On Survival

Life is the incurable condition. Depending on one's relative state, we are either afflicted by life or gifted with it, but no matter how we experience it, there remains a fundamental truth: it is limited.

It ends.

This truth carries many valences: the end of a life can be a tragedy, a relief, a surprise, a calculation – but it is inevitable. The fact of death is never a plot twist, yet this recognition is something so many of us spend incredible amounts of energy avoiding. We are both mortified (literally and figuratively) by death and would prefer to fritter away our limited supply of life engaging in activities that deaden us to the fragile, febrile nature of our existence.

Today, I am overwhelmed with these thoughts in a way that I did not fully expect. Five years ago today, I received a life-saving (or rather, life-prolonging) organ transplant. There is something about survival and trauma that is both invisible and pervasive: an assassin lying in wait, taking a shot when you've been lulled into forgetting he's hunting you.

I received the call at 2:23 pm on Tuesday, January 22, 2020. At first, I was annoyed and almost ignored the ring: I was forming an LLC for a client at the time and didn't want to time out of the terrible old Pennsylvania filing system. But I looked at the caller ID and saw that it was coming from my doctor's office.

"Hi Owen. We think we've found a match. We need you to get down to Allegheny General Hospital within two hours as we run some additional tests on this organ to ensure compatibility. Can you get here by 4:30?"

"..."

"Hello? Owen?"

"Yes. Yes, of course. I will be there as soon as possible."

Here's the thing about getting a transplant when you're waiting for a cadaver donor: it may never come and it can arrive anytime. I'd been listed for a transplant for nearly two years and the doctors told me I was a difficult match. Not only does the donor need to match the recipient's blood type, but there needs to be a very high similarity in antibodies and various other technical things that I cannot pretend to understand. Anyway, you can't just plug in any organ to any person and hope it works.

For three years, my body was trying to die. It's an odd recognition that "you" are at war with your own body, taking distinctly unpleasant medications daily to hold on in hopes that an unlikely event comes to pass. Every day feels like an eternity and a nothingness at the same time. "Nothingness" isn't exactly right: it feels like some cruel game. The worst and least fun game of chance you could dream up.

So each day, you wake up hoping for and not expecting the Call. Limbo. You are constantly waiting for it, but inevitably unprepared when it arrives. If it arrives.

It may sound absurd, but it took me years to understand that what I went through was a classically traumatic period. Trauma with a capital T.

After my transplant, I was sent home in five days. For a liver transplant, that is a light-speed discharge. I'm not going to post the photo I took of my stapled-together abdomen when I got home because I don't want to subject unsuspecting folks to something rather frightening. Still, if you understood the type of surgery I underwent, you'd be unsurprised that it's often two-plus weeks before people get discharged.

Not three days home and I was rushed back into the hospital. My body was rejecting the transplanted organ. Here's the irony of transplants: you replace a dying organ with a healthy one to keep you alive, but your body sees a foreign object and kicks your immune system into overdrive to kill the interloper.

Somehow your body knows this isn't supposed to happen. You're fucking with nature. You should be dead.

And in order to stop my body from finally finishing the job it began years before, the doctors basically turned off my immune system. When I went back in, the whole medical team was very hush-hush about what was happening. They kept telling me everything would be fine, until I told them that, for better and worse, I'm not stupid and know that if this doesn't work, I'll die – so please just tell me the unvarnished truth about the state of play.

There's comfort in the truth, even if it augurs your own demise.

I can't speak for any other person who has experienced trauma or the constant self-aware struggle for survival. I can only speak to my own experience.

The past few days, and this morning very acutely, I have been feeling an extreme sense of survivor's guilt. A sense that perhaps I wasn't supposed to make it, that things would have been better off had nature taken its course. I feel this in the nuclei of my cells: somebody made a mistake.

And at the same time, I feel a deep shame that I have not done more with the gift of this excess time living. If I've been afforded these five years to spend with Audra, to build some businesses, to work on Pennhollow – to have a child! – why haven't I done more? What additional sense of urgency could I possibly need?

In the end, though, no matter the circumstances, we remain mere mortals. I can know that my time is limited and dawdle or doomscroll instead of work. I can understand that this replacement part can go at any time and still make plans for five or ten years from now. Just because if I had been born in literally any other time in human history – just twenty years earlier than I was – I would be dead and not typing these words does not mean I don't fall prey to the petty bullshit that all of us do. And yet I feel an all-consuming guilt both for being here and not doing enough while here.

Trauma is a complicated thing. Existing in a mode of survival for any extended period fundamentally shifts something inside of you. And this morning, five years on, I am filled with gratitude and awash in anxiety.

I've written elsewhere that I'm not necessarily afraid of dying, but I am afraid of not living. And that's true enough. Today I am reminded of something Nietzsche wrote: "Life is nothing but the smile on a dead man's lips."

Yes, but a smile nonetheless.