Parasite Eve (9 page)

    Yoshizumi stood to Mariko’s
left. Joining him also were two anesthesiologists, three surgical assistants,
and two nurses. The walls were a light green and exuded a most inorganic feel.
Excepting the large equipment and the operating table, the room was bare and
looked more spacious than necessary. The doctors wore green surgical gowns
similar in color to the cover sheet that draped the lower half of Mariko’s
body. Amid this sea of green, her abdomen stood out in bizarre contrast.

    Yoshizumi looked up at the
shadowless lights in the ceiling: six ball-shaped bulbs arranged in a circle,
an additional one nestled in their center. The lighting in an OR was usually
arrayed under an , umbrella-like frame, but this OR, designed especially for
transplantation surgery, had a special ventilation system to keep it germ-free,
and the lights had been designed to impede the flow of air as little as
possible. They looked just like the bottom of a flying saucer and gave a clear
definition to everything in the room, from the outlines of all the equipment to
the doctors’ expressions and color of a patient’s organs.

    Bubbles of disinfectant
solution scintillated on Mariko’s skin. One of the surgical assistants inserted
a catheter into her bladder to clean it out. This rinsing, too, had to occur in
a germ-free state.

    “Present time is 6:47 pm. It
has been 76 minutes since heart stoppage and 40 minutes since the kidney
extraction.”

    “OK. Let’s begin.”

    With the catheter left in place,
Yoshizumi set to make the first incision. He made a mark from the left side of
her torso to just above her genitals and cut along this line with a standard
scalpel. At this point he switched to an electric scalpel, which he would be
using for the duration of the procedure. He cut through the rectus fascia,
exposing the external obliques and rectus sheath. The obliques were located on
either side of the abdomen and were red in color, while the sheath was white.
Yoshizumi carefully ran the electric scalpel along the area where these two
joined. Next, he opened the edge of the rectus sheath, then slowly cut the
secondary layer underneath it. Mariko’s first transplant two years ago had been
to the right-hand side. This time, it would be her left.

    A transplanted kidney was not
actually situated in its natural location, but slightly lower, closer to the
pelvis. The kidney was therefore connected not to the aorta abdominalis or vena
cava inferior, but instead routed to the internal iliac artery and vein. This
lower spot wasn’t hindered by other organs and permitted a speedy operation.

    Yoshizumi carefully peeled
off the peritoneum, exposing the gastroepiploic vessels. One by one, he bound
the lymph nodes that ran along the bottom of these vessels and clamped them off
to prevent unwanted excretions from saturating the operating field. Next, the
inner iliac artery and vein were both severed in advance to avoid veinal
thrombosis during attachment. Yoshizumi also clamped back the inner iliac
artery with forceps and cut off a moderate amount of its remaining length.
Using an injection needle, he cleansed the inside of the artery with heparin to
avoid clotting.

    Yoshizumi took a breath and
checked the placement of his incisions. With the cavity held open by silver
forceps, numerous bindings were visible. Forceps clamped vessels shut. An
assistant wiped away the blood left inside. The field was clear. He could see
the ilium’s blood vessels very well now and there was no evidence of
hemorrhaging. Now, he could finally attach the kidney into Mariko’s body.

    At that moment, Yoshizumi
suddenly felt hot.

    Startled, he lifted his face.
The assistants around him continued working as if nothing were wrong. He looked
around the room, but no one else seemed to notice.

    Then, the assistant across
from him interrupted with a suspicious glance.

    “Is something wrong?”

    “No...” Yoshizumi muttered
from under his mask.

    The heat continued. As he
tried to get his bearings, he sought the source of the sensation. He was
perspiring heavily, but the air felt the same. The heat was all inside him. A
nurse wiped his forehead. He was sweating.

    Before long, the heat
subsided and he was back to normal. The assistants checked on him once more to
make sure he was still up to the task. He assured them with a raised hand and
returned his attention to the operating table.

