Parasite Eve (25 page)

    He entrusted the nurse to
handle things, smiled once more at Mariko, and left the room. Strolling down
the long hallway towards the elevator lobby, he watched the daylight pour in
through the windows, casting sunny rectangles across the floor.

    Does Mariko’s condition
indicate organ rejection. Yoshizumi turned the question over in his mind as he
walked. He was still unsure after viewing the results so far. Organ rejection
was becoming more and more infrequent in recent years thanks to the
advancements in immuno-suppressants. But there was a trade-off in that the new
drug cyclosporin’s toxicity was rather hard to gauge.

    There was no denying
cyclosporin’s efficacy. It was a necessary part of Mariko’s treatment. But
cyclosporin had the drawback of being reno-toxic if too much of it accumulated
in the blood stream. At the City Central Hospital, blood samples were taken
every morning to monitor the extant level of the drug. Intake was then adjusted
to avoid the triggering of any side-effects.

    The results of Mariko’s
monitoring were sent daily from the lab to Yoshizumi’s office. From what he had
seen already, her cyclosporin level was not rising dramatically, but he had a
feeling that her blood creatinine was. It could have meant either rejection or
kidney poisoning, but from Yoshizumi’s experience, he felt the former was more
likely in this case.

    Why would rejection be
setting in now?

    Yoshizumi felt cheated. No.
He was only being pessimistic because things had gone almost too smoothly.

    He was overwhelmed by doubt.

    Remembering that Mariko had
stopped taking her medicines the first time, he stopped dead in his tracks.

    Could she be throwing away
her drugs again?

    Nonsense.

    He shook his head. The
presence of the immuno-suppressants had been confirmed in the test results.

    He resumed his stride, head
lowered in shame for having doubted her even a little. He wondered if he had
ever expressed suspicion towards her without even knowing it. Maybe she was
sensitive about this. It would certainly explain her hostility towards him.

    Maybe that was why she was so
reluctant to open up to him.

    Yoshizumi took a deep breath
and pressed the elevator button.

    The results of the wave test
were finished and reported back to Yoshizumi. As he suspected, there was a
noticeable decline in blood flow. He decided to take a needle biopsy
[31]
from her kidney and scheduled a
time with the nurse.

    Mariko was brought into the
OR. Yoshizumi soon followed after disinfecting himself in the scrub room.

    The procedure was over in a
few minutes, the sample then passed off to an assistant.

    “Send this to the Biopsy
Department for me. I want an immunofluorescence examination, light micrograph,
and electron micrograph. How long will it take?”

    “With the light micrograph,
twenty minutes.”

    “Okay, let’s hope for the
best.”

    But as Yoshizumi exited the
OR and stood by in the office, he could not control the anxiety welling up
inside him.

    Would Mariko’s kidney give
out on him again?

    Would it need to be removed
after all they had done?

    Were this a typical case,
Yoshizumi would not have given it a second thought, and he was surprised at his
own reluctance to do so if necessary.

    When Mariko’s organ rejection
had set in, she had been immediately rushed to the hospital. Her father had
found her at home alone in terrible pain.

    Yoshizumi had been taken by
surprise. Since leaving the hospital, she had been taking medications and
coming in for periodic checkups to make sure her new organ was being accepted.

    When Mariko was brought into the
ICU, Yoshizumi was shocked to find that the presence of immuno-suppressants in
her blood had decreased. Acute rejection. He took drastic measures and
immediately gave her an injection of OKT-3, but it was too late. Mariko
received an emergency blood transfusion and dialysis, but her kidney had
already become a threat to her very health. There was no choice but to extract
it.

    Nothing was more depressing
than extracting a transplanted organ. It meant reversing all the effort put
into the treatment for many months by an entire staff. In fact, the patient’s
perceived quality of life would be lower than before the transplant. It was
usually the surgeon who knew the positions of the blood vessels from the first
op who was tasked with the extraction procedure. Preparing for it was, for
Yoshizumi, the greatest possible humiliation.

    On the day of the extraction,
it was drizzling outside. Yoshizumi watched it from his office window,
regretting that he had not brought an umbrella with him. The gray sky seemed to
see right through his heart.

    The extraction was performed
in the same operating room as the transplant. The only difference was that
Mariko already had a scar on her lower right abdomen. Yoshizumi reopened it
with an electric scalpel.

    He was relieved to find that
the transplanted kidney had not adhered to any of the surrounding anatomy. Six
months had passed since Mariko’s transplant. Her rejection was not a gradual
process and all signs pointed to acute kidney failure. In cases of chronic rejection,
inflammation often occurred which bonded the organ strongly to the abdominal
wall, making it impossible to peel away all of the blood vessels without
damaging them. In Mariko’s case, Yoshizumi would have no such problems.

    From beginning to end, the
operation was plagued by an oppressive atmosphere. Even when connecting the
blood vessels with nylon thread, Yoshizumi was unable to allay his nerves. He
knew it was a procedure which required precision, and he did not think himself
fit to be extracting Mariko’s transplanted kidney...

    The test results were in.
Yoshizumi confirmed that the kidney had been rejected again. Though the
rejection was still slight, there was a large amount of PMN leukocytes in the
capillaries and some thrombosis in the narrow renal artery. In the case of
cyclosporin poisoning, there were usually minute glasslike grains in the
arteries. Mariko’s sample exhibited no such formation.

