francisco varela - intimate distances - fragments for a phenomenology of organ transplantation

7/20/12 7:33 PMFrancisco Varela - Intimate Distances - Fragments for a Phenomenology of Organ Transplantation

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Intimate Distances - Fragments for a Phenomenology of OrganTransplantation

Some two years ago, prior to writing this articleFrancisco Varela was battling with the worseningcomplications of Hepatitis C which had evolved overthe years through cirrhosis, and then to liver cancer,and then to the necessity for a liver transplant. Hedescribes the experience of the transplant and itsaftermath in these notes written prior to his death onMay 28th, 2001. He uses his own experiences veryvividly to make some important phenomenologicalreflections on post transplantation life, personalidentity, embodiment and many other importantissues. This is an incomplete version of the textpublished in the Journal of Consciousness Studies,8, No. 5-7, 2001, pp. 259-71.



Francisco J. VarelaCNRS, Paris, France

Intimate Distances -Fragments for a Phenomenology of Organ

Transplantation

L'intrus n'est pas un autre que moi-meme et l'homme lui-meme. Pas un autre que le meme qui n'en finit pas des'alterer, a la fois aiguise et epuise, denude et surequipe,intrus dans le monde aussi bien qu'en soi-meme,inquietante poussee de l'etrange, conatus d'une infinteexcroissante.J.L. Nancy, L'intrus[1]

I: 5.00 pm, Day 5

The scene is viewed from the side. The patient is Iying onhis half-raised hospital bed. Tubes, sutures and drainscover his body from nose to abdomen. On the other side ofthe bed, two masked men in surgical outfits look at thescreen of a portable scanner. The senior doctor explainsand demonstrates rapidly to his apprentice, the probesearching around the right side under the ribs and over the



stomach, in sweeping motions. The intern listens raptly,nodding repeatedly. The screen is turned so that the patientcan also see it. It is J+5.

I emerged from surgery with the liver of an unknown fivedays ago. My attention now shifts to the two men as theyspeak, I follow their conversation and wait expectantly forwords directed to me. It is a crucial moment: if the veinsand arteries have not taken to their new place, my wholeadventure comes to a halt. The graft, from their point ofview, represents hardly anything more than a successfulfixture. I am short of breath as I pick up the doctor'soverheard telegraphic comments: Good portal circulation,no inflammation.... Abruptly he smiles to me and says: 'Toutva bien!' I am now my prostrate body that feels broken up,in bits and pieces, aching from a visible incision that goesfrom right to left in an arching path, and suddenly bifurcatesover the chest right to my sternum, almost immobile fromthe multiple intubations and perfusions. His reassuringstatement oddly makes me feel my liver as a small sphere,as if I am carrying an infant (I remember the pictures of mylast son's beating heart in his mother's belly); it is tingedwith a light pain, it is definitely present.

In the background, the brokenness of my body beckons mewith an infinite fatigue, and a primordial desire to close myeyes and rest for eternity. Yet the screen is a fewcentimeters away and a simultaneous curiosity perks upunflinchingly. I can see my new liver, inside me. I follow thedetails: the anastomoses of the cava and the porta veins,the two large hepatic arteries, the II then the III lobulesquished one into the other. I travel within, gliding insideand out of the liver capsule, like an animation. I listen with



unabashed interest to the explanations to the intern ('Here,look at how best to catch the flow with the Doppler'; it goesswishhh, swishhh now, as histograms display theparameters in charts and line drawings; 'Here is the bestway not to miss the hepatic peduncle'; this time the object islost to me in a sea of grey).

We are looking at the scene from the side, you and I. Andyet for me alone is echoed in multiple mirrors of shiftingcentres each of which I call 'I', each one a subject whichfeels and suffers, which expects a word, which is redoubledin a scanner's image, a concrete fragment that seems topartake with me of a mixture of intimacy and foreignness.

II: Contingency, Obsolescence

So there it is: some two years ago I received the liver ofanother human being. An organ came tumbling down acomplex social network from a recently dead body to landinto my insides in that fateful evening of June 1. My sickliver was cut from its circulatory roots, and the new onesnugly fitted in, replacing the vital circulation by laborioussuture of veins and arteries. I can thus pronounce a uniquestatement (with a few hundred people around the world)with all the sense of truth that is given to humans: I havereceived someone else's organ!

