A piece of my mind. Commander.

Abstract

Bill and I stood at graveside. My children were there too. For them, this was the first experience of the loss of a friend. Our efforts to save this life had been futile. Biopsies, liver enzyme assays, several operations: each time the patient recovered and for long periods. Then some new intervention was required. Ironically, the very means of the early basis for our relationship had failed: a liver allograft reached end-stage function. Hepatic coma was the end. Bill Gurley and I had begun working together years earlier. He was a PhD candidate studying cyclosporine pharmacology. I was part of a busy multiorgan recovery and transplant service that had developed through clinical and animal laboratory investigative channels. It was early in the cyclosporine experience and no transplant center fully understood the drug's pharmacokinetics. It was very effective in preventing allograft rejection, but could also cause severe renal and hepatic damage.