Authors: Hideaki Sena
Toshiaki went to the
university early the next morning, overcome by a sudden desire to be alone. He
drove slowly through the streets which now seemed to him devoid of shadow and
form. A faint mist hovered around the campus grounds. As Toshiaki inhaled damp
air into his lungs, he walked into the building and went straight to his lab.
It was still early, so there was no one else around. He sat down at his desk
and leaned back in the chair, letting out a deep breath. Outside the window,
the pale houses along the road blurred far into the distant haze.
The image of Kiyomi’s
comatose face wavered in his mind.
Toshiaki had witnessed the
death of loved ones more than he would have liked, whether from terminal
illness or simply old age. He could honestly say he was capable of
understanding death. That is, until he saw his wife’s body lying motionless on
a hospital stretcher. Any previously held notions of mortality no longer
applied.
But was she really dead?
In Toshiaki’s delusional
state, pessimism encountered the warmth lingering in his hands from the night
before in subtle billows of conflict.
His knowledge of the
controversy surrounding brain death had been gleaned from television,
newspapers, and further from various educational materials and medical
journals. If anything, Toshiaki’s attitude was affirmative. Brain death was to
him a scientific matter that was unfairly subjected to sentimental arguments.
When there were patients who needed organ transplants in order to survive, why,
he wondered, should people hesitate to have replacements extracted from
brain-dead donors?
He gnawed his lip at the
thought of taking organs from Kiyomi’s living body.
Toshiaki conducted
dissections on rats and mice nearly every day, yet he was far from accustomed
to it. It always made him terribly uncomfortable to imagine doing likewise to a
human being. In his mind, the image of an anesthetized lab rat with its stomach
cut open overlapped with that of Kiyomi’s nude figure, the rat’s liver and
kidneys distorting into her abdomen...
Kidneys.
Toshiaki shut his eyes.
Kiyomi had registered as a
kidney donor last year. It all came back to him quite clearly now.
Toshiaki thought organ
transplants were something to be lauded. It would be wonderful, of course, if
Kiyomi’s kidneys could be of any use. Yet, because she was still warm with life
and her heart going strong, he could not let himself be reconciled to the idea
of extracting her kidneys. He simply didn’t feel that his wife was dead. He was
confident that she could go on and live.
He opened his eyes. The mist
had already dispelled outside and the buildings along the streets now greeted
the dawn, scintillating blindingly in the morning sun. A crow’s cry could be
heard in the distance. A new day was beginning. For most, it would be like any
other. For Toshiaki, it would become the day in which the reality of his wife’s
accident would leave behind its first indelible traces.
He needed to move around. But
before returning to the hospital, he walked over to the Cultivation Room to
check his cell cultures once more. He would replace them with a new batch if
they had stabilized.
He inspected his flasks under
the microscope. There was nothing particularly in need of his attention. He
gazed vacantly at his hybridoma
[6]
and cancer cell cultures. Then, without warning, an idea came to him.
Toshiaki took his eyes from
the lenses and peered at the red indicator solution
[7]
inside the flask. A voice filled with wonder escaped
from his lips.
“Oh, Kiyomi...”
His heart was racing. He
sprung from his chair. The idea spread swiftly through his mind. As he
staggered away, he could not take his eyes from the flasks upon the table.
Kiyomi’s body undoubtedly
suffered extreme brain trauma. Still, when he held her hand, he knew life
continued to emanate from her.
Not
everything
in her
had died.
His eyes still glued to the
flasks, Toshiaki clenched his fists and shouted at the ceiling.
In his excitement, the
hospital was much too far away...
He slammed on the gas pedal
and changed gears hastily, muttering Kiyomi’s name under his breath. There was
so much to do. He had to see what Kiyomi’s parents thought about offering up
her kidneys, reestablish his connections with an old surgeon friend, and
ultimately gain the doctor’s approval for his plan. He was sure of achieving
this all without a hitch. Kiyomi was still alive. Knowing this for sure, tears
began to flow from his eyes.
From now on, my dear, we’ll
always be together...
So did his heart cry out.
4
Toshiaki and his
father-in-law watched intently as the second examination was carried out. The
doctor in charge, whom they had met only yesterday, divided his duties with
another. Toshiaki had prepared himself for some grandiose procedure, but in
actuality, all they did was place headphones on her and poke her skin to see
whether or not she responded to stimuli. Kiyomi’s brain waves remained even.
The head doctor recorded the results on the chart. Toshiaki mused about how
unscientific their methods were.
All findings were negative.
When he was done, the doctor handed over the form and gave a look that seemed
to implore acknowledgment. Toshiaki compared the chart to Kiyomi’s face, then
returned it to the doctor with a single nod. The doctor accepted the form,
signed his name on the top, and stamped it. “Kiyomi-san has been judged to be
brain dead.”
“Yes.”
Toshiaki knew he could have
said something more appropriate and was amazed by his own vapid response.
“Well then, please step into
my office for a moment,” the doctor said, and led them in.
A woman was waiting inside.
Upon noticing them, she stood up from her chair and bowed politely. Toshiaki
returned the gesture vaguely.
“This is our transplant
coordinator, Azusa Odagiri,” stated the doctor by way of introduction. “It has
been brought to my attention that Kiyomi-san is a registered kidney donor, so I
took the liberty of inviting her here.”