Such an assertion has no echo in the past; human historyremains mute. Ten years ago I would have died rapidlyfrom my complications of Hepatitis C, transformed intocirrhosis, then rampantly turned into liver cancer. The



surgical procedure is not what creates the novelty of asuccessful transplant. It is the multiple immunosuppressordrugs that prevent the inevitable rejection. (A code word fora phenomenon specious in itself; we will return to it.) Had ithappened in ten more years it would have been a differentprocedure and my post-transplant life entirely different. Iwould surely have been another kind of survivor. In thethousands of years of human history, my experience is aspeck, a small window of technical contingency in theprivileged life of upper-class Europeans.

From this narrow window I must (we must) reflect on andconsider an unprecedented event, that no accumulatedhuman reflection and wisdom has ventured into. I taketentative steps, consider everything as only a tentativeunderstanding, a lost cartographer with no maps.Fragments, no systematic analysis. We are left to invent anew way of being human where bodily parts go into eachother's bodies, redesigning the landscape of boundaries inthe habit of what we are so definitively used to call distinctbodies. Opening up the landscape where we can borrow apiece from another, and soon enough, order it to size bygenetically modified animals. One day it will be said: I havea pig's heart. Or from stem cells they will graft a new liver orkidney and preselect the cells that will colonize what wasmissing in us, in a sort of permanent completion that can beextrapolated beyond imagination, into the obscene. This isthe challenge that is offered to us to reflect on through andthrough, to live up to the challenge, to give us the insightand the lucidity to enter fully into this historical shift.

My life in its contingency mirrors the history of techniques,the growing know-how about human bodies, which knows



nothing about the lived-bodies that can and will come fromit. Technology, as always, stands as the mediation thatreveals the interelatedness of our lives. Contingencies oflife that accumulate in the history of body-technologies,from antibiotics, to tailor-made drugs, to geneticengineering. All the more so now that the contingency oflife, always at the doorstep of reflection on human destiny,acquires a speed that impinges even on our ability toconceive, to assimilate, to work through the ramifications.

In ten years, these reflections will probably be obsolete, theentire reality of transplantation having changed the scenariofrom top to bottom; all the work I must do is for a littlewindow of history before it snaps out of focus and we are tore-start anew.

III: Frame, Paradox

As I peer inside me (but which me?) at the other's liver, themedical gesture explodes into a hall of mirrors. These arethe points where the transplantation situation can be carriedto the sentimental extremes of either having being touchedby 'a gift' (from somewhere, from 'life' or 'god'), or else thesimplicity of the doctors who remain set at the level of theirtechnical prowess. In between lies the lived phenomenon,that must be drawn out otherwise, in other parameters.

Transplantation creates and happens in a mixed or hybridspace. There are several subjects that are decentred byexchanging body parts; or decentred as the 'team' thatmakes the technical gesture, or even further, as the



distributed network of the National Graft Centre who thatfateful day decided it was my turn. At the same time this isan embodied space, where my body (and his/her nowdead) are placemarkers, experiencing the bodily indicatorsof pain and expectation. As if the centre of gravity of theprocess oscillates between an intimate inside and adispersed outside of donor, receiver and the 'team'.

We can start with the embodied sentience of the organism,the 'natural' basis for the study of lived events. Sentience, inthis sense, has a double value or valence: natural andphenomenal. Natural because sentience stands for theorganism and its structural coupling with the environment,manifest in a detailed and empirical sense. It thus includes,without remainder, the biological details of the constitutionand explanation of function, an inescapable narrative.Phenomenal, because sentience has as its flip side theimmanence of the world of experience and experiencing; ithas an inescapably lived dimension that the word organismconnotes already. Moreover, that the organism is a sentientand cognitive agent is possible only because we arealready conscious, and have an intrinsic intuition of life andits manifestations. It is in this sense that 'life can only beknown by life' (Jonas, 1966, p. 91). This intertwining can begrounded on the very origin of life and its world of meaningby the self-producing nature of the living. Given that thescientific tradition has construed the natural as theobjective, and thus has made it impossible to see theseamless unity between the natural and the phenomenal bymaking sure they are kept apart, no 'bridging' or 'puttingtogether' would do the work. The only way is to mobilizehere a re-examination of the very basis of modern science.But this gets, all of a sudden, too ambitious.

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Exploring the phenomenal side of the organism requires agesture, a procedure, a phenomenological method, contrathe current prejudice that we are all experts on our ownexperience. Little can be said about this lived dimensionwithout the work that it requires for its deployment. (In abasic sense, this is also close to the recent interest in 'first-person' methods in cognitive science.) And therein residesits paradoxical constitution: our nature is such that thisgesture needs cultivation and is not spontaneouslyforthcoming. This is why it is appropriate to reserve thename of feeling of existence (sentiment d'existence, a termI borrow from Maine de Biran) as the core phenomenonhere, the true flip side of sentience.

