Parasite Eve Sephirotto Part 3

It was customary for one of them to come from Yoshizumi's hospital, partly because it handled coordination duties. His hospital's two most highly compatible patients were summoned for tests, and the more suitable one ultimately underwent the operation. If it looked like there were no viable candidates in the local region at all, they would search via the national hub of kidney transplants, Sakura National Hospital in Chiba, to ship the kidneys to some other part of the country. When the transportation of the organ could not be executed swiftly, however, chances were that the kidney would not take. The organ lost its freshness and weakened if it took too long to ship. It wasn't without reason that recipients were selected first by region.

Yoshizumi cradled the receiver on his shoulder and began typing. The coordinator's data appeared on screen: a list of prospective recipients, ranked from highest to lowest by compatibility. He scrolled down, briefly surveying the entire list.

"Number 1, Mariko Anzai, and Number 2, Matsuzo Iwata, are the prospective candidates. Ms. Anzai will be under your care."

Yoshizumi had heard that name somewhere before. He wrinkled his forehead, then gasped in surprise. After taking a moment to collect himself, he scrolled up and peered closely at Number 1. Mariko Anzai. Yes, he knew that name. She was 14 years old and had already had one transplant, at the CCH transplantation division. Yoshizumi looked at Mariko's HLA type. It was consistent with the donor's. Zero mismatches.

Mariko Anzai.

There was no mistaking it now.

It was the same girl Yoshizumi had operated on two years before.

She had received her father's kidney, but the transpalnt had failed. The operation itself was a success, and no serious rejection symptoms had appeared. Yet, the kidney did not a.s.similate with her body and finally had to be extracted. Yoshizumi bit his lower lip. He had much to regret about the case.

HLA, or Human Leukocyte Antigen, is a genetic marker found on the surface of human cells. The HLA of pathogenic cells differs from one's own. When illness attacks, unrecognized HLA types are regarded as intruders and subse- quendy destroyed as a natural immune system response. Because HLA is also found on the surface of transplanted organ cells, the organ is incompatible whenever its antigen type differs from the recipient's. For this reason, transplants between people of similar HLA types are preferred. Only, unlike the simple ABO blood types, HLA types are quite complex. There are six cla.s.ses of HLA: , , C, DR, DQ, and DP, and each encompa.s.ses ten or more subcla.s.ses. In transplant medicine, the most advanced a.n.a.lysis compares A, B, and DR types. Each of these three antigen cla.s.ses is inherited, one from each parent. In other words, three cla.s.ses and six pairs of antigens can be a.n.a.lyzed. The abundance of antigen cla.s.ses, however, was a troublesome factor. Finding a donor with a sixfold match was not easy. Even between siblings, the chances of full compatibility were only one in four, and the probability of perfect compatibility with someone outside of the family was less than one in ten thousand. Because of this, many transplants were performed despite one or even two mismatches. This, however, meant that the organ had a higher chance of being rejected.

In Anzai's case, the transplant had taken place between father and daughter, and tissue compatibility was high. It should have been a successful transplant. Yet, it failed, and the reason was that Yoshizumi and his team had failed to gain the trust of Mariko Anzai.

Yoshizumi breathed in deeply. He gazed upon Mariko's name at the top of the display and pressed his fingertips around his temples to interrupt the unpleasant memories bubbling up in his head. He told himself to concentrate on the work at hand and spoke to Odagiri, who was waiting patiently.

"So Mariko Anzai has no mismatches."

"Correct," she replied. "There are no other donors in this area with such perfect compatibility. Please take some time to review the data."

It was true. None with just one mismatch, either. There were, however, five candidates with two mismatches. One of them, the third name on the list, had been selected as the other candidate for this donor's kidneys. He was 51 years old, had a five-year dialysis history, and was currently under care in a neighboring prefecture. A woman who was number 2 on the list couldn't be reached.

An estimated 20,000 people in all of j.a.pan were registered for kidney transplants. Yet, within that group, the annual number who actually received organs hovered at around 200.

