Authors: Hideaki Sena
“So what department are you
in?”
“Pharmaceutical Sciences,” he
answered.
“Oh? So you learn about
drugs? How to make cold medicines, that sort of thing?”
He smiled bitterly at the
questions he had heard many times before and took a swig of beer.
“Well, that’s how it started
out, but these days it’s a bit different. When I was younger, I always thought
it was just studying to be a pharmacist.”
Kiyomi nodded. She remembered
there being many girls among her high school classmates who, when considering
easy jobs, had been encouraged to become hospital pharmacists.
“But the School of
Pharmaceutical Sciences is really wide- ranging. Sure, you can become a
pharmacist, but you can also do more fundamental research. It’s a mixed bag,
really. Everything from medicine and physical science, to agriculture and
engineering. So even within the department there’s a lot to choose from. Some
people do organic synthesis, others measure and analyze, for example, certain
components of blood. Then there are those whose work is not directly related to
medicine. Others culture all kinds of cells and study the effects of cancer on
DNA replication. It’s a small department, but a unique one, so it’s hard for
outsiders to really get the gist of it. But ‘true’ pharmaceutical science is a
combination of all these things and more, I think.”
The young man told her about
the various kinds of research being conducted in each course within the school.
She chimed in now and then, listening intently all the while. He broke down his
explanations of the seemingly difficult mechanisms of cells and genes. Though
Kiyomi’s knowledge only went as far as what she had learned in high school
biology, she clearly followed what he was saying.
“That’s wonderful. That you
get to study it, I mean. You really seem to know a lot.”
“Nah, I just started my first
year in the master’s program. I’ve still got a long way to go.”
He scratched his head
bashfully. Kiyomi assumed he was twenty- two years old, if he was just
beginning his master’s. She understood now why he’d given off an impression of
being mature.
“I’m even thinking of going
for a Ph.D., as long as I’m able to. But if I was going to do that, this would
probably be my last time showing up at a party,” he said jokingly.
Kiyomi was deeply impressed.
She had been such a passive listener in her classes, but here was a student
already doing his own research and even had the willpower to pursue a Ph.D.
“So...what exactly are you
doing research on?” In spite of a fear that his answer would be too technical
to understand, she asked anyway in an effort to keep the conversation going.
“Mitochondria.”
THUMP.
As soon as she heard his
answer, Kiyomi’s heart leapt. She let out a yell and pressed a hand to her chest.
“...something wrong?”
He looked doubtfully into her
face.
“No...it’s nothing.”
She forced a smile and clung
to her chest.
What was that?
Kiyomi
focused her attention on her body’s interior. All she could sense was her own
heartbeat. The odd, single thump had come and gone.
She turned her head a little
to the side and thought to herself,
Maybe I’m just a little drunk is all
,
then smiled again to ease his concern.
“Really, I’m fine. Please,
continue.”
The young man seemed
unconvinced, but soon he was telling her all about his research.
“Mitochondria are usually
mentioned briefly in junior high and high school textbooks, so you’ve probably
heard of them before.
Basically, they’re necessary
components of cells that create energy.”
“Yeah, I know that much.”
“When fats and sugars are
drawn into the cell, they undergo a conversion process and are changed into
acetyl-CoA in mitochondria. There, the ‘citric acid cycle’
[28]
leads to the formation of adenosine triphosphate, or
ATP. It’s this ATP that the body uses in various ways as energy.”
“I understand...1 think,”
Kiyomi said, nodding slightly. She had apparently retained more than she
thought.
“My research focuses on why
such a conversion occurs in mitochondria in the first place. The process
requires a lot of enzymes, and mitochondria are packed with them. Here we run
into a problem. We’re usually taught that only the nuclei of cells contain
genes, but you might be surprised to know that mitochondria also have their own
DNA, though it’s a very small amount in comparison. But this genetic material
doesn’t have the info for the enzymes necessary to convert fats and sugars. The
genes only code enzymes for the electron transport system needed for making
ATP, and just some of those enzymes at that. So where are the genes for the
conversion enzymes? They’re all in the nucleus. In other words, the nucleus
controls the production of enzymes. When the nucleus needs energy, it sends out
a command. The more enzymes you have, the more conversions you get. Now,
enzymes are usually produced by ribosomes in the cytosol, after which they must
find their way into the mitochondria. But how do they get inside at all? Since
enzymes are proteins, they can’t just pass through the fatty mitochondrial
membrane. Also, how does the nucleus know it needs energy? How does it signal
that enzymes have to be produced? And stepping back for the big picture, how
does the nucleus control mitochondria anyway? Mitochondria must have originally
carried the genes for the enzymes. How did the nucleus just pull those
mitochondrial genes into itself? It’s so mysterious. At least, I think so.”
Kiyomi was completely
overwhelmed. She had known what mitochondria were, but she’d never had any
reason to think about them so extensively. They were certainly mysterious, as
he had said. She was now aware of just how much was still unknown about our
biology and that there were people actually trying to bring clarity to all of
this.
Thinking he may have been too
long-winded, the young man smiled wryly and ended there. He then looked at the
glass in her hands and reciprocated her earlier favor by pouring some beer into
it. There was only a little left in the bottle, so he dumped the rest into his
own glass.
“So, what’s your name?”
“Kiyomi Kataoka.”
“Well, Kiyomi, pleasure to
meet you. My name’s Toshiaki Nagashima.”