Odagiri handed them her
business card. This suit-clad woman looked younger than Toshiaki and gave the
impression of a capable professional. Her piercing eyes contrasted with the
gentle curve of her cheek lines, and this imbalance helped give her an air of
being approachable. Her expression promised honesty and intelligence. She bowed
slightly again and said how pleased she was to meet them.
A recipient’s transplant
procedure could only be consummated when a donor was present. The only
available donors, excluding those still living and depending on the type of
treatment needed, were usually patients diagnosed with brain death or heart
failure. ER doctors needed to stay focused on their own tasks, so it was
undesirable for them to push to perform these operations. On the other hand, if
a transplant surgeon approached the patient’s family directly for the organs,
it invariably ended in hurt feelings. To mediate between transplant and
emergency medicine, someone had to deal specifically with all these issues.
This was where the transplant coordinator, Odagiri, came in. Hers was a job
which spanned many areas and, because of the doctors’ overbearing schedules,
meticulous familial consolation and care were upheld as the most important of
her duties.
Toshiaki and his in-laws
seated themselves on the couch and faced her.
“I will get right to the
point here. With Kiyomi’s kidneys, we could save the lives of two dialysis
patients. CRF, or chronic renal failure, is a condition that can afflict even
the very young. Unfortunately, there is no cure. All they can do is clean out
the body through dialysis treatment. But because of the time factors involved,
it’s nearly impossible for such patients to lead an active social life, and
they are under strict dietary restrictions as well. With a transplant of just
one kidney, such a patient could begin to live normally. I can assure you that
these kidneys would by no means be wasted.”
Toshiaki listened to this
earnest appeal and spoke up to discuss details.
“I understand perfectly well
that Kiyomi’s kidneys could save the lives of others and I’d like to donate
them for that purpose. It was her wish to register in the first place and I
think we should respect it, so please do what you feel is best in this
situation. I only ask that you remove nothing more. I don’t know if Kiyomi
would have approved of any further extractions. I would never dream of doing
anything without her prior consideration.”
He felt they were conversing
like actors in a play. After speaking his mind, he awaited the reaction of his
father-in-law, who closed his eyes and managed to nod once in approval.
“I am truly grateful for your
willingness to go through with this. I cannot thank you enough.” Odagiri bowed
her head deeply in gratitude. “I will help you through the entire process to
the best of my ability.”
Toshiaki carefully filled in
the transplant consent form that Odagiri presented. In the center of this thin
sheet was written:
I hereby consent to
the surgical removal of the following organs and tissues:
from the body of the
patient for the purpose of transplantation.
This dry sentence had been
printed in the middle of the form. In the blank spaces above it, Toshiaki
entered in his wife’s name, address, date of birth, and sex. Then, gathering
all of his strength, he circled the word “kidneys.” At that point he inhaled
deeply and, before exhaling, entered in the current date, his surname as the
consenting party, address, and relation to the donor.
“I’ll also need your seal
here.”
Odagiri pointed to a spot at
the bottom with a long white finger.
Toshiaki took out his
personal seal from his front pocket. With great tact, Odagiri removed a red ink
pad from her purse and placed it in front of him. Toshiaki pushed down hard on
the seal with a slight wriggling motion, affixing it to the form. His name
stamp “Nagashima” stood out vividly, almost to the point of lewdness. He
averted his eyes for a moment and wondered if he was making the best choice. He
had just officially sanctioned the removal of organs from the woman he loved
more than anyone. Such a serious decision made by merely signing a single sheet
of paper... but this was the right thing to do.
Toshiaki shook his head. It
was late in the game to be having such qualms. Hadn’t he decided that this
would extend her life? Didn’t this have to be done so that he could be with her
always? Kiyomi was not only what was on the outside, but rather,
every
living cell in her body
was Kiyomi. And he had to make her his.
Toshiaki needed to make his
move.
Just then, a sort of fever
seized him. It was the same heat that had visited him when the doctor had told
him about Kiyomi’s condition. His head began to spin.
As they were leaving the
office, Toshiaki edged stealthily past
his father-in-law over to the
doctor and spoke in a hushed voice.
“I actually have a request
concerning Kiyomi.”
“Yes?”
“Please, just hear me out,
and this is to be confidential between us... I want something in exchange for
offering her kidneys.”
“Exchange? What...”
The doctor eyed him
suspiciously. Toshiaki placed his trembling arm around the doctor’s back as if
restraining him, and whispered:
“Give me Kiyomi’s liver... I
want to use it for a primary culture.”
[8]
5
Upon finishing his ward
duties, Kunio Shinohara returned to the Department of Surgery on the fifth
floor of the Clinical Research Center. He rode the elevator down, proceeded
right, and opened the office door.
As he massaged his shoulder,
he crossed the lifeless room over to his desk. When he passed the
experimentation table, he cast a glance at the digital clock resting upon it.
It indicated 5:30.
On his desk were two memos
left by his secretary. They concerned his request for a copy of a medical
article (alas, it couldn’t be found) and a visit from a pharmaceutical company’s
marketing representative. Shinohara took a small note pad from the chest pocket
of his white coat and tossed it onto the desk. He massaged his shoulder again,
trying to loosen the stiffness that had knotted itself there during the course
of the day. These actions had become frequent and involuntary for him. He
mumbled out loud that the distance from the ward to his office was just
impossible. Hearing himself, he looked around embarrassedly.
It was rare for no one else
to be here. Usually at least one of his younger research students was around.
Maybe they had gone out to eat a little earlier than usual.