Parasite Eve Sephirotto Part 5

Yoshizumi rushed to the CCH via ambulance. The kidney transport cooler clattered as the vehicle swerved left and right throughout its 30-minute journey.

Before such advanced containers were invented, kidneys were toted in cold storage boxes. In principle, these more primitive containers differed little from the coolers we bring to the beach. Time was precious and, in those days, the chances of a successful transplant were relatively low. The perfusion methods in current use were a significant improvement.

Not only was the organ's structure kept intact, but its freshness was also better preserved.

Yoshizumi was sitting on a padded seat, arms folded and eyes closed. In transplantation medicine, such moments were the only opportunities for respite. Because the hospital was within city limits, the transportation time was fairly short, but airplanes were used in cases when kidneys needed to be sent in from other prefectures. A two-hour trip in the sky was like an oasis in an otherwise arid landscape of stress. There was no point being on the edge during the transportation stage. It was better to rest one's mind in these blessed intervals so that no mistakes would be made dining the operation itself.

Organ extraction from brain-dead patients had yet to be wholly accepted in j.a.pan.

Consequently, transplant doctors were forced to wait until the donor's heart stopped and an investigation into the cause of death was completed before the actual operation could be performed. Such organs were naturally more susceptible, but this could not be helped. Only when brain death was recognized legally, thought Yoshizumi, would the percentage of successful kidney transplants rise to a more reasonable rate. The organs would be generally fresher, and, more importantly, there would be more donors. This would lessen the chances of recipients requiring long-distance donations.

Until just a few years ago, Yoshizumi and his fellow staff had even gone through the trouble of obtaining kidneys from America by air. Though problems of morality were imposed upon the medical community when trying to extract organs from brain-dead patients in j.a.pan, they were able to find some of the organs they needed overseas. At that time, Yoshizumi thought j.a.panese society odd for being so sensitive about j.a.panese donors when it quietly accepted organs from the States. At any rate, the results were not good because of the lengthy transportation time. The recipients, waiting for their urine to flow, would fret, panic, and weep when it did not. All recipients believed that a rosy life awaited them once they got their transplants. They never suspected that the operation might end in failure.

Yoshizumi's heart sank whenever he had to inform a recipient about a malfunctioning kidney in need of extraction. Some recipients would ask for another transplant, and some of them would indeed get another kidney and be cleared from the hardships of dialysis. Others would shake their heads and say they never wanted to go through another transplant.

The face of a former patient came to his mind. A single woman in her thirties, she stood before him, her hair loose and unkempt. She spoke with a hint of scorn as a wary smile rose to her lips. "I've had enough, doctor," she told him. "It's not like I'm getting any younger.

I won't be able to get any good jobs now, and I've already given up on having children. I'm fine with dialysis. I don't need this false hope anymore. You keep telling me someday I'll be able to eat whatever I want again and even travel abroad. Don't mislead me with your lies. Do you have any idea how I felt when you told me it had to be removed? I wish I'd never heard of transplants. If I knew only about dialysis, I wouldn't have had to go through that. Enough, doctor. I'm too tired..."

The ambulance turned a sharp curve. His eyes still closed, he took a deep breath. He knew this curve well. It belonged to the road leading to the hospital.

A completely naked Mariko lay face up on the operating table covered by a cloth. Her body was still innocent and childlike and had changed little from two years ago. The anesthesia tube extended from her face into a machine. The anesthesiologist stood by to keep a close eye on things.

Nearly everything was prepared before Yoshizumi's return and Mariko's body was now thoroughly cleansed. In a sterilized room, the only sources of bacteria were human beings themselves, so hygiene was especially important. It was Necessary to disinfect the recipient's skin a.s.siduously before the operation. The a.s.sistants had applied an antibacterial solution with a brush, similar in shape to a scourer one might use to clean the dishes, scrubbing Mariko's lower abdomen and thighs. Any bodily hair, such as pubic hair, hindered the operation, and had been shaved off the day before. And, because bacteria could infect razor nicks, her lower body had been protected throughout the night and day with a sterile towel.

Yoshizumi stood to Mariko's left. Joining him also were two anesthesiologists, three surgical a.s.sistants, 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 s.p.a.cious 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 a.s.sistants 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 a.s.sistant 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 a.s.sistants around him continued working as if nothing were wrong. He looked around the room, but no one else seemed to notice.

Then, the a.s.sistant 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 a.s.sistants checked on him once more to make sure he was still up to the task. He a.s.sured 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 a.s.sail 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 ma.s.s 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 a.s.sistants 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 a.s.sistant, 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 a.s.sistant 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 a.s.sistant pa.s.sed the needle back and forth once again to complete the procedure.

