How a snake bite made two St. Michael’s doctors share a liver

By Christy Janssens

What do you do first when someone tells you to find a new liver? Dr. Robert Stewart, a kidney transplant surgeon at St Michael’s for 20 years, had no idea where to begin finding a new organ for himself.

That life-altering dilemma stemmed from an experience in Southeast Asia a year earlier, when he was visiting his daughter, who was studying there. On the way to an elephant sanctuary in the jungle, they stopped at an outdoor market to get food for the elephants. As he reached out to a table piled high with bananas, a snake bit him.

Dr. Stewart, a kidney transplant surgeon at St. Michael’s Hospital, was scheduled to fly home the next day and, after a Google search revealed that the pattern of bites on the hand wasn’t likely to be poisonous decided to handle the issue back in Toronto. After a 21-hour flight home, he had developed extensive cellulitis and was systemically unwell.

For the next nine months, Dr. Stewart grappled with symptoms related to Stevens Johnson syndrome, a reaction to the antibiotic treatment, including a rash, sloughing of skin, arthritis, and nightly fevers and daily chills.

“I didn’t understand fully how sick I was,” says Dr. Stewart. “It didn’t strike me that I, as a healthy physician, could be so sick and not realize it. It’s something that we need to reflect upon; the fact that we feel invincible or that we aren’t as vulnerable to disease as our patients are.”

By November of that year, Dr. Stewart was seeing more doctors and undergoing multiple tests to understand why he wasn’t getting better. Finally one doctor, after looking at the tests, said that she was sending him to the liver transplant clinic the next day. He had end-stage liver disease as a complication of the antibiotic reaction.

“All of this happened within one day,” says Dr. Stewart. “It was shocking. I was reeling. I didn’t know how to process it.”

There was some urgency to find a new liver. But Dr. Stewart’s job had always been to transplant the kidneys once they had been found. He was never part of the early part of the search for a donor.

A colleague gave him advice. “He said ‘you can’t advocate for yourself. It’s awkward. You can’t ask someone for a chunk of their liver. It’s too much,’” says Dr. Stewart.

Dr. Stewart’s wife, an ICU physician and senior scientist at University Health Network, shouldered the task of sending emails to friends and family and colleagues all over the world, searching for a liver. Dr. Stewart had no idea who she was asking or who might be a donor.

“A potential recipient is told nothing,” says Dr. Stewart. “You are told you need a liver, but you aren’t told whether there are zero, two, or 100 people in line. They just tell you to keep running the race. That is pretty frustrating for any doctor who is used to being in control. I understood the confidentiality need to keep the donor and recipient processes separate, but the opacity of it almost killed me. I was freaking out.”

One of the people who saw the call-out was Dr. Marie Faughnan, a physician in the respirology department at St. Michael’s and a colleague of Dr. Stewart’s. Her first reaction was that someone should help. Then the thought, “why not me?”, entered her mind.

She considered the risks and benefits for months, mulling it over as she biked to work. She explored the idea with another colleague, a liver transplant surgeon, who helped her understand that the procedure was safe. Then, she signed up for a liver test to see if she might be compatible.

“Ultimately, the hardest part was making the decision,” she says. Although she wrestled with some fear, waiting to hear if she was a good candidate to donate part of her liver, she ultimately made the choice that, if she was a good candidate, she would do it.

“I realized that it was just fear speaking,” she says. “I was so excited when I heard that, yes, I was a good candidate. By then, I felt very ready.”

Upon hearing Marie was the donor, “I was both shocked and surprised,” says Dr. Stewart. “It was the greatest day of my life. I had no idea that she had come forward.”

Ultimately, the liver transplant was a success. Dr. Stewart was released after five days in the hospital, and Dr. Faughnan, after four days, which is a very short time after that kind of surgery.

“It was an amazing feeling,” says Dr. Stewart. “If you want to know what I was thinking when I was put to sleep before the surgery, it was that I wanted so badly for Marie to have a soft landing after the surgery.”

“I am relieved that it has gone so smoothly for both of us,” says Dr. Faughnan, “I am so happy about my decision. It felt right.”

“At first, Rob referred to it as ‘your liver,’” she says, about navigating life after the surgery. “But I told him that I had fully given it to him and he could start calling it his own. We’ve stopped thinking about it that way, now.”

The experience changed Dr. Stewart’s life.

“I’m a lucky survivor of this experience,” he says, “Being critically ill is a full-time job. It percolates out in so many different dimensions that I didn’t appreciate beforehand. I didn’t really understand the collective suffering in the waiting room. Now I understand that every one of those patients has a story, and I am just one of those patients myself. I became a patient, and it changed me as a doctor.”

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.