Authors: Hideaki Sena
Maybe I failed the last
time because I couldn’t figure out why
. At a loss, Yoshizumi shook his head
to dispel his self-doubt.
“You should be able to stand
up and move around a bit the day after tomorrow. You’ll get to eat some real
food then, too,” he said and patted Mariko on the head. The nurse at his side
smiled reassuringly. But Mariko still made no effort to look in their
direction. As if to shut out the existence of Yoshizumi’s hand, her head lolled
lifelessly under his touch. Yoshizumi removed his hand.
It was quite a different
story after her first operation, when Mariko looked gratefully at Yoshizumi
with tears in her eyes and thanked him countless times. He had smiled in return
and patted her head as he’d done now.
Until her first transplant,
Mariko underwent dialysis for about one year. After that, her father offered
his own kidney, to which Yoshizumi gratefully obliged.
When Mariko first appeared
before them, the cherry blossoms were in full bloom. They all watched from the
waiting room window as petals fell plaintively in the courtyard. Mariko was
charmed by the pink scenery fluttering outside, as if seeing it for the first
time.
She had just started sixth
grade. She wore a white top with a green skirt and sported a bobbed hair style.
Her large, round eyes were wide with joy. She listened closely to what
Yoshizumi had to say and even laughed at his jokes. Her cheeks were still
slightly swollen, making her all the more charming. She had hardly grown at all
in the preceding two years. Even in class, she was usually moved up to the
front during gym or morning assembly, a fact that made her feel a little
uncomfortable.
There were a number of
orientation sessions with patients before the actual transplant took place.
They were informed in detail about the types of treatments they could receive,
the pros and cons of each, the truths of the operation itself, and how they
were to carry on with their lives after recovery. Their goal was to alleviate
any misconceptions or anxieties born of ignorance. Nurses also carried out a
similar duty, but in Mariko’s case Yoshizumi had taken
it upon himself to provide
any and all explanations.
Mariko listened to his words
enthusiastically, but was devastated to learn that she had to continue taking
immuno-suppressants even after the operation. Nevertheless, she accepted it
soon enough.
“So how long do I have to
take them?” implored the young Mariko, staring at Yoshizumi intently.
“For as long as you live,” he
answered, not taking his eyes away from hers.
“Always...until I die?”
“Yes, but I know you can do
it.”
Mariko covered her eyes and
was silent for a long while. She seemed to be thinking seriously about what
this meant. She then looked up, her lips tightly sealed, and nodded firmly.
She progressed well for a
number of days following the operation. She was beside herself with joy and
spoke to everyone smiling, exhibiting a happiness and talkative disposition
typical of successful patients. This was usually a result of being released
from dialysis and was in proportion to how much the patient had hated it.
Still, Yoshizumi didn’t feel bad seeing her so happy. The dialysis experience
must have been hard on her, and she genuinely seemed to appreciate having a new
kidney. She seemed simply moved that she was urinating again, and when he
visited her a week after the operation, she cried out and buried her face in
his white coat with tears of gratitude, he patting her head.
Even after Mariko left the
hospital, Yoshizumi met with her several times for checkups. Her face had
rounded a bit, a side-effect from the steroids he prescribed, but she was as
darling as ever. She was delighted to be eating the same school lunch as
everybody else, freed from her strict diet. She repeated over and over how good
her meals tasted, how happy she was that she’d had a transplant.
“Doctor, I’m all healed now,
I’m not sick anymore, right?” Mariko interrupted their conversation one day,
smiling broadly, peering into his eyes.
For a moment Yoshizumi was
silent, not taking her meaning.
“You can live normally now
like everybody, so in that sense you’re cured. But with transplants, you can’t
let down your guard. You’re still taking the immuno-suppressants, right? You
absolutely mustn’t forget to take them. Without them, even a successfully
transplanted kidney will stop working. You must promise me that you’ll always
take your medicines. Can you promise me?”
“...yes,” she nodded.
Yes. She’d nodded. She did
nod...
And yet she would return to
the operating room only four months later.
“We haven’t discovered any
pathogens yet,” said Yoshizumi as he walked Anzai out of Mariko’s room now. He
invited Anzai into his office to tell him about her post-op condition.
Yoshizumi offered him a seat.
“Our nurses have been taking
samples of Mariko’s fluids and sending them for analysis. We haven’t found
anything, so I wouldn’t worry.”
Anzai looked relieved and
wiped the sweat from his brow.
“But as long as we’re here,
there’s an issue I feel I must address...” he said gravely. “Just why is Mariko
acting that way?”
Anzai looked downward.
“Mr. Anzai?” he asked again.
“I...don’t know,” he
responded. Yoshizumi’s silence urged him to continue. “Ever since the first
transplant failed, I haven’t been able to tell a single thing she’s thinking.
She’s kept her emotions hidden from me all this time. I’m beginning to wonder
if this is all my fault...”
“Did Mariko not want this
transplant?”
“That’s not the case!” Anzai
looked up to say, but his voice was shaking.
Yoshizumi tried to wear a
warm smile. “Please tell me the truth, Mr. Anzai. I realize a parent such as
yourself has only his child’s best interests in mind and naturally wanted this
operation... But Mariko didn’t, did she?”
“No,” Anzai confessed, his
head drooping. “I don’t know what to say, after all you’ve done for her. It was
the same when the coordinator called. Mariko kept it from me at first. I was
surprised to learn we’d been contacted about a transplant. And when I returned
the call to give the go ahead, Mariko was so furious that she was spasming...