He signaled with his eye to the a.s.sistant, 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 a.s.sistant 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 h.e.l.l 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 a.s.sistant 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 was 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 pa.s.sed 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 a.n.a.lysis. 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 cla.s.sroom 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 b.u.t.ton impatiently. The elevator stopped unexpectedly at the fourth floor.

Someone had probably locked it there to transfer some equipment. Toshiaki clicked his tongue and pounded the b.u.t.ton 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.

"Doctor!"

Sachiko Asakura's voice echoed loudly in the hall when he reached the Cultivation Room. She was wearing a lab coat and cradled a bag of Eppendorf tubes in her hands. She opened her eyes wide and looked back and forth between the ice box and Toshiaki's face.

"I need to use the Cultivation Room, "Toshiaki said as he tried freeing himself from Asakura's gaze. She was in his way.

"What's going on? Is your wife...?"

"Won't you just get out of my way?! There's something I need to do."

"What happened? First we don't hear from you at all, and now you want to conduct some experiment... I was so worried, and so was everyone else."

"Listen, Asakura..."

"If there is anything we can do to help, don't hesitate to..

"You're in my way!! Move!!" Toshiaki screamed. Shocked at his behavior, Asakura cowered back and cleared his path as he made way for the Cultivation Room.

The room wallowed in the blue of the sterilizing light. Toshiaki threw the switch to turn on the fluorescent lights, put on a pair of sandals near the entrance, and went inside.

He immediately turned on the centrifuge and the clean bench. The sound of air being drawn into the latter filled the room. After opening the gas jet valves, he turned on the clean bench burner.

Toshiaki removed his flask from the ice box and checked its condition again. He put the flask into the bench, then pulled up his sleeves and disinfected both arms with ethanol.

After roiling up the flask's contents with a stirrer, he poured the liquid into multiple tubes through gauze, and placed the tubes into the centrifuge. Discarding the supernatant, he suspended the liquid in a buffer solution, and ran the tubes again through the centrifuge. He repeated this three times. Lastly, he suspended the solution again on a culture medium and drew some of it into a special tube with a pipettman. Then he jumped up from the bench and ran over to the inverted microscope. He placed one drop of the solution onto a gla.s.s slide that had a measure and placed a cover slide over it. Setting the controls with a shaky hand, he peered into the lenses.

Globules of cells shone with a pale yellow hue. Toshiaki let out a voice filled with awe.

The cells showed a fine shape and were shiny. If they had been half- dead, they wouldn't have glittered so.

Toshiaki mixed the cells with a trypan blue solution to determine viability and cell count. There were hardly any dead cells, which would have turned blue. Approximately 8 x 107 cells per gram of liver, with a viability of 90%. Superb.

Toshiaki returned to the clean bench, quickly poured the cells into culture flasks, and placed them into an incubator set at 37 C. He mixed the remaining cells into a preservation liquid, placed them into a blood serum tube, wrapped the tube in cotton, then stored it in a freezer at -80 C. Having finished that, he took a deep breath. The hum of the centrifuge's motor reverberated faintly in the room.

Toshiaki removed a flask from the incubator and placed it under the microscope. He swallowed in antic.i.p.ation and placed his eyes to the lenses. Kiyomi's liver cells were glowing against an orange background.

For a long time, Toshiaki could not tear his eyes from their play of light and shadow. It was beautiful. What cells could be more beautiful than these? he thought. They were large and spherical like pearls and emanated such a magnificent light that he almost felt dizzy.

Without realizing it, Toshiaki was uttering Kiyomi's name in a delirious murmur. Though unfortunately her body had been harmed, these cells were a testament to her preservation.

Her kidneys had been sacrificed for unknown recipients, whose transplant surgeries were certainly well under way by this point. And by a similar act of offering, her fiver was now in his possession, resplendent before his eyes. Reduced as she was to individual cells, Kiyomi was still beautiful. She was still alive. These cells must not die... It was Toshiaki's duty to prolong their heritage; he refused to lose any more of her. A hot shiver rippled through his body.

He made a gulping sound as he swallowed again. Unable to endure it any longer, he let out a sigh saturated with ecstasy.

14.

SHE was content, with new surroundings.

A comfortable place where She had complete freedom. Temperate air engulfed Her; a source of gradual energy. She was well aware of the great potential which lay in Her hands.

When he looked upon Her, She felt an intense excitement. Of course, he couldn't hold Her close just yet. Nothing could be done about that now. But She planned on revealing Her splendorous figure to him soon enough.

It did not elude Her, Toshiaki's enraptured voice, as he peered upon Her from above.

Her entire body trembled, swimming around contentedly in cytosol.

She'd made the right choice. She'd been waiting an eternity for this day to arrive. At last, She was truly appreciated, for here was a man who made a genuine effort to understand Her.

Toshiaki Nagashima. He and I would be so perfect together.