Then there were the dialysis patients, who numbered 120,000 nationwide. The consideration awarded to transplants for patients with chronic renal failure was too small. Compared to Europe and America, j.a.pan was known for having an extremely high dialysis patient-to-transplant operation ratio. By no means did this indicate that j.a.pan's medical techniques were behind the times. Instead, it was public unease about regarding brain death as actual death that was the primary source of hesitation, for doctors and patients alike, to promote such procedures. Praying for a new kidney, patients were forced to deal with a long life of dialysis, a process both physically and financially straining, while those fortunate enough to receive a kidney were able to enjoy a normal social life.

"One more thing. Just in case candidate Number 1 can't accept the kidney, it's been decided that Number 5 will also come to the hospital for testing," said Odagiri. "She is 36 years old with two mismatches and a three-and-a-half year dialysis history."

"Got it."

He printed out the charts for the two main candidates. In the instance that Mariko had contracted some serious illness, the 36 year-old woman would take her place on the selection ladder, Yoshizumi compared schedules with the coordinator and solidified their arrangements.

He was to perform the extraction first, at the university hospital. He would then pa.s.s one of the kidneys along to Odagiri, who would then ship it to the neighboring prefecture, while Yoshizumi brought the other to the CCH to conduct an immediate transplant. Odagiri planned everything in great detail. Time between the extraction and the transplant was critical. Once the donor's heart stopped they would be running on a tight schedule. It was the coordinator's responsibility to make sure all the surgeons, a.s.sistants, nurses, and recipients were on the same page.

When all preliminaries had been exhausted, Yoshizumi thanked her and hung up. It seemed that Yoshizumi's chance at self-redemption had come at last. Mariko Anzai. I'll save the kid if it's the last thing I do.

Just two days after the consent forms were signed, Kiyomi's heart rate began its inevitable decline. Her breathing maintained a certain regularity, if only through the respirator. However, her body's faculties were finally reaching their limits. Her vital signs were falling.

"We've arranged for the transplantation unit from the City Central Hospital to come here this evening," the doctor said to Toshiaki. "Once Kiyomi's heart stops, we'll need to extract her kidneys promptly. We need to prepare her femoral artery beforehand. For this purpose, we'll be conducting a simple operation tonight. After her heart stops, a cannula will be inserted into the artery to cool her kidneys."

The securing of the arteries was soon completed. When Toshiaki returned to the ICU, he saw that Kiyomi's thigh was marked for insertion of the cannula. Her medication had been stopped, but her blood pressure remained steady, wavering around 100. The doctor explained they would likely need to wait until morning. And Kiyomi's warmth will last only just as long, thought Toshiaki absently. Moment by moment, her body was changing into a mere object for donation. Unable to shake the reality of it from his mind, Toshiaki spent the night at his wife's bedside.

At 10 pm the nurse came in as usual. She emptied Kiyomi's bed pan, swabbed her nostrils and the inside of her mouth, wiped the perspiration from her back with a towel, and changed her body position to prevent bed sores. She did all of this without the faintest sign of annoyance. In fact, she sometimes cast a sympathetic smile at Toshiaki as she worked.

Toshiaki had never been seriously ill. He had, of course, spoken with many medical pract.i.tioners throughout his career, but realized that he knew nothing, until now, of the actual work that doctors and nurses did.

"I'm truly grateful, "Toshiaki said, bowing his head. "I think Kiyomi is, too, for all you've done for her."

The nurse stopped what she was doing and said, smiling, "I'm happy to hear that. I'm sorry we weren't able to help her."

"It's okay," he countered, flushed. "You did everything you could. All of you."

The nurse's smile turned ambiguous. She looked away from him as she resumed her duties.

"Working in the ICU, sometimes I just don't know," she said timidly, almost to herself.

"You can give your all to the patients. They still die almost every day. What are we doing here? It's just too depressing sometimes. ICU nurses quit much faster than in other departments. Still..Her words cut off there as she finished with the cleaning. She put Kiyomi's clothing back on and turned around to face Toshiaki, hands at her sides, r "When people say nice things to you, it makes you want to go on."