They both smiled and lifted
their glasses to drink up.
9
As Anzai walked out of the
room, he looked at his daughter once more.
“I’ll be back...I’m just
going to talk with the doctor for a little while.”
Mariko was turned the other
way, her mouth shut tightly in defiance. Anzai understood from her body
language that she wanted nothing to do with him. He cast a glance at the floor
and left.
While walking along the white
hallway which ran straight trough the ward, he thought about the operation.
Ten days now, and still
Mariko was making no efforts to talk to him, nor to anyone else for that
matter. The only time she spoke was when they were checking up on her, and even
then she answered only bluntly and without eye contact.
Apparently she had had
another bad dream the night before. Her loud screams had been audible even in
the hallway. The nurse assigned to her that night tried to shake her out of it,
but Mariko appeared lost between dream and reality. Despite all of this, when
Yoshizumi asked if anything was wrong, she said nothing and turned away as
always.
Before he knew it, Anzai was
in the lobby. He pressed the down button and waited for the elevator to arrive.
He had spoken to Yoshizumi
many times throughout this entire ordeal. They inevitably talked mostly about
Mariko’s practically autistic behavior.
Yoshizumi made it clear he
was having a very difficult time with her and complained of the indifference
that had been absent in the little girl he had treated two years ago.
No matter how much he tried,
Anzai could not figure out why she was shutting herself off from everyone.
The doors opened in front of
him. Anzai entered the elevator without paying much attention and pressed the
button for the first floor. The doors closed, followed by a gentle sensation of
descent. The ventilation fan hummed quietly above his head.
When first informed of his
daughter’s renal insufficiency, Anzai knew nothing about the condition. It was
the winter of her fourth- grade year. When Mariko was wheeled out from the
waiting room, the attending physician had a pitiful look in his eyes and gave
Anzai the bad news.
“To put it more technically,
she is suffering from glomerular nephritis. In your daughter’s case, the
inflammation has been progressing slowly for some time now. As it is, her
urinary lining has become compacted. If we don’t act soon, her kidney will
malfunction, blocking her urinary production altogether. Please take a look at
this data. We tested her glomerular filtration rate, abbreviated here on the
chart as GFR, and blood urea nitrogen levels, BUN. From this information, we
were able to make a fairly confident diagnosis. She is already starting to show
some common signs, such as swelling, breathing abnormalities, and nervousness.”
Frightened, Anzai fell
silent, then said, “Is there a cure?”
“I’m sorry, but no.” He was
unnerved by the doctor’s sudden bluntness. “There is currently no established
cure for chronic renal failure. Medications and surgery are no use. The cells
themselves just stop working.”
“So, what should we do?”
“The only option right now is
dialysis treatment. People like her actually get along fairly well with it. We
just hook up a machine that does the work of the kidneys, expelling used-up
matter from the body. I will set you up with the best dialysis treatment center
in the area. They’ve handled plenty of cases, so you’ll be in good hands.”
Anzai hardly noticed when the
elevator reached the first floor. He got off and went into the lobby. The air
conditioning was overpowered by hot air coming from the entranceway. He wiped the
perspiration from the back of his neck and crossed over to the building where
Yoshizumi’s office was located.
Anzai lamented the fact that
he and Mariko had hardly talked at all these past few years. His time was
currently consumed with product development, and he felt that his work was
vital. He would be pushing into his fifties this year. At any rate, if he didn’t
work there, he’d have achieved nothing in his life.
In truth, his lack of
interaction with Mariko was not a recent development. It had been this way ever
since he joined the firm. Work was really his only occupation. That was not to
say he never found the time to marry, though he hardly ever opened up to women.
He met his future wife when he was thirty-three. Even after they were wed and
Mariko was born, Anzai never made an effort to come home early. On most
Sundays, too, he was out on business and hardly spent any time with his wife
and daughter.
Immediately after buying
their first house, his wife died of an illness, leaving their large two-floor
house as a monument to loneliness. Mariko came to spend much of her time alone.
She was usually in bed by the
time he got back. After waking her up in the mornings, he would rush off to the
bus stop. Her affliction had therefore gone unnoticed much longer than it
should have.
The hospital was
well-accommodated with dialysis equipment of all kinds. Anzai stared in wonder
when he and Mariko were first shown through the facilities. There were at least
fifty beds spread out in a large room, nearly all of which were occupied with
patients. Dialysis machines were set up at every bedside, a sight that made him
queasy. Everyone was lying around languidly with tubes in their arms. While
many were looking intently through magazines and comic books, others, like the
person next to Anzai reading tabloids, were simply idling the time away. And
weaving among them like white threads were the nurses. Anzai was informed that
nearly three hundred people were receiving dialysis treatment there.
The patients varied in age.
There were a few children Anzai thought to be even younger than Mariko and many
who looked to be in their seventies. There was also a man his own age. Maybe it
was the fluorescent lights, but most of them seemed to have sickly complexions.
And despite the very modern machinery, everything seemed somehow run down.
It was not long before Mariko
had to begin dialysis herself. The doctor said she would need to undergo
surgery to have a shunt made for her. To enable dialysis, a tube had to be
hooked up to a vein in the arm, and to facilitate this an artery was joined to
the vein to widen it. Mariko would get an internal shunt. It was hard to make
one for children, but it didn’t get infected easily and therefore lasted
longer.