The feeling of existence, in itself, can be characterized ashaving a double valence too. This is expressed as a tensionbetween two simultaneous dimensions: embodied anddecentred. Embodied: on the one hand examiningexperience always takes us a step closer to what seemsmore intimate, more pertinent, or more existentially close.There is here a link between the felt quality or the possibledepth of experience, and the fact that in order to manifestsuch depth it must be addressed with a method in asustained exploration. It is this methodological gesturewhich gives the impression of turning 'inwards' or'excavating'. What it does, instead, is to bring to the fore theorganism's embodiment, the inseparable doublet quality ofthe body as lived and as functional (natural/phenomenal;Leib/Körper). In other words, it is this double aspect that isthe source of depth (the roots of embodiment go throughthe entire body and extend out into the large environment),as well as its intimacy (we are situated thanks to thefeeling-tone and affect that places us where we are and of



which the body is the place marker). Decentred: on theother hand, experience is also and at the same timepermeated with alterity, with a transcendental side, that is,always and already decentred in relation to the individualityof the organism. This defies the habitual move to see mindand consciousness as inside the head/brain, instead ofinseparably enfolded with the experience of others, as if theexperience of a liver transplant was a private matter. Thisinescapable intersubjectivity (the 'team') of mental lifeshapes us through childhood and social life, and in thetransplantation experience takes a tangible form as well.But it is also true in the organism's very embodiment,appearing as the depth of space, of the intrinsicallyextensible nature of its sentience, especially in exploringthe lived body.

These parallel themes serve as the hidden scaffolding forthe analysis here. First, the lived body as focus: theintrusion, the alien as flesh, and the always already mobilesubject of enunciation and hence the mobility of the livedbody's identity. Second, the networks of disseminationplaying in unison: the social network of the gift, and theimaginary circles of the images that give this inside ametaphorical concreteness.

IV: Rejection, Temporality.

I've got a foreign liver inside me. Again the question: Whichme? Foreign to what? We change all the cells andmolecules of a liver every few weeks. It is new again, butnot foreign. The foreignness is the unsettledness of the

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belonging with other organs in the ongoing definition that isan organism. In that sense my old liver was already foreign;it was gradually becoming alien as it ceased to function,corroded by cirrhosis, with no other than a suspendedirrigation of islands of cells, which are then left to decay andwither away. Years before the transplant, during a biopsythe surgeon came to see me: 'I saw your liver, it looks verysick'…

… It is not the liver, but the 'team's' strategy, thatconstitutes the intrusion, for the body-technologies are outof synchronization with the temporality of the welcomingthat is our basic condition. The paradox of alterity is aparadox of the timing of hospitality. The body-technologiesto address rejection are absurdly simple: disable theongoing process of identity, weaken the links between thecomponents of the organism. Immunosuppression is, todate, the inescapable lot of transplantation. One starts byspecial suppressive drugs and massive doses of corticoid(leaving the mind disjointed, hallucinating, and with anobsessive compulsion to repeat certain inner discourses;nights spent in the corticoid desert are certainly a form ofhell). As the rejection does not yield, the treatment mountsone step, I am treated with the 'heavy' means as the doctorsays. As in napalm warfare, the entire repertoire of immunecells is massively eliminated by a slow injection. (As I feltthe effect coming in a few minutes, my whole body wasswept by uncontrollable shaking, like an alien possessionthat left the me [who?] in a limbo of non-existence; lookingsteadily into my wife's face the only reference point in adisappearing quagmire.)



Complete immunosupression does stop the rejection, butnow simply being in the world is a potential intrusion, as thetemporality of my somatic identity has been erased for afew days. A new lifestyle of masks, careful watching for theslightest sign of fever, and concern about opening windows,makes the body into a life of withdrawal, its proudmovement and agency shrivelled down. In time, the body isallowed to reconstitute; I recover my assurance of my dailyembodiment, as the immunosupression is milder. Thisbecomes a life condition. Weakening the links that are thebackbone of the temporality of the lived-body, this alterationis experienced as a newly acquired attention to symptoms,as a travelling to destinations of unknown hygiene.Immunosuppression is a walking stick; I feel the world asthrough an extension.

