike Jim, who was e-mailing the morning after the transplant). The plan is to veg happily and watch movies with the kids, which I think I'll be able to stand for about a week.

When we left Jim he was being relieved of yet another tube of his full panoply of tubes, IV-drips, catheters, etc. The big project now for him is to organize the administration of his own immuno-suppressive drug regime. But he's feeling great. And the kidney is a champ.

Thanks to everyone for your prayers, good thoughts, cards, e-mails, and general positive energy. We felt as if we were moving within a web of love and support.

The staff of the AMC is fantastic. We have only good things to say about that impressive institution.

I'm not supposed to overdo it, so I'll keep it short.

much love,

Nancy

* * *

In April 2008, I found time to type out the entire journal I wrote out in my moleskin notebook while in the hospital.

N.

* * * * *

3 November 2007 (3 days after the transplant)

I don't think I could have written like this yesterday. Yesterday was Jim's 66th birthday, our 25th anniversary, and two days after the kidney transplant. It's taking a long time to get back into focus. Jim is going great guns. He began sending e-mails out on Thursday morning, the day after the operation! The new kidney is strong and producing enormous amounts of urine. And my remaining kidney is also being loyal, working hard to take up the slack and do all the work on its own.

We checked in to the AMC early Tuesday morning, coming by train, first class (which we never do, but we wanted to avoid the commuter crowds). Jim went to F5 noord (nierafdeling) and I to G5 noord (algemene verpleging). I waited in a patient's recreation room (living room with TV) for about 10 minutes until someone came to show me my room, 209. As I was unpacking, a young doctor arrived to hook up an IV drop which would fill my body -- and kidney -- with fluid and put it in an optimum condition for the operation. He then took me down to an examination room and gave me a thorough physical, taking down my medical history and profile as well. I was able to point out any aspects of my health that I thought were strange or suspects. Then back to my room. The appointment with the anesthesiologist with Jim was scheduled for 1:15, so I ready Harry Potter (5) and had lunch. The IV drip was making me feel very fit and very hungry.

At 1:15 I was taken to the office of the anesthesiologist, where I met up with Jim. All this time I was being treated by a very young nurse who had to keep chasing me around the hospital to replace the IV bag. Jolanda was her name, I think. Early 20s and really quite good. Also the surgeon stopped in, Dr. Ibu, whom the earlier doctor had praised for his skill. An Indian man with a warm smile. He said I would not wake up with a belly full of gas [which was the experience of a friend who had a similar operation]; they remove the gas first. I spent most of the day reading. Had dinner and went to bed and slept quite well.

I was awakened at 7:00 so I could freshen up. I washed my hair in the sink (no shower with the IV drop) and put on the surgical gown given to me by the nurse. No breakfast, of course.

Sylvia [head of the transplant team] dropped in at around 7:30 to wish me luck. The nurse gave me 2 paracetamols and a half of a tiny blue tablet to calm me down. Although I didn't feel nervous, my legs were trembling. I was taken to the verkoever (recover room), where the little blue pill calmed be totally and knocked me out. I have no recollection of being taken into the OR or of being anesthetized.

Next thing I knew I was waking up in the recovery room. A nurse by my side said all went very well, and that Jim was in an ICU just cattycorner from where I was in recovery. He was still out and would spend the night there.

The nurse also told me they had had trouble "entubing" me for anesthesia, so they ended up using a mask. Oddly enough, they had the same problem with Jim! She said they had written all this out in technical language for us. She also said it was a rare problem! For days I had a sore throat.

I was taken back to my room at about 3:00 (vague on the time). I felt pretty decent, but very sore and a little nauseated. Couldn't get out of bed. Catheterized, fortunately. I had another IV drip on the other hand with fluid and morphine, and a little device by which I could administer doses of morphine myself. I only did this a couple of times. The pain was not severe. I was assured that I could not overdose myself.

Slept a great deal. Visitors? Wendy and Anne -- so good to see their sweet faces. Silouan, Thomas. Slept OK considering.

Thursday was a blur of sleeping, having my catheter checked, trying to get a little bouillon down. Jim was wheeled down to see me! Obviously in better shape. He just sat there and cried. I couldn't read, couldn't focus on words.

Thursday night was bad. I had terrible heart palpitations and shallow breathing. Strange dreams.

In the morning I told the doctor about the palpitations. He ordered blood tests and an ECG. Later on a cardiologist came to talk to me and said the tests showed nothing, but if it happened again to call a nurse directly and another ECG would be done.

The catheter was removed and the IV drip as well.

It was Jim's birthday and our anniversary! I was able to read and move more comfortably and could get out of bed. I walked around the G5 ward, very slowly.

