Part 9 (1/2)
6.
”How are you feeling?” Yos.h.i.+zumi said to Mariko and flashed a smile.
Five days had pa.s.sed since the operation, and everything was going smoothly. Two days ago they had removed the upper drainage tube from her kidney and today the urinary catheter. The bladder tube was still in place, but would be removed tomorrow.
Barely glancing at Yos.h.i.+zumi's face, Mariko looked away.
Didn't think so... Trying not to betray his disappointment, Yos.h.i.+zumi said, ”It seems your fever's gone down, and so has your CRP value. Don't you feel better? You're still slightly anemic, so let's adjust your transfusion level.”
He then explained the test results in a way Mariko would understand. If she knew about her condition fully, he thought, she would have a much more positive att.i.tude towards the treatment this time around. She should also be relieved to learn that there were no symptoms of organ rejection or serious infections.
The real transplation treatment didn't begin until after the operation. In the case of kidney transplants, the surgery itself was relatively simple, something any trained surgeon could perform. The problem was what happened afterwards.
A transplanted organ was a foreign body and inevitably elicited resistance from the recipient's immune system. It was to minimize this that HLA compatibility checks were made. Yet, immuno-suppressants were always necessary, and the dual use of prednine, an adrenal steroid, and azathioprine used to be common. The success rate for transplants shot up, however, with the development of more effective suppressants like cyclosporin and FK506. Because these drugs are renotoxic, today they are used only in conjunction with other drugs. Based on clinical data, Yos.h.i.+zumi's group favored a three-drug combo consisting of a minimum of cyclosporin, some adrenal steroid, and mizoribrine, an antibiotic. Since this wasn't Mariko's first transplant, she'd been prescribed a relatively small volume. Suppressing the immune system helped the new kidney survive but made the patient vulnerable to infections, a potentially lethal outcome given the lowered barriers. This was the crux of a transplant procedure, which was often compared to tightrope walking. The patient had to be kept under close watch for signs of organ rejection on the one hand and infections on the other. Yos.h.i.+zumi was painfully aware that transplants were the work not of the surgeon alone but of the nurses, clinical technicians, and pharmacists who had to stay in close touch during the post-op period.
Mariko was still turned away. Yos.h.i.+zumi cast a backwards glance at her father, but he, too, looked away.
Yos.h.i.+zumi sighed in his heart.
Mariko was clearly not in the mood for small talk. She had been acting this way with her father and the nurses as well. It seemed she wanted to forget, even deny, that the transplant had ever occurred.
In the eyes of a young patient, parents and doctors were dignified, powerful figures and therefore understandably intimidating. Yos.h.i.+zumi remembered having similar instances with other transplant patients under his care. However, in Mariko's case, he suspected there were other issues. He had no idea why she was so adamantly opposed to the transplant, even after the fact.
Maybe I failed the last time because 1 couldn't figure out why. At a loss, Yos.h.i.+zumi shook his head to dispel his self-doubt.
”You should be able to stand up and move around a bit the day after tomorrow. You'll get to eat some real food then, too,” he said and patted Mariko on the head. The nurse at his side smiled rea.s.suringly. But Mariko still made no effort to look in their direction. As if to shut out the existence of Yos.h.i.+zumi's hand, her head lolled lifelessly under his touch.
Yos.h.i.+zumi removed his hand.
It was quite a different story after her first operation, when Mariko looked gratefully at Yos.h.i.+zumi with tears in her eyes and thanked him countless times. He had smiled in return and patted her head as he'd done now.
Until her first transplant, Mariko underwent dialysis for about one year. After that, her father offered his own kidney, to which Yos.h.i.+zumi gratefully obliged.
When Mariko first appeared before them, the cherry blossoms were in full bloom. They all watched from the waiting room window as petals fell plaintively in the courtyard. Mariko was charmed by the pink scenery fluttering outside, as if seeing it for the first time.