V: Touching the Lived Viscera

According to my doctors I cannot feel my liver. There is noinnervation for the organ, and the connective capsulesurrounding it is left with the old, cirrhotic one. Eppure, I dofeel my organ right here, under my ribs, slightly eccentric. Itbeckons my attention, like a fist that presses my side fromthe inside, just enough to let me know it is there.Sometimes it stretches and speaks with a tension, which isnot quite pain, but makes me move for relief. It is sotangible, stuck like an envelope of the hidden organ.(Interesting: browsing through the internet, I stumbled into aweb page addressed to transplantees, displaying a chatroom where a dozen people gave the same account: wefeel our livers, doctors say we shouldn't.) Such is the



presence of the unfeeling liver. Maybe a dis-memberedproprioception from the terminals left behind in the hole ofmy previous liver. And when the new one comes to lodge,as a newcomer lays down to sleep in a warm bed, I imaginethose connective tissue membranes that were left there,dangling like the veils of a mummy, senseless, sentient-less. In time (I imagine) they will find their way into the newnooks and crannies of those new cells. They will havebecome entrapped into new fascia fibres that pull them,carrying them along as lost relatives.

Thus between this me (which one?) that imagines andthinks, and the other I blended into the lost tissue fibres"driven as one by this bottomless desire for integration" wehave reached a balance, almost a cooperative agreement.They provide me the basis to dress the fantasies with flesh,and we give him the credit to manifest in this lived body. Inphenomenology, the lived body (corps propre) is thehallmark of intimacy wherein I am, wherein I can be. It is notmine, but it is indissociable from me in this single centre oforientation. The intimacy is multiple. It constantly reappearsas the lived body disappears into the background, into atransparent mode while I am immersed in the world. Andthen a pain, an emotional upsetness, a sudden breakdownbrings this absent body back to its deeply present presence(Leder, 1991). There is also the touching that brings it out,the feeling of one's own surfaces. In the classical example,one of my hands touching the other is the very paradigm ofthe self-based experience of intimacy. It is the 'solipsistic'level of the lived body that Husserl finely describes(Husserl, 1952, 43-47).

The touch afforded by the extended surface of one hand



over the other, or over other sensitive skin, leads us directlyto the experience of the darkened side of the corps propre,the innards, the viscera. Husserl proposes an analysis of 'Ifeel my heart' (ibid., p. 165). To do so I stretch my palmover the heart region, and press gently. The inner sensationsurges up and I close the link between the self that touchesitself in the mediation of the distance, the space of the bodyitself. I touch through a surface. Likewise I can pressthrough, and my fingers can awake in my right side the liverand its boundaries, which show up clearly. I can feel theboundaries up into the ribs and down into the abdomen.The organ responds with a heightened sensation, and infact with a tinge of pain as if inflamed. (The persistentHepatitis C virus surely creates a degree of inflammation; Iimagine this heightened sensation as also the mediation ofthose invisible dots of molecular agency which co-exist withmy new liver.) All of this is 'given to myself asinterdependencies in co-presence' (ibid., p. 166: für michselbst in Kopräsenz zusammengehörig gegeben).

But, as Derrida remarks incisively, even in the ideal case ofhand-to-hand touching this intervening space is already,and constitutively, the presence of the foreign, the other,the distance (Derrida, 2000, Tangent II, pp.l83-208). Noexploration of the lived body, even in the 'pure' case of twohands touching, can be conceived as pure self-affection, asan internal feeling that rests on itself alone. There is aheteroaffection that slips in place precisely because of theintervening space:

cette experience est deja hantee, au moins,mais constitutivement hantee, par quelquehetero-affection liee a l'espacement, puis a la



spatialite visible: par ou l'intrus, I'hote, un hotedesire ou indesire, un autre de secours ou unparasite a rejeter (ibid., p. 205).

The received notion of the solipsistic lived body appearsincomplete in this light: it leaves aside the irrepressiblepresence of the alien. All sensing is an admixture of auto-hetero-affection, which makes the intimacy of the bodypossible, and visible even when the distance between thetouching hand and the viscera is 'mere' skin and bone. Butthe constitution of the lived body presupposes in its heartthe passage through the other as an outside and the Otheras horizon. A horizon is not itself an appearance, but isalways pre-given, that is, it mediates the relation betweenwhat is given and the anticipations of what is possible. ThisOther lodges the openness to a multiplicity: the image of ascanner of its 'inside', the mounting infection, the gentletouch of friendship, but also the needful absence. It canalso be the passage through which the body-technologyforces open a wider space by an imposed shift to the bodyas subject of technique, as Korper, forcing a temporality offoreignness.

Tentative conclusion: it is not the body-technology thatintroduces the alterity in my lived body as a radicalinnovation. That technology widens and slips into what isalways already there. The alien and the foreign of thetransplantation gesture is not a sharp boundary marker forhow my body holds its place as the locus of intimacy. Can Ithen say that the transplant makes me different? As if thepropre of my corps was settled and pure? The appropriation



of intimacy as interminable, as at the same time possibleand impossible.

