Can I get a liver?

I was recently consulted on a patient who developed acute liver failure of unknown etiology. He was fine until 3 weeks ago when he felt tired and achy. Then someone at the store told him his eyes looked yellow. Two weeks later he was transferred to our hospital because we do liver transplants. Infectious Diseases physicians are consulted to make sure the patient has no infectious contraindications to a transplant as well as to make sure they are on proper antibiotic prophylaxis pre-operatively.

This patient crashed fast. He was intubated, on continuous dialysis, on 2 medications to support his blood pressure, and his heart rate kept plummeting. We had done a bone marrow biopsy on him a few days earlier because his blood cell counts were a little off. As we waited for that result, and many other lab tests, to come back, we were supporting him in every way we could.

Yesterday morning, I was in his room in the ICU when the transplant surgery fellow came in. I've gotten to know him well, since we share a lot of the same patients. The nurse was also in the room. A few minutes later, the patient's wife and a priest came in. The 3 of us healthcare providers took a step back and let the priest pray over the patient. The surgeon's eyes never left the heart monitor, but his lips moved with the Lord's Prayer. The nurse watched the dialysis machine while she made the sign of the cross. I stood, hands folded, and alternated watching the priest and the ventilator.

Then, the priest and the wife left, and we all went back to examining the patient and talking about what we needed to do next. It was a very surreal moment, and it wasn't one that happens often. But, it was nice.

We later found out that the patient had an aggressive type of lymphoma, which rendered him "not a transplant candidate." He died shortly after.