Parasite Eve Sephirotto Part 16

She had at last been responding to him the past few days. That said, she answered only bluntly, but for Yoshizumi 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.

Yoshizumi 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 Yoshizumi'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, Yoshizumi 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, Yoshizumi 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. Yoshizumi 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 Yoshizumi'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 Yoshizumi's experience, he felt the former was more likely in this case.

Why would rejection be setting in now?

Yoshizumi 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.

Yoshizumi took a deep breath and pressed the elevator b.u.t.ton.

The results of the wave test were finished and reported back to Yoshizumi. 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. Yoshizumi 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 Yoshizumi 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, Yoshizumi 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.

Yoshizumi 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, Yoshizumi 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 Yoshizumi, the greatest possible humiliation.

On the day of the extraction, it was drizzling outside. Yoshizumi 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. Yoshizumi 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, Yoshizumi 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, Yoshizumi 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. Yoshizumi 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.

Yoshizumi 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.

Mariko was a completely different person after the extraction.

She lapsed into the deepest depression. Patients whose kidneys did not take were rarely in good spirits. At first, Yoshizumi thought that Mariko was so closed because the transplant had failed. And so, when he recommended that she and her father register for the waiting list, he thought he was doing her a favor. He told them about a new method called CAPD, hoping to alleviate, if only a little, the pressures of returning to a life of dialysis.

However, when he thought about it now, Mariko s state of mind was more complex than that.

At the time, Yoshizumi never figured out why Mariko did not take her medicines.

Some children did, of course, forget. There were various reasons for this. Sometimes it was in defiance of adults, others disliked the facial swelling which often occurred as a side-effect, and still others simply stayed over at their friends' or went on trips without telling their parents. Also, many decided that, since they felt so good after the operation, it was okay not to take them.

Yoshizumi honestly did not understand children's feelings very well. He had never quite figured out how to interact with them. He thought maybe it was because he had no children of his own.

Soon after he began his career, Yoshizumi married one of his former cla.s.smates.

Because both of them worked at the hospital, they had no time to raise children. Some years after they married, when they were finally able to make time for themselves, Yoshizumi discovered that his sperm was abnormal and that he was incapable of making any woman pregnant.

When Yoshizumi gave her the news, his wife, who'd always said that work came first and that they could have children later on, looked away from him, but not before he'd caught a brief but unmistakable look of contempt in her eyes.

He ought to have paid more attention to Mariko's state of mind. He regretted it though it was too late. He should have talked with her more.

It had looked like she'd gotten out of her depression. She'd listened to Yoshizumi and Anzai and even agreed to registering for another transplant. Yoshizumi had a.s.sumed she'd gotten over the trauma of extraction.

How wrong he'd been.

Coping with her now, he understood that she was far from over it. It wasn't because of the extraction itself two years ago that she was depressed. She was tormented about something else unknown to Yoshizumi. Whatever it was, she was keeping it to herself. She'd only been pretending to be okay, fooling all the grown-ups around her. Yoshizumi hadn't been able to see it.

Maybe it was already too late.

Maybe he was past the point of ever being able to win her confidence.

No, thought Yoshizumi.

If he couldn't win the patient's trust, then he should retire from transplant medicine.

He had to talk with Mariko more.

That evening, Yoshizumi went to see her again.

She was lying in her bed with an IV tube in her arm, staring at the ceiling in solitude.

She seemed surprised at his visit. Her reaction was to be expected. Unless it was urgent business, he would normally not make an appearance except dining scheduled patient rounds.

"What's wrong? Are you upset because you can't go out?"

She turned away without answering. Yoshizumi paid no attention and sat down in the chair at her bedside.

"The rejection is still very slight right now," he continued. "If you just take your medications, you'll be fine. There's no need to worry."

"It's okay. Things will calm down in no time. I'm sure of it. Soon, you'll be able to go home and eat whatever you like."

"By the way..."Yoshizumi hesitated for a moment before asking what had been burning in his mind. "Won't you tell me what happened after your first transplant?"

He saw her shoulders move somewhat at the question. He went on.

"You never told me that anything was troubling you... I never asked, and I'm sorry.

There must have been some reason you didn't take your meds?"

"Won't you talk to me about it?"

Mariko was silent, but she was clearly agitated.

Without saying another word, Yoshizumi waited a long while for her to speak up. The silence was almost palpable, drifting down slowly from the ceiling like snow, embedding itself in Mariko's bed sheets.

"Doctor, I'm sleepy.." she said at last.

"I see..."

Yoshizumi stood up. He'd gotten a pulse at least. Unlike before, she was making an attempt, however slight, to be communicable.

"Don't worry about a thing, okay? We'll make it all better," he said, and left the room.

The following evening, Yoshizumi again looked over the biopsy results. He compared the data from the frozen samples, examined with an electron microscope, to the absorbency test results.

"This is a bit strange," said the lab technician.

Yoshizumi, cradling the phone, was looking at a film brought to him by a nurse from the lab, to which the technician's comment had been attached, prompting him to inquire into the matter.

"Given that the rejection is so slight, there are no immediate concerns. But something worries me "The technician lowered his voice in an evasive tone. "I've never seen anything like this."

Having already noticed the abnormal shapes on the film, Yoshizumi understood what the technician was talking about.

"You carried out the procedure without difficulty, I a.s.sume?"

Glitches in setting up a tissue sample could yield images that were contrary to fact. He suspected it may have been an error in the dying technique.

But once he knew no mistakes had been made, he had no other explanation.

He removed the first biopsy results from the filing cabinet and looked them over once more. Yoshizumi started. There was clearly something there. He was careless not to have seen it before.

The mitochondria in her kidney cells were deformed.

They were several times larger than normal and had fused in small sac-like nets across every cell.

He, too, had never seen anything even remotely like it.