A Friend In Need - 1. Chapter 1

Michael heard those four fateful words. The four tiny words any patient dreads and fears above all others.

He was sitting in the consultation room with his mother and father, the day before his fourteenth birthday. It’s impossible to know who took the news worse; Michael or his parents.

“I have bad news.” The four words that any doctor hates saying, yet probably says a dozen times a week if not more.

Michael had been diagnosed with clear cell sarcoma of the kidney at the age of nine. He had sailed through treatment with only the resilience a child can show. He had the nephrectomy only a few days after the diagnosis was confirmed. He suffered through twenty four weeks of chemotherapy with cyclophosphamide, etoposide, vincristine, and doxorubicin. He then had to endure four weeks of postoperative radiotherapy as well.

Only one thing got Michael through all of that. It wasn’t his parents, it wasn’t his doctors, and it wasn’t even his unquestioning faith in God; it was Gavin. Michael and Gavin had been the closest of friends since nursery school; where one boy was, the other wasn’t too far away.

For still being four months away from his tenth birthday, Gavin had stood by Michael’s side through the best and the worst of his cancer treatment. Michael was in the hospital for eight days after having had his kidney removed, and Gavin had visited him both before and after school every day, and then spent the entire weekend with him. When Michael was vomiting from the chemotherapy, Gavin never once shirked from helping to clean his friend up. When Michael was suffering with chills from his weakened immune system, Gavin never thought twice about wrapping his friend in a blanket and cuddling up with him to provide some additional warmth. When Michael had that awful four week long bout of diarrhoea, Gavin never once shied away from cleaning his friend, and then washing his clothes. When Michael finally went completely bald from the chemotherapy, Gavin, over his parents objections, had all of his hair shaved off; just so that his friend wouldn’t be the only bald kid in school.

By the time Michael had finally finished all of his treatments and had then spent the best part of six months recovering, it was hardly surprising that Gavin and he had become closer. They say that a friend in need is a friend in deed; well, Gavin had taken that to heart, and he had really run with it. Although Gavin had quite literally nursed Michael through his cancer treatment, although Gavin had done things for Michael during that time that Michael’s own parents had blanched at doing, Gavin never once asked for, nor ever expected, anything in return.

God knows Michael tried to repay his friend on numerous occasions, but Gavin’s answer was always the same. “I didn’t do all of that for you for money, or toys, or games. I did all of that because I love you. You’re the Laurel to my Hardy. You’re the Yogi to my Boo Boo. You’re the Dick Dastardly to my Mutley. I’d never have allowed you to suffer through that alone.” Then, as he always did, Gavin hugged him.

Michael shook off his reverie. “What’s wrong, Doc?”

“It’s that nasty kidney infection you picked up six months ago. There appears to have been far more damage caused to your remaining kidney than we originally thought; and it doesn’t seem to be recovering. The blood tests we’ve been doing have unfortunately shown a marked drop in your renal function over the past six months. You’ve probably still got a few years before you need to worry about anything untoward happening, but I want to put you on the transplant waiting list now.”

Michael and his parents sat in stunned silence.

“I know it sounds bad Michael, but since it can take a couple years before a kidney becomes available, I want to start the ball rolling now. Based on your current renal function, you’ll most likely be down the bottom of the transplant list since you are probably a couple of years away from having to even think about dialysis.”

“You mean I’ll end up on a machine!”

“If the worst happens, and we don’t find a suitable kidney sometime in the next two to two and half years, then yes, you’ll end up on a machine; but it’s not the end of the world. Now I know that’s easy for me to say, but there are thousands of people who live a normal life on dialysis. Though we are really getting ahead of ourselves here. I don’t want you to worry about dialysis; I’m hopeful that we’ll find a donor match before we get to that stage.”

The doctor gave Michael and his parents all the literature he had on organ donation, what it involved, and what to expect. He then spent the next half an hour going over everything that will be involved in the work up Michael would need to go through to see what the donor match requirements will be. They were then advised that an appointment would be arranged with one of the transplant nurses sometime in the next week to make a start on his case.

“What’s this ‘living donor’ thing, Doctor?”