She was abnormal.”
“Abnormal...?”
“She yelled, ‘I’m not a
monster’...”
Yoshizumi didn’t know what to
make of this and changed the subject. “She’s been having constant nightmares
since the operation. Any idea?”
“None.” Anzai shook his head
in despair.
“I think she’s afraid of
something. She might have developed a bad image of transplants. So she didn’t
want one and is having nightmares now. She wasn’t this way the first time. It’s
as though it’s not being operated on that she hates, but transplants and
transplant doctors like me. Any idea why she feels this way?”
“I’m sorry, but I really have
no clue.” Anzai could only hang his head in shame. He seemed to be pleading for
an answer himself.
Yoshizumi felt much sympathy
for the man. He said gently, “I’ve been informed that the other recipient’s
been diagnosed with accelerating rejection.”
“Accelerating?”
“It can occur anytime from twenty-four
hours to a week after the operation when the recipient turns out to have had an
antibody against the donor’s antigen. He’s being treated as we speak.”
Anzai was speechless.
“Thankfully, Mariko’s
condition is stable. But I can’t predict how it will turn out in the long run.
I will, of course, do anything in my power. If she has no will to get better,
though, we could lose her to an infection. We have to get her to open up to
us.”
“...how wonderful that would
be...”Anzai assented feebly.
7
Toshiaki sat before a
co-focal laser scanning microscope and entered his calibrations with an
external computer mouse. After staining the Eve 1 cultivation with Lodamine 123
stain, he placed its flask onto the platform inside the machine.
Toshiaki had cloned Eve in
the past few days. The batch that displayed the strongest propagative abilities
he named “Eve 1,” allowing it to multiply for experimental use. The laser
microscope had just been installed in the joint lab on the second floor this
past spring. It was an ACAS ULTIMA, the newest model. A rather large piece of
equipment, it took up the space of an entire business desk. An inverted
microscope was fitted on the left side while the right was furnished with a
command monitor that displayed all the data. Behind it was the laser tube. The
central computer itself was located underneath the desk.
Toshiaki examined Eve l’s
mitochondrial structure. The Lodamine 123 stain caused the mitochondria to glow
with a distinct fluorescence that made them more visible. The laser activated a
fluorescent agent that emitted photons of certain wavelengths. These passed
through an optic cleansing filter and clearly outlined the shape of each
mitochondrion. The most remarkable feature of the ACAS ULTIMA was that any part
of a cell could be isolated. Cells themselves had a thickness and weight to
them and one could not completely lay out their structural details using
standard microscopic technology. Gathering information through the latter
therefore had its limitations. But with this machine, one could cut any tens of
layers from top to bottom of any cell and view images of individual sections on
the monitor. After this, the image data were rendered into a three-dimensional
model of the cell. This device exhibited unsurpassed accuracy in the research
of nerve cells and others requiring 3-D constructive analysis.
Toshiaki clicked to start the
program. Mitochondria appeared in succession as slender green shapes, scattered
here and there against the black background of the screen.
When he was finished looking
over the data, he entered a series of commands into the computer and a 3-D blot
graph appeared. At that moment, Toshiaki simply couldn’t contain the sudden
exhalation that left his lungs. These mitochondria were unlike any he had ever
seen before. They were expansive and fused together in a vast, advanced
network, as if energy superhighways had been built between them.
He felt a thrill of hope
throbbing in his heart. He selected other cells inside the flask and performed
similar scans to identical results. A radical change had occurred in Eve 1’s
mitochondria.
Toshiaki printed out his
findings and shut down the machine, then returned to his lab on the fifth floor
to check how many stained Eve 1 cells were left by using the flow cytometer, a
device which measured the intensity of fluorescence in cellular material
through a process known as a histogram.
He collected cells from the
flask and placed them into a centrifuge. After purifying them with a buffer,
Toshiaki took the cells and returned to the joint lab once again. He turned on
the flow cytometer. A moment later, the previous images reappeared on the
monitor. He put in a new set of parameters.
Toshiaki hooked up a nozzle
from under the machine to the tube. The cells were then sucked into the
cytometer and sent to a laser apparatus. Because the collection tube was so
thin, cells passed through it in a linear fashion and were hit by a laser one
at a time to detect their fluorescing properties, the levels of which were
dependent on the amount of agent used. This machine differed from the
microscope in that it calculated the degree of stain in each cell individually,
plotting their distinctive features on a graph.
Toshiaki set the tube in
place and clicked on the word “GO” above the image. At once, countless dots
appeared on the monitor, each denoting a single cell. Toshiaki focused on the
histogram to the right as its line graph moved in short spurts.
“My God...”
The intensity was off the
charts. Beyond comprehension. The mitochondria in each cell of Eve 1 were
indeed increasing and their forms undergoing dramatic changes. The mechanisms
which normally governed them were causing anomalies via excessive mitochondrial
production. Toshiaki knew of no research having ever reported anything remotely
like this. “Astounding” was the only word he could think of to describe it.
That the cells had acquired some strange propagative capability suggested a
sudden change in gene-linking proteins. There was a high possibility that this
was influenced by the mitochondria within the cells themselves.
Toshiaki was shaking with
excitement. Something new and unknown had awakened in Kiyomi.
He printed out these results
immediately and ran back to his lab, where Asakura was performing a DNA
extraction.
“Asakura, come here for a
moment.”
Toshiaki grabbed her and
rushed her to the Cultivation Room. He showed her the Eve 1 flasks in the
incubator. She eyed them with suspicion.