“I had a feeling that something was wrong for a long time.” Fifty-six-year-old David Clark says as he lies recovering at a friend’s home from a liver transplant he received on June 13, 2008. He pauses for a long moment during which he is time-traveling back to 1971. “The best explanation was the injections I had gotten in the Army, even before I got to Vietnam. I was with a group of returning second-tour NCOs, and we had all gotten injections using jet-injectors, which are no longer used. They had no protective measures to prevent flashback [indication of blood in the syringe]. They really didn’t understand viruses at that point. We walked in a line down a hallway, and various medics shot us in the arm with these air guns, and they splashed blood back on us. Everybody had a bleeding arm.”

Seeing Clark on July 3, little more than two weeks after surgery, the normally robust, mustached man in the California wine industry looked pale, shaven, gaunt, and weak. He smiled and his eyes seemed clear. His demeanor was one of optimism.

“While I was in the Central Highlands several months later, I had an episode, an unexplained illness. They first thought it was malaria. Medical records show ‘unexplained virus or viral-like symptoms.’ I had general weakness, loss of appetite. I really felt bad, but they

couldn’t nail it down. I was with the 101st Airborne, just transferred. Actually, the 101st had just stripped down and took their colors back to Fort Campbell, Kentucky. I was transferred from this company in Cam Rahn Bay and then shipped up to the Central Highlands at Plei Ku [or Pleiku]. I was a foot soldier, 11th Bravo. MOS code. Our assignment was guarding the outskirts of this attack helicopter base at Camp Holloway. We did this by patrolling during the day and then setting up ambushes nightly in the open areas, the kilometers surrounding the camp. Booby traps, things like that.

“It was several years after that that I again experienced symptoms of hepatitis: weakness, but not jaundice. At the time they called it non-A and non-B hepatitis, which to me meant nothing. Being a cynical Vietnam vet, I

didn’t really believe anybody about anything. I didn’t trust authority, and the war had done a job on my attitude. When I heard ‘non-A’ or whatever, I heard ‘We don’t know.’ It turns out they were on the threshold of understanding viruses at that point. Then about three and a half years ago, I had some blood numbers done. They came back and I was told, ‘We really don’t like these numbers.’ They did more tests and confirmed a diagnosis of hepatitis C.

“Over the years, it had caused cirrhosis. I went through various medical protocols, such as interferon, and was monitored pretty closely. I had cleared the virus pretty much, but it came back. It was resident in my liver. My circulation

wasn’t good, and I hadn’t eliminated the viral infection completely. The doctor said, ‘Well, that’s it. Check out the Internet, maybe, and see what kinds of treatment are available.’ I wasn’t real happy with the endgame part of the carrot on that particular episode. I had been MRI’ed, CAT-scanned, sonogrammed a million times. My wife Diane was really my advocate here. She went toe-to-toe with the insurance company and finally got me a one-time consultation with Dr. Rose. He’s nationally recognized, a top guy in liver transplants. He looked at my images, and there were two tumors in my liver, one really small, the other large, and they were extremely diffuse. He pointed us in the right direction. I went to the UCSD Liver Transplant Clinic, and they’ve been handling it ever since.

“With the presence of those tumors, three surgical procedures were indicated, including one almost like a laparoscopic kind of insertion guided by imaging. They generate a microwave field around the tumors and, in effect, cut them out. After two operations, they had to go back in and make sure they had everything. Thanks to Dr. Rose’s good care, that cleared the decks for me. All this time I was on the waiting list for a liver transplant, but because of the tumors they had to be sure this wasn’t something spreading through my body. If that were the case, it would, like, have been all over, basically.

“I got through that period okay. It was a matter of waiting. I did go through another course of interferon for about nine months, which was a weekly thing, injections and taking pills several times a day. It was a very demanding treatment, and that again reduced my immunity. During this time, I was going through various support groups for people with hepatitis and who were pre-transplant. I also decided I should go to counseling, and so I did at the veterans’ Center in Vista, where I live. I discovered I had all the key symptoms of post-traumatic stress disorder.

“My experience with the waiting list was that this is usually a matter of a few years and is, was, enormously frustrating trying to keep my spirits up and stay positive. It was a challenge because it went on so long. A few months ago, I was told by doctors that they would probably do this transplant in the fall [2008], so I would have some advance warning. But you could get a phone call at any time during the day or night, and you’d have to rush down to the hospital and be available to receive a transplant. [These are] what they call ‘standby people,’ a number-two or -three person on the list. You have to be there, in case something goes wrong with the primary person, who might not be able to arrive on time or [in case there are] other problems, so that they cannot receive the donated organ. It can happen at any time, without warning, and every transplant patient understands this. But in my case, having been led to believe this

wasn’t likely until fall, I decided to go on a short vacation, a long weekend, to Seattle to see one of my oldest and best friends [science fiction author Greg Bear], and they said, that’s fine. Then one night, right about midnight, [while I was] getting ready to fall asleep, my friend’s daughter was saying something about a phone call and something about a liver. I was instantly in a state of shock. I couldn’t believe it. Sure enough, it was UCSD clinic and a Dr. Barry, my surgeon, calling me to ask — could I be in San Diego in the morning? Six in the morning.

“They had a liver that was a perfect tissue match! But there were other factors as well, and he had to examine me. I had never met Dr. Barry before in my life. So, taking the word of someone I had never met, I had to attempt to get from Seattle to San Diego to get this transplant. It was a lot to have dropped in my lap in the middle of the night, and we had to make snap decisions.