VI: Transference, Metaphor - An organ is transferred.

If we listen to the Greek roots, we can say it wasmetaphoros from somewhere into me. The exchange hasthe logic of a metaphor, of something standing in forsomething else, a limp piece of tissue packed in icestanding in for a gift of life, it is said. At some point theabstract idea of the transplant becomes specific as thetransfer is decided and the metaphor on its way. A newsomething is standing in, marking the place. One can saythat the whole is so impossible to enunciate in its totalitythat we can grapple with it only as a metaphor, as thatwhich speaks the unsayable and the apophatic.

As I arrived in the hospital after the crucial phone callstating that a donor had been found for me (paradoxicalmyself, altered as I was by the nearness to death, by acancer eating up my cells, with a finite horizon for thedisappearance of identity), the nurses at the reception,professional and kind, let out: 'It's coming from Marseille, it'san organ in excellent condition.' This mere suggestion islike the skeleton onto which the imagination unleashes thefull contents of the transfer-metaphors. (I see a youngmotorcyclist sprawled next to the autoroute, his brainsspread over the tarmac, and the paramedics franticallycalling the family to get their authorization for taking theorgans. One of a thousand scenarios that go through mymind. I will never know.)



That is, then, the beginning of the relation with my donor,the source of the don. I was not alone any more in myspontaneous representation of myself: there was the donor,that other X whose path had ended one afternoonsomewhere in Marseille. Saying that there was a don, alsosays that there was a gift, according to a received,canonical interpretation. Since Marcel Mauss, a gift is anevent-action that belongs to the symbolic order. The key ofthe gift is its reciprocity: what is given is returned, sealing apact. The Maussian account of the don has been bothrefined and contested (Godelier, 1996, Part I). In spite ofever-present refinements, the gift remains a key for theunderstanding of early human societies. Since then, ourmodern life has evolved to constitute other social norms,and the gift has become strict exchange or commerce. Giftsexist now in the personal sphere, within our immediatecircle, and have lost the power to be the ground of sociallinks.

Was X in Marseille a donor? The core of giving is that oneis personally addressed. Once a donation is made inabsentia, to a general population, like the philanthropist to acommon cause, its nature is profoundly different. Thepersonal touch is lost, replaced by a quality of possibilitylacking a direct address. Yet by law the donor is to remainforever anonymous. In its place there is a mediationbetween the family who authorizes, a complex arrangementput in place over many years by the National Graft Centrefor centralization and re-distribution. It so happens that theGraft Centre is located not a block away from my apartmentin Paris. During the interminable wait, I used to take walksin front of it, and ponder the almost tangible contingency ofmy life (if I survived) within this arrangement. Being



inscribed on the waiting list is already a matter of decision,done locally by the 'team' to which I was never privy. Itrusted my surgeon who seemed to have taken a liking tome (but what is this feeling in the riddle of the acceptanceof a life-death?). The local list somewhere reaches a centrallist, at the Centre where I went for my reflective walks. Aftermonths I was requested to carry on me at all times adedicated portable phone, and to never be far from thehospital. At some point I am told (in confidence, as anaside) that I am on top of the list, but this still depends onthe city and blood group, and whether other patients are orare not put ahead, their conditions being more threatening.Weeks without end; every minute the pressure of myportable phone as witness awakening me to the immensefragility of my life and the tenousness of my identity in thistangle of deferred causalities. And then, as the decision ismade (will I ever know who or how?), the phone call, thehurried trip to the hospital, the assembling of the medicalteam, at the end of the day, tired technicians coming afterdinner for all-night surgery around that emblematic figure,the chief surgeon.

And in his position as middle man, the surgeon is the onlyone who knows both the donor's and the recipient'sidentities. He thus represents a unique link between us, ameta-instance who holds the key to a riddle that must bekept secret by an unbreakable ethical code. This triangle isemblematic of the strength of the imaginary social link thatmakes the transference possible, and at the same timebinds the entire network from donor to recipient in a singlestroke, as if joining a total stranger in too short a time tomake acquaintance, to welcome, and thus to arrive withoutclash. In my experience, surgeons are entirely oblivious of



their place and role as transferential passageway; it was upto me to deal with the enormous alterity in which I foundmyself. His business centred on the techne, he has littletime to listen to the relentless production of imaginarycontents, even after the first weeks and months of thetransplant. At best he receives with a nod what the patientsays as personal thanks. In the early temporality of theexperience, I said, the social imaginary link is intense andgripping. And the longing to find the source of this don oflife is clearly present; it feels as ancestral and ancient asthe compulsion to bury our dead; it surges forth from rootstoo old to be conscious. It is here that there is a moreappropriate use of the term 'gift' in the anthropologicalsense. Even as modern Western subjects, we experience,as if in a distant echo, the marks of our ancestors. I foundmyself spontaneously desiring a reciprocity, to seal a pactwith the anonymous donor. In fact, in anthropologicalstudies one constant is the stable nature of the rights of thegiver over the gift. This translates on the imaginary level tothe presence of the donor in the gift itself, attached to it,and following its transferences. Since gifts are neverdetached, the links established are of a personal nature,between individuals that engage with one another, and thegift is the representation of their obligations (ibid., pp. 76,94).