“Well, Mr. Turner, it is possible for a kidney to be donated by a living person, instead of us having to wait for a cadaveric kidney to become available. At the moment, more than one in every three kidney transplants comes from a living donor, and that actually helps the process along for the recipient. Instead of waiting two, three, or perhaps even five years for a cadaveric kidney, a family member could donate a kidney within six months. If you are interested, I can make sure that the transplant nurse knows to discuss this with you.”

“Thank you, Doctor. That would be appreciated.”

Over the next three days, Michael’s parents read through all of the material they had been provided with on both kidney transplants and living donation, and they also researched the subject on the internet. They were also contacted by the hospital to inform them that an appointment had been set up with the transplant nurse for the following Monday.

The day before the hospital appointment, Gavin had been invited over to Michael’s for dinner, and the boys were playing in Michael’s room.

“How are you doing, Michael?”

“Not so bad. I think I’ve started to come to terms with the whole needing a transplant thing.”

“Hey, at least your folks are prepared to donate a kidney, so hopefully you won’t have to wait too long.”

“That’s one good thing I suppose. They didn’t handle my cancer or the chemo side effects very well, so I’m a little surprised they’re so quickly prepared to do this.”

Gavin looked over a Michael and let out a deep sigh. “You really have been through it, haven’t you?”

“And you’ve been there with me, all the way. Through all the diarrhoea, puke and God knows what else you cleaned up. Without you, I wouldn’t have made it out the other end.”

“Don’t talk like that. You’re far stronger than you give yourself credit for you know.”

“Maybe, but it’s still the truth. I’ll never forget everything you did for me, and I’ll never be able to repay you for it.”

“I’ve told you before; you don’t need to do anything to repay me. Your friendship has meant more to me than you’ll ever know.”

The day of the appointment with the transplant team dealt two massive blows to Michael, both his mother and his father were quickly ruled out of being donors; his father over a positive crossmatch (indicating a high chance of the transplanted kidney being rejected), and his mother over a previously undiagnosed hypertension. The day had really kicked the shit out of Michael, and as soon as they all got back home, Michael locked himself in his bedroom and refused to come down for dinner.

(Michael’s entry)

Dear diary,

Is it not enough for me to have had cancer before my tenth birthday? Is it not enough for me to be told my one remaining kidney is now failing? I now fucking find out that neither of my parents can donate one of their kidneys! I mean, come on. Give a kid a fucking break!

Just how much shit can You throw at one kid! And here I thought Job suffered! He hasn’t got shit on what I’ve been through.

I really don’t know how much more of this I can take.

Over the next week both of Michael’s uncles and his three aunts all underwent testing to see if they could donate a kidney. One was found to have an incidental 11 mm renal cell carcinoma (and is now waiting on a nephrectomy herself), two were found to have previously undiagnosed hereditary polycystic kidney disease, one tested crossmatch positive, and one was found to have insufficient remaining renal volume if their other kidney was donated.

(Michael’s entry)

Dear diary,

Just my fucking luck! My whole family are turning out to try and donate a kidney to me, and the Great One In The Sky keeps on finding ways to piss all over their offer.

I keep on being prodded and poked, and I’m undergoing test after test and it’s doing my fucking head in.

Please, just let my suffering end.

“You don’t look so good Michael. What’s up?”

“It’s this fucking transplant thing. Every single member of my family has been ruled out as a living donor for one reason or another. God’s sitting up there having a right fucking laugh at my expense.”

Gavin wrapped him in a hug, and squeezed Michael as hard as he could. “Don’t say that Michael. I know how strong your faith is. Even during your worst weeks on the chemotherapy, you literally made me drag your sorry arse to church.”

“You’re right. I’m just feeling sorry for myself, and I’m lashing out. Though between you, me, and the four walls, I really don’t know how much more of this I can cope with.”

“Please don’t say that. I don’t know what I’d do if you weren’t around.”

(Gavin’s entry)

Dear Diary,

I can’t believe I’ve still got this diary. I just finished reading over the old entries, and the last entry was from the day Michael had his one year post-treatment scan, and was told the treatments had worked and there was no sign of cancer; that was about three years ago. I remember so many of the events from that time, but still, reading back over this diary has brought so much of it flooding back. To paraphrase Dickens, they really were the best of times and the worst of times.

For someone who isn’t even old enough to buy a beer in a pub, he’s gone through so much already, and now he’s being asked to cope with more shit. For as much as I try to support him and stop him getting down on himself, I know I’d never have been able to cope with what he’s been though.