“They had a couple of commuter flights leaving early in the morning, so I said, yeah, I’ll be there. We had to shower, repack our bags, and my friend’s daughter drove us to the airport. We caught a little tailwind, and so we were all right. I had told them that I probably could not be there exactly at 6:00 or 6:30 and then asked what time they really, absolutely had to have me there. They said, if we can have you on the operating table by 9:30, then we’re good to go.

“Arriving just a little before 9:00 in San Diego, I rushed out in front and grabbed the first cab in line and said, ‘Take me to UCSD hospital in Hillcrest.’

“The strange thing about this cab, though, was that when I got in I saw that the driver was maybe an east African or Middle Eastern guy, and on top of the fare box was this beautiful museum-quality statue of the Egyptian god Anubis. Black-lacquered and gold-painted trim atop of the meter box, and I was nonplussed because Anubis is the carrier of the soul on its journey through the underworld after death. And by the way, this was happening on Friday, June 13. It took me aback, and I asked the guy what the deal was, and he just shrugged. It was probably another guy’s cab he was driving, but anyway, there was Anubis. An omen, if you will.

“So I got to UCSD, reported to the prep area, then I was taken to a large room with a number of beds and given a hospital gown to change into. Diane was still making arrangements for the car. After this costume change, I was just sitting there on the bed and I reached this very calm space, said a brief prayer, and just put myself in the hands of God. I had to surrender all and any control. Diane showed up shortly thereafter. They wheeled me out on the bed and prepared me for surgery. The chief anesthesiologist wanted to be involved in this, and he was on another operation so there was a bit of delay. About that time, I could no longer recall anything because of the medication they give you which knocks you out. It induces amnesia as well, so it gets kind of hazy.

“I was unconscious for the better part of two days. The next thing I remembered was somebody asking me to blink my eye twice, so it wouldn’t be accidental. I was asked to move my toes, and I remember being very pleased that I could do so. I was in the intensive care facility. They had me in restraints, with an oxygen tube down my throat so I couldn’t talk. I remember one nurse there, a woman, short, Hispanic, and her name was Elena, I think. She had incredible patience. I also remember a tallish Vietnamese woman, and several others, like a circle of angels around me.

“Diane had a pad of paper for me to communicate with, and I remember my handwriting was…it looked like those scripts they find from an Arctic explorer with the handwriting going off the edge of the page, you know, ‘Arrgghh…’ But someone asked me how I was doing, and I remember answering, ‘With all these lovely women around, how could anything go wrong?’

“During all of this, breathing became the central focus of activity. Somehow I had lost the connection with breathing. All I could think about was

drawing air in and out. I

couldn’t do it without thinking about it. I wrote down, ‘Fifty-six years of age and I still haven’t mastered the art of breathing.’ It was much labored.

“At some point there was a crisis with another patient nearby, and so they were distracted away from me. At that time, I became aware that though the nurses would have been standing on the right side of my bed, there was a presence to my left. I could never see a face, but there was a vivid impression of another person, another presence coaxing me to breathe the entire time I was awake. I was awake for two days after I came out of the anesthetic. That presence never left my side.”

At this point I asked Clark if any problems had presented themselves for the surgeon, Dr. Barry.

“Yeah, after my transplant had been done — which took about five hours, and that’s normal — they discovered I had a blood clot in my liver, so they had to go back in. This was very late at night, and Diane was down in the cafeteria. The [nurse] went running down there, found her, and said, ‘Come with me right now!’ She went with them back up to the ICU and had to sign papers for the second operation. That went on well into the morning, so I was actually operated on twice.”

Clark’s predominant impressions of the experience involved imagery of a mythological underworld. He elaborates: “I was taken, at various points, down into hospital corridors in the basement. I began to notice that all the terminology in medicine is Greek based, like the names of characters out of Greek mythology. My mind would pick up on cues very easily and then run with them. I was very amused by it. I kept having the feeling that I was in some kind of after-death experience that, had you gone digging in some old hieroglyphic papyri, you would find the details of it. That feeling persisted for rather a while. I remember thinking afterward, in terms of advice for others: it’s good to fill your mind with interesting stuff, read the classics, because you never know when you might find yourself flat on your back on a gurney with a lot of events flowing by you. I felt well served by it.

“What I hadn’t been aware of, or maybe prepared for, was that there was this whole other experiential, spiritual aspect to this transplant thing that accompanied it, triggered it. I really had never talked to anyone who had discussed this aspect of it. It’s a very powerful experience, still going on here more than a month later, still manifest. It is, in fact, a journey to the underworld. The liver, to the Greeks, was the seat of the soul, not the heart, like we talk about today as a kind of metaphor of our being. Now we know it’s just kind of a pump. But to the Greeks, it was the liver. I seem to remember that Prometheus, who stole fire from the gods and gave it to mankind in Greco-Roman mythology, was punished by being chained to a rock, and every day vultures would tear out his liver. Then it would grow back, and he would experience this tremendous pain every day.

“So, I thought I was not prepared for this experience, but I had been really preparing for it my whole life. Being wheeled around on gurneys in the underground of this hospital had such mythological associations. I was just flooded by religious imagery. It was the crescendo of epiphany.”

During this time, Clark wrote poetry, including one “very Japanese or Zen-inspired poem of blank verse. I had been reading a lot of Japanese and Chinese poets, and they were an influence on what I was doing. Having a transplant is like diving off of a high board: you’re either in or you’re out. Once you jump off the end of the board, you’re in, there are no second thoughts. I have learned to trust in God, or whatever name you care to put to it. I call Him God. It really helped me, and I can say that there was no fear involved. I knew that the donor was 24 years old, though the circumstances of his death are unknown, and I feel his presence, along with a sense of responsibility to do something good with the rest of my life. To do something with it in a positive way.” — John Brizzolara