I have another in me, I am partly another, it is commonlysaid. Some report having acquired new dispositions (to eatmeat, to like animals) as a direct manifestation of this spiritthat came with the gift. Transplant patients routinely findpersonal ways to deal with the impasse of the search forthe unfindable donor. They go to a cemetery and offerflowers to an unknown grave. Or to a wood and make an



offering to the spirit of the deceased donor. It is clear thatonly a strict regulation of anonymity stops this strong urgefrom becoming a delicate dealing with the misplaced formsof gratitude-driven obligations. As the days went on, thefantasies began to fade and to lose sense. Having the gift inme did not make me become another in any way thatexperience could attest with any stability. On the contrary, itwas the work (again) of temporality that became central: thewelcoming, the acceptance of this new form of alterity inspite of immunosuppression, the imaginary elaboration ofthis intrusion that was willed and wished, regaining theequilibrium from the brutalness of the technology. Theimages began to disappear, the sudden emotions for thedead giver gave way to a decentring into a larger field ofintersubjectivty.

VII: Offering, Giving

Pointing to the field of intersubjectivity here is also a way ofpointing to a shift in our understanding of the gesture oforgan donation (so-called). In the statement: I give to you,one follows the long trail of the recognition proper to the gift,which 'primitive' societies manifest so clearly. But here, inthe gesture of organ donation, what we are concerned withis more an offering, a passing without exchange or with thehope of receiving back. The offering is not mine "that wouldbring it into the realm of commerce" but just 'taken' from anopen field, from whom or how I do not know. The offerproposes to us that we keep it. In the world of gifts, what iskept and not given, is just as much the key as theexchange. And what is kept is what is sacred, making the



gift possible (Weiner, 1992). What I keep as an offering isspecial; it is to be kept safe. It's yours for keeps. It's to bekept close to you, in the greatest intimacy. We must thusdistinguish the gift from the offer, or better the offer withinthe gift. A gift is an offering when there is, at the heart of thegift, the withdrawal of the gift, the disappearance of its waysof being present (Derrida, 2000, p. 112). The liver I have,then, is not a gift but an offer, a gift which has been'withdrawn' as such by death, by the law, by the socialmediation. It comes to me from nowhere, there is nopresence of the donor in it. It arrived for keeps, if only Icould keep it. Donors should be called offerers. In thetemporality that is proper to accepting and keeping an offer,the imaginary exchanges, which seemed so present in thegift, disappear, are transmuted as part of the constantalterity, the ongoing alterations that are the very nature ofthis me-ness.

VIII: The Image, the Touch

Modern medical imaging accomplishes what began in theeighteenth century as a desire and a search for illuminatingevery dark corner, especially for seeing the insides of thehuman body. Modern man has since been renderedsomatically transparent, in gestures that extend into puttinginto full view not only the hidden but the ultimatemicroscopical, the DNA fingerprinting, the biochemicalprofiles, the immune cellular probes and markers. Our timeshave renewed the visible and the explicit as a preeminentpresence, compared with times in which only the rarefiedworld of pure ideas and Logos was supreme and the image



mere appearance (Stafford, 1993).

Increasingly we communicate with images of people, withvirtual persons existing as bytes in optical fibre ready formultiple displays. The radiologist looks at his echographymachine, not at me. The image becomes the inevitablemediator between my lived intimacy and the dispersednetwork of the expert medical team for which the imagesare destined, the larger medical world. I am disseminated inimage fragments that count more as the relevant interfacethan this presence (my lived body then, but again thequestion of which one?). The image holds the bond at justthe right distance: sufficiently close in liking to be a habitualpart of my intimacy, sufficiently detachable to introduce awide space wherein the intrusion of otherness arrivesmassively every time I go back to the stretcher and raisemy shirt, and the probe glides over my abdomen (in thesesituations, habit has transformed them almost into a self-touching, a tribute to the force of the image: I can feel thoseblack and white patterns on the screen).