God knows I’d do anything for Michael. I love that boy probably more than I love my own parents. Am I so wrong for feeling like that?

I know what I need to do for him. I just hope I get the support I need.

“No way in hell!”

“Mum, I want to this.”

“Gavin, I know he’s your friend, but you are not going to do this.”

“That’s not fair. If I want to do this, I should be allowed to.”

“I’ve been reading about it, and there is no way in hell that I’m going to allow you to even contemplate donating a kidney. End of discussion!”

Gavin ran out of the house, tears streaming down his face. He knew he needed to get out of there before he said something either he or his mum would regret. He ran over to Michael’s house as fast as he could.

He was out of breath by the time he reached Michael’s front door. He rang the doorbell, and Tony, Michael’s dad, opened the door.

“What’s wrong, Gavin? You look like hell.”

“I . . . I . . . All . . . All I wanted . . . .” That was as far as Gavin got before he completely broke down.

Tony wrapped an arm around Gavin’s shoulder and led him into the house.

“Calm down, Gavin. Take a couple deep breaths.”

“I just-” The rest of his sentence caught in his throat.

“Gavin, get a hold of yourself first. We’ll talk in a minute.”

Gavin just nodded as his tears continued to fall. Tony sat him down on the sofa and then sat down next to him.

“Dad, who was that-” Michael’s entry into the living room was abruptly halted as Gavin jumped off of the sofa and wrapped him in a death grip. Gavin held onto his friend like a limpet, while his tears flowed; Michael led him back over the sofa and sat him back down.

Michael held on to Gavin while he cried himself out. It took Michael and his dad the best part of twenty minutes to get Gavin to calm down the point where they could have a sensible conversation.

“Now Gavin, what’s up?” asked Michael’s dad.

“I told my mum that I wanted to be tested.”

“Tested? Tested for what?”

“To see if I could donate a kidney to Michael. She just went nuts on me. She wouldn’t even discuss it.”

“Gavin, that’s very generous of you, but I was reading the literature and I think you need to be at least eighteen to be a living kidney donor.”

“Actually Mr Turner, I’ve been looking into it. A child can donate an organ, if they are deemed competent to understand the reasons for the transplant and the risks to themselves. It also requires the agreement of the Human Tissue Authority, an order from the High Court, and the agreement of the parents. So it is technically possible for me to be able to donate a kidney. But, I don’t want to start all those legal proceedings and consent stuff, if I don’t even know if I’m a match.”

“I can understand that. But it’s still a huge thing to even contemplate, Gavin.”

“Dad’s right. You’ve already done far more for me than I have any right to expect from a friend.”

“I’ve told you before Michael, I love you. If this will help you not to suffer anymore, then I want to do it. It should be my choice what I do with my own body.”

“Tell you what Gavin. I’ll speak your mum, and tell her what you’ve said. If she agrees to at least allow you to begin the testing phase, we can arrange for it to happen, and then we can worry about where we go from there.”

Tony spoke with Gavin’s mum that evening, and after a lot of give and take, and the use of language that should not be uttered in mixed company, she came to realise how much this meant to her son, and so she agreed to allow him to start the testing process. Gavin even managed to persuade his mum to allow him to stay there for the night. Tony then contacted his son’s transplant coordinator and explained the situation to her.

“Mr Turner, your son’s friend is quite correct in what he has found out. However, it is far from being that simple. There have been, in rare situations, living donations between blood relatives who are children, but to the best of my knowledge, there has not yet been what is termed an emotionally related live donation from one minor to another; which is what we are talking about here.

“However, since the legal wrangling can take a while to sort out, I think we should do the initial compatibility testing phase, and then take it from there. You need to warn him though, that it is extremely unlikely that he will be a close enough match to allow us to even think about doing a transplant. Although, there really is no rush to get this sorted, since it seems to mean so much to Michael’s friend, we have a slot free at ten o’clock tomorrow morning, if he can come in.”

Tony quickly checked with Gavin who immediately agreed. “Sure, that’ll be no problem. We’ll be there at ten. I’ll let his mum know, as she wants to join us.”

When Tony hung up the phone, Gavin gave him a hug. “Thank you for doing this for me, Mr Turner. If something ever happened to Michael, and it turned out afterwards that I was a match, I’d never forgive myself.”

