Raj: One year after liver transplant, Raj had finished a job retraining program. He moved to another city to manage a department store. It was the first time that he lived away from home. But the work experience would offer him better career opportunities.
Shortly after the move, Raj complained to his new doctor that he could not concentrate or sleep well. He felt run down. A dull ache in his right side was always present. "I have lost my appetite," he said. "Something must be wrong. Maybe my liver is not working as it should." But a series of tests showed nothing wrong. The doctor's response irritated him. "Maybe you are working too hard. Try to take it easy," he had said. "Hard work has never bothered me," Raj thought to himself with anger.
Unfortunately, Raj had not told the doctor all of his symptoms. And the doctor neglected to ask. Raj found himself crying in the evening when home alone. Sometimes he thought that everybody might have been better off if he had not survived the surgery. But he had been ashamed to tell the doctor these things. "I should be thankful for the opportunity that I have. I should not bother a doctor with stupid things like this."
Due to his isolation, Raj did not have others who knew him well enough to know that he was in trouble. If he had still been living at home, somebody might have encouraged him to search out proper help. Unfortunately, doctors do not always think of depression as a possible cause for unexplained physical complaints. For this and other reasons, doctors and nurses often miss depression. This is a great tragedy. We now know a great deal about how to help with depression that happens before or after transplantation.