Liver Failure
by Brad Shurmantine

In diverse parts of the ancient world, the liver occupied a central position in superstitious or mystical beliefs about man’s character and destiny. In Babylon during the second millennium BC, the soul was thought to reside in the liver . . .

Some Meanings of the Liver, Sherman M. Mellinkoff

“Why aren’t we talking about a liver transplant?”

Donny’s question penetrated the numb silence and hung there like an errant balloon. Gary had no response, and their mother Sarah was still stunned by the doctors’ verdict, delivered seconds ago with sledgehammer efficiency. The three of them had just learned that Kenneth, the oldest brother, would be dead by the end of the day. Kenneth’s weak liver, crippled at birth by a rare form of leukemia, was finally shutting down.

“How come we haven’t looked into that?” Donny insisted, batting the balloon up into the air again.

At their mother’s urgent request the two brothers had flown in from the coasts to assemble here in the long white hallway of a hospital in Tucson. Their sister Laura had a houseful of kids and kept herself informed with daily phone calls. Kenneth was sick again, seriously sick. For several days they struggled to sort out all his doctors and grasp the complexity of Kenneth’s disease. Each consultation was briefer and more sober than the day before.

By “we” Donny was including, and mostly blaming, the two doctors who had just walked away. But Gary heard himself directly implicated in that question. He had given up on Kenneth days ago; he was just waiting for his brother to get it over with and die. 

“I guess because he’s too far gone, he’s too compromised,” Gary said. “Or maybe livers aren’t that easy to come by. We should ask Dr. Albert this evening.”

“We should ask him now. I’m calling his office now. They should have thought of this sooner.”

Donny walked quickly away to the nurse’s station, to find a phone. His mother stood still, sunk in misery, lost and mute. Gary put his arm around her, feeling awkward. He didn’t know how to comfort her. “Mom, go sit down. When Donny comes back we’ll get some breakfast.” Sarah obeyed and drifted like a zombie into Kenneth’s room.

Gary walked down the hallway, away from the nurse’s station. His brother would probably die today; if not they would transfer him to a hospice facility tomorrow, which was much cheaper. That was the message Dr. Albert and the hepatologist, Dr. Somebody, gave them a few minutes ago.

How should he feel about Kenneth dying? He felt neither grief nor anger; his mother and brother were having appropriate reactions, but Gary was numb.

He hardly knew his brother, who was five years older. Kenneth always seemed dorky and clueless. He wasn’t a mean guy, but he had alienated Gary when they were kids growing up together in Kansas City. Their father had died and their mother was off to work each day, and Kenneth attempted awkwardly to fill the parental void. Clean up the kitchen. Now! “Go fuck yourself. Don’t tell me what to do.” That had been their dynamic. To Kenneth’s credit, he usually gave up right away and retreated into his bedroom. He didn’t have much of a toolbox when it came to running the household.

Their fights were just another thing that wore their mother down. Gary, honey, please. Do what your brother tells you, she’d say. I hate coming home to a messy kitchen. She would take Kenneth aside and try to coach him on how to talk to his little brother, how to get him to do what needed to be done. And then Gary would wipe the counters down while she put TV dinners in the oven. Sarah was rarely angry with her children; she was a cheerful and loving mother, but raising four kids all by herself exhausted her. She’d doze off on the couch and suddenly snap awake when the laugh track erupted on The Honeymooners or The Lucy Show. Then she’d watch for a while before dozing off again.

Eventually Gary would do the dishes, clean the kitchen. That was his job. Kenneth had the living room and the laundry. Donny had the boy’s bathroom and the yard. Only Kenneth did his chores conscientiously. Donny got away with murder—the yard always looked like hell, and half the year it was winter so everything was brown and dead anyway; their bathroom was always gross. Gary knew he had gotten the short end of the stick because he was the youngest son and his brothers could push him around. Cleaning the kitchen seemed like a girl’s job to him; Laura should do it! But she was the baby of the family and somehow escaped responsibility. And when she was given little tasks to do she was even worse than Donny in shrugging them off.

The brothers got along, were rarely at each other’s throats. Kenneth and Donny were only a year apart so they had things in common, teachers and such. But even they were not buddies. The three boys were more like roommates than brothers, and eventually they grew up and went their separate ways: Kenneth to Tucson, Donny to Jacksonville, and Gary to San Jose. Laura found a good man, stayed in Kansas City, and gave Sarah six grandchildren to love and mother to death.

As kids they lived a middle-American life that was safe, comfortable, digestible, a sitcom and junk food life. They saw themselves in all the TV shows they watched—not Bonanza of course, but all the rest. Gary grew up thinking all those sitcoms were set in some midwestern city just like his own—not in Pasadena or New Rochelle. He preferred sitcoms because they seemed real to him, despite the laugh tracks and all the commercial breaks. His life too lacked drama, lacked momentous, heart-wrenching events. In the end that’s what drove him away from his hometown. He couldn’t leave fast enough—he was dying for something to happen.

