Liverly

Ever soaped your sweetie in the shower? Or, to be less (so I've been told) disturbing: have you held a piece of hardwood, turned and sanded smooth as glass, oiled and rubbed until it's like hot ice; passed your hand over the surface, thrilled at its silkiness, its undulating shape? Did you find it stunningly beautiful? If so, you have an idea of what your liver feels like. But really, because it's warm and taut and alive, the first question conjures it more closely. In terms of touch.

Surpassingly smooth, firm and full as a biker's buttock (I ride a Trek 5500), resolutely protected by the ribs and sealed snugly -- by surface tension and suction -- under the diaphragm, the liver releases itself with a certain reluctance. To explore it, you must make it come to you, but its barely-moist slipperiness resists exposure: you have to insinuate your latexed fingers gently between its lower edge and the underside of the ribcage, usually far to the left, while bending your wrist back to get the angle right. Then, as you glide upward and over, feeling the corrugation of the ribs across the back of your hand, you can guide yourself all the way to the dramatically domed apex.

There's not much space; what little there is tightens rhythmically with each breath. By pulling gently but insistently downward you precipitate a releasing of suction, and the liver falls partly toward you, not always silently, an exhalation. Too forceful, and the capsule could tear into the substance, like what happens sometimes when pulling the membrane off a boiled egg. You sweep over a mass larger by far than your open palm; chunky, chocolate, yet feeling as if it could shine in the dark. Nearly luminous; like a living agate. Sometimes, in order fully to free the liver, you need to slide your hand all the way across the top surface; in doing so your hand is more than full, and with it, your senses. The glide, the only slightly-yielding thickness, the meaty heat, the landscape as it moves your palm up and down, the fingers together and apart. Close by, separated by the thinnest part of the diaphragm, beats the heart; its throb is on the back of your hand, and under it. In some people, the pattern of the ribs is inverted onto the surface of the liver, making furrows and waves.

This is beauty a lucky few are privileged to experience. I've said it before: to me it's exhilarating. A gift given only to some, it is in no way based on worthiness. Which is why it's also humbling. And why I keep trying to convey the feeling: to give everyone the amazement I've been lucky to know. Once more I find myself using sensual terms, sounding sexual. But other than enabling transcendent joy from physical sensations, it really isn't; not like that. Not any more than being overwhelmed at the sight and smell and sound of the ocean, feeling like you could fly. The insides of the human body have awed me, filled my senses. I'm trying to let you in on it.

The liver, for its bulk, in its bastion, seems to preside over it all. To the ancients, it -- not the heart or the brain -- was the seat of the soul. And, while literally sensational to me, it's also terrifying. A dark crystal ball, the liver truly augurs your future. Unlike the soothsayer, it doesn't misinform. As delightful as it is in perfection, so are its imperfections portentous. Nothing in the operating room savages me more than when that sliding hand finds its way to something awful. It augers unwell for life. Searching the abdomen for signs of trouble when operating on cancer, -- say, of the colon -- feeling it in the liver sinks the heart, deflates hope, robs you of a job well done. It changes the climate with the suddenness of a thunderstorm; forces into your head terrible truths, from which there's no escaping the need to be told.

In the injured person brought rapidly to surgery, my hand goes first to the liver, over the top; and when a finger finds its way to a crack, and falls in, my pulse rises faster than the patient's, fearfully. Broken, the liver can defy every effort to put it back together. Fractured like a melon, it bleeds in a way that wells up and overflows, too fast to see into the depths, defying attempts to stanch it. Silent and relentless, it's the most dire sort of bleeding there is. (Some lacerations are very simple to care for, actually. Big, deep, and stellate, however, they often aren't.)

Nor does the liver lightly suffer indiscretion. Hammer-hard and knobby as knuckles, transformed from a lovely earthy purple-brown toward ghastly gray, the liver of an alcoholic rejects its most crucial blood-flow, forcing it back to the gut whence it came, pressuring veins till they might burst. Or, filled with fat by dietary excess, it morphs to mournful mush -- red-specked and muddy yellow; sick and squishy, like putrid paste.

Makes you want to step back into the shower, alone.