Authors: Hideaki Sena
After a while, Kiyomi’s
stretcher was wheeled back into the OR.
“Please stay in the waiting
room,” a nurse called to them.
Kiyomi’s parents entered the
narrow waiting room and collapsed onto the couch. Seeing this, Toshiaki went
down the hallway to find a phone.
“Kiyomi... hold on just a
little longer,” he murmured, recalling the image of her stark white cheek.
Soon, he would take her to a warm place where he could tend to her always. He
would raise her.
Kiyomi, I will never part from you
.
Mariko was wheeled along on a
stretcher. Shigenori Anzai followed along, holding the hand of his anesthesized
daughter.
“I’m sorry sir, but you
cannot pass beyond this point,” informed one of the nurses, placing a hand on
his arm, as they reached the OR. The young doctor pushing the stretcher opened
the door. Anzai was not allowed so much as a peek inside as Mariko’s body was
wheeled in.
“Please leave everything to
us,” said the doctor before ducking out of sight.
Anzai gazed at his palm,
where Mariko’s hand had been only a moment before, and instinctively made a
fist to keep her warmth there.
“Mr. Anzai, calm yourself.
Everything’s going to be fine. Please rest over here,” a nurse said, and led
him into the waiting room. She sat him down upon a couch, then brought him some
coffee from a vending machine. She handed Anzai the hot paper cup, which he
grasped with both hands. His thoughts were churning over the events of the
night before.
Soon after talking with the
coordinator, he’d arranged for a taxi to take them to the hospital. Mariko
threw such a tantrum the entire ride over, he feared she’d have an actual fit.
When they arrived, she calmed herself somewhat, but cried for what seemed
forever. She was never so emotional during the last transplant.
Mariko was moved immediately
into the ICU for testing. After verifying her dialysis data and checking her
blood pressure and potassium count, she was subjected to dialysis and
transfusions. She was screened thoroughly for infectious diseases. They seemed
to assume that the thought of undergoing an operation was making her nervous.
By the time she was informed about the details of the operation and asked to
give her approval, she seemed an empty husk.
“You’re still okay with
this?” asked Yoshizumi. Anzai naturally agreed. Yoshizumi then peered into
Mariko’s face. “And you, Mariko?” he asked.
“Is that person really dead?”
she responded despairingly.
Yoshizumi understood what she
was getting at and explained that the donor was brain dead. There was no chance
of her coming back to life.
The tests confirmed Mariko’s
eligibility. They had prepared all last evening for today’s procedure by
shaving off any body hair around her abdomen and covering her with a sterilized
sheet from the waist down to prevent razor burn infections. They also
prescribed immuno-suppressants.
[10]
Anzai spent the entire night sitting in a chair at her bedside.
Odagiri was a very perceptive
woman. She understood Mariko’s nervousness and fitful anger and talked with her
throughout the night. Anzai was still concerned, but everyone was handling the
situation with great patience.
They received word at 1:30 pm
that the transplant would begin. When Yoshizumi came to Mariko’s bedside to
relate the information, her eyes widened in fear, to such an extent that Anzai
feared they would pop right out of her head. Her lips quivered. Her teeth
chattered.
“Don’t be afraid, it’s just
like before. Everything will work out fine, I promise,” Yoshizumi said gently
and gave Mariko a pat on the head.
She’d opened her eyes wide
again and asked the same question, still rigid from fright. “Is the person
giving me this kidney really dead? Is she really,
truly
dead? Won’t she
come back?”
Yoshizumi was gone now. He
was at the UH... to get Anzai’s daughter a kidney from a “truly” dead person.
Anzai looked up at the nurse’s
face. She returned his gaze with compassion. He glanced absentmindedly at the
clock behind her. It was 5:35.
10
Bringing one assistant with
him, Yoshizumi went into the dressing room and changed into a green surgical
outfit. Although he was accustomed to wearing it, it always felt crude when he
put it on. He then entered the washroom nearby. Yoshizumi stood in front of the
two stainless steel sinks that fined the wall and stared at his own face in the
mirror, covered in mask and surgical hat.
He and the assistant opened
the sink plugs, washing their arms with filtered water. Next, they put a
disinfectant solution into their palms and smeared it thoroughly over their
arms. They then each took a scourer in their hands and scrubbed vigorously.
After working up a fine lather, they rinsed it off with the shower nozzles and
cleaned their fingertips and nails with a small brush. This process was
repeated three times.
Proper hygiene and a sterile
environment were always necessary for any operation, but one had to be
particularly attentive to these issues in transplant surgery. A transplant
recipient’s immunity had to be regulated in order to stave off rejection of the
new organ. While this did increase the chances of success, the treatment
severely weakened the recipient’s resistance to bacterial infection.
If the new kidney became
infected, the patient could actually die. The surgeons therefore took the
utmost care in the pre-op disinfection procedures.
They entered the OR, put on
gowns handed to them by a specialized nurse, and slipped on latex gloves.
Yoshizumi flexed his fingers a few times to stretch out the gloves until they
fit comfortably.
Yet another assistant was busy
disinfecting the donor’s skin. Only her abdomen was left exposed, draped on all
sides by sterile green cloth. More than just covering the body, the cloth
served to prevent any lingering bodily bacteria from infecting the operating
field, and to keep the surgeon’s focus from straying. The green color dampened
the visual impact of blood.
Yoshizumi walked around the
body and positioned himself at its left. The first assistant came over and
stood opposite. Yoshizumi exchanged a glance with him, then surveyed the room,
checking to see that everyone else was ready.
“Seventeen minutes since
heart failure,” Yoshizumi heard the nurse announce.