   
What was that?
he
thought. It wasn’t a dizzy spell, the heat didn’t assail just his head, but his
entire body. Just when he’d pictured the donor’s kidney. Now he remembered how
hot the donor’s husband’s hand had seemed when he’d shaken it. Had the man been
prey to a similar bout?
What’s going on here?
Yoshizumi found it hard to
keep his focus on the operation for some time.

    The kidney was still set in
its container. While transporting it to the CCH, any changes in the kidney’s
perfusion status or mass were recorded by the machine. Yoshizumi had already
examined these readings before beginning the operation to see that there were
no anomalies. He asked for the current stats just to make sure. The perfusion
volume was at a viable 117 ml per minute.

    Yoshizumi and his assistants
took the kidney from the container and started on the blood vessels. First,
Mariko’s inner iliac artery had to be attached to the kidney artery. The
procedure required the utmost care. Working closely together with the first
assistant, who stood across from him on the other side of the patient,
Yoshizumi joined the blood vessels at their severed ends with two strands of
surgical thread. These held the arteries together while they performed a more
complete suture, rotating the operating table to provide the best angle at each
point. None of the vessels in the kidney had hardened, so there was no fear
that the inner membrane would peel off. When this was finally done, an
assistant slowly lowered the kidney into the body cavity. An involuntary sigh
of relief escaped Yoshizumi.

    The position of Mariko’s
pelvic vein matched up well with the kidney’s. Yoshizumi checked to see that the
vessels weren’t twisted

    or folded in any way, and
picked a spot where they would join. First applying a couple of forceps just
below it, he opened a hole in the patient’s vein. After cleansing the inside of
the vessel, he and his assistant passed the needle back and forth once again to
complete the procedure.

    He signaled with his eye to
the assistant, who nodded and began removing the forceps, first from the outer
iliac artery, then moving on to those near the vein tips, and finally to the
main arterial clamp.

    As blood flowed into the
kidney, some seeped out of the needle hole where the renal artery had been
joined, but it soon stopped after some pressure was applied. The transplanted
kidney accepted Mariko’s blood and everyone watched as it reddened and regained
surface tension. Yoshizumi rubbed it to encourage circulation. He had witnessed
this scene numerous times in his career, but never had he seen such dramatic
revival. The organ appeared literally to be coming back to life in Mariko’s body.

    Just then, urine spurted from
the ureter. An assistant hurriedly picked it up with a forcep and caught the
urine in a saucer. This type of discharge was common enough with transplants
from living donors and usually came a few minutes after the blood vessels were
connected. It almost never occurred, however, with kidneys of a lower
viability. Yoshizumi, who had performed nothing but kidney transplants at the
CCH, had never seen such a healthy discharge in an organ from a dead donor. He
had no doubts that this transplant would be a complete success.

    Just then.

    He looked up with a jolt.

    Again. That heat.

    He could hear his own pulse
throbbing in his ears. Something was manipulating his heart. The heat. It felt
like he was on fire.

    Yoshizumi started to pant.
Everyone appeared blissfully unaffected as before and he tolerated his agony
alone with all his might.
What the hell is this?
he thought to himself.
Of course he had no answer.
Why?
The heat returned just after blood
began flowing through the kidney.
It’s almost as if...

    Thinking that much, he shot a
gaze at the kidney.

    He refused to believe it. He
denied even entertaining the possibility. It was madness. He shook his head. He
couldn’t afford to lose it just yet. The operation wasn’t quite over; the
ureter still had to be sewn in.

    He took a few deep breaths
and at last the feverish attack subsided, but some of the heat remained,
tingling inside like an afterglow. Yoshizumi tried his best to mask this change
in himself and set out on the remaining leg of the operation.

    He first shifted a few clamps
to see the bladder more clearly and cut it open vertically right at its center.
Then he sucked out the salt solution used earlier for cleansing, to see inside.