That evening, Dan, Wendy, Cait and Björn came for a sort of party. Wendy brought a huge fruit basket. They wheel-chaired me down to Jim's room, and Wendy hung up slingers. Dan took pictures and Jim showed us a sonogram of the new kidney, working beautifully. Silouan came, too, with Leonidas chocolates to pass around.

Saturday was a lovely day. Now that the catheter and IV were out I could take a shower. Wonderful! Went down to visit Jim (in a wheelchair). He was doing very well. Maria Faber came and brought a small icon of the Kazan Mother of God and CD of the choir form the Convent of the Kazan icon in Russia. She also brought a copy of the day's Trouw with a lead article about kidney transplants! Mostly about a Dutch man who had received four kidneys from his brother, mother, father and wife. Wendy also stopped by.

Nice evening. Watched a little TV and read. Had heart palpitations again and called the night nurse. He had another ECG taken. Showed no irregularities and my blood pressure is normal (124/71), but my pulse was irregular. He said it was probably an extra systolic beat, which is not an uncommon problem. The palpitations stopped after midnight. Saturday night was the first really normal night of sleep, partly due to the fact that I figured out how to adjust the bed properly, partly because I could sleep on my side without pain or discomfort.

Sunday morning I chatted for a long time with my roommate, who is here to have her thyroid removed. Lovely person, 39, two daughters, nice husband, good marriage, good sense of humor. Walked to Jim's room for the first time! He's doing fine and is learning how to manage his new -- very complicated -- medication regime. I tried to translate all the papers he got but could only do page 1. Exhausting!

Tomorrow I go home.

Tonight Dan and Noah came to see us! It was so great to see Noah. I just couldn't stop kissing him. We all walked to Jim's room and showed Noah the picture of the kidney in Trouw. Jim showed him the sonogram image. A lot for a little boy to take on board, but we tried to make him feel comfortable and appreciated.

The nurse said I would probably be able to go home before noon tomorrow.

* * *

A day of visitors

2007-11-06T07:35:00.000+01:00

Cait and Anne appeared mid-day yesterday to collect Nancy. She called when she got home to let me know she actually walked out of the hospital -- no need of a wheel chair.

It was a day of overlapping visitors: First Cait and Anne, then soon afterward Fr. Sergei Ovsiannikov (bringing communion), then Maryleen Schiltkamp, and finally Tom and Kylie, who left a little after eight. Nearly eight hours of guests!

Fr. Sergei told me about the visit over the weekend of the monk and iconographer Zenon, whom I had interviewed at his monastery in Russia back in 1987 when I was writing Pilgrim to the Russian Church and who later became part of Praying with Icons in the chapter on the making of icons. He came to Amsterdam to look at our church and, having done so, gave a lecture after the liturgy on Sunday about how best to make use of a basilica-type building.

I had never received communion apart from the liturgy before. It can be done quite simply, Fr. Sergei explained, but he had decided to preface communion with many elements of the liturgy so that what we were doing might be an extension of the full liturgy in the church the day before. It was an intense experience. I was asked to do some of the reading, including the creed, and found myself weeping with gratitude that I was part of a community spanning many centuries which has said these words day after day. Fr. Sergei turned the small table at the side of my bed into a simple altar, as you see in the photo. (Several other pictures taken yesterday have been added to the Flickr site: http://www.flickr.com/photos/jimforest/sets/72157602782265033/.)

Maryleen arrived just after communion and, following Fr. Sergei’s departure, told me more about Zenon’s lecture. Now I feel as if I had almost been present to hear it. Maryleen is an artist -- a painting she gave us years ago hangs in our living room. She and Tom Collord have a gallery show opening this Friday in Amsterdam. They will be hanging it tomorrow.

Tom and Kylie arrived as Maryleen was leaving. We mainly talked books. Tom estimates Kylie reads about five books a week. She insists it’s no more than three. Our cheerful conversation was interrupted by my noticing the bed felt damp and then discovering the blanket was soaking up blood. It turned out to be a leak on the small plastic sack that had been attached to the place where the catheter to Nancy’s kidney had been cut yesterday. In fact the bleeding had stopped hours before, but the stopper on the sack had somehow come loose, freeing the contents. The little dramas of healing!

Medically, my big hope for today is that the catheter connected to my bladder can be removed. Using a tiny lens on a thin cable, they’ll be taken a look at the inside of the bladder to be sure it has healed well from the small wound made in connecting it to Nancy’s kidney.

One has to say that modesty takes a different form for hospital patients.

