In conversation

A face-to-face with an erstwhile smooth beauty: my liver

Did you know that Friday 19 April was World Liver Day? I didn’t either, but as it happens, I was in the process of drafting the following exchange between my liver and myself. When my therapist suggested this Gestalt-like activity, I initially was about to dismiss it as silly, but then I thought well, I’ve done sillier things than this. It was an illuminating experience.

What my Liver said to me

My little Sophie (Sofaki mou - a term of endearment in Greek)

I have kept your body working well for most of your life, and I am proud I have been - so far - successful at it. Everything in your body, including me, worked as clockwork for decades. Do you remember? Or was your healthy body like water to a fish?

You will probably remember you were diagnosed with diabetes fifteen years ago - that was the beginning of the big health troubles. My close colleague, the Pancreas, and I were overwhelmed with the the chronic inflammation in your body and the levels of sugar circulating in your blood. Not that you noticed any of it, of course. You took some medication that helped somewhat, but you carried on as before. I also carried on working, like a tireless, loyal engineer keeping the machine working smoothly, never complaining, never even making my existence felt. I bet you rarely thought I was there.

With the passage of time, fat droplets started forming in my smooth, beautiful, rich coloured flesh. The first ever image of me, an ultrasound in Tehran, showed I was overloaded. I had become ‘fatty’ (sounds like a playground taunt). But it wasn’t just fat: I kept getting hurt, and after every wound scar tissue took the place of my smooth flesh. Not only did it look ugly, scar tissue also works less efficiently, if at all. Part of me started hardening, losing colour and pliancy, but the part of me that was still healthy continued working hard.

After that ultrasound in Tehran, the doctor suggested you try to lighten up my load by losing some weight. Such warnings have always fell on your deaf ears: they’ve always sounded like your Mama’s admonitions, and therefore ignored or worse, actively rebelled against. The doctor did not stress how serious my condition could turn. Neither did she explore other factors that could be at play - you faced a full set of those too: chronic stress from everyday life and relationships; constantly elevated levels of inflammation in the body; regular use of NSAID medication to keep arthritic pain at bay; the air pollution that still hangs like a curse over Tehran.

Back in London four years ago, you were informed that I had got so scarred that parts of me had given up: I had arrived at the cirrhotic stage. Unless you made changes, I would deteriorate rapidly. Luckily, despite the numerous scars, I still continue to work. I will continue to do so for as long as I can, in the hope of preserving the soft flesh that produces life-sustaining enzymes and so much more. I simply cannot let more scar tissue form.

I hold the keys to the sugar stores for your body’s energy. Each stress episode throws the gates open and lets sugar supplies into the bloodstream, to be used either for fight or flight. But you neither fight nor fly, and in any case, there isn’t enough insulin to let the sugar energy into your cells, so it ends up circulating around your body. As an added complication, you turn to carbohydrate snacks as a first-aid comfort food - and that’s how the vicious circle goes round and round.

I know you are trying to manage stress levels - you are trying deep breathing, singing, mild exercise. But the fact of the matter is that - for whatever reason - too much sugar still circulates in your body, which continues to tax my close colleague Pancreas and me almost constantly. What can you do about it?

Apart from the multitude of physiological processes, I am also the seat of anger. I have housed quite a lot of it for most of your life. Your anger towards Mama, the Tall Dark Stranger and others took up permanent residence in my flesh, but kept well hidden, so much so that you didn’t feel its presence anymore - which doesn’t mean it wasn’t wrecking the place. Thank you for all the work you’ve done to evict this noxious tenant (or should I say ‘squatter’?) Even so, Anger turns up every now and then, and after you’ve given her some attention, turns away again.

In her place, I am giving room and board to Courage. I am determined - as I was in your youth - to face what’s left of your life with courage and determination. Fortunately, I still have enough smooth, fully-functioning flesh working well, so we may make it yet (where?)

The average life expectancy for a cirrhotic patient from the moment of diagnosis is around 12 years. We are now 4+ years post diagnosis, so let’s say we’ve got 8 years to go. Let’s make them the best we can! Who knows? You may be one of the lucky ones: there may be more where these came from.

What I answered to my Liver

My little liver (jiyarak-am: a term of endearment in Persian)

Thank you for being my loyal, uncomplaining companion since, well, before I was born. I am grateful of every single day you have worked to keep my body working.

What can I say? I took you for granted - paid no heed to the doctors’ warnings that you were being choked by fatty deposits. Did I not care? I can’t say. I did not stop long enough to think. I did not make the connections between the factors and your disease until the hepatologist in London diagnosed your serious condition. When the repeated alarms sounded previously there was so much going on in my head and heart that I had no headspace to think about my body and you in particular.

Yes, I remember clearly I was diagnosed with diabetes in Tehran in 2009. I don’t remember researching your role in all this. Even now, I am still not sure I full understand it. But I remember the Reiki session back in 2005, when the therapist warned me you were very heavy, overloaded. Your whirring, manic energy was the first alarm call I ignored. The Reiki therapist asked me whether I was angry about anything. I said no: I had no idea that I had dumped a lot of unrecognised (repressed?) anger on you. It may have been there for so long I had grown used to it and stopped noticing it - if I ever did - much like the burden of the flat in Athens. (A couple of year after that Reiki session came the greatest crisis of all my life. It created much more anger, more disordered eating, more burden on you.)

The diagnosis that you had become cirrhotic was delivered by a sensitive, empathetic hepatologist at Charing Cross Hospital. That’s what she said: “Cirrhosis is generally non-reversible. However, if we can remove or at least mitigate the various factors, we can slow down the progression of the disease, and the liver can regenerate itself to an extent. On the other hand, the liver can continue to function adequately even with cirrhosis, and in your case, it seems to be functioning normally, so yes, your condition is treatable. However, I must mention, the cirrhosis may progress, albeit more slowly, despite what you do.”

After the diagnosis of cirrhosis in January 2020, things started to shift. The anger you stored for so long bean to spill out, made the Tall Dark Stranger notice. I don’t want you to take this the wrong way: I am grateful for your scar tissue, and for raising the most strident alarm (so far). I am grateful that a part of you turned hard if it meant it was the only way to make me pay attention. At last you’d made yourself heard! I needed that punch in the gut in order to take stock.

I am really sorry it has come to this. I took you for granted, did not heed your repeated warnings, used you as a dumping ground - and despite all this, you continue to support me loyally. I am grateful that all your functions are still intact.

You are right in asking me what I am planning to do to keep us going on for as long as we’ve got. Since the diagnosis I have followed the majority of the guidelines: minimal salt consumption; no preserved meats or uncooked or undercooked seafood; total avoidance of NSAIDS, paracetamol and aspirin; taking extra care to avoid infections and contamination; getting regular exercise (to the extent that arthritic pain allows); losing some weight (minimal loss but better than nothing). Regulating blood sugar levels has been and continues to be a challenge - as is disordered and emotional eating. I am now beginning to address these two related issues, through therapy and therapeutic journaling. It is hard going, but the tools and the support are there. I promise you I will try to protect you from further damage.

Neither the past not the future lie within my sphere of control. I can only take care of the ever-present, and let go of the outcome. Hang in there, don’t give up.

The heart meets the (left) hand in an embrace of imperfection