She had just started sixth grade. She wore a white top with a green skirt and sported a bobbed hair style. Her large, round eyes were wide with joy. She listened closely to what Yos.h.i.+zumi had to say and even laughed at his jokes. Her cheeks were still slightly swollen, making her all the more charming. She had hardly grown at all in the preceding two years.
Even in cla.s.s, she was usually moved up to the front during gym or morning a.s.sembly, a fact that made her feel a little uncomfortable.
There were a number of orientation sessions with patients before the actual transplant took place. They were informed in detail about the types of treatments they could receive, the pros and cons of each, the truths of the operation itself, and how they were to carry on with their fives after recovery. Their goal was to alleviate any misconceptions or anxieties born of ignorance. Nurses also carried out a similar duty, but in Mariko's case Yos.h.i.+zumi had taken it upon himself to provide any and all explanations.
Mariko listened to his words enthusiastically, but was devastated to learn that she had to continue taking immuno-suppressants even after the operation. Nevertheless, she accepted it soon enough.
”So how long do I have to take them?” implored the young Mariko, staring at Yos.h.i.+zumi intently.
”For as long as you live,” he answered, not taking his eyes away from hers.
”Always...until I die?”
”Yes, but I know you can do it.”
Mariko covered her eyes and was silent for a long while. She seemed to be thinking seriously about what this meant. She then looked up, her lips tightly sealed, and nodded firmly.
She progressed well for a number of days following the operation. She was beside herself with joy and spoke to everyone smiling, exhibiting a happiness and talkative disposition typical of successful patients. This was usually a result of being released from dialysis and was in proportion to how much the patient had hated it. Still, Yos.h.i.+zumi didn't feel bad seeing her so happy. The dialysis experience must have been hard on her, and she genuinely seemed to appreciate having a new kidney. She seemed simply moved that she was urinating again, and when he visited her a week after the operation, she cried out and buried her face in his white coat with tears of grat.i.tude, he patting her head.
Even after Mariko left the hospital, Yos.h.i.+zumi met with her several times for checkups. Her face had rounded a bit, a side effect from the steroids he prescribed, but she was as darling as ever. She was delighted to be eating the same school lunch as everybody else, freed from her strict diet. She repeated over and over how good her meals tasted, how happy she was that she'd had a transplant.
”Doctor, I'm all healed now, I'm not sick anymore, right?” Mariko interrupted their conversation one day, smiling broadly, peering into his eyes.
For a moment Yos.h.i.+zumi was silent, not taking her meaning.
”You can live normally now like everybody, so in that sense you're cured. But with transplants, you can't let down your guard. You're still taking the immunosuppressants, right?
You absolutely mustn't forget to take them. Without them, even a successfully transplanted kidney will stop working. You must promise me that you'll always take your medicines. Can you promise me?”
”...yes,” she nodded.
Yes. She'd nodded. She did nod...
And yet she would return to the operating room only four months later.
”We haven't discovered any pathogens yet,” said Yos.h.i.+zumi as he walked Anzai out of Mariko's room now. He invited Anzai into his office to tell him about her post-op condition.
Yos.h.i.+zumi offered him a seat.
”Our nurses have been taking samples of Mariko's fluids and sending them for a.n.a.lysis.
We haven't found anything, so I wouldn't worry.”
Anzai looked relieved and wiped the sweat from his brow.
”But as long as we're here, there's an issue I feel I must address...” he said gravely.
”Just why is Mariko acting that way?”
Anzai looked downward.
”Mr. Anzai?” he asked again.
”I...don't know,” he responded. Yos.h.i.+zumi's silence urged him to continue. ”Ever since the first transplant failed, I haven't been able to tell a single thing she's thinking. She's kept her emotions hidden from me all this time. I'm beginning to wonder if this is all my fault...”
”Did Mariko not want this transplant?”
That's not the case!” Anzai looked up to say, but his voice was shaking.