Name day

2007-11-05T13:46:00.000+01:00

Nancy was picked up by Cait and Anne about an hour ago -- they will be back in Alkmaar by now. I’m now on solo setting at the AMC, but it may be not for long. The doctor who saw me this morning said I might be ready for release as soon as Wednesday. (I had been guessing Friday or Saturday.) The timing depends on tests scheduled for tomorrow when staff will be doing a seven-hour series of blood tests to fine-tune my medication. Also they’ll be taken a very close look at my bladder be make sure it’s healing well. If the bladder test is positive, it may be this is my last day of having to live with catheters. I’m now down to two, as the catheter that was connected to Nancy’s kidney was removed at mid-day. Amazing

The nurse of duty this shift suggested that both Nancy and I drink lots of cranberry juice from now. Great for the kidneys, she assured me. I mentioned this to Cait and now have three bottles of cranberry juice.

Cait and Anne also brought the cable that connects my little Sony camera to the laptop. As a result there are now a number of new photos in the kidney-transplant related folder -- see: http://www.flickr.com/photos/jimforest/sets/72157602782265033/.

The photo I'll paste into this posting is one of the additions: Nancy's holding an echo scan of her kidney at its new address.

I’ve been doing more writing the past 24 hours, including a recommendation for its Amazon page of Fr. Meletios Webber’s fine new book, Bread and Water, Wine and Oil, which I’ve been re-reading these recent days. It’s one of the best books on spiritual life I’ve come upon.

Speaking of spiritual life, our rector, Fr. Sergei Ovsiannikov, is on his way here to bring me communion. He reminded me it's my name day.

Four days since the transplant

2007-11-04T09:44:00.000+01:00

Yesterday’s landmark event was being able to take a shower. A tricky undertaking as I am still connected to several draining tubes and at times feel like a prop for a science fiction film. I was delighted to discover that I was able to stand straight. The abdominal incision is apparently healing well.

The nurse tells me that the IV connection attached to the back of my right hand will be removed today after an injection planned for later in the morning -- that will make things a little easier.

I start taking charge of my anti-rejection medicine today following a schedule that was given to me last night. For the first two days a nurse will be double checking to make sure I get it right. There were five different sorts of pills to be taken at 8 this morning. I’ll be on anti-rejection drugs for the rest of my life.

With the assistance of a nurse who pushed a wheel chair, Nancy came down for a long visit yesterday. She too had managed a morning shower but found herself exhausted afterward and had to take a nap. Her operation was more radical than mine -- about three hours compared to about 90 minutes for me -- and the recovery time will also be longer. She had the good news that she can return to Alkmaar on Monday.

We looked through the many e-mail messages friends have sent, as well as comments that have been posted on the blog. So much encouragement!

The e-mail included plans for our annual family Thanksgiving meal, which this year will be with Nancy in the background rather than on the front line in the kitchen. It’s the one American holiday we observe, though on the last Friday of November rather than Thursday (as Thursday is a normal work day in Holland).

One of the members of our parish, Maria Faber, dropped by for a visit, bringing with her a small bronze relief icon of the Virgin of Kazan (one of the many titles of Mary), whose feast day it is today, plus a CD of the liturgy recorded at the monastery of Kazan in Russia.

Wendy came by for a nice long visit just after Maria. We talked about which ten books we would take with us had we to move to a small desert island. (It proved far from easy making the choices; the lists are still a work in progress.)

We also considered which one museum painting we would like to borrow if only the museum was willing. Wendy decided on one of Van Gogh’s final paintings, crows over a wheat field against a dark blue sky.

Perhaps because I was reading a book about Bruegel yesterday, I chose his painting of the fall of Icarus. It inspired one of my favorite Auden poems:

In Bruegel’s Icarus, for instance: how everything turns away
Quite leisurely from the disaster; the ploughman may
Have heard the splash, the forsaken cry,
But for him it was not an important failure; the sun shown
As it had to on the white legs disappearing into the green
Water; and the expensive delicate ship that must have seen
Something amazing, a boy falling out of the sky,
Had somewhere to go and sailed calmly on.

(Double click on the image to see it in more detail.)

Last night's photos

2007-11-03T10:15:00.000+01:00

Holding a birthday card -- we were given tickets by the children to attend Bach's St Matthew Passion at the Concertgebouw in Amsterdam next March. Double click in photo to enlarge. Two other photos Dan took last night are now posted at: http://www.flickr.com/photos/jimforest/sets/72157602782265033/
Here is one of them...

Hurrah!

2007-11-02T20:12:00.000+01:00

Night time. A nice view out the window of the southern edge of Amsterdam. Lots of amber lights stretched out like Christmas tree decorations. There’s a train pulling into the nearby Metro station.

For the first time, I’ve been out bed part of the day, actually standing up for a time, if not very straight. I was given a wash by one of the nurses who decided to spruce me up before I had my first post-operation visit with Nancy this morning. She’s in a room in the short-term surgery section about a minute away by wheel chair. Then in the mid-afternoon we were together for a second visit while Anne was here. (She brought framed drawings she had made of each of us. I’ll try to place a photo of at least one of the drawings with this posting. The one of me was inspired by a photo Nancy took 24 years ago when Anne was a day old.) There is likely to be a third visit in the evening with more of the kids dropping in.

