Transplantation by Mark Keane

Monday, December 19, 2016
When Quinn's ruinous alcoholism threatens his life, an organ transplant triggers such a fundamental change of lifestyle that his long-suffering wife feels left behind; by Mark Keane.

Quinn's liver was damaged beyond repair. He was taken into hospital. A liver transplant was his only hope. He could not drink again. It was not a question of cutting back, not a matter of switching from whiskey to wine or from wine to beer. Alcohol was off the menu.

Quinn had been unwell for some time. He lacked energy and was out of breath after the slightest exertion. His skin developed a yellow pallor; his eyes were discoloured and dull. When his wife found him slumped over the bathroom sink coughing up a bloody discharge she urged him to visit the doctor. He resisted but she was persistent. She accompanied him to the clinic.

The prognosis of later stage cirrhosis came as a shock to Quinn. There were no throw-away remarks or offhand bravado. His wife could sense his fear and shame. Quinn's stony-faced reaction to the doctor's dry summation did not disguise his panic.

Quinn convinced the doctor he was finished with booze. He was committed to sober life. The difficulty was finding a suitable donor. There were more people in the queue for a transplant than there were donors. Quinn's name was added to a list. He left hospital and returned home to wait.

He lay semi-comatose in his front room, watching TV. He was barely able to follow the action on the screen or make links in the simplest story-lines. This was so unlike the active and sharp-witted Quinn. His wife monitored his food and fluid intake. She doled out his tablets, balanced his protein requirements, avoided salt and all the time watched for tell-tale signs of clandestine alcohol.

A suitable liver became available. They were not told the donor's name. Quinn's wife understood the reason for anonymity. She made tactful enquiries regarding the cause of the donor's death. A car accident, she was told.

Quinn was given medication to suppress his immune system. A cocktail of medicine, the doctor noted glibly. He was more vulnerable to infection. Quinn accepted the conditions that resulted from his past conduct. It was time to reap a new life from the dissolute seeds he had sown. He had been granted a second chance.

Quinn was under the knife for fourteen hours. Disconnection of the old liver from the abdominal tissue proved problematic. Nevertheless, surgery was successful and there was no reason why he should not make a full recovery. He remained in intensive care for forty-eight hours and was moved to a private room where his condition was monitored.

The surgeon spoke to Quinn's wife after the operation. He was a busy man with no time for niceties.

"The liver was in terrible condition, pumped up like foie gras. Your husband must have liked his booze."

Quinn's wife steeled herself before each visit to the hospital. She hated the ugly room with its blank white walls. A small window looked onto the corner of the car park. She felt ill at ease, seated on an uncomfortable metal chair with the door open at her back. The continuous human traffic in the corridor was distracting. The rush of orderlies and the shuffle of the aged and decrepit, staring with sunken eyes over medical walkers.

Quinn did not receive visitors. He was too guilt-ridden to see anyone. Least of all his old drinking companions, not in these surroundings, not under these circumstances.

She brought him books to read but they remained unopened. He was listless and could not focus on the bland dialogue she prepared beforehand. His sad smile offered a brief reminder of the healthy Quinn. She stifled her tears. He was getting better. That was all that mattered.

They had no children. It was a conscious decision, mutual though never discussed. Quinn would joke that he was little more than an overgrown child. She loved him though he had sorely tested her love. She stuck by him, lived with his mood swings. His incoherent rants and his introverted penitence. The lies and careless self-abuse. His thoughtless actions had left her feeling undesired and superfluous. She had been cast aside in favour of whiskey, the mistress whose allure he could not resist.

Any thoughts she had of leaving him were fleeting. Quinn was the predominant figure in her life. She watched his decline, a spectator without the resources to effect change. His repeated promises to reform were followed by a descent from attentiveness to bonhomie to neglect, to aggression and self-loathing. His weakness was a fundamental dissatisfaction, an unreasonable yearning. She did not know what he sought. Though she had listened to his drunken insight, she was none the wiser. What was important now was his recovery. They could begin again with the benefit of hindsight.

