The Price of Vita’s Liver
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Excerpts from Vita’s Expensive Liver by Elsa DemoSie benötigen den Flashplayer, um dieses MP3 zu hören.
A story by Albanian author Elsa Demo, translated by John Hodgson.
In post-communist Albania,
foreign embassies have taken on the role
of the Investigator’s Office.
A fatherland cannot be won:
it is a trophy of war,
that will ask you to sacrifice Iphigenia.
“When was he diagnosed?”
“Have you tried before to send him abroad.”
“Yes, to Greece.”
“Our whole family lives there. We thought it would be better in Greece than somewhere else where we don’t know anybody.”
“Your means of support?”
“I’ve rented a small tailor’s shop. I work with my daughter, People don’t have any money, but still they don’t save. They’d rather buy ready-made than made-to-measure.”
Vita came out into the corridor, regretting that phrase about people not having money but still not saving. This was her first meeting with the health minister, in the very hospital itself. Biku, as her husband was called for short, stared at the other patients with a weary gaze, but the people round him were more exhausted still.
Reaching her shop, Vita raised the shutters. The sign above the door read, “English Style”
On the way she had held Biku’s hand. His fingers had grown thin and dark, as had his lips, as if stained by blackberries, Biku was a bit like a child gathering blackberries, a small child who has stopped playing because of a stomach ache, and is picking blackberries to quell this inexplicable pang. His liver was this colour. The darkest organ in his body. It must look like a rough, knobbly cluster of blackberries. If the liver continued like this, with its rough edges it would tear itself to shreds.
Those thin fingers that felt so moist in Vita’s hand used to hold a magnetic screwdriver and tighten with difficulty the little screws of clocks. Biku’s way of killing time was to dismantle and reassemble clocks and electrical appliances. It called for concentration. Concentration takes time and time requires activity. But now he just lay there or sat stroking the cat if he were alone in a desert. He would be ready to plough a desert, yard by yard. But how can you do that? His liver is a desert, without directions, without signs.
He should have had a local anaesthetic in the liver region. Then they would have sent in a long sound to extract a liver sample. But each time he collapsed. They tried twice while Vita waited outside, once with the door half open, and once with it shut, when she sensed that he had caved in. She had run in and seen him. But this procedure, known as a biopsy, was vital. It was the best kind of test to determine the degree of scarring and inflammation. Then they would decide on the kind of therapy, the dosage, and the programme for the future, because all the treatment so far had been guesswork. The dosage would be adjusted according to his reaction. There was no diagnostic laboratory for Hepatitis C in this country. The patient has developed cirrhosis; cirrhosis calls for a transplant, even though the virus might reappear even after the transplant.
-- Biku’s body has become an object for research.
-- If he gets help soon, your husband will have a long life.
On the day when Vita had held Biku’s hand in the street as they went home from the meeting with the minister, Biku had explained to her that Albania had no agreements with foreign countries about liver transplants. The only remaining possibility was for the Health Ministry to send a memo to the embassies of neighbouring countries, so that Sabri could obtain a visa and go to a hospital that carried out liver transplants in Greece or Italy. He would have to be resident in the country where the operation would take place. he would need a visa, a long-term one. In fact, both husband and wife would need visas, and a lot of money.
“It will cost a lot,” said the minister sceptically.
“My husband receives invalidity benefit of 7,200 leks a month. My family paid for the first six months of the treatment. If the state hadn’t paid for the treatment after that, which cost up to 3,000 leks a month, we would have been sunk.”
“I understand,” said the minister, for the sake of something to say. He came from the Greek minority, and had shown that a person’s good name was the best form of passport in this country, where a tradition counts for more than anything you might do. His surname, of Latin origin, meant something like “sole” or “solitary”. As a minister belonging to the party of the Greek minority, he had come to understand that when there is nothing you can do, the best thing is to use a calm, paternal tone with these Albanians, who can flare up over nothing, like cotton wool soaked in paraffin. This ensured you were remembered fondly even if you didn’t lift a finger to introduce the slightest reform. In this state administration, reform meant sacking supporters of the opposition parties, and employing activists of your own.
“So, you will use your ministerial influence?”
“I will do all I can.”
“My parents have found a hospital in Athens that promises an accurate diagnosis. We aren’t asking the state for financial help for the operation. We’re not even thinking of it any more. We know that the state can’t run to that... We’re ready to sell our house. We can borrow too... and if necessary... I’ll be the donor.”
“I can imagine...” The avuncular minister shook himself awake. He seemed to Vita the most ordinary kind of person. After seven years of waiting, it seemed that a single moment like this could bring an instant solution to a hopeless situation. “I can imagine,” he repeated. “Liver transplants are now possible not only with organs from people who have died, but from living donors, if they are found compatible.