    He prescribed
Methylprednisolone. Had Mariko’s condition been more severe, he would have used
OKT-3, but he saw no reason for it here. He would check up on her after three
days of this treatment, then draw a conclusion, observing her closely for one
week thereafter.

    Yoshizumi finished his
instructions, took a breath, and swallowed some coffee. He went back to his
desk and gazed absentmindedly at the white steam rising from the cup.

    Mariko was a completely
different person after the extraction.

    She lapsed into the deepest
depression. Patients whose kidneys did not take were rarely in good spirits. At
first, Yoshizumi thought that Mariko was so closed because the transplant had
failed. And so, when he recommended that she and her father register for the
waiting list, he thought he was doing her a favor. He told them about a new
method called CAPD, hoping to alleviate, if only a little, the pressures of
returning to a life of dialysis.

    However, when he thought
about it now, Mariko’s state of mind was more complex than that.

    At the time, Yoshizumi never
figured out why Mariko did not take her medicines. Some children did, of
course, forget. There were various reasons for this. Sometimes it was in
defiance of adults, others disliked the facial swelling which often occurred as
a side-effect, and still others simply stayed over at their friends’ or went on
trips without telling their parents. Also, many decided that, since they felt
so good after the operation, it was okay not to take them.

    Yoshizumi honestly did not
understand children’s feelings very well. He had never quite figured out how to
interact with them. He thought maybe it was because he had no children of his
own.

    Soon after he began his
career, Yoshizumi married one of his former classmates. Because both of them
worked at the hospital, they had no time to raise children. Some years after
they married, when they were finally able to make time for themselves,
Yoshizumi discovered that his sperm was abnormal and that he was incapable of
making any woman pregnant.

    When Yoshizumi gave her the
news, his wife, who’d always said that work came first and that they could have
children later on, looked away from him, but not before he’d caught a brief but
unmistakable look of contempt in her eyes.

    He ought to have paid more
attention to Mariko’s state of mind. He regretted it though it was too late. He
should have talked with her more.

    It had looked like she’d
gotten out of her depression. She’d listened to Yoshizumi and Anzai and even
agreed to registering for another transplant. Yoshizumi had assumed she’d
gotten over the trauma of extraction.

    How wrong he’d been.

    Coping with her now, he
understood that she was far from over it. It wasn’t because of the extraction
itself two years ago that she was depressed. She was tormented about something
else unknown to Yoshizumi. Whatever it was, she was keeping it to herself. She’d
only been pretending to be okay, fooling all the grown-ups around her.
Yoshizumi hadn’t been able to see it.

    Maybe it was already too
late.

    Maybe he was past the point
of ever being able to win her confidence.

    No, thought Yoshizumi.

    If he couldn’t win the
patient’s trust, then he should retire from transplant medicine.

    He had to talk with Mariko
more.

    That evening, Yoshizumi went
to see her again.

    She was lying in her bed with
an IV tube in her arm, staring at the ceiling in solitude.

    She seemed surprised at his
visit. Her reaction was to be expected. Unless it was urgent business, he would
normally not make an appearance except during scheduled patient rounds.

    “What’s wrong? Are you upset
because you can’t go out?”

    She turned away without
answering. Yoshizumi paid no attention and sat down in the chair at her
bedside.

    “The rejection is still very
slight right now,” he continued. “If you just take your medications, you’ll be
fine. There’s no need to worry.”

    “...”

    “It’s okay. Things will calm
down in no time. I’m sure of it.

    Soon, you’ll be able to go
home and eat whatever you like.”

    “...”

    “By the way...” Yoshizumi
hesitated for a moment before asking what had been burning in his mind. “Won’t
you tell me what happened after your first transplant?”

    He saw her shoulders move
somewhat at the question. He went on.

    “You never told me that
anything was troubling you... I never asked, and I’m sorry. There must have
been some reason you didn’t take your meds?”

    “......”

    “Won’t you talk to me about
it?”

    Mariko was silent, but she
was clearly agitated.

    Without saying another word,
Yoshizumi waited a long while for her to speak up. The silence was almost
palpable, drifting down slowly from the ceiling like snow, embedding itself in
Mariko’s bed sheets.

    “Doctor, I’m sleepy...” she
said at last.

    “I see...”

    Yoshizumi stood up. He’d
gotten a pulse at least. Unlike before, she was making an attempt, however
slight, to be communicable.

    “Don’t worry about a thing,
okay? We’ll make it all better,” he said, and left the room.

    The following evening,
Yoshizumi again looked over the biopsy results. He compared the data from the
frozen samples, examined with an electron microscope, to the absorbency test
results.

    “This is a bit strange,” said
the lab technician.

    Yoshizumi, cradling the
phone, was looking at a film brought to him by a nurse from the lab, to which
the technician’s comment had been attached, prompting him to inquire into the
matter.

    “Given that the rejection is
so slight, there are no immediate concerns. But something worries me “The
technician lowered his voice in an evasive tone. “I’ve never seen anything like
this.”

    Having already noticed the
abnormal shapes on the film, Yoshizumi understood what the technician was
talking about.

    “You carried out the
procedure without difficulty, I assume?”

    Glitches in setting up a
tissue sample could yield images that were contrary to fact. He suspected it
may have been an error in the dying technique.

    But once he knew no mistakes
had been made, he had no other explanation.

    He removed the first biopsy
results from the filing cabinet and looked them over once more. Yoshizumi
started. There was clearly something there. He was careless not to have seen it
before.