Reunited with his brothers now, he thought of how their relationship had been colored by the American mythology of prime time TV, which they had all guzzled down together as they consumed their TV dinners. He remembered one show in particular—My Three Sons. Watching that show had always embarrassed him; he had felt ashamed that all the love and allegiance and wisdom those brothers showered upon each other was totally missing in his dumpy house. Kenneth wasn’t remotely like Mike, who was a wise and steady brother, someone you turned to when you were bullied or girls didn’t like you. Gary kept all that to himself. Kenneth would have been no help at all.

However, Gary sadly reflected, as he reached the end of the hospital corridor, Kenneth had one thing in common with Mike: he would soon disappear forever.

Kenneth was only forty-seven, he deserved a long life, but he had always had health problems. He’d been in and out of the hospital before because of his weak liver and related issues. But the doctors had always patched him up and sent him home. Even now, Gary knew, Kenneth was expecting to wake up and feel better and be sent home.

  Yesterday, after the doctors made their rounds and delivered their bleak prognosis, Sarah and her sons had an uncomfortable discussion. Gary started it off.

“Well, it looks like he’s not going to make it.”

“No,” Sarah answered. “No. My god. This can’t be happening.”

“Mom,” Donny said, “he’s been sick for a long time. Sicker than we knew. He must have been in a lot of pain and he never told us. But this is hard to believe.”

“Shouldn’t we tell him?” Gary suggested. “Shouldn’t we tell him how serious this is? He has no idea.”

It was true. Everyone had been positive and upbeat and put on brave faces when Kenneth was awake. He spent most of the time asleep, sometimes groaning, sometimes briefly woken by the need for a bedpan or water. All three of them had projected the same attitude: We’re here, buddy. We’re with you. We’ll get through this. Hang in there. No one had suggested, even remotely, that this was the end of the line, buddy, and you better get your house in order.

“No!” his mother protested. “I can’t bear to frighten him like that. He doesn’t need to know. The priest has been here, his soul is ready. We’ll ask Father to come again. He’ll be so afraid. Please, I don’t want to tell him.”

Sarah was a devout and observant Catholic, a collector of rosaries. Growing up the family had taken their faith for granted. Sarah did not proselytize or bully her children about religion—she let the priests and nuns do all the heavy lifting. She sent them to Catholic schools and made sure they went to mass on Sunday; that’s it. But as the years went by and her children flew the coop she became more fervent. Plus, she became a Republican, because of abortion. Gary rejected organized religion, and he hated Republicans, so he and his mother had a somewhat strained relationship. Kenneth and Donny, who remained cafeteria Catholics and were also Republicans, were closer to her.

Wasn’t faith supposed to be a bulwark at times like these? Gary thought. Wasn’t faith supposed to put you at ease and pull you through?

“Mom, he needs to know. Wouldn’t you want to know if you were dying?”

“No, Gary.” She said this sharply, with a touch of anger, “I wouldn’t. I would want to drift off into God’s arms. That’s what I want Kenneth to do. We are not telling him.”

Donny had remained quiet until now, but he spoke with decision. “We’ll do as mom says. She’s his mother. We’ll follow her lead.”

“Thank you, Donny.” His mother and Donny embraced. Gary watched them for a while then drifted away, refusing complicity.

Kenneth had friends who came to the hospital to see him, and to her credit his mother gave them a sober and truthful account of Kenneth’s situation before allowing them in the room, but she instructed them to be positive and optimistic in her son’s presence. They were all grateful for these instructions; no one knows what to say to a dying man. Everyone told Kenneth he looked great, they couldn’t wait to have him back in the office. Is there anything I can do for you? Water your plants? No, there was nothing they could do; Gary was staying in Kenneth’s apartment and Gary was watering the plants. We miss you, guy. Hurry up and get better.

Something awful was happening. He saw Donny coming down the hallway after his phone call to the hepatologist. The awful thing wasn’t that Kenneth was dying. We all die. It was the charade. A man deserves to know if he’s dying. To die suddenly is one thing; to have a car accident like the one that killed their father. But to be tricked into dying is something else.

Donny had grim news. “I couldn’t get a hold of him; he’s still making his rounds. But I talked to the nurse in his office. She says it’s too late, this should have been explored years ago. She blames his other doctors. She says we don’t have the right insurance. She says he wouldn’t survive the operation.”

“None of that surprises me,” Gary said.

“Yeah, well fuck them. I’m going to sue their asses.”

No one was going to sue anybody. Donny liked to talk tough; he probably would call a lawyer. But when he learned how time-consuming and expensive it would be he would lose interest and let the grass grow a little taller, like he did when he was a kid.

