“We Don’t Waste Good Livers”
A farewell to stigma, in honor of my late sister, Alison Muir Decker.
Alison Muir Decker died at 53 years old. She was my sister. That was 15 years after her first and second suicide attempt. I haven’t talked about this before publicly, and it’s about time. Because I loved her, and it’s part of “why” I do what I do. We should not have as much of a problem with that as we do.
My parents, Vita West Muir and Arthur Joseph Muir, Jr., became her parents. My father, in all fairness, was her biological father. My mother adopted her when she and my dad married. Alison was 14 years old at the time. Her biological mother—my father’s first wife—I still don’t know her name. She’s not dead. She just didn’t want this particular daughter any more. My sister posted, bitterly, about it, on her Facebook thusly:
Our mother, who is still alive, loved her. But the abandonment of one’s self by their birth mother, as a feeling, rarely fades. It didn’t fade for Alison. She was quite gifted, and if there’s anything to blame for the path to hell that her life became, it is the institution of medicine. She was trained as a professional chef, at LaVarenne, in Paris. This professional identity stayed with her long after the ability to do that job was taken away by a degenerative spine condition. She was a teacher, and a good one.
She was one of the many people who, in an attempt to relieve their suffering, had surgery on her spine. At that time, high-dose opiates were a regular post-op plan. Her ability to eventually leave opiate medications behind was not prioritized by the house of medicine. Her pain was real. Our ability to relieve it, with Oxycontin, was not.
When I was applying to medical school, she had made two suicide attempts within a week of each other. The first was actually pretty serious, and was evaluated in an emergency room, but no follow-up care was meaningfully arranged and no admission to a hospital took place. I’m not sure that either would’ve helped, but I am only cynical about that because I’m also a psychiatrist. I’ve seen how unhelpful these experiences can be.
Another attempt to die by suicide followed the week later. I’m being intentionally vague about methods here, because reporting about suicide is important to get right, and mentioning methods can lead to other people using those methods to end their lives.
After the second attempt, she was admitted to the intensive care unit, where she stayed for several weeks. She was placed on a liver transplant list. The doctors thought she would need one imminently. The liver transplant committee (and every hospital has a transplant committee that makes these kinds of decisions), declined her for a new liver.
I don’t know the exact wording of transplant committee report, but at least according to my mother, who was with her, the decision was:
“We don’t waste good livers on people who are just going to ruin them.”
Keep in mind, most liver transplants occur to save the lives of people who have cirrhosis of the liver, which is usually the result of years of alcohol use disorder or other conditions in which one has a role. There are plenty of debates I could have with the transplant ethics committees, on which I have sat in the past. Here at least, I will note my response at the time, and leave it to my readers to decide what they think or feel— “Wow, that seems pretty cold.”
The liver is a remarkable organ, and hers decided that (transplant committee be damned) Alison deserved another shot. It healed itself.
She lived another decade…
I have more to say about this. But, later.
To be continued…
—O. Scott Muir, M.D.
Thank you. Yes, thank you for unashamedly opening the chapters of your sister’s life. I find the gray cloud of shame and less worthiness cast on family, friends, neighbors, coworkers who are besieged by the darkness of depression and even worse those who end their pain by suicide, an impenetrable barrier to healing as a health care provider and as a family member with generations of unspoken mental illness. I welcome professional honesty and candid reflections. Again, thank you. M. B. Sebas MS FNP-BC