One of the doctors did an echo scan of the new kidney this morning -- her birthday gift was a print out of the picture that I’ll post it once I’m home and can scan it. It looks like a dark donut with a bite taken out, or a disoriented C. The doctor was pleased to see it wasn’t swollen.

Blood tests today showed my creatinine level -- over 900 when I arrived at the AMC on Tuesday -- is now down to 166. (Yesterday at was 326.) Nancy’s kidney is a powerhouse. Meanwhile Nancy has been reassured that her one kidney has immediately taken over the work of two. No problem. Divine redundancy.

This morning Nancy found she wasn’t yet up to holding the Harry Potter book she brought along -- The Order of the Phoenix, a massive hardcover book -- but by this afternoon she had it in hand. In those intervening hours she had been freed from the IV and was no longer tied down by tubes.

Ah, I hear visitors approaching...

An hour later. Visit over. Nancy, Wendy, Cait, Bjorn, Dan, and Silouan. They brought with them a huge box of fruit, tickets to attend a performance of the Saint Matthew Passion at the Concertgebouw next March, and a box (soon depleted) of Leonidas chocolates. Tom was planning to come but had to work late at Nike. Kylie is in Alkmaar taking care of Lorraine. There will soon be some photos on Dan’s FaceBook page. The room is now bedecked with a banner that says “Hurrah!”

Kidneys in motion

2007-11-01T10:32:00.000+01:00

This comes from my hospital bed, room 227 in section F5 North of the AMC. It’s the first of November. All Saints day, on the western calendar. A blue sky with some white clouds outside. I’m half sitting, thanks to the adjustable bed. Not easy to be writing. An IV is connected to the back of my right hand and I’m hitting more wrong keys than right ones. My lower abdomen on the right is seriously sore. That’s the location of what was formerly Nancy’s kidney. She is now down to one while I’m graced with three, two of which have become bit players, one of which is an instant super star. It’s already doing a great job, the nurses tell me. My creatinine level has fallen dramatically. Other indicators are equally good. My only complaint is that for the time being I must do my best to avoid coughing -- then the abdominal soreness turns to serious pain. I’ve got a green button with which I can press to administer morphine, but so far have only used it once. All that Nancy and I had hoped for seems to have happened.

I remember a transparent blue mask being pressed over my nose and mouth in the operating room , after which the first thing I remember is waking in the recovery room to discover Wendy and Anne sitting next to the bed. I could just barely focus my blurry eyes. So good to see them!

Not sure when I will get to see Nancy -- but hopefully by tomorrow, our 25th anniversary and my 66th birthday. (The birthday gift has been delivered.)

PS from Nancy added 19 December: The surgeon who operated so skillfully on both of us is Dr. Mirza Idu. A little web research reveals that he's an MD PhD (a medical doctor with a PhD), or, as the 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.

Home plate

2007-10-31T17:48:00.000+01:00

Again more with the hijacking.

We've sent out a few e-mails to those on Jim's mailing list to keep everyone up to date on the surgery. Unfortunately some of the e-mail addresses were not entirely correct so the messages might not have gotten through to some of you. For this we apologize profusely!

Jim has now successfully received his third kidney and has been taken to the recovery room to sleep it off. All went well with the surgery; again no complications.

Nancy is back in her own little hospital room, feeling groggy but doing fine.

Once we've heard from the two patients we'll get back to you on their current status and possibilities for visiting for those who are so inclined.

Cait

Half way

2007-10-31T13:25:00.000+01:00

I've hijacked the blog to leave a quick message for those who might not be on the mailing list.

Nancy is now out of surgery - no complications, everything went according to plan. She'll be groggy for a while, but should be on speaking terms tomorrow (and definitely Friday: Jim's birthday and their 25Th anniversary!!!)

Jim is now being wheeled into the anesthesiologists and will be fast asleep shortly. They should be all done in about 3,5 hours and we'll here from the hospital then. So I'll be posting again soon...

Cait

At the AMC

2007-10-30T16:10:00.000+01:00

It’s 4 pm. Nancy and I arrived at the hospital about six and a half hours ago.

We’re in different sections -- me in the department for kidney transplants, Nancy in a nearby section for short-term surgery. We saw each other when we were together in the anesthesiology department earlier in the afternoon, but otherwise have mainly been in our respective rooms. I’ve had various tests (x-ray, ECG, blood, etc.) plus questions to answer (mainly having to do with medical history) and now await a final session of dialysis. The nurse I’ve seen the most of is a fellow cheese head, as people living in Alkmaar are called.