    The bladder was a soft, white
organ located behind the pubic bone. One ureter already entered into it from
the recipient’s own kidney on the reverse side. The opening of the ureter was
clearly visible through the incision in the bladder. To create a new ureter
hole right next to it, Yoshizumi and an assistant held up the membrane with a
surgical splint. He dug into the mucous tissue with the electric scalpel,
without driving all the way through. The hole had to be at a slant; if it was
perpendicular, the urine would leak. Yoshizumi placed the tips of a pair of
right-angle forceps into the opening and slowly peeled away the mucous
membrane, after which he switched to a pair with longer ends to ease out a
diagonal tunnel. He now pierced the hole with his scalpel and exposed the
forcep’s tips on the other side of the bladder.

    The remaining length of the
ureter from the extracted kidney as more than sufficient. Yoshizumi paid
special attention not to twist it with his forceps as he led it into the
bladder. After tucking it in to a proper length, he cut off the excess.

    Next came the joining of the
ureteral opening. He turned around the lining of the ureter and, spreading it
open within the bladder, sewed it with thread. Yoshizumi placed his forceps
into the new ureteral opening to confirm that it had spread out. Sometimes it
was sewn partially to the back lining by mistake. He inserted a thin tube
inside the ureter and it passed through smoothly.

    Good. He breathed relief. The
kidney was attached to the recipient. Now, all that was left was to close up
the body. He wanted to get this over with.

    He sutured up the bladder
lining and moved the clamps upward to make a final check on the kidney and take
a biopsy sample. He would have to create a slice specimen for later analysis.
They checked that there was no blood leakage and washed the area with salt
solution. A suction tube was placed in the area around the kidney and bladder
so that its other end would stick out of the body. Then they proceeded to sew
the muscles back together.

    “10:36 pm. Time since
extraction is four hours, twenty-nine minutes.”

    All the incisions sewn shut,
the doctors and nurses breathed a collective sigh, Yoshizumi included. He
glanced at the suture. The kidney was now completely embedded.

    What was it with this kidney?
Yoshizumi was unable to take his eyes away from the sutures. The heat had
weakened and was now only a faint glow. The beating of his heart flooded his
ears. All he could think was that the kidney now in Mariko’s body was jerking
his heart around and burning him from the inside.

    Mariko was to be moved to the
main ward, where she would be kept under close observation for a few days for
possible infections and sudden rejection symptoms. Yoshizumi remained aloof,
avoiding the usual string of duties, while they readied for her transport.

    He felt the remaining heat
smoldering within his body. He also felt a little dizzy but couldn’t rest yet.
Though he would have to keep a close eye on Mariko’s condition, he wanted nothing
more now than to get as far away from the kidney as possible. Proximity to it
would bring no good. Yoshizumi found this feeling impossible to shake. His
heart was pounding vigorously, as if it was laughing at him about his feeling.

13

    The Pharmaceuticals building
rose into an evening sky tinted in navy blue. Atop a hill just a few miles away
a television tower radiated color like a brocade, and the light was
illuminating the very heavens. The digital clock in the dashboard read 7:54.
Some people were still working, as indicated by the windows lit up irregularly
along the side of the building. The light was on in the Biofunctionals
classroom too; many of the students were probably still in. Toshiaki parked his
car at the main entrance and ran inside with the ice box.

    Without bothering to change
into his sandals, he rushed into the elevator lobby and pressed the button
impatiently. The elevator topped unexpectedly at the fourth floor. Someone had
probably locked it there to transfer some equipment. Toshiaki clicked his
tongue and pounded the button with his fist, then just made a break for the
stairs. The sloshing inside the cooler told him the ice was melting. On the way
up he ran into someone on a stair landing, spilling water out onto the floor.
He hastily opened the box and checked its contents. The flask was safe. Whoever
he had run into said something to him, but he ignored it and scaled the
remaining steps.