Elizabeth Rand knew she should go home. Just 13 days earlier she'd had a mastectomy, reconstructive surgery and a breast reduction. The last of five surgical drains had just been removed during a postoperative checkup at HUP - the Hospital of the University of Pennsylvania.
Rand, a senior liver specialist next door at Children's Hospital of Philadelphia, knew her patients were in good hands. She knew that 17-month-old Nadia Kadi would be fine during the last 10 days of Rand's recuperation.
Rand didn't need to check on her.
Her husband, Spencer, reading her mind, had asked her to please come home after her appointment. A colleague had warned her it was too soon to visit CHOP, that she would get sucked in.
But Rand couldn't stay away. Not from those children. Not from their families. Not from Nadia.
It was Thursday, April 26. Rand, 45, slowly walked the one block to CHOP, careful not to pull any of her stitches. Apart from the ridged purple scabs beneath both breasts, she had an abdominal scar stretching from hip to hip where the plastic surgeon had collected the fat tissue for her breast reconstruction.
Nadia's parents, Allison and Joe, would be crazy with worry, Rand thought. The toddler was rejecting her newly transplanted liver.
The first month after a transplant is generally the most dangerous, when the potential loss of the liver is greatest. Forty percent of liver-transplant patients experience some rejection, but doctors can employ an array of drugs to treat and prevent it.
Still, nearly 20 percent of livers transplanted in children across the country fail, leading to second transplants. At CHOP, only 8 percent required another organ.
Rand was going to do everything possible to make sure Nadia didn't join that group.
When she arrived on 8 South, the ward at CHOP where liver patients are treated, Nadia was awake.
The little girl looked up curiously to see who was coming into her room. She offered Rand a coy smile before turning back to hug her father and hide her face in his chest.
She looked good, thought the doctor.
The trick was the meds. Nadia's immune system was attacking the foreign organ. Rand had to find the right mix, the proper alchemy, that would fool Nadia's body into accepting the new liver as its own.
The child was taking 10 different medicines. Two immunosuppressants, tacrolimus and prednisone, to prevent rejection. The rest of the drugs she'd take were to counteract side effects from the first two. Nystatin to prevent fungal infections in her throat and mouth. Bactrim to prevent pneumonia. Ranitidine, an acid blocker, to limit stomach acid. And so on.
Rand's task was to find not just the right balance, but to constantly adjust it as Nadia grew and her body changed.
Joe listened carefully. Allison was home with the couple's 3-week-old baby, Adam - born the same day Nadia got her new liver. He would call her after the doctor left.
Rand was glad she had made the trip to see them.
It was important to be there with her patients and their parents. She didn't believe doctors should build a wall between themselves and those they treated.
Her experience with breast cancer reinforced that approach. She had come to be with Nadia, as she would any patient.
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