I have a wonderful view from my room -- huge sky, dramatic clouds, the Arena sports stadium in the distance looking like an immense flying saucer that had come to rest in the southeast of Amsterdam. All in all, the AMC (the Academic Medical Center) seems a nice place to be if one has to be in a hospital.

On the calendar of the Russian Orthodox Church, tomorrow is the feast of the Gospel author and physician, Saint Luke. Not bad timing for major surgery.

(photo: Nancy on the train en route to the AMC.)

Anointing

2007-10-29T12:16:00.000+01:00

Yesterday, at the end of the Liturgy, Fr Sergei Ovsiannikov announced to the parish that there would be a special prayer service at 11 a.m. on Wednesday for the kidney transplant. (As it happens, Nancy will be undergoing surgery at that hour.) Also, about an hour after the Liturgy, there was a short service of anointing the two of us -- several photos taken by Vlad Dobrovinski are posted here:

http://www.flickr.com/photos/jimforest/sets/72157602782265033/

I don’t find it easy to write about the experience of being anointed in preparation for the transplant or being so intensely prayed for by the members of our parish. Short as it was, the anointing reminded me of our marriage in the church -- a similar sense of standing in a zone of pure grace.

Guaranteed to cure

2007-10-25T20:48:00.000+02:00

Today we got a card from our friend Seraphim Honeywell, lawyer by profession and also warden of the Orthodox parish in Oxford. On the front of the card was a reproduction of a full-page ad published in 1893 in The London Illustrated News promoting the sale of the Carbolic Smoke Ball, guaranteed to cure coughs, colds, catarrh, asthma, bronchitis, throat deafness, snoring, sore eyes, influenza, hay fever, headaches, croup, whooping cough and neuralgia. A hundred pound reward was offered to anyone who took the remedy and afterward contracted influenza. Testimonials were provided by such distinguished users as the Bishop of London (“The Carbolic Smoke Ball has benefitted me greatly.”) and a list was provided of aristocrats and other notables to whom the medicine had been supplied, including the Duke of Edinburgh and Alfred Lord Tennyson.

While there was no claim made that this excellent product also would cure kidney illness, one assumes any medicine so all-powerful as this could easily restore kidneys to mint condition.

Ah, if only we had known there was a non-surgical alternative!

Sadly, the Carbolic Smoke Ball Company was successfully sued by a user, Mrs. Carlill, who had contracted influenza. The company ended up going into liquidation.

Jim

Yes I said yes I will yes

2007-10-24T15:11:00.000+02:00

What goes into making a decision like this, to offer a vital organ to someone?

It took me a long time. When Jim first learned from the doctor that dialysis was in his future, the idea of a kidney transplant didn’t really hit me. Each time he went to the doctor to get his levels tested we were apprehensive, then relieved to hear that he was still on the positive side. But finally the doctor told him he had crossed the line, and dialysis had to begin immediately. That was in January 2006.

At first I reasoned that I couldn’t even begin to consider myself a possible donor because I’m the principal breadwinner in the family, and we couldn’t afford it. I imagined myself bedridden for months, weakened by the loss of the kidney, unable to do any work of any kind. In May of 2006 we both attended a conference in France where we met a Canadian woman who said she was willing to donate a kidney to Jim. We were touched and thrilled, and the woman began to investigate the procedure. She even made contact with the transplant people at our hospital in Amsterdam, and they approved her offer (often these kinds of distant, non-family donors are not approved). But after a while it became clear that she was too busy to actually go through with it.

At that point I began to wonder if I could give it a try. I had been doing some internet investigation and had learned that kidney donation is not as debilitating as I had thought, and I wouldn’t be out of commission for all that long.

But you have to reach a certain point when you sit down, open your mouth, and say the words, “I want to donate a kidney to you.” Recently people have told me how brave I’m being, but believe me, the bravest part of this whole process is just saying those words, getting yourself to that point where you overcome all your excuses and fears. I kept thinking of Frodo in The Lord of the Rings, who finally makes the decision to carry the ring in order to destroy it in Mount Doom. He must make this decision on his own, and when he finally says, “I’ll carry the ring,” he becomes the organizing principle for the entire story. I have always believed that Tolkien was very deliberate in naming Frodo, and that his name could easily fit into the long etymological entry for the word “free” in the Oxford English Dictionary. Frodo -- one who acts out of freedom. Freedom does not mean doing whatever you feel like if it’s in your interest, because sometimes you do things that you think are in your interest only to discover later on that you did them under some kind of compulsion -- peer group pressure, fear of rejection, fear of loss. Acting under compulsion is not freedom. But acting out of love, sometimes doing something that’s downright dangerous, is what freedom truly is. (Interestingly enough, the word “free” and the word “beloved” and “friend” are related, as the OED etymology also shows.)

