I know that I haven't talked that much about my brother Joel and about what he was going through at this time.  You know that the kidney started working pretty much right away and that he had some problems starting his PCA, but after that he was doing really well (in fact it may have even been his wee bag that overflowed onto the floor now that I think about it.)

But for the first few days, once I started having trouble with my epidural, I was just trying to get through the days.  I knew Joel was okay, so apart from putting on a brave face when he came to visit me on his birthday, I didn't worry about him.  Of course as soon as I could get up and spend time with him in the day room I started doing all the usual big sister things – fetching and carrying for him, until I sat down again and realised that for once in our lives he was in better shape to fetch and carry for me!

Although I was able to go home first this was because they didn't need to monitor me any more – Joel was actually in better shape, but they needed to get the dosage of his immunosuppressant drugs right and they also needed to monitor 1,001 other things about him too.  I was so sad to leave him there, but I couldn't wait to get out of the hospital.

After a day or so at home I really missed him, and desperately wanted to see him, but actually going back to visit was out of the question.  (To put things into perspective, after several days at home, my friend Orla rang, I sat down in the hallway talking to her for maybe an hour.  Then I was exhausted and had to have a little sleep.)

At the same time, rejection reared its ugly head.  Although you should be advised that there may be some periods of rejection as the kidney settles in, when I first heard that word it was like a knife in my chest.  The problem is that the symptoms of rejection are very similar to any one of a number of other problems; infection, even the patient being given too much immunosuppressant medication – so the only way for the doctors to know if they need to increase or decrease the dosage is to take a biopsy of the kidney.  I sat at home and I waited and I prayed.  I prayed that he would at least get one good year before the kidney rejected, I prayed that it wouldn't have all been for nothing.

And my prayers were answered, Joel got through that initial period and finally, finally was allowed to come home.  And there he bugged the hell out of me, being fitter, healthier and eating three times as much as me.  Sadly, eventually 7 and a half years after the operation Joel had to start dialysis, but that time will always be there.  Last year when he had my kidney removed, I was there, at the hospital and then later at home, helping him to get through the pain, and although I was just a bystander, he and I both knew that I had been through worse for him, and that will always be there - a special bond that will never fail.

A year after the operation Joel was in great form, he enjoyed a wonderful 30th birthday party, looking round and healthy.  But a year later he was back in hospital.  There had been some concerns about the amount of weight he had put on, as, of course, he was on steroids and he reacted to the dietary advice by cutting lots of unhealthy foods out of his diet.  His weight plummeted and he got vicious ulcers in his mouth and throat that left him unable to eat properly.  He ended up back on the ward with a rucksack full of microwaveable Dolmio pasta and sauce, about the only thing he could swallow.  This went on for several weeks when I finally got a phone call; the doctors thought he was rejecting the kidney.  Then I got another phone call, and another, as all of my brothers and sisters called to check that I was okay.  I was very calm and peaceful, after all I had prayed for one good year and he had got it. 

I mention earlier that the symptoms of infection are very similar to the symptoms of rejection.  Just as the doctors were about to increase his immunosuppressant drugs again, one of them took another look at his results and said "Stop!"  He realised that Joel actually had a very rare virus in the kidney (it's quite common in the US, but Joel was one of the first transplant patients to have it in the UK.)  It was probably in the kidney when I gave it to Joel.  I was all set to find out he was rejecting, instead I found out I had unwittingly given him a virus along with the kidney, that was making him really sick!  In fairness I couldn't feel guilty for long, after all, it was not something that even the doctors had thought to screen for, how could I have possibly known?  The treatment was simple, just drop down the immunosuppressant drugs and let his body kick the infection – and it did.  He was soon back to being healthy, and more robust than before – thank goodness.

In the end, 7 and a half years after the transplant, the kidney wore out rather than rejected.  It took time, always a little more time than the doctors estimated – so we have that to be thankful for, and in the meantime Joel managed to give away both of my sisters at their weddings (and I of course got to be the bridesmaid.)

Even though I felt I was prepared two years after the transplant, as the time for Joel to start dialysis approached I knew that it was going to hit me hard.  I spent time in Morocco last March, wandering on the beach, having a good cry, thinking I was getting it over with.

On the day that Joel actually started dialysis my sister rang me and I couldn't stop crying.  I had to call my boss at work to bring my stuff down to me so I could go home.  Whatever I said and however I tried to rationalise it, I felt like a failure.  Over the years, being a kidney donor had become part of my identity, and it felt like a very important part of my life was over.  When they removed the kidney it was weird, to think that a part of me was dead, and there were moments when I felt like it had all been in vain.  But the truth is that Joel had 7 and a half good years, yes it would have been nice if it had been 30, but I gave him everything I could give him, and that can never be a failure.