The Liver Dialogue: Final Interview with a Damaged Liver
On the occasion of World Liver Day, I conducted a unique interview. I spoke to the liver of a patient who recently died from alcoholic liver disease. He appeared nodular, shrunken, and hardened… a sharp contrast to the smooth, reddish-brown coloured, lively and healthy liver.
ME: I am sorry for how this ended. It must have been an exhausting journey for you…
LIVER: Thank you, Doctor. I am… very tired. But I am glad you asked. If my story can save even one liver from this kind of suffering, then this is worth the effort.
ME: You are called the powerhouse of the body. Can you describe how your days were before the end?
LIVER: The heart is the engine but I was the factory and the refinery. The work of the heart is loud and rhythmic, but my work happened in silence. I was the central processing plant, running over 500 types of jobs every single day.
Just to mention a few… I filtered the blood so that his brain could think clearly. I manufactured albumin to maintain the fluid level in his blood and prepared clotting factors to stop him from bleeding. I also stored energy for the days he forgot to eat. I was the ultimate multitasker.
ME: How did you keep working even when the damage started?
LIVER: He was my human. I knew that if I stopped, he stopped. Even in those last few years, when my millions of my cells were dying, I tried to compensate. I worked overtime to clear the toxins. It was my desperate attempt to keep him alive.
ME: Then what happened?
LIVER: It was the continuous assault. You see, I have a superpower… regeneration. I can rebuild myself from almost nothing. But regeneration requires time and energy.
Every time alcohol hit me, it caused inflammation. I tried to heal, but before I could finish, another wave would come. Eventually, I ran out of healthy tissue. The scarring… what you call cirrhosis… was really just my desperate attempt to recover my health. But scar tissue cannot work or filter blood. Eventually, my whole structure just collapsed.
ME: Why didn’t you signal for help sooner?
LIVER: That is the tragedy of my kind of organs. We are silent sufferers. The heart pounds to demand attention, the stomach growls when it is empty, the skin shows every scratch and scar. But livers? We suffer in silence.
I have no voice until I start screaming. By the time I turned his eyes yellow with jaundice and swelled his belly with fluid, I was damaged and silently failing. I wish I had a way to cry out earlier.
ME: Was there a time when you felt embarrassed?
LIVER: Yes, many years ago, during a routine ultrasound test. The radiologist diagnosed me as “fatty liver”. I felt heavy, choked by the stuffing of fat in my cells. It was not just the alcohol… it was the diet and his lifestyle too. I felt very sluggish. That was the first warning sign, my first silent cry for help when they looked at me. But because I did not cause any pain, I was ignored.
ME: Looking at the current lifestyle of humans, what worries you most?
LIVER: I worry that people think this is only about alcohol. Alcohol is a major problem. But that is NOT the only one… I see a new epidemic of “fatty liver” caused by obesity, excessive intake of sugar and processed foods. I see livers looking like big sponges dipped in oil inside people who have never touched a drop of alcohol. I hope people realise this soon.
I want to see a future where people treat us with the same respect that they give their hearts. We livers are also as important and as fragile.
ME: What advice do you have for those humans whose livers are still functioning?
LIVER: Please, treat us like your partner, not just a filter.
- Alcohol is a direct poison. Avoid it. Though I can handle small amounts, do not abuse me.
- Belly fat is suffocating us.
- Since I cannot feel pain until the end, please check on me with blood tests (LFTs) and ultrasound tests. They are the only way to hear my voice.
ME: Finally, some patients ask me about “liver detox” supplements. What do you think?
LIVER: (Sighs) Please, no. I am the detox organ. Evolution has designed me perfectly for that “detox” job. I do not need expensive herbal tonics or cleanses… those can sometimes increase my chemical workload or even cause drug-induced injury.
The only “detox” I need is for you to stop putting toxins into your body.
Give me clean fuel, keep me fit, and I will take care of the rest.
ME: Thank you. Please rest now.
Key Learning Points
- The liver has a massive functional reserve. Clinical symptoms like jaundice, bleeding, encephalopathy and others do not show up until >70% of the liver is damaged.
- Whether due to alcohol or metabolic syndrome, the damage to the liver is the same. Steatosis → Steatohepatitis → Fibrosis → Cirrhosis.
- As there is no pain sensation in the liver, testing is based entirely on blood tests and ultrasound.
- Fibrosis is reversible in early stages… cirrhosis is generally considered irreversible. But even with cirrhosis liver function can be maintained. Think of the liver early and take care.
Dr. Shashikiran Umakanth (MBBS, MD, FRCP Edin.) is the Professor & Head of Internal Medicine at Dr. TMA Pai Hospital, Udupi, under the Manipal Academy of Higher Education (MAHE). While he has contributed to nearly 100 scientific publications in the academic world, he writes on MEDiscuss out of a passion to simplify complex medical science for public awareness.