So I said yes. And when I did, I suddenly felt as if all the winds were blowing in the right direction, as if I had made a free decision that was somehow in line with a kind of cosmic truth. I realized that for all the months that I had been saying I couldn’t donate a kidney out of economic considerations, I had made myself responsible for a kind of self-wrought logical argument that had to be constantly reinforced with my own insistence in order to stay in place. But the yes floated freely. The yes was borne up by something beyond me and my own logical arguments.
This is not to say that the coming days will be easy or painless, or that I feel confident and fearless. I’m still very apprehensive, and when I think about the operation I feel my heart starting to beat faster and my breathing becoming shallower. But I wouldn’t go back on this decision for anything in the world.

Clearing the decks

2007-10-23T19:47:00.000+02:00

Just a week from now we’ll have been in the hospital ten hours, been through a battery of tests, and be well primed for surgery the next day. It’s hard to take on board. Today, over lunch, Nancy read aloud a memo from the AMC full of detail about all that will be done both to donor and recipient -- not much of which one would regard as high on the list of things to do during a holiday but somehow we seemed to be in very good spirits as we made our way through the text sentence by sentence. (I had even managed, and Nancy as well, to sleep well last night, entirely without surgery-connected dreams.)

Mainly I find myself trying to clear the decks so that I can go to the hospital without being annoyed with tasks undone. The fall In Communion is finished -- the printed copies mailed out and the files for the web version sent to the web master, Michael Markwick, today. Nancy is now two-thirds of the way through proof-reading the revised edition of my Merton biography. The new text should be with Robert Ellsberg at Orbis in the next few days. I’ve also made a start on reading the galleys of the revised edition of Praying With Icons, also to be published next year. The original editions of both books are now more ten years old.

One complicating factor as we prepare for the events of next week is trying to work out Dutch government permission for Lorraine, Nancy’s 90-year-old mother, to reside in Holland. She has been with us about five months now, here in a six-month tourist visa. We’ve lately gotten a two-month extension, but the bureaucratic labors -- already costing many, many hours -- are far from over. One of the undone tasks is somehow to prove that Lorraine had only two children, Nancy and Doug (who died suddenly half a year ago). How does one prove such a thing? Unlike Holland, America has no national or even state-by-state birth register. There are special extra seals we need to get on certain official documents we already have. It all takes time, with no guarantee that in the end permission will be given. Until it is given, Lorraine isn’t eligible for Dutch health insurance and cannot even open a Dutch bank account.

Meanwhile she isn’t even certain that she wants to stay in Holland. It’s a lonely life in a strange culture. She has periods of painfully missing the US and its way of life.

Interesting. The stress we’re living with at the moment seem to have more to do with this aspect of our lives than with the upcoming operations!

The Oneness of Adam & Eve

2007-10-22T11:59:00.001+02:00

Yesterday after the Liturgy, while having coffee with Silouan in the parish bookshop, I happened to notice in the postcard rack a reproduction of a 13th century image of Eve being lifted by Christ out of Adam’s sleeping body. Adam sleeps peacefully while Eve is wide awake. The right arm of Jesus suggests his power to create and also seems to be a sign of blessing, while his left arm grasps Eve's wrists in a gesture that reminds me of a midwife pulling a child from the womb. Jesus contemplates both Eve and Adam with a expression of wordless love.

This special moment recounted in the Book of Genesis was a much loved subject of Byzantine and medieval art. In churches, it is usually part of a cycle of images that begin with the creation of the cosmos and end with the expulsion of Adam and Eve from Paradise. In all the creation scenes, Christ is the key figure. Though not yet incarnate, we see him as the man he was to become. The Church Fathers saw the Second Person of the Holy Trinity as the one especially involved the work of bringing matter into existence and shaping it into the vast array of life forms, with Adam and then Eve at the pinnacle of created beings.

While I found this illumination an especially fine version, just about any of the images that have to do with Adam and Eve fascinate me. Among the Primary Stories of the human race, there are few more primary than this: what many of our ancestors imagined the first human beings to be like. Remarkable, they saw Eve's creation as coming later than Adam's. Her being called into being is the final great event in the creation narrative.

Such a story has almost nothing to do with what, these days, we think of as history. In fact we know very little about the first human beings. Much that we think we know is speculative. But the Adam and Eve story is profound. It stresses an original oneness in Adam and Eve, the two of them mysteriously one being until the body of Eve is drawn out of the body of Adam.

Was Eve made from one of Adam’s rib? So the most familiar English translation of Genesis has it, but other translators say in fact that the key Hebrew word means “side” -- thus Eve was one side of Adam. She is his other half. Thus Adam’s maleness is coincident with his separation from Eve and her femaleness.

