Dead Tomorrow

immediately be dispatched to cause clotting and stop the bleeding. ‘How elevated are the enzyme levels?’ After years of looking up everything Caitlin’s doctors had told her on the Internet, Lynn had accumulated a fair amount of knowledge on the subject. Enough to know when to be worried, but not enough to know what to do about it.
    ‘Well, in a normal healthy liver the enzyme level should be around 45. The lab tests that were done a month ago showed 1,050. But this latest test shows a level of 3,000. Dr Granger is very concerned about this.’
    ‘What is the significance, Ross?’ Her voice came out choked and squeaky. ‘Of the rise?’
    He looked hard at her with compassion showing in his eyes. ‘Her jaundice is worsening, he tells me. As is her encephalopathy. In lay terms, her body is being poisoned by toxins. She’s suffering increasingly from episodesof confusion, is that right?’
    Lynn nodded.
    ‘Drowsiness?’
    ‘Yes, at times.’
    ‘The itching?’
    ‘That’s driving her crazy.’
    ‘The truth is, I’m afraid Caitlin is no longer responding to her treatments. She has irreversible cirrhosis.’
    Feeling a deep, dark heaviness inside her, Lynn turned for a moment and stared bleakly through the window. At the fire escape. At a wintry, skeletal tree. It looked dead. She felt dead inside.
    ‘How is she today?’ the doctor asked.
    ‘She’s OK, a bit subdued. Complains that she’s itching a lot. She was awake, scratching her hands and her feet, most of the night. She said her urine’s very dark. And her abdomen is swollen, which she hates most of all.’
    ‘I can give her some water tablets to help get rid of the fluid.’ He made a note on Caitlin’s index card and suddenly Lynn found herself feeling indignant. Surely this warranted something more than a sodding index-card note? And why didn’t he have such things on a computer these days?
    ‘Ross, when–when you say deteriorated quite dramatically –how–what–I mean how–how is that stopped? You know, reversed? What has to happen?’
    He jumped up from his desk, went over to a floor-to-ceiling bookshelf, then came back holding a brown, wedge-shaped object, cleared a space on his desk and set it down.
    ‘This is what an adult human liver looks like. Caitlin’s would be just a little smaller.’
    Lynn looked at it, the way she had looked at it a thousand times before. On a plain pad he started drawing what lookedlike a lot of broccoli. She listened as he explained, patiently, how the bile ducts worked, but when he had finished the diagram she knew no more than she already knew about the way the bile ducts worked. And besides, there was only one question that mattered to her now.
    ‘Surely there must be some way to reverse the failure?’ she asked. But her voice carried no conviction. As if she knew–as if they both knew–that after six years of hoping against hope, they were finally arriving at the inevitable.
    ‘I’m afraid that what’s going on here is not reversible. In Dr Granger’s view we are in danger of running out of time.’
    ‘What do you mean?’
    ‘She hasn’t responded to any medication and there aren’t any other drugs out there that we can give her.’
    ‘There must be something you can do? Dialysis?’
    ‘For kidney failure, yes, but not for liver failure. There’s no equivalent.’
    He fell silent for some moments.
    ‘Why not, Ross?’ she probed.
    ‘Because the liver’s functions are too complex. I’ll draw you a cross-section and show—’
    ‘I don’t want another fucking diagram!’ she shouted at him. Then she started crying. ‘I just want you to make my darling angel better. There must be something you can do.’ She sniffed. ‘So what will happen, Ross?’
    He bit his lip. ‘She’s going to have to have a transplant.’
    ‘A transplant? Shit, she’s only fifteen years old! FIFTEEN!’
    He nodded, but said nothing.
    ‘I’m not shouting at you–I’m sorry–I…’ She fumbled in her bag for a handkerchief, then dabbed her eyes. ‘She’s just been through a lot in her life, poor angel.A transplant?’ she said again. ‘That is really the only option?’
    ‘Yes, I’m afraid it is.’
    ‘Or?’
    ‘To put it bluntly, she won’t survive.’
    ‘How long do we have?’
    He raised his hands helplessly. ‘I can’t tell you that.’
    ‘Weeks? Months?’
    ‘A few months, at most. But it could be a lot less if her liver continues to fail at this rate.’
    There was a long