“Alright, let’s begin.”
A scalpel was passed into
Yoshizumi’s dexterous right hand.
From a round hole opened in
the cover sheets, the body’s abdomen shone under the lights. Yoshizumi placed
his hands upon it and made the careful first incision. Blood oozed out vividly
from his precise line. He secured the slit with forceps to stop any further
arterial leakage. He spread open the incision by hand and, pulling the outer
layers, cut through the peritoneum. He clamped a number of smaller forceps into
the body cavity. Blood from numerous veins still permeated the area, but time
was scarce and he could not I afford to stop all of it. Yoshizumi staunched the
blood as best he could and sped up the incision until the digestive organs were
exposed. He lifted the upper part of the liver with a spatula-like tool to see
more clearly inside, then passed the device over to his assistant.
Yoshizumi immediately
recalled the face of the donor’s husband. He could not drive it from his head.
There was something very peculiar about him. The man’s eyes were vague, yet
somehow alive with conviction, trembling as if possessed. And when he shook his
hand, Yoshizumi almost called out involuntarily, for it felt like plunging into
boiling water. He had feigned calmness, despite wanting nothing more at that
moment than to break away from him.
Yoshizumi shook his head once
again. He forcibly erased Toshiaki from his mind to focus on the operating
table. There were much more important things in need of his immediate
attention.
Many think that the kidneys
are in the vicinity of the waist, but they are actually higher, located just
behind the bottom-most rib of the rib cage. In order to reach the kidneys,
internal organs such as the stomach and pancreas had to be systematically moved
out of the way.
He tied off all visible
arteries in the colon and pancreas area and cut them away. The assistant sucked
out the contents of the stomach through a tube. When everything looked clean,
Yoshizumi severed the esophagus. At this point, almost every digestive organ in
the upper body was cleared. His goal was now within close reach. Had Yoshizumi
been extracting a kidney from a living person, he could not be so careless, but
dealing now as he was with a dead body, an abbreviation of time necessitated
this indifferent handling. Again, the nurse dictated time since heart failure.
“Twenty-three minutes.”
Yoshizumi and his assistant
removed digestive organs from the peritoneal cavity, turning them over and
placing them on a tray between the donor’s legs. On top of the green cover
sheets, these organs took on the appearance of some morbid exhibition. Since
all peripherals had now been removed, only the kidneys remained. The assistant
widened the incision with his hands to give a better view for Yoshizumi. The
neatly hollowed space allowed for more room in which to work. He could see both
kidneys perfectly now. They were a neat pink color and glittered with reflected
light. Yoshizumi was pleased at their excellent condition.
With such an unobstructed
view, he easily located the aorta abdominalis into which the balloon-tip
catheter had been inserted. The swollen balloons were at exactly the correct
junction, indicating that perfusion had been a complete success. He looked down
to find the ureter, a minute threadlike tube running from the kidney to the
bladder. In order to ensure an easy extraction, Yoshizumi peeled away the
surrounding tissue, then severed the ureter near the ileum, leaving only the
kidney veins and arteries to be cut. If these incisions were miscalculated, it
would impede the transplant later on. Yoshizumi could no longer be so
haphazard. He progressed cautiously as he peeled away extraneous blood vessels.
“Thirty minutes.”
When extracting both kidneys,
they were not severed and taken out one at a time, but were removed
simultaneously, with the blood vessels between them still attached. Only then
were they separated.
Yoshizumi ordered that
preparations be made for transport. After both kidneys had been extracted, they
would be separated so that one could be delivered to the CCH.
Upon checking to see that the
assistants had set up the storage device, which contained extracellular fluid,
he cut off the upper portions of the lower kidney arteries and motioned that
the perfusate now be stopped. He then promptly cut the aorta abdominalis. The
assistant held both kidneys gently and shifted them over to a lower area. A
nurse supported the assistant, keeping close watch on the delicate blood vessel
tips. The two kidneys were now attached only to the arteries and veins
stretching from the lumber artery. Yoshizumi cut these now.
OK
, he thought to
himself.
The first assistant scooped
up the kidneys and placed them into a stainless steel tray.
“Thirty-six minutes,” the
nurse stated.
“We’re separating the
kidneys. Get the coordinator in here.”
The nurse ran out of the
room. Yoshizumi took the two lumps sitting on the tray into his hands and
examined them carefully, checking the arrangement and length of each blood
vessel with scrupulous care. Every kidney’s anatomy varied subtly depending on
the person. At times, the shape of the blood vessels did not quite match up. A
close inspection was imperative at this point to ensure a smooth transplant.
Yoshizumi carefully separated
the two precious organs. Odagiri entered in an operating gown and with a
shipping bag, from which a container was quickly removed.
“Take the right one,” he
said. “It looks fine, and it should do just fine. It has a healthy ureter,
artery and vein all intact.”
“Time?”
“Thirty-eight minutes,” the
nurse responded.
“Got it.” Odagiri timed her
watch while Yoshizumi placed the kidney into the container. She picked up the
bag and left the room after a brief thank you. She was now responsible for the
organ until it reached the neighboring prefecture. A two-hour drive awaited her.
Without even waiting for
Odagiri’s departure, the first assistant began setting up the cold storage
container for the other kidney. He ran a perfusate through the kidney and
watched as the meter sprang to life. He adjusted the pressure until the meter
indicated 50.
“Forty minutes,” the nurse
announced.
“There, it’s done.”
However, the procedure was
only half finished. Yoshizumi now had to return to the CCH and perform Mariko’s
transplant. They immediately rounded up all of their equipment and exited the
OR.