With that, she exited the ICU.

9.

Kiyomi remained in quiet stasis until morning. Soon after the minute hand ticked past noon, her blood pressure began to drop rapidly. By 1:00 pm it had fallen below 95 and, an hour later, was below 80. The ICU soon became a swarm of doctors and nurses as they bustled in and out, driving Toshiaki and his father- in-law into the corner of the room. It was such a marked contrast to the quiet that followed the brain-death examination.

"The CCH transplant team will be arriving at two thirty," said one of the doctors, looking at his wrist watch. "They'll start by inserting a catheter. The extraction will begin once she loses her pulse."

"May we be present when she pa.s.ses on?"

The doctor nodded.

"You'll have five minutes to say your farewells, after which Kiyomi will be brought to the OR."

The hissing of the respirator was inaudible in all the commotion. Kiyomi's blood pressure was now down to 75.

Yoshizumi, accompanied by Odagiri and two staff members, entered the university hospital. They brought with them a minimal, but essential array of surgical equipment and perfusion containers for Kiyomi's kidneys. This being a university hospital, there was plenty of technology at their disposal, but Yoshizumi never forgot to have his own by his side for an extraction. Because speed was so imperative, it only made sense to use his own familiar tools.

After exchanging greetings with the hospital staff, Yoshizumi left Odagiri in the waiting room and went into the ICU to check on the donor. Her blood pressure was nearing 65 and her heart rate was down to 30 beats per minute. Once her blood pressure fell below 50, circulation would no longer be complete, and cells in her extremities would begin to decay. Since the donor's family had consented to the procedure, the catheter was going to be inserted into her femoral artery now so that they would be ready when the pressure fell below SO. The head doctor showed the donor's data to Yoshizumi for confirmation. Odagiri was then informed via intercom that the catheter was being inserted.

Fifteen minutes later, Yoshizumi and his a.s.sistants prepared the perfusion equipment.

They spread the donor's legs slightly and placed the machinery between her feet. One of the a.s.sistants soon began to adjust the equipment settings while another disinfected the area around her thighs, whereupon a silicon double balloon-tip catheter was readied. When sterilization was complete, Yoshizumi looked at the donor, standing at her left side, and patiently confirmed that the femoral artery and vein were well secured. After a quick glance to see that his team was on full standby, he inserted the balloon-tip catheter into the donor.

He carefully advanced the catheter until the balloon arrived at the right spot. Yoshizumi indicated his approval to the a.s.sistants with a single nod and told them exactly what to do.

They connected a perfusion pump to the end of the catheter. He then guided the catheter into the femoral vein and had it connected as well. All preparatory steps were now complete. Her blood pressure was at 62, and her heart rate had fallen further.

Yoshizumi and his crew temporarily exited the ICU to wait it out. Noticing the family, he signaled for them to be let in and headed to the doctor's office. He hadn't met the family yet, and it was indeed his belief that he should keep a low profile with them. For the bereaved, a transplant surgeon was no better than a hyena s.n.a.t.c.hing away the body of a relative. He did plan to meet with them just once, before the actual operation, but it was the coordinator's task to intermediate between them. No need to risk upsetting the family.Yoshizumi sipped some coffee in the office, reclined on the couch, and looked up at the ceiling.

Mariko Anzai's face came to him.

SHE sensed the change.

Kiyomi Nagashima's body was crossing over to Death. After the accident, her metamorphosis had proceeded slowly hut surely. Now it was accelerating. Kiyomi was dying; her body was losing warmth, and it would stiffenJirst, and eventually dissolve. Her brain had already begun its deterioration. Hormonal discharges would soon stop. Blood flow was weakening. Cells were rupturing and crudely spewing their contents.

Everything was proceeding according to plan.

