Part 4 (1/2)
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 pota.s.sium count, she was subjected to dialysis and transfusions. She was screened thoroughly for infectious diseases. They seemed to a.s.sume 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 Yos.h.i.+zumi. Anzai naturally agreed. Yos.h.i.+zumi then peered into Mariko's face. ”And you, Mariko?” he asked.
”Is that person really dead?” she responded despairingly.
Yos.h.i.+zumi 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. 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 Yos.h.i.+zumi 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, ”Yos.h.i.+zumi 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?”
Yos.h.i.+zumi 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 compa.s.sion. He glanced absentmindedly at the clock behind her. It was 5:35.
10.
Bringing one a.s.sistant with him, Yos.h.i.+zumi 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. Yos.h.i.+zumi stood in front of the two stainless steel sinks that lined the wall and stared at his own face in the mirror, covered in mask and surgical hat.
He and the a.s.sistant opened the sink plugs, was.h.i.+ng 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. Yos.h.i.+zumi flexed his fingers a few times to stretch out the gloves until they fit comfortably.
Yet another a.s.sistant 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.
Yos.h.i.+zumi walked around the body and positioned himself at its left. The first a.s.sistant came over and stood opposite. Yos.h.i.+zumi exchanged a glance with him, then surveyed the room, checking to see that everyone else was ready.
”Seventeen minutes since heart failure,” Yos.h.i.+zumi heard the nurse announce.
”Alright, let's begin.”
A scalpel was pa.s.sed into Yos.h.i.+zumi's dexterous right hand.
From a round hole opened in the cover sheets, the body's abdomen shone under the lights. Yos.h.i.+zumi 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 die area, but time was scarce and he could not afford to stop all of it. Yos.h.i.+zumi 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 fiver with a spatula-like tool to see more clearly inside, then pa.s.sed the device over to his a.s.sistant.
Yos.h.i.+zumi 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, Yos.h.i.+zumi 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.
Yos.h.i.+zumi shook his head once again. He forcibly erased Tos.h.i.+aki 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 a.s.sistant sucked out the contents of the stomach through a tube. When everything looked clean, Yos.h.i.+zumi severed the esophagus. At this point, almost every digestive organ in the upper body was cleared. His goal was now within close reach. Had Yos.h.i.+zumi 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.”
Yos.h.i.+zumi and his a.s.sistant 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 a.s.sistant widened the incision with his hands to give a better view for Yos.h.i.+zumi. The neatly hollowed s.p.a.ce 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. Yos.h.i.+zumi was pleased at their excellent condition.
With such an un.o.bstructed 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, Yos.h.i.+zumi 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. Yos.h.i.+zumi 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.
Yos.h.i.+zumi 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 .
Upon checking to see that the a.s.sistants 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 a.s.sistant held both kidneys gently and s.h.i.+fted them over to a lower area. A nurse supported the a.s.sistant, 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. Yos.h.i.+zumi cut these now.
OK, he thought to himself.
The first a.s.sistant 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. Yos.h.i.+zumi 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.