She drew on memories of tenderness and hope. Their bicycle trips to the sea and elaborate picnics. Leaving the cinema on cold winter evenings, he would pull her closer to him as they walked into the night. Best of all were weekend mornings and his improvised breakfasts. While he prepared the food, she would sip her coffee and scan the newspaper he brought her. Those were such simple pleasures.

Quinn could not conceal his drinking. The extra pint at the bar, two for the one had by everyone else. A whiskey before the meal then as an apéritif and finally to accompany the food. The bottles of whiskey secreted about the house, the hiding places more haphazard and pathetic.

He never wanted the celebrations to end. The revelry grew more tired. Parties where he was the only remaining guest were sad affairs. The hangovers became darker and enduring. Quinn loosened his hold on responsibility. He was hell bent on oblivion, on letting go. He never considered the likely aftermath.

At the end of each visiting period, she gave Quinn's hand a reassuring squeeze. She did not want to leave him. Back in the desolate house, she continued to find errant whiskey bottles. The empty ones she disposed of with sad fatalism. The ones that still contained whiskey, never more than an inch or two, caused her greater despondency. Quinn would not get to finish these.

Out of the blue, she received a phone call from Tom McCormick. He was Quinn's most steadfast drinking mate. He asked after his friend, referring to Quinn as the patient. Was the patient well? How was the patient enjoying hospital food? When was the patient planning to come home? On an impulse, she invited McCormick to the house. She felt isolated and vulnerable and welcomed the company.

She answered the doorbell. The bashful McCormick fidgeted on the doorstep in obvious discomfort. He had never been in the house without Quinn, arriving after the pubs had shut with paper bags filled with bottles. He sidestepped the reason for Quinn's absence. He relaxed after the second glass of wine. McCormick could not hold his drink as well as Quinn. He was quicker to lose his moorings though she had never seen him other than cheery or confused. She had never witnessed a darker side, no off the leash extremes of rage or self-serving mawkishness. She enjoyed his illogical banter and was comforted by his self-effacing good humour.

He offered his help, a vague wave of his hand encompassing the many ways he could be of assistance to her. Paradoxically, in describing his own circumstances it was clear that he was hopelessly disorganised. He led a chaotic bachelor life and was oblivious to practicalities. She knew his overture was well meant. His empathy though poorly expressed was heartfelt.

"The patient won't know himself when he gets out."

It was McCormick's parting shot before he turned and walked down the path. She imagined he would stop at the first pub to nurse a drink and wonder about his friend. There but for the grace of God, McCormick may think to himself. The house felt emptier after he left. His presence had been heartening. She should have pressed him to stay and offered him something to eat. He could probably do with a square meal.

Eighteen months had passed since Quinn's operation. There had been the danger of a relapse. In good times, he had always reached for a full glass to enhance the sensation. Quinn's wife worried he was capable of a calamitous denial of the opportunity for a new start. She worried no longer. Quinn had changed and the change was dramatic. He was devoutly teetotal, nothing short of zealous in denouncing alcohol. He frowned when she treated herself to a glass of wine and lectured her on the evils of drink.

She discussed this with his doctor who assured her it was a natural reaction. Quinn was bound to be guarded and overly sensitive to the threat of alcohol. His caution was understandable. She should be pleased. Had he not returned to work and resumed normal activities? She did not agree. Nothing was normal, not with respect to the Quinn she knew.

Quinn was no longer Quinn. Sitting in their front room, she watched her husband and could no longer hide from the truth. He was dressed in neatly pressed overalls and was methodically coating the bookshelves with shellac.

"That's right, that's right."

He had taken to repeating this phrase to no apparent purpose. He reached for one of the brushes that were arranged in order of increasing size. He examined the wood grain closely, checking the underside of a shelf. Applying more coating, he stopped for a moment and looked at her through vacant eyes. This was definitely not the same Quinn.