Occasionally in one of the check-up visits the clinician asksme to lie down, and he touches my liver region. Iexperience it as a relief, as return to an embodiedpresence. The touch reestablishes an older intimacythrough his touching hand, touching/ being-touched theparadigm of oneness, me-ness. These gestures are alwaysconsidered supplementary: only the images and the chartsspeak the reliable truth, having captured the essence of thestory. These body-techniques seem to stand for all that washaptic, tangible and ready-to-hand, now transformed intoweightless apparitions. The new body is constantly on theverge of losing its seemingly invincible spatial and temporal



structure.

It would be idle to set up an opposition of correct/incorrectbetween these pervasive images and the contrasting senseof touch, anchored in the lived body. Even in touching, thealterity is constitutive, the image rides on this doubling as athorough mediation. We witness a push and counterpullbetween depth and imaginary surfaces that become a newidentity in post-transplantation life.

IX: Intimate Distance

From the place where I now write, the old new alterity of thedistributed selves has re-acquired its own temporality. Butthere was, there has been, the encounter with the radicalalteration of death, which approached closely over theyears, and then finally made its irruption in all the brutalityof a night when my chest and abdomen were laid open. Itwas done; I was not there, drowned in anaesthetics (whichI? certainly there was presence, I suffered). The descentwas slow. First, waiting in a room; then getting undressedand covered with a hospital gown; then naked under asheet so that the nurse could shave me entirely in a form ofnudity that seemed to reach me under the skin. Thentransferred to a wheeling stretcher, parked in the surgicalroom, shaking from cold and fear as nurses madeconversation. The anaesthetist comes, takes the perfusiontube and perfunctorily injects the first wave of anaesthetic. Ihave a minute or so to let anything that was left of me go asif in an involuntary flight. Never had I felt more acutely myfragile ontology, the impossibility of grasping onto anything,



a living dot suspended in a space that goes so beyondanything representable. The utter loneliness for which thereis no utterance. Deprived of any intimacy, nothing left butgaping gap for intrusion.

Then they opened me up, cut the circulation, replaced it bymachines, took the organ from an ice pack, and proceededto rebuild me again back into a normal body. Or that is whatthey say. Awakening into my new state, I see that the nightwhen death travelled through my open body is to remainindelibly. It is there each time somebody looks at my torso,and I see their eyes darting quickly down to check the tracethat crosses from side to side and up the chest with suturepoint (with big stitches, like a sack of merchandise). It'sdeath's trace, which never lets me slip by this memory thatis not a memory, but rather a feeling of recognition of itspresence, of an inevitable guest whose movements are waybeyond anything within my reach. From then on the trace ofdeath has set its own agenda, its own rhythm to my life. Ihave, in fact, become another never entirely re-done afterbeing so meticulously undone.

X: Which Life?

The life retaken, is taken differently, forever changed (but towhom shall we attribute this change?) by a triplemovement: the one that led to being on the waiting list; theone that led to an organ to be transferred; and the one thatleads me into my present condition. This is the living realityof transplantation, my entire identity grazed profoundly bythe opening to death, sutured back and left to function in



the world with a 'new' life. Soon the traces of the lastmovement began to enter my life as multiple foreignness.There is first and foremost the drug treatments, which areprescribed in quantities and taken by grammes per day,and that mark the temporality of the day, of travel alwayspresent in its medicine bags, bulky and obtrusive. Then thedrugs themselves. The cortisone and immunosuppressors,which induce a diabetes needing careful checking three orfour times a day. The effect on the stomach, producingsometimes uncontrollable diarrhoea that in all its undignifiedpresence overtakes my life. And of course the repetitivemedical controls, the enzyme levels to keep track of, theoverload of the kidneys to verify. The virus is, we all knew it,still with me, and we know it to be back in full action, themost mysterious of my foreignness, degrading the newliver. It must also be suppressed and controlled. It is animaginary circle: I am back from where I started from,intertwined with these amazing dots whose molecularstructures I sometimes contemplate in awe of their twistedproteins and minute RNA. But the only known antiviraltreatment is inteferon, an immunitary stimulant, whichproduces a permanent feeling of fatigue as if one has abudding cold. In fact, for effectiveness it must be a bi-therapy with ribavirine, which leads to anaemia. Oddly, theimmunosupression to avoid rejection is exactly a countermove to interferon, so that the body is pushed on oppositesides at the same time. (A constant paradox:immunosuppressed to avoid rejection; immunostimulated toavoid the virus. A telling metonymy of my condition). Thereis also the return to the hospital for a sudden explosion ofviral activity, for the accumulation of liquid around the liverthat needs extensive examinations. Changing symptoms



that emerge and subside.... Echographies; weight control;blood samples so often my veins seem to expect theneedles.