The next day Gavin, Michael, Tony and Josephine (Gavin’s mum) were at the hospital. The transplant coordinator greeted everyone.

“Okay, Gavin. You understand that even if you do prove to be a match with Michael, that there is a massive uphill battle to be fought, for you to be allowed to be considered as a living donor?”

“Yes, ma’am. I’ve been reading up on it. If I’m a match then great and we can move on to the next step. If I’m not a match, then sure I’ll be upset, but no harm no foul.”

“Let’s see what the test results show first shall we. Now there is quite a bit to get done. The workup is quite extensive and you’ll need to come back in three days time to get the results, because they will need to be reviewed by our transplant panel on Thursday first, and they will make the determination as to whether you are a viable donor candidate.”

Gavin was first seen by a nurse who took some blood, and made him pee in a cup, in order to test his kidney function and to look for the presence of certain viruses such as CMV and hepatitis. Then he went up to the third floor where he was first hooked up to an ECG machine, and then he was wheeled around the corner to the radiology department. He had an ultrasound scan of his kidneys and a chest x-ray, and then he had a cannula put into his hand so that a contrast dye could be injected for a CT angiogram; all of which was to check for any signs of lung problems and to make sure that the kidneys and ureters are working properly.

After having been poked, prodded and scanned for the best part of three and a half hours, he was told that the initial test results were promising; he was confirmed as having a compatible blood group and the crossmatch testing had come back negative. He was then sent home, and told to return on Friday at ten o’clock so that he could find out all of the remaining test results, and the initial opinion of the transplant panel.

The next three days dragged on, but Friday morning found the four of them back at the hospital.

“So Gavin, I have your test results here, and the decision of the transplant panel. We actually had the lab run all of the tests twice just to make sure. Amazingly, you are a near perfect match for Michael.” The two boys started cheering, thinking the worst was now over. “Now boys, it’s not a perfect match, but it’s almost as close a match as we see in blood relatives. Now as I’m sure the transplant coordinator has already told you, the obstacles to you becoming a living donor are huge, but I don’t believe that they are insurmountable. I think if we all pull together, we can convince the various agencies to support this transplant. Now the first thing you’ll need to do is to convince both me and a psychologist that you fully understand what this transplant entails and the reasons for this transplant happening.”

“Actually, Doctor. The first thing he’ll need is consent from me and my husband, which we do not give.”

“What! I thought you’d come around Mum!”

“Mrs Dinage, am I to take it that you do not wish for your son to proceed with the donation?”

“That’s right. My husband and I allowed this testing to take place under the belief that it would show he was not a match, and then we could drop all of this living donor nonsense.”

“Mum! That is bang out of order. You can’t raise Michael and mine’s expectations like that and then pull the rug out from underneath us. We all now know that I’m a match, and could potentially be a living donor, and for some reason you won’t allow it to happen.”

“I’ve read the literature Gavin, and there are large risks to you in going ahead with this. As far as I’m concerned, the risks to you are far too high.”

“And there are even larger risks to Michael, if it doesn’t go ahead. He’ll end up on a machine, to keep him alive. Are you really prepared to do that to him?”

“There is nothing more to discuss. Thank you Doctor. Tony, I’m sorry, I really am. Gavin, come on we’re going home.”

“You do this to me Mum, and I’ll never forgive you. I swear to God, I’ll hate you and Dad until the day I die.”

“Then fine, hate us. At least you’ll still have two kidneys and you’ll be alive.”

Josephine then dragged her son out of the consultation room, and took him home. Michael folded over into one of the chairs and wept. His last hope had been dashed. All of his fight had finally left him. He was completely and utterly defeated.

Michael didn’t see Gavin or hear from him at all on Saturday or Sunday. On Monday afternoon he was checking his e-mails when a new e-mail appeared in his inbox.

My dearest Michael,

This e-mail has been time delayed since eleven o’clock this morning, and a similar e-mail has been sent to the transplant team. By the time you get this, it will already be too late.

My parents stopped me from giving you this gift in life, but they will not be able to stop me from giving you this gift in death.

You are the Laurel to my Hardy. You are the Yogi to my Boo Boo. You are the Dick Dastardly to my Mutley. I have never, and will never, allow you to suffer.

My dying wish is for you to live. My dying thoughts are of you.

I love you.

Yours, always

Gavin