Part 16 (1/2)
She had at last been responding to him the past few days. That said, she answered only bluntly, but for Yos.h.i.+zumi it was a relative improvement. Maybe allowing her to walk around in the courtyard had lifted her spirits enough to instill some self-confidence.
Her recovery was going smoothly. Any signs of infection or refusal had yet to appear.
Beginning this week, the amount of adrenal steroids in the immunosuppressant solution had been reduced, and she had also been allowed outdoors. Her chances of developing infections from outside contaminants were negligible by now. If things continued this way, she could be released from the hospital soon. Any signs of organ rejection, however, would prolong her stay.
Yos.h.i.+zumi lightly disregarded her succinct 'dunno.' She was probably telling the truth.
Patient awareness of the first stages of rejection was vague. Fever and Weariness were common, but these were often the result of the patient's restricted water intake, so the situation had to be dealt with carefully.
”I just want to do a few more tests. There's still a possibility your new kidney could be rejected, but all signs so far point to a swift recovery.”
Upon Yos.h.i.+zumi's mention of the word 'rejected,' Mariko nearly jumped out of her skin, though her expression didn't change.
”We'll postpone your going out into the garden for a while, okay? I'd like to do an ultrasonic wave test on you. You remember we did that the first time?”
Silence.
”We'll just be listening to your blood flow. It only takes a minute or two. It won't hurt at all, I promise. We'll take a look at the results and judge from there.”
Mariko gave a wordless nod as a signal of consent. Upon seeing that, Yos.h.i.+zumi told the nurse to prepare the Doppler meter. With this machine, they would be able to tell if the transplanted kidney was hypertrophic or if blood flow was inadequate. Because this method was easily administered right there in the sick room, Yos.h.i.+zumi used it whenever possible.
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. Yos.h.i.+zumi 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 acc.u.mulated 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 Yos.h.i.+zumi'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 Yos.h.i.+zumi's experience, he felt the former was more likely in this case.
Why would rejection be setting in now?
Yos.h.i.+zumi 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.
Yos.h.i.+zumi took a deep breath and pressed the elevator b.u.t.ton.
The results of the wave test were finished and reported back to Yos.h.i.+zumi. As he suspected, there was a noticeable decline in blood flow. He decided to take a needle biopsy from her kidney and scheduled a time with the nurse.
Mariko was brought into the OR. Yos.h.i.+zumi soon followed after disinfecting himself in the scrub room.
The procedure was over in a few minutes, the sample then pa.s.sed off to an a.s.sistant.
”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 Yos.h.i.+zumi 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, Yos.h.i.+zumi 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.
Yos.h.i.+zumi 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, Yos.h.i.+zumi 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 Yos.h.i.+zumi, the greatest possible humiliation.
On the day of the extraction, it was drizzling outside. Yos.h.i.+zumi 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. Yos.h.i.+zumi 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 pa.s.sed 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, Yos.h.i.+zumi 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, Yos.h.i.+zumi 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. Yos.h.i.+zumi 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 gla.s.slike 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.
Yos.h.i.+zumi 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.