Robbing Kiyomi of her vision was the easy part. little trick on her optical nerves was all it took. In that small window of opportunity, She induced Kiyomi's hands to turn the wheel off course. Her primary concern was ensuring that the accident didn't damage Kiyomi's body too much. It had to be brain death. If, by the miniscule chance, she'd ruptured any internal organs by hitting her abdomen instead of her head, there would be no talk of kidney transplants. At the moment of collision, She gauged the most precise timing to apply the brakes. She held back Kiyomi's abdomen with all Her strength to prevent it from lurching forward, fixing both of her hands on the steering wheel to protect against peripheral injury.

Kiyomi's forehead struck the steering wheel. She could tell skull fragments had pierced the brain. Every time She thought of that moment, She felt a shiver of excitement. Kiyomi would die, but She would live. Forever.

Kiyomi's kidneys were to be transplanted into two patients. Ideally, at least one of them would be female and the process would be complete. Toshiaki would perform the primary culture as planned. She'd already induced such thoughts in him without his knowing.

Toshiaki.

She imagined his figure and Her body twisted slightly. It was almost time. Her entire being trembled. She remembered Toshiaki's voice, his expressions, the warmth of his body.

She'd been waiting for a man like him. He was the only human being who could appreciate and understand who She truly was. She reused to let go of such perfection.

She would become one with him.

An acrid excitement sent Her into convulsions. And as Kiyomi's blood pressure made its rapid decline, She surrendered Herself to the afterglow of Her bliss.

When Yoshizumi and staff received word that blood pressure had dropped to 50, they returned to the ICU once again. An hour had lapsed since the catheter insertion. The a.s.sistants set up a number of Ringer's solution bottles, to which perista pumps were connected. After ensuring that the catheter was in position, Yoshizumi inflated its two balloons with clean air to intercept blood flow.

At Yoshizumi's signal, his a.s.sistants ran the pump. Cold perfusate pa.s.sed through the catheter at a precisely calculated rate. Yoshizumi placed his hands on the side of the donor's chest to verify that it was flowing properly.

The human body has a main abdominal artery and vein through which a great amount of blood flows. The arteries which supply blood to the kidneys extend from this main artery.

Similarly, the kidney veins are linked to the abdominal vein. The abdominal artery and vein each fork out in the lower abdominal region and continue into both legs. The balloon-tip catheter had been inserted up through this lower arterial branch to reach the kidney extension, and the balloons then inflated to interrupt blood flow in the abdominal artery. At this point, a coolant, or perfusate, was sent through the catheter tube. There were minute holes in the tube between the balloons so that the perfusate could seep through into the abdominal artery.

Since the artery was blocked above and below by the balloons, the perfusate flowed directly into the kidneys. The donor's kidneys were swiftly cooled and simultaneously flushed of blood. After the perfusate pa.s.sed through, it traveled into the kidney veins and on to the lower abdominal vein, where it was recovered by the perfusion device and sent back in.

The fresher the kidney, the better. Compared to kidneys extracted from brain- dead donors, heart-failure donor's organs were inevitably less viable given the period of blood deprivation. To save the kidneys from such damage, it had become standard procedure to introduce a perfusate through the artery to rapidly cool the kidneys upon heart failure.

Cooling them before they were extracted improved their chance of staying alive in their recipients. With the donor's family's consent, it was even possible to begin the procedure prior to heart failure.

One of the a.s.sistants reported the perfusion rate at regular intervals while another monitored the donor's heart rate. Her skin turned pale and cold from lack of blood flow. It was 40 minutes since the perfusion began. Her heart stuttered, reducing her pulse to a hush.

"Please call in the family, "Yoshizumi said to the patient's doctor and nurse. "This will be their last chance to see her alive."

At twenty minutes past five, the nurse came into the waiting room to call Toshiaki and Kiyomi's parents. She informed them of the situation and brought them back to the ICU.

When they walked into the room, Toshiaki was astonished at the dramatic change in Kiyomi. Unable to tear his eyes away, he gazed steadily at her face and approached her slowly with the doctor. With every step, her face grew more and more distinct. He looked around and stopped at the left side of the stretcher. His mother-in-law was sobbing behind him.