Not the Quinn who had upended the bookcase when he lost his footing in a drunken stupor. Books and shelves came crashing down, smashing the glass coffee table into smithereens. He slurred his apologies as he walked glass into the carpet and trampled on his beloved books. Not the Quinn who switched from contrition to belligerence in the blink of an eye and demanded more whiskey. Just a tot. Slumped in his chair, he held forth on one of the books he had picked off the floor. She left him as he poured another helping into his glass. The bottle was uncapped and stood in readiness by his side.

Nor was this the Quinn of the following morning, ashen faced, eyes red rimmed. She could hear the violent sounds from the bathroom as he expelled the poison from his body. Retching and dry retching until there was nothing left to retch. Not the Quinn who sheepishly swept the broken glass and stared with dismay at the damage he had caused.

How could this be the same Quinn, tutting aloud at imperfections in the shellac? He spoke about the price of items he purchased in the supermarket. He did all the shopping now.

"Four bagels for the price of three. That's much more reasonable than the bakery."

He used a flat piece of wood to scrape crumbs from the tablecloth into his cupped hand. She had never seen this implement before but Quinn used it regularly to remove inconspicuous particles. He was very much concerned with tidiness.

"If you go to the supermarket after five you can find a ciabatta that is still fresh for a fraction of the cost at the bakery."

This Quinn appreciated a bargain.

"What I want to know is what happens in those supermarkets that don't offer these deals. What do they do with the bread that isn't sold? Do you think it's binned or reprocessed?"

She did not reply. Quinn took no notice; he did expect or acknowledge any input from her.

"Six chocolate muffins for less than the price of a bakery scone. It's impossible to turn that down."

He carefully cut the discounted bun into quarters using a knife and fork.

"They're a little dry but that's offset by the tea."

He enjoyed a refreshing cup of tea.

He was a stickler for punctuality, truculent if she was a few minutes late. Sighing heavily as she rushed out of breath to meet him he would the tap the face of his watch.

"Why can't you be on time, it's the least I ask of you."

It was not all he expected. This Quinn demanded nothing less than total abnegation. The old Quinn was not bothered about time. He never owned a watch and was chronically unpunctual.

What had happened to the impetuous Quinn who surprised her with small gifts, books, chocolates, flowers and impromptu restaurant meals? Theatre tickets left beside her morning coffee. Gaudy scarves, blouses and jumpers that were the wrong size. Quinn misplaced the receipts so it was not possible to exchange the presents. He was not concerned with receipts. He lived for the moment, never examined cause and effect, action and consequence.

The current Quinn planned every banal act. He prided himself on precision, drawing up schedules that he continually revised. He made lists of things to do, repairs to the garage roof, cracks to be sealed in the front driveway, dates for planting bulbs to flower in March or April. He was prepared for the future. Uppermost in his mind was the household budget.

"We must cut our cloth to suit our purse."

Quinn now had the habit of clearing his throat while hitching up his trousers. There were other mannerisms she witnessed with a sinking heart. He slurped his non-alcoholic drinks. He questioned the cost of her gym membership.

"I'm not necessarily saying you should cancel it. The exercise must do you some good. We need to watch unnecessary expense, that's right."

Quinn made her feel she was a scrounger, an unacceptable burden that he had to bear. She took on extra translation work. He wanted her to find a permanent job and contribute fully to the household expenses. She had studied French at university, which was where she met Quinn. He stood apart from the other undergraduates. She was struck by his delight in the uncomplicated and understanding of the complex. He was unpredictable, exciting, always willing to take the extra precarious step.

She gave private tuition in French to a group of students but did not tell Quinn. It provided her with spending money. He held the purse strings and pulled them tight. No longer were there unexpected restaurant bookings, no chocolates, no colourful scarves. Life with Quinn held no surprises. Apart from her conviction that this was not Quinn.

She wondered if the change in her husband was a side-effect of his medication. It seemed unlikely. Whenever she spoke to him, he looked into the distance and grimaced. He avoided eye contact and took his time before responding to innocuous questions. He pored over home improvement manuals and announced planned refurbishments in ponderous tones. She was expected to assist him. Holding a ladder or gripping a plank of wood as he sawed, she was subjected to his disdain.