“Why don’t you take mom down to the cafeteria and get some breakfast?” Gary said. “I’ll sit with Kenneth for a while.”

Alone in the room with his brother, Gary watched Kenneth sleep and thought about what he should do. If it was me, I’d want to be told. If I thought my family was lying to me, that alone would give me a stroke. 

He wouldn’t have any more opportunities like this, alone with Kenneth. Donny and his mom had spoken, and they would take the blame for the deception. But he could do the right thing now, and tell Kenneth he was dying.

I’d want to know, he thought. I wouldn’t want to die still shucking and jiving, pretending.

He’d have to wake Kenneth. His brother was heavily drugged and pain-free, the doctors told them. He would drift along for another few hours until his heart gave out. But he still had periods of consciousness. He always smiled at everyone when he came to the surface, and he thanked them, and he told them he was doing fine, he was feeling better. Gary would have to bring him out of his sleep to tell him he was dying.

He rehearsed what he would say. Kenneth, wake up. I have something to tell you. Something you need to know. The doctors are telling us that you’re not going to pull out of this. You’re going to die. Do you understand? You’re going to die.

The words trembled on his tongue, but he held them back. He watched his brother sleep, a man he barely knew. The last few days he had wandered around Kenneth’s place, looking for clues, anything that might reveal the man his brother had become. Kenneth lived alone in a condo on a golf course on the edge of the desert. He had married and come here, of all places. His young wife soon left him; she met someone else and dropped off the planet. Kenneth never referred to her; he never spoke badly about her. The apartment was sterile, decorated with stale Southwestern art. There weren’t any plants to water, just a cactus garden. The decor was J.C. Penney’s glass and chrome. The only thing he owned that Kenneth boasted about was a big-screen TV that took up half the living room. Nothing in the apartment suggested Kenneth’s inner recesses, not even Penthouse magazines. Gary had checked under the mattress, where they stowed them in the good old days. Nope. No books on the glass shelves, no record collection, no turntable. He just watched his big-ass TV.

But Kenneth was the one their mother loved best. He was kind to her and worried about her, all alone in Kansas City. He tried to get her to move out west. He was always grinning and good-natured; even his divorce didn’t crush him. 

Gary and Kenneth had taken a drive once, up and down the west coast, staying in campgrounds. It was Kenneth’s idea. Gary was drifting around and hopped on board. He had good memories of that trip. The surf at Pismo Beach. Breakfast in Mill Valley. They had a couple arguments about politics but mostly drove in companionable silence, wanted to do the same things. Kenneth was a good man, but he had dismissed him, never reached out or let him in. Maybe, in another lifetime, if Gary had not been Gary, they could have been brothers.

He watched his brother sleep and made no attempt to wake him. He couldn’t decide if he was a coward or was doing a wise and loving thing. If Gary was dying, he would want to be told. But it was Kenneth who was dying.

Donny and their mother came back from breakfast, and then Gary went down. After eating he took a long walk. He thought about Kenneth, but he also thought about all he had to do when he got home. He and Kendra had just bought their first house and were fixing it up. He had been in the middle of installing a new front porch railing when he got the call that Kenneth was in the hospital and probably dying. Now that they owned a house, they were planning to have a kid. Everything in its proper time.

That afternoon the three of them stood beside the bed and watched Kenneth struggle to breathe. He took one shuddering breath after another, and then he stopped. He never knew he was dying. His mother didn’t let go of Kenneth’s hand, not even to wipe her tears away, which streamed silently down her cheeks. Donny stood behind her, with both hands on her shoulders.

A few days later Gary flew back to San Jose. He stared out the window and imagined the plane suddenly nosing down and rocketing toward earth. Would he have time to set his affairs in order, get right with God? He would probably be locked up in fear and panic. Having death at your throat is not the time to settle accounts. They should already be settled. They should always be settled. When you die you’ll find out. So, sleep.

Within a few weeks Gary had finished the front porch and started on his next project, a white picket fence. While setting a corner post he thought this might be a good place for a rock garden. Ferns, perennials. Or succulents; they don’t require much attention. Kenneth had a tidy, elegant cactus garden in the foyer of his townhouse, with a dozen varieties. He lived alone and was always scrambling to make a living; he didn’t have time for gardening. A cactus garden made perfect sense.

Gary sat back, butt on the ground, and remembered the lovely little garden he had ignored every time he came and went. There was so much more to Kenneth than Gary knew or appreciated. No, keeping the secret wasn’t the awful thing. The awful thing was that Kenneth was dead.

Brad Shurmantine lives in Napa, CA, where he writes, reads, and tends three gardens (sand, water, vegetable), five chickens, two cats, and two bee hives. He backpacks in the Sierras, travels when he can, and prefers George Eliot to Charles Dickens, or almost anyone.