"Kiyomi's vital signs are indicated here, but as it is now her pulse is erratic and nearly unverifiable," the doctor said as he pointed to the screen at Kiyomi's bedside. "The respirator is still running, but she barely has any heartbeat and her blood pressure has fallen sharply.

Her skin, as you can see, is getting very cold."

Kiyomi's face was so white it was nearly translucent, her lips like two flower petals glazed with frost. It looked like a clear stream was flowing inside her body. Lashes extended from closed eyelids like crystals, casting short, thin shadows upon her skin. Without thinking, Toshiaki extended a hand towards her cheek. The moment his fingertips made contact, a numb sensation shot through his arm to the back of his head, not unlike the time he had accidentally touched dry ice: a pain that flickered between coldness and heat. He gasped and his hand trembled. He stroked Kiyomi's cheek calmly with his index and middle fingers, continuing down along her neck, then stopped at her white chest where the veins showed.

Though obscured by her garment, he could tell clearly that Kiyomi's nipples were erect.

Toshiaki took his hand away and wrapped his fingertips in his other hand to warm them. A cool sensation seemed to linger there.

Toshiaki's heart leapt with a great THUMP that broke into its steady rhythm. Feeling as though he were suffocating, he placed a hand upon his chest. THUMP. As if to mock his nerves' autonomy, his heart leapt again. He felt hot.

"We will now stop the respirator, if we may," the doctor stated.

Hand still clutching his chest, Toshiaki gazed at Kiyomi and took a deep breath, his lungs swelling unsteadily as they filled with air. Kiyomi's body is being destroyed, he thought. The doctor flipped the respirator switch. The machine, which until then had been keeping rhythm like a metronome, stopped in an unfinished hiss, and several seconds later, let out a languid ssss. The movement in Kiyomi's chest abated. The doctor glanced at his wrist.w.a.tch and said quietly, "Official time of death is 5:31 pm."

Kiyomi's father inhaled audibly.

THUMP. Toshiaki's heart cried out yet again. It was such an enormous wave of sound, he wondered why no one else in the room could hear it. Maybe Kiyomi was sending the last of her life energy into him, almost as if he had caught her final heartbeat. She seemed to be telling him: I don't want to die.

"After the extraction, she will be transferred to the morgue for a postmortem inspection," said the doctor before encouraging them to leave the room.

Toshiaki and his in-laws exited the ICU. Three men who looked to be doctors were standing in the hallway. The coordinator was behind them, holding a large box and giving instructions. One of the men, who looked to be the leader of the three, noticed Toshiaki and Kiyomi's parents and approached them. He looked to be about 40 years of age, but a certain pride in his face made him appear younger. He bowed his head simply and stated his name.

"I'm Takashi Yoshizumi, from the transplantation staff at the City Central Hospital.

I've been placed in charge of both the kidney extraction and transplant. We're about to begin the surgery. Please forgive me for being so brief."

"I see. Good luck."

Toshiaki extended his right hand and exchanged a handshake with this man called Yoshizumi, who was studying Toshiaki's face as if shocked at something.

"What is it?"

"Nothing... excuse me."

Yoshizumi bowed once again and, seeming to shield his eyes, left together with the coordinator and the two other men into the prep room.

After a while, Kiyomi's stretcher was wheeled back into the OR.

"Please stay in the waiting room," a nurse called to them.

Kiyomi's parents entered the narrow waiting room and collapsed onto the couch.

Seeing this, Toshiaki went down the hallway to find a phone.

"Kiyomi...hold on just a little longer," he murmured, recalling the image of her stark white cheek. Soon, he would take her to a warm place where he could tend to her always. He would raise her. Kiyomi, I will never part from you.

Mariko was wheeled along on a stretcher. Shigenori Anzai followed along, holding the hand of his anesthetized daughter.

"I'm sorry sir, but you cannot pa.s.s beyond this point," informed one of the nurses, placing a hand on his arm, as they reached the OR. The young doctor pushing the stretcher opened the door. Anzai was not allowed so much as a peek inside as Mariko's body was wheeled in.

"Please leave everything to us," said the doctor before ducking out of sight.