Thus the foreignness of the grafted liver is less and lessfocused. The body itself has become a constant, ongoingsource of foreignness altering itself as in echo, touchingevery sphere of my waking life. This is the life that I havesurvived for, not a coming back to where I was (but I wasalready alienated by the disease for long years, and beforeseems distant and abstract). A life with its own temporalityto put together and live with the multiple manipulation thattechnology demands (once again the historical contingencyof the body-technologies: in ten years more I would havebeen some other kind of survivor). Compensation to thedecompensations that multiply in a hall of mirrors. Thesuffering varies from one person to the next in its extremes.The phenomenon rests: transplantation has made the bodya fertile ground of opposed, coincidental intrusions.

Transplantation is never in the past, then. It produces aninflexion in life that keeps an open reminder from the traceof the scar altering my settledness, bringing up death'strace. It is my horizon, an existential space where I adaptslowly, this time as the guest of that which I did not arrange,like a guest of nobody's creation. This time, the foreign hasmade me the guest, the alteration has given me back abelonging I did not remember. The transplant ex-poses me,ex-ports me in a new totality. The expression of it all, Iknow, eludes me, makes me face a twilight language.Nancy goes further:

Je le sens bien, c'est beacoup plus fort que'une sensation:



jamais l'etrangete de ma propre identite, qui me fut pourtantsi vive, ne m'a touche avec cette acuite. 'Je' est devenuclairement l'index formel d'un enchamement inverifiable etimpalpable. Entre moi et moi, il y eut toujours de l'espace-temps: mais a present il y a ltouverture d'une incision, etl'irreconciliable d'une irmnunite contrarie (Nancy, 2000,p.36).

XI: Inconclusion

Old themes from phenomenology have reappearedthroughout this analysis: the lived body and its exploration,the unalienable alterity of our lives, the key ground oftemporality, body-technologies and ethics. Yet theseclassical themes re-appear under a new light, perhaps evenpushed to an extreme that both sharpens them and movesbeyond their initial scope. The radical novelty pushes ouranalysis into new steps. Perhaps we are all (the growingnumbers that have entered into the sphere of thistransference) 'les commencements d'une mutation' (Nancy,2000, p. 43). I can see it: all of us in a near future beingdescribed as the early stages of a mankind where alterityand intimacy have been expanded to the point of recursiveinterpenetration. Where the body technologies will and canredesign the boundaries ever more rapidly, for a humanbeing which will be 'intrus dans le monde aussi bien quedans soi-meme' as the epigraph says; we would do well toconsider every sentence of it. It is this urgency that drivesthis examination of the ancient ethos of the human will topower re-expressed as transplantation. Even if my ownwindow is narrow in time and fragmented in understanding.



Somewhere we need to give death back its rights.

References

Derrida, Jacques (2000), Le toucher, Jean-Luc Nancy(Paris: Galilee).

Godelier, Maurice (1996), L'Enigme du don (Paris: Fayard).

Husserl, Edmund (1952), Ideen zu einer reinenPhainomenologie und phanomenologischen Philosophie.Zweites Buch: Phainomenologische Untersuchungen zurKonstitution, ed. w. siemel' Husserliana Vol. III (The Hague:Martinus Nijhoff).

Jonas, H. (1966), The Phenomenon of Life (Chicago:University of Chicago Press). Leder, Drew (1991), TheAbsent Body (Chicago: university of Chicago Press).Nancy, Jean-Luc (2000), L'Intrus (Paris: Galilee).

Stafford, Barbara (1993), Body Criticism: Imagining theUnseen in Enlightenment Art and Medicine (Cambridge,MA: The MIT Press).

Varela, F and Cohen, A. (1989), ~Le corps evocateur: unerelecture de l'immunite', Nouvelle Revue de Psychanalyse,40, Automne, pp. 193-213.

Varela, F and Coutinho, A. (1991), 'Second generationimmune networks,' Immunology Today, 12, pp.159-67.

Weiner, A. (1992), Inalienable Possesions: The Paradox of



Keeping-While-Giving (Berkeley: university of CalifomiaPress).

************* Editor's Addendum On May 28, 2001,Francisco J. Varela passed away at his home in Paris. Hedied calm and at peace, in the loving embrace of his family.

Notes

1 Jean-Luc Nancy (2000), p. 45. This brief but profoundtext is, I believe, the only extant attempt to grapple head-onphilosophically with transplantation from a lived perspective.The impact of Nancy's work is present throughout my ownexploration here. ---------------------- [back to the text]

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