There is an ancient Jewish commentary which responds to the question: Why was there only one Adam and only one Eve? The answer is so that no human being can regard himself or herself as being of higher descent than anyone else. The basic fact about all human beings is that we are all belong to exactly the same family tree.

At the same time there is the elusive but compelling memory that has haunted the human mind of a primordial Eden: a paradise in which there was no war, indeed no enmity. The first murder occurs only after Adam and Eve have been expelled from Eden.

For Nancy and me at this particular moment, this image of Adam and Eve has another level of meaning. We are on the verge of a different sort of physical opening of our bodies to one another. A kidney that was Nancy’s will, in nine days, be in my body. Somehow this image seems to foresee such two-way traffic between the sons of Adam and the daughters of Eve.

(Double-click on the image to see it in more detail. This blog entry has since been expanded into a short essay, "The Original Oneness of Adam and Eve."

Valentine, R.I.P.

2007-10-19T19:24:00.001+02:00

"Nature red in tooth and claw," as Tennyson put it, and that's what we see shown here. Sitting on the garden table is Beckett, actually Anne's cat, about 7 years old and a glorious specimen of male felinity. He's been living with us for a year or more. Below is Valentine, an original inhabitant of our house, 16 + years, much smaller than Beckett but a tough old lady, always willing to give Beckett a run for his money and never willing to give up her territorial rights. Today she is no more.

This past Monday we had a "family meeting" at the Amsterdam hospital where the kidney transplant will take place on the 31st. Our three daughters -- Wendy, Caitlan and Anne -- were there, as was our priest, Fr. Sergei Osviannikov, and the head of the live kidney transplant team, Sylvia ter Meulen, held forth. She explained exactly what we could expect and how long the recover period might be. One thing she said was that when the transplant is over and Jim is home, he will be on non-rejection (immuno-suppressive) drugs to keep the new kidney from being rejected. This means he'll be vulnerable to all sorts of germs, viruses, etc. She also said that one thing we had to be wary of was cats.

It so happens that Valentine had suddenly started doing a lot of sneezing in recent weeks. I checked the internet and discovered that such sneezing could indicate a cat flu, which is highly contagious (to other cats) and could also affect humans. Concerned that she was spreading her nastiness all over the house, I made an appointment with the vet.

The vet said what I expected. We could put her in the local pound, where she might live for another two miserable years, but no one would take her. No one takes 16-year-old cats, and she would be very unhappy. The vet said, harsh as it sounds, the only solution is to put her down. She's lived a good 16 years and she's had a good life. I agreed. So I took her on my lap, the vet gave her a shot to put her into a deep sleep (took about 5 minutes), and then gave her another shot to stop her heart. It all happened very quickly.

The Alkmaar hospital is between the vet's office and our house, and it so happened that Jim was there for his dialysis session. I went there directly and told him Valentine was gone. He was shocked (didn't expect it) and deeply grieved. I took the photo you see of him at the same time.
So Beckett has now indeed become King of the Castle, the only cat at Kanisstraat 5. It will be strange without Valentine (and her sister Maggie, who ran away from home three months ago to die and never came back). Like all cats, she was a piece of work -- a distinct personality, tough old broad, independent and very cuddly. She was also particularly attractive to fleas (I never did successfully rid her of the happy colony living off her little person) and she was very hairy. I won't miss the fleas or the fur balls, but I'll miss Valentine jumping up on my lap every night to watch the 8 o'clock news.

Comparing photos

2007-10-19T18:19:00.000+02:00

With the posting I made yesterday, there is a photo of me taken by one of the nurses on the dialysis staff at the Alkmaar hospital. It was taken either at my first or second session of dialysis in January last year. Now here’s the second photo taken under similar circumstances, made today by Nancy when she dropped in for a visit. I’m using a newer dialysis machine but the main thing, Anne observes, is that I look like dialysis isn’t so strange an event in my life. After approximately 270 sessions of dialysis, indeed it has become, if never exactly normal, at least something I have adjusted to.

What neither photo shows is how I have used the time on dialysis. In those early months I mainly watched films, using a small DVD player that had been my Christmas present. But then I discovered that, with care, I could do more with my left arm -- the arm in which the two needles are inserted -- and so began to use the hours for reading, and since then have done as much reading in a month as I might have done in three or four months in the past. It’s an aspect of dialysis I will miss (assuming the transplant goes well). Today’s reading was chiefly a Dorothy Sayers’s classic mystery novel, Murder Must Advertise, a book that is as much a spoof of the advertising industry as it is about a crime to be solved. The DVD player has been passed on to Anne...