"Keep it steady, you're here to help me. That's right, that's right."

She could taste his sourness.

They went to bed at different times. She took a glass of wine with her, read for an hour and was asleep by midnight. Quinn remained downstairs in the study where he had converted the futon into a bed. He spent hours at the computer. The old Quinn was an unapologetic Luddite. When she asked him about this newfound interest, his response was equivocal. He was searching the internet for information on household projects. The computer table had been moved so the screen was no longer visible from the doorway.

It was unseasonably humid, a heavy closeness that presaged violent thunder and lightning. Her skin felt clammy, the sheet clung to her legs. Moist air entering the open window condensed on her wine glass. The curtains billowed wetly in the intermittent breeze. She could not concentrate on reading. Sounds came from downstairs, Quinn was still up.

She had worried that he would come to her. That he would enter the bedroom, lie on the bed, touch her and draw her to him. A shiver of unease ran through her body at the thought of his skin against hers. It was an extreme reaction but she found everything about him repellent.

Quinn had not attempted any physical contact. He ignored her except to deliver a derisive rebuff or correct a minor detail, a mispronounced word, a scissors found in the wrong drawer. She plumped the pillow and adjusted her position in bed. Sleep brought relief.

Quinn was at work. She turned on the computer. This Quinn was too arrogant to cover his tracks, his electronic footprints. Too arrogant to believe she was capable of monitoring the sites he visited with a simple click of the history icon. She looked up at an unexpected sound in the hallway. The surreptitious search made her queasy but she needed to know. What drew Quinn to the computer? How did he spend his nights gazing at the screen?

She clicked on the links that took her to the sites Quinn had visited. Pages and pages on guttering, insulation, energy efficient light bulbs, ladders, screws and adhesives. She skimmed endless images of wallpaper, wood flooring and boilers. Advice sheets, FAQs and blogs on ways to cut fuel costs, water meters, tax credits, savings accounts, broadband deals, recipes using leftovers and discount coupons. Clicking and clicking she went from the home page of electricity suppliers to insurance companies, wholesalers, secondhand shops, free events and libraries. Figures, tables, diagrams, zig-zag lines, pie charts, energy consumption graphics.

How could he find interest in this, in this meanness? This was the new Quinn. Before the operation, he never cared about cost or price. It was incompatible with his laissez-faire attitude. He was never a penny-pincher. She closed each window on the screen and shut down the computer. This was not her Quinn.

It was Saturday morning. She was preparing breakfast. Quinn had decided this should be one of her tasks. He appeared with his newspaper, wearing a sweat stained old tee-shirt and tracksuit bottom. He ran one mile each Saturday. On his return, he ate a bowl of porridge made to his precise instructions, not too thin or too chewy. If it failed to meet his exacting standards, she would face his censure. With each spoonful of porridge, he smacked his lips, a wet smacking that shredded her nerve endings. He had a cup of tea and a slice of toast with home-made marmalade. Reaching for a knife, his shoulder touched her arm. She flinched instinctively.

He read the newspaper and commented aloud on items that interested him.

"It says here scientific tests have shown the brain of the human male is bigger than the female brain. Men have greater processing power, makes us more efficient at completing tasks. Better at numbers too. That's right."

He was wearing the glasses he had bought in the supermarket. It was cheaper than going to the optician even with a discount coupon. Using glasses now he decided would preserve his eyesight and save money in the long term.

"There's a sale of firewood this weekend. We should stock up at these prices and use the fire in winter."

She avoided his dead eyes behind their discount lenses. How she hated him.

She lay awake staring at the sliver of light on the wall where the curtains did not close. One night he was sure to come up the stairs. She would know when he was standing outside the door, hitching up his trousers. That's right. What would she do when the door was slowly pushed open? Sleep was impossible. She was at the end of her tether. There were dark rings under her eyes.

She felt helpless and reached for her wine. How could she continue with this monstrous Quinn? What had caused this transformation? She had wanted him to change but not like this. A niggling thought deep in her brain had grown into a suspicion. It seemed unlikely, even far-fetched but she had to find out. She owed it to her memory of Quinn.

