Robert didn’t ask anyone to consider donating. He didn’t want to be disappointed in people.
“It’s not fair to be disappointed in someone for not being able or willing to give you an organ. It’s just not fair,” he offered years later. “And what if I couldn’t do all the things I needed to do? Then we would both be fucked up.” He didn’t want the responsibility of a kidney from someone still walking around.
But in that moment, I didn’t need him to say it. I made up my mind to not say another word about it to him until I knew if I was a match.
As I went through the process of finding out if I could donate my kidney—blood tests to confirm that we were a compatible blood type (type O) and that I had no signs of diabetes or high blood pressure; a physical exam to confirm I had no signs of disease (minus the rectal exam, which I refused to allow—“I am not middle-aged and I don’t have a prostate. Your finger does not need to go there,” I said to the petite nephrology fellow, and she backed down without further fuss); a twenty-four-hour urine collection to confirm that there was no blood or protein that hinted of kidney disease; and finally a CT scan to confirm that I actually did have a kidney to spare (and wasn’t the 1 in 750 born with just one kidney, or the 1 in 400 born with two fused into one horseshoe-shaped kidney)—I told family, friends, and colleagues of my plans. Most were supportive, impressed even, at my willingness to do such a thing.
“It’s not an extra pair of shoes, Vanessa,” said one awed colleague in response to my attempt to shrug off praise with a nonchalant “He needs one and I have two.”
But not everyone was so supportive.
“I would do it for my partner in a heartbeat, but we’ve been together for more than a decade,” said another colleague. Translation: Girl, you don’t even have an engagement ring. Are you crazy?
“Can’t somebody else do it?” asked my devout Christian sister.
That ain’t Jesus, I thought, because her brand of devout was beyond just plain devout. It was the kind of devