Moonface (6 page)

The lawns and the roofs of the houses were covered with white. Snow moved in thin gauzy sheets across the road. The wind kept trying to push me off the sidewalk and onto the street, but I dug the heavy black soles of my boots into the snow. I was mummified, wrapped tight under layers of thermal underwear, fleece, and corduroy and nearly suffocating in a parka, scarf, and knit cap. If there was one thing I learned in Iowa, it was that you could never wear enough layers and that those layers couldn't be thick enough. And yet, six layers deep, it still felt like the cold air passed through me as if I were a sieve. Then, oh no, I thought, suddenly feeling as if the molecules I was composed of were breaking apart. I didn't know if the feeling was running through my blood or if it came from my gut or if it was me trying to doom myself with a bleak prophesy, but I just knew, standing there at that moment, that something was wrong with my kidney.

I'd seen this day coming across the horizon for a few years now, and I'd been given fair warning by the doctors that a transplant wasn't a cure for kidney disease, just another treatment. The original disease could come back in the transplanted kidney, or my body could start to reject it. Or it could just stop working, like a heart tired with age.

I knew what had to be done now. I had to call the nephrolo-gist, who would probably order some blood work and maybe a biopsy of the kidney. Seeing as how I was now fresh out of siblings, I just hoped that the kidney would last me through to the summer, until the school year was over and I could better focus on the problem. I looked down the snow-covered road, and all I could see was a succession of tests, appointments, prognoses, and diagnoses, and as I had done for the cold Iowa winter, I braced myself for it.

The nephrologist I'd been seeing since we'd moved to iowa was a mouse of a woman with grayish brown hair and a nose that was too small for her face. She kept a close eye on me all fall because I was a new patient, not necessarily because she saw the rejection coming.

“That's what it is, right? Chronic rejection?” I asked her as we sat on the couch in her office. She brushed her hand against my back and confirmed my self-diagnosis. “We should start thinking about dialysis,” she said.

“But, wait, it's not that bad yet, is it?” I had a feeling that the kidney was changing, but I hadn't recognized any symptoms yet. No swollen ankles, no remarkable fatigue. Even my blood pressure was holding steady. I had called this one on a hunch, nothing more. I was just grasping the concept of actually being right; I didn't want to talk about what was going to happen next.

“Your kidney function is at about 50 percent now, but it's not getting any better. We can hold off putting a dialysis fistula in your arm for now. But that'll probably need to happen soon. I know you want to finish out the semester before you start any treatments, but I can't make that call right now. I suppose we can hold off and just watch your creatinine level every week,” she said reluctantly.

I trudged through winter in a daze, trying to stay ahead of the schoolwork and the teaching just in case something were to happen. I should have been excited that my freshmen were finally looking more alive in class as the mornings became warmer, but no matter how well things were going in school or how much closer spring was getting, it always felt like I was still under the cloud of winter. After teaching my Monday morning class, I took the bus from the university to the hospital and had my blood drawn per Dr. Mousy's orders. I again put off her recommendation to have the surgery that would enlarge the vein in my arm—a procedure that would allow me to start dialysis treatment immediately after my kidney officially failed. I couldn't take a week off to recover from surgery right when my students were finally paying attention.

“Not yet, please,” I begged her. “The semester is almost over.”

One day, I sat in the kitchen of Beth's tiny bungalow staring at a shadowbox that held her collection of miniature things: a tiny hairbrush, a tiny glass pitcher, a tiny red harmonica. She was making a spinach cream sauce and stirring the pasta in a giant pot over the stove. “Should we have bread, too?” she asked me.

When I stood up to get a baguette from the counter, I caught a glimpse out the window. It was late spring, and Beth's backyard was getting into shape. She'd planted yellow flowers that now blossomed and curled along the edge of the yard; an overgrown tree that seemed menacing all winter was now trimmed and handsome. She had hosed down the white-painted iron patio table and chairs so they were free of leaves and dirt. Summer was going to be beautiful for her: quiet barbeques in the back, Saturday mornings tending to her new vegetable garden. I wondered what summer would look like for me. I didn't know if I'd be right there with her, or if I'd be in a hospital room trying to get better. I wanted to feel as hopeful as that bright backyard, but I had no clear window into my summer.

I must have been staring at the garden for a while because I heard her call, “Hello? Hello?” She grabbed the baguette from my hands and put it on the table. She looked at me through her black-rimmed glasses and said, “Clearly, you need a distraction. And so do I.”

Beth was in fine physical health, but her love life was currently requiring her attention. She knew it, too, and she was trying to be cautious with her steps. She was a recent divorcee, ending her first marriage right after coming to Iowa. This was a fact that she didn't share with me until several months into our friendship, and even then, I had to grill her for details.

“I was too ambivalent,” she'd said once, shrugging ambivalently.

“What does that mean?” I asked her. “Isn't the whole idea of marriage that you're making a choice? You pick someone and promise that you're going to be with that person for the rest of your life?”

“Yeah, I guess,” she said. “We were dating, and everything was fine. And when he wanted to move here from Chicago, I told him I'd go. When he asked me to marry him before we left, I just sort of went along with it.”

“I guess you didn't want him bad enough to try to work it out.”

“I don't know. There's a point in a marriage when you can't go back to the beginning.”

It had seemed she was ready to be single for a long while, not really mentioning anyone she was interested in and not really making an effort to meet anyone new. But then I'd heard reports that she and a professor from the media department were seen talking extensively with each other at two different parties.

“Beth,” our friend Erica said at one of our many department potlucks, “you were spotted in a red car with a man.” Everyone in the room turned to listen to her response, but Beth didn't make a peep. She sat in the corner rocking chair and stuck her nose deep into her wine glass, her cheeks visibly turning warm.

The distraction beth was referring to in her kitchen that afternoon turned out to be a job. At the Johnson County Administrative Building as a part-time transcriber. After working for a few days, she reeled me in, too.

It was the end of the semester by then, and after I had turned in my final grades, I knew I didn't want to sit at home and worry about what the rest of the summer would look like or when the kidney would shut down for good. So, for the early part of the summer, Beth and I sat in the air-conditioned office and listened to recordings of the daily county council meetings through headphones. There were months” worth of tapes that needed to be transcribed just to get up to date, so the work seemed endless. But I didn't mind the rhythm of it. It was a lot like what I imagined sewing to be, using the foot pedal to start and stop the tape, and hunching over the keyboard to watch my busy fingers at work.

Charlie liked that I was keeping busy, but wanted to make sure I was getting some rest, too. He'd call me a few times a day just to check that I wasn't wearing myself out. When I came home, I busied myself by reading or cooking, trying not to dwell on worst-case scenarios.

“I don't think you should stress out about the kidney, but I also don't think you should pretend like nothing's wrong,” he kept telling me when I got quiet at night.

The kidney was holding on, as I hoped it would, but it was slowly starting to show signs that it was breaking down. I woke up one morning to find my mouth full of sores. The nurse at Dr. Mousy's office said it was a sign of end-stage kidney failure. I didn't talk for a week, and sadly, Charlie didn't seem to mind.

“This is what it takes for a man to get some peace?” he joked, poking my ribs so I'd at least smile.

Then at work one day, I hobbled like an old woman from my desk to the filing cabinet on the other side of the room. Beth caught me.

“What's wrong with you?” she asked.

“I don't know. I don't remember stubbing my foot or anything, but I woke up this morning and I couldn't step down on my big toe.”

Later, when I wobbled off the sidewalk in front of our house and landed awkwardly on my ankle, Charlie took me to the emergency room. The doctor who tended to me said it was the gout.

“Huh?” I said. “Don't old people get that?”

“Usually,” he said, looking at my chart, “but it's also a problem for people with failing kidneys.”

Dr. Mousy was losing patience with me. At my next appointment, she tightened her lip and said, “I think it's time to get you some treatment.”

“Just a little bit longer,” I pleaded. I didn't know what I was waiting for. I guess I was just hoping that the future I hadn't planned for would finally sit right with me.

Dr. Mousy nodded, but not in a particularly comforting way.

As soon as I got back to the office, Tammy, our blond, Nordic-looking supervisor who had been transcribing Johnson County Council tapes for years, called me into her office.

“Look,” Tammy said, pointing with her portly fingers to the monitor on which she had pulled up my most recent transcription. “You keep putting words in where they don't belong. Listen to the tape and then read what you've written. Your job isn't to edit the words, it's to transcribe them.”

The next day, I was taking my time with a recording, slowing the tape down and rewinding it more often than usual, when my cell phone vibrated in my pocket. It was the doctor telling me that my weekly blood test came back and that my creatinine level was 6.6. “It's time,” she said. “I'm not asking you this time, I'm telling you. We're doing this now.”

I hung up the phone and swallowed hard. Tammy was on the phone, interns were shoving metal file drawers shut, and someone at the front desk was ringing the bell for service. Beth tapped away at a computer, wearing those black, puffy, donut-shaped earphones. When I came to her desk, she pulled them down and away from her face. “They're putting me on dialysis. I have to go,” I said.

Beth, who usually hides her brown eyes behind her black-rimmed glasses, lowered her chin, looked at me over the frames, and bit her lip. “Oh, man.”

“I have to go to the hospital. I have to tell Tammy what's happening. I have to call Charlie. Oh no, how is Charlie going to get to the hospital? What if—”

She stood up and seemed strikingly tall, especially when she put her hand on my shoulder to stop my breathless rant. “I will tell Tammy. I will call Charlie; I'll pick him up myself if I have to. You, go!”

I sat in the car in the office parking lot and breathed into the steering wheel. Then, I drove. I drove down a street called Summit, though there was no summit at all. Just a long, hot road that led to the hospital—an immense brick building that slowly began to fill my windshield as I neared it.

My kidney was no longer working, which meant that it could no longer regulate my blood pressure and clean my blood of toxins and waste. Eventually, I'd stop urinating, which meant my body was starting to hold on to liquid—swelling first my ankles and my hands, and then eventually flooding my whole body. My kidney had been working twenty-four hours a day to clean my blood, and now that it couldn't do that, I needed a machine to do that work for me. That treatment was called dialysis, during which long tubes would pull the blood from me, run it through the machine to clean it, and drain it back into my veins.

The problem now was how to get to my blood. Dr. Mousy had wanted me to get the fistula in my arm for weeks now. The surgery of fusing together a vein and an artery of my arm together to make one big superhighway for the big dialysis needles was not an immediate solution. The new vein needed time to heal and grow. But since I needed a dialysis treatment right away, I had to get temporary access through a vein in my neck, or a catheter, which needed to be surgically inserted.

A nurse had me lie on a table in a procedure room and began cleaning off my neck with Betadine swabs. Dr. Mousy stood over me, too, claiming that this was a minor procedure and that I wouldn't feel anything. I kept my face tight and still as I looked up at her, telling myself that this was nothing. But soon my face was covered by a paper sheet and there was tightening in my neck. A surgeon who I couldn't see pulled and tugged at my skin as he twisted and turned a tube through my jugular. Before I knew it, I was taking shallow breaths and feeling the tears stream down my face, not really knowing if I was crying from the pain or from the fact that I was actually going through this, that this was happening.

“Over!” Dr. Mousy finally yelled. “See?” She pulled the sheet from over my face. “Rest here for a while. Let me talk with the nurses about when we'll get you on the machine.” I heard her clogs as she stomped out of the room. I opened my eyes to see sinks and cabinets far off to the left and pale green tiles that worked their way up from the floor and onto the walls. I couldn't yet turn my neck to the right because of the pain and the bulki-ness of my new appendage, but I could tell that I was on a very small table in a very big room. And I felt so lonely.

Dr. Mousy came in again to tell me they'd call me in soon. “And Charlie's here,” she said. He stood behind her, leaning against the doorjamb, the sleeves of his chambray button-down folded up to his elbows. “We'll start the dialysis in a few minutes. For now, I'll leave you two alone.”