She made an appointment with Quinn's doctor, knowing he would not release the information she wanted. Arriving at the clinic, she had no plan of action beyond playing it by ear. On the telephone, the doctor questioned the purpose of her visit. It was a delicate matter that she must discuss with him. Seated at his desk he observed her expectantly. She had a question.

"Is it possible to donate a donor liver? My husband wonders if he can offer another person the chance he has been given."

The doctor raised an eyebrow but did not reply.

"If the cause of death is not liver related can the organ be used again? I thought it best to ask your advice."

"Has your husband suffered a relapse?"

"No, nothing like that. He's fine and following your instructions. He wants to donate all his usable organs but in particular he hopes his liver can extend the life of a deserving patient."

The doctor appeared flustered.

"This really is a most unusual request. I don't believe an organ has been transplanted more than once. Let me check your husband's file."

Rooting in a cabinet, he took out a folder that he opened. This was the opportunity she had hoped for. She could not make out any details from her vantage point. Sighing loudly, she toppled forward onto the desk. The doctor looked up, his face expressing concern.

"Mrs. Quinn are you alright?"

She lay back in her chair and squeezed her eyes shut, aware of the doctor looming above her.

"Can I get you anything?"

"Some water please."

The doctor left the office. It was too easy. How could such a hopeless ruse have fooled a professional medical man? She turned the pages to face her. There it was in the top corner, the answer she sought; the name of the donor.

He returned with a glass of water. She took a drink and assured him she felt better and was able to make her way home unaided.

"It's nothing, just a momentary faintness. I haven't been sleeping well these nights with the terrible humidity."

She had a final question.

"If for some reason my husband even at this stage of his treatment rejects the liver, would it be possible to obtain a second donor organ?"

The doctor frowned. He was wary, even distrustful.

"Are you quite sure your husband's condition has not deteriorated?"

"I know I'm being foolish and there is no reason to expect anything to go wrong. I'm just concerned about him."

The doctor did not seem convinced.

"This is not something we need consider now but a second donor liver is unlikely."

It was not difficult to find details of the fatal car crash that provided Quinn with his new liver. She pulled up the report from a newspaper website. There had been more than one fatality in the accident. An innocent pedestrian was mown down by the car, which crashed into the wall of a bookmaker. What were the odds of that happening, the old Quinn would have asked. An elderly woman, retired schoolteacher, who was walking her dog died in hospital. The dog, a Bichon Frise, had to be put down.

The driver died at the scene. According to the newspaper article, he was an accountant, a loving husband but there was no mention of children. A pillar of society, chairman of the neighbourhood watch, active in local politics on the far right of the spectrum. Passing reference to a lifelong pursuit of collectibles and an interest in DIY and gardening. The text described someone irreconcilable with the Quinn she married but it could be applied to the current Quinn.

In a matter of minutes, she found the address of the deceased organ donor. She did not check Quinn's recent browsing history but made sure all trace of her search was removed.

The widow was a nervous woman, an unprepossessing figure in a housecoat over a plain blouse and skirt. She stood in front of the open front door, which afforded a glimpse of carpeted hallway. A detectable tremor ran through her body. Quinn's wife introduced herself as a former colleague of the woman's husband. She had learned of his death and came to offer her condolences. The woman seemed indifferent. With an apathetic gesture, she invited the unexpected visitor into her home.

Seated on a stiff toile armchair in a well-appointed sitting room the widow kept her head bent, revealing white roots at the centre parting of her hair. Her body continued to shake as she sniffled, every so often withdrawing a handkerchief from the sleeve of her housecoat to dab at her nose.

A large bay window with leaded panes and insets of stained glass looked onto a lawn that extended some distance beyond two mature oak trees. Geometric clipped hedges were interspersed with blocks of colour, verbena and geranium, enclosed in straight-line borders. Everything was ordered and formal. Quinn's wife took in the ostentatious chandelier, ornate wrought iron fireplace and mahogany surfaces. A chess table sat forlornly in one corner.