Thirteen days to go

2007-10-18T22:22:00.000+02:00

We've talked about doing a journal about our great kidney adventure and now Cait, in creating this blog, has given us the opportunity to actually do it.

It's now about five years since I contacted our GP and suggested that, being 60, it might not be a bad idea to run some basic tests to see if there is anything that needs special attention. The main result was the discovery that the creatinine level in my blood was higher than it should be, a signal that all might not be well with my kidneys. I was sent to the Alkmaar hospital for further testing, which confirmed that indeed I was in the early stages of kidney failure. The cause was uncertain (a biopsy was done but failed), but the guess is that high blood pressure was the culprit. I was already under treatment to keep my blood pressure down, but additional medication was prescribed and I was tested regularly. In January 2006, it was decided it was time for me to begin dialysis --three sessions a week, each three hours long. (You can see me connected to a dialysis machine in the photo.)

There's an essay about what I went through in coming to terms with kidney failure here:

http://incommunion.org/forest-flier/jimsessays/the-pilgrimage-of-illness/

This describes it in terms of pilgrimage, not a word I would have used for having a chronic illness four years ago.

Now the main event isn't the illness as such, but what seems to me a kind of miracle: one person giving to another a part of her body. I think about this day and night. I made it a point not to ask Nancy, or anyone, to volunteer a kidney and could easily think of reasons to discourage anyone who was thinking of doing so (the time involved, the disruption of ordinary life, the pain of recovering from surgery, the element of risk involved simply being in a hospital, etc.).

It's now about a year since Nancy made the decision to do this and perhaps ten months since it began to look like, thanks to initial tests, she might be a suitable donor.

It was far from an easy decision. One of the cautionary factors is the fact that Nancy is the family's leading breadwinner. She brings in more as a translator than I do as a writer. For both of us to have to stop work for an extended period raised some practical economic questions.

Once it became clear to her that, no matter what the obstacles, she wanted to do this, we decided not to worry about lost income and to push forward.

The testing she went through was both thorough and protracted -- and slow. A test and then a month of waiting. Another test -- and another month of waiting. Nearly a year of tests. What Dutch doctors don't know about Nancy at this point cannot be much.

And now we're thirteen days away from the event itself. I find myself feeling very keyed up but not anxious, at least not so far. This may have to do in part with all the people who have been cheering us along and praying for us. It no doubt has a lot to do with the doctors, nurses and social workers who have been involved with us all these months. Good and caring people, highly motivated and competent. As Nancy put it the other day, we have never felt we were objects moving along a conveyor belt.

The latest major event was this past Monday. Along with Wendy, Cait and Anne, plus Fr Sergei Ovsiannikov, priest of our parish, we were at the AMC (the Academic Medical Center, part of the University of Amsterdam) for a meeting with Sylvia ter Meulen, the coordinator of the transplant team, to go over details of the transplant and to ask any questions we had.

We learned exactly what the operations will entail, what the preparations will be, how long it will take, what to expect when we come out of the anesthesia (how many tubes will be attached and where and for how long), and how long it will take before we can expect to feel our usual selves. We've heard from friends that hospital care at the AMC is very personal and that has been our experience so far.

Nancy will be operated on in the morning (it’s a longer operation) and me a few hours later.

Assuming all goes well, Nancy will return home four or five days later. I'll probably be in the hospital for eight to ten days. (Cait and Bjorn have offered to bring us home.) We'll both be able to walk fairly quickly after surgery -- thus no need to turn the living room into a bed room once we're back home; we'll be able to climb the stairs -- but no lifting for six weeks.

In my case, it will be about three months before I am in a state that could be described as normal. I'll also be going back and forth to the hospital quite a lot -- twice a week for a while, then once a week, then once a month. A major concern is the close monitoring of the anti-rejection medication I'll be on following the transplant.

So there you have it as of October 18 at 10:55 pm.

October 18, 2007

2007-10-18T20:33:00.000+02:00

Thirteen days until T-Day (Transplant Day). Last night our friend Tom came over and we talked about the cellular make-up of the body, and about how each cell has a particular intelligence all its own. We tend to think that the mind is located in the brain, but is it? Is there awareness outside the brain? Is the individual's sense of himself or herself active in each cell and in other parts of the body? When my kidney is in Jim's body, what will it be like for him? Should I instruct my kidney now to be nice and to behave itself?

Then last night I had a dream. I dreamt that I looked in the mirror, and I had a white beard! Was it me? Was it Jim? Were the borders suddenly less clear?

We were told by staff in the Alkmaar and the Amsterdam hospitals that the success rate for kidney donations between partners is amazingly high -- amazingly because the partners are never blood relatives. Is it because the cells of the two bodies understand each other so well? That they've learned to listen to each other?

[Double-click on the kidney poster to enlarge.]