Her husband was supposed to feel pain in his liver, to the right of his stomach, just under the rib-cage. But in fact he did not. He merely felt a tiredness that was worse than pain. A sense of impotence. An impotent husband.
“Biku eats everything.”
“It is more tiredness, doctor. he has lost concentration. As you see, he’s lost weight too. 170 cm. tall, but just over 60 kilos, no more.”
“With difficulty, and urine like Coca-Cola.”
“How is his sleep?”
“I can’t say that he wakes up in the morning, because he doesn’t sleep all night.”
“If he has no pain, he has a temperature. If he doesn’t have a temperature, it’s insomnia. And then the psychological stress. We’ve sold our house. We’re waiting for our visas.”
“Aggravating factors have to be avoided.”
Vita wanted to touch Biku’s fingers. But she frowned, thinking that this intimate gesture might be noticed by this security guard of the Greek Embassy with red bushy hair who duty it was to keep order among the visa applicants. The consulate yard was enclosed by walls, surmounted by railings, and was observed by cameras at every corner. This plain-clothes redhead was having fun with his knowledge of Albanian as he read the names in the lost. Names such as Jana, Harrilla, Marie, Petro Jorgo, Margarita, Kristaq, Dhimitraq, Nasi, Trifon made him grin. The queuing applicants smiled at this nice Greek who was trying to use his time in Albania to get to know its people. If it were up to him, he would do more for these people in line. But the same people who smiled at the Greek’s little rituals would later gasp or furrow their brows in consternation to see the guard set aside his cup of filter coffee on the ledge beside the window and rush forward, as if ready to bite the nose off someone who was talking too loud, using his cellphone, or not keeping in single file. A policeman in a uniform with an eagle on his sleeve with flames coming out of its beak was told off for smoking, and neither his uniform nor his eagle was any help.
“Aggravating factors have to be avoided.” Vita repeated the doctor’s advice. The redhead’s mouth opened for the insertion of a french-fried potato from a plate on the counter. The security guard had returned to his place after commenting on the uniformed policeman to the face behind the glass, which now asked:
“Why do you want to go to Greece?”
“Because of my husband’s health.”
“Who will cover the expenses?”
“Where will you stay?”
“With my parents.”
“Why is your husband going?”
“For a liver biopsy. The doctors are expecting him.”
The woman behind the pane of glass gave her a cold, quizzical, lizard-like stare, as if to say, gineka, gineka, I didn’t ask if the doctors are expecting him. The ministerial note also gave her no priority or privilege over the others waiting in line. But her Englsih did not permit her to properly express the justice of this opinion, which was based on the rules and regulations that governed the relationship these two women opposite each other, separated by a pane of glass. The woman behind the window bristled and fixed her lizard eyes on the Doko family’s file, rechecking one by one the rubber stamps and the signatures on each page. Without raising her now weary reptilian gaze, she told the Albanian interpreter next to her to tell these Dokos to turn up at the Greek Embassy on 7th January.
On 7th January, Sabri Doko was handed a Greek visa, free of charge, for health reasons. Vita’s application was rejected on the grounds that she did not meet the necessary criteria. The official letter informed her that she could appeal to the Greek Foreign Ministry within 90 days. Her husband’s visa was valid for a 30-day stay within a three-month period. But it was useless to him, because he could not travel without Vita.
And so he did not go. He spent some time in hospital merely for some therapy that would prepare him for the journey, and put on a drip with the usual medications and mineral salts. His liver was now collecting water and had to be drained. He was also given a form of medication sent from America, a plant-based medicine that carried out the function of the liver and eliminated toxins. He became stronger. He was perhaps as well as he ever would be.
Vita came back from the office of the Foreign Ministry, where she had requested a clear explanation of why she had failed to meet the criteria. She applied again to the Greek Embassy. Climbing the stairs of her apartment block, she recalled Biku’s doctor: risk factors have to be avoided. What were they in this case? They had sold their house. Soon they would have to move to another flat and pay rent. How often Vita had heard her neighbour’s voice calling their eldest daughter, “Fiori, Fiori, your grandfather’s fallen on the stairs... “ Biku would come done and pull his father half-way up. The old man, half-asleep, trailed his legs down the stairs, while his arm, stronger than his son’s, swung like a pendulum over the invisible wound that was Biku’s liver. Vita held her breath on those stairs, up which Biku had so regularly hauled his drunk father. She recalled her neighbour’s regularly mocking voice, “Fiori, Fiori, your grandfather...” and her throat went dry. Events had taken a different turn.
That evening Biku suffered a cerebral haemorrhage.
Half lying on a couch in the Gastro-hepatological department, he vomited blood. A stream of blood gushed from his ribcage. The jet was broken as Biku’s body jackknifed and folded up like a night flower in Vita’s arms. His head hung over his wife’s shoulder. A strange hoarse voice came out of him, and said, “My darling.” Vita held to her breast her broken husband, who had made no other sound. Biku entered a coma for five days, and never came round again.
The day of Vita’s appointment at the embassy arrived. Sometimes she thought of not going. Anger, grief, tension, and a sense of injustice all seethed inside her. But she went. She sat in the waiting room in two minds. What would she say to them? Pen-pushers came and went, and a young woman said to her, “Excuse me, they’re talking about you.” In this waiting area in front of the counters, they seemed to know everything. The queue was long and they told Vita to wait. She decided to play the game. She told them that she wanted to speak to the official responsible for the Doko file. Again, they told her to wait.
Vita went outside into the street in front of the embassy, and sat in a cafe. After quarter of an hour, her husband’s cellphone rang. It was a woman’s voice, in Albanian.
“We’d like to speak to Mr. Sabri Doko.”
“Who is this, please?”
“I’m sorry, I can’t say.”
“I’m his wife.”
“Where’s your husband?”
“This is my husband’s telephone. I’m keeping it.”
The line went dead. Immediately, Vita’s own phone rang.
“Is that you again?”
“Yes, it’s me.”
“Why have you got both phones?”
“I just have them.”
“I don’t understand.”
“Nor do I. Is it the normal procedure to phone visa applicants on their cellphones?”
“We want to talk to your husband.”
“My husband’s at home.” Then she added at once. “You want to speak to my husband. I want a meeting with the consul or the ambassador.”
“Why? Over which application?”
“About the first one.”
The voice on the line fell silent for a moment, and resumed. “I must inform you that it’s not possible to contact the consul or the ambassador now.”
All week, Vita racked her brains for an explanation. Her head swam. She rehearsed over and over again their possible cheap excuses: we’ll give the patient a visa, but not his wife, because she won’t come back.
Again the woman’s voice from the embassy:
“Is that Mrs Doko?”
“What happened to your husband?”
“Why do you ask me about my husband when you know perfectly well?”
“No, we don’t know.”
“You know perfectly well, ever since I told you when I came to the embassy.”
“Why did you say then that he was at home?”
“My husband is at his own home and I didn’t tell you which. If you want to know my husband’s address, I’ll take you there. I want to know who is responsible for what happened to my husband.”
“But what do you want now. Do you still want a visa?”
“You should know very well what I want. You should realize that I’ve not only lost my husband, but my home too. My children are on the streets. I want to know if you personally are responsible for the refusal of my visa. Or for what’s happened to me.”
“If you, my dear lady, are not responsible, I’m not going to waste words on you. I asked to meet the consul or the ambassador.”
“Do you want to say these things to the consul or the ambassador?”
“Do you speak Greek?”
“I don’t need to speak Greek. I’ll bring an interpreter.”
“An interpreter wouldn’t be allowed,” said the voice.
“Well, the consul or the ambassador must speak some foreign language. That’s no obstacle.”
“We’ll let you know.”
“I don’t want you to let me know. I want an appointment, and you must give me an answer, yes or no, to my face. I want to meet you face to face.”
In the second week of March, Vita was granted a Greek visa. She was informed by a text message to her cellphone. A one-month visa. She thought of taking the matter further, asking the ambassador or the consul or the official responsible what they thought she could do with this one-month visa. But then she thought, Albania is my home. What would she stand to gain? She would merely go through all that stress for no purpose. She wouldn’t even find out who that person was who decided human life or death. Who was this mighty person?
There was no point trying to embarrass the Albanian Foreign Ministry. Vita went there, but they didn’t give her an official reply. Their only response was off the record: we have no power over the Greek Embassy.
This state was powerless to lodge a complain on her behalf, let alone demand an explanation of the error she was supposed to have made in submitting her documents. She had nothing to gain here. What else could she do? She remembered the doctor’s useless advice: Avoid aggravating factors.
Sabri Doko died on 19th February 2009, six weeks after he, but not his wife, had been granted a Greek visa. One of the Tirana daily papers wrote, “Sabri Doko passed away aged 42 following a cerebral haemorrhage. He had suffered from hepatitis C for the last eight years, and needed a liver transplant. Throughout this time, the Gastro-hepatological unit of the Internal Medicine Department of the Mother Teresa University Hospital had become his second home. He leaves behind his wife and two daughters. He had sought help from state institutions for years, and received nothing, but it was the Greek Embassy which sealed his fate by denying a visa to his wife.”
One month later, his father followed him. He had given up drinking, and also eating. Vita received a 30-day tourist visa from The Greek Embassy three weeks after her husband’s death, but did not leave Albania.
Elsa Demo was born in Fier in 1976, and studied Albanian language and literature at Tirana University. Since 1999 she has been a regular contributor to the cultural sections of the Albanian press, and is in cultural editor of “Shekulli,” Albania’s largest paper. She has written numerous essays, articles, and stories.