The walls were bare but she could make out square and rectangular outlines where pictures must have once hung. There were obvious gaps in the bookcases. Where were the photographs, the standard framed family images that were integral to a room such as this? Had they been removed?

The widow showed no sign of initiating any conversation. She appeared detached, disconnected from her surroundings. Quinn's wife took this to be a manifestation of her grief. She tactfully mentioned organ donation. The woman responded with unexpected vehemence.

"I insisted that all his organs were taken."

It was difficult to imagine her insisting anything.

"He wouldn't have wanted that but I made sure every organ was donated, every last one of them. The rest I had cremated."

This was no grieving widow, distraught and incapacitated by her husband's sudden death. This was a woman who had lived through years of mistreatment, browbeaten and denigrated by a tyrannical husband.

"Did your husband drink?"

"Never, not a single drop."

The response was immediate though the widow seemed surprised by the question.

"Was he a difficult man to live with?"

She used her handkerchief to blow her nose. She trembled as if chilled by a cutting draught though the temperature in the room was pleasantly ambient.

"He never helped anyone but himself. Never gave anything willingly. He didn't have an ounce of charity in him. When he died I saw to it that he gave someone else the chance of life."

It was grotesque, the organ donation was an act of vengeance.

The widow was subsisting on hatred though the cause of her hatred had been removed. Quinn's wife stood to leave. She would not stay for tea and doubted the woman was capable of even that small act or any gesture of good will.

She left the house and walked past tasteful family residences. In her preoccupied state, she took no notice of her surroundings. Quinn's new persona was connected to the liver transplant. Could the dread of a new beginning have caused such a mutation of character? Or was it a transference? Had the widow acted out of malevolence to prolong the organ's toxic existence?

The reason was immaterial. She had to escape the poisonous Quinn. Life with him was unbearable. She did not want to become the widow, defeated and malignant. What she craved was companionship, a kindred spirit, someone who was kind-hearted. Someone she could love. If he had faults, it did not matter so long as he was generous and sympathetic. She could learn to love his faults. Someone who accepted her as she was. Someone who offered her the balm of love.

It felt strange holding the telephone and pressing these numbers. Listening to the ringtone, she poured herself another glass of wine. The voice that answered seemed bewildered.

"Tom, yes it's me. I know, an unexpected call."

Confusion at the other end, the scatter-brained Tom McCormick trying to work out why he was receiving a call from the wife of a friend who had cut him dead. Once Quinn returned from hospital, he refused to talk to him.

"How are you Tom?"

An incomprehensible hum and haw, McCormick did not know how to respond. She took a gulp of wine.

"Could we meet, for a drink say?"

McCormick's surprise was obvious.

"What's the name of the pub on the harbour you like, the one with seafaring gewgaws and a library?"

McCormick came back with the name though he was all at sea.

"That's it; I'll see you there on Saturday at eight. Let's make a night of it."

The wine rushed through her blood to release a blanket of calm. McCormick was hopelessly trying to phrase the question she knew he would ask. He was so considerate.

"Don't worry about Quinn, he won't mind. It will just be the two of us."


  1. I loved this story, engaging and rueful and a challenge to the pleasures of self-righteous puritanism -- as well as being spooky and mysterious. Many thanks,

    1. Thank you Ceinwen for your encouraging comments.

  2. I've heard of rebellious hands, brains and other parts before (what was that Jeff Fahey movie?), but never livers. It seems unlikely, but Aristotle thought that the brain was for cooling the blood.

    1. Aristotle also proposed that the liver played a more important role than the heart and possibly controlled emotions.

  3. A superb tale of codependency, so well told! Bravo! Thank you.

  4. A very interesting look at what happens to a relationship when someone quits drinking. Adding the liver transplant as an element definitely gave some added depth to the story. I've actually seen similar relationship issues crop up after one partner leaves addiction behind.

    1. Julie, I am glad that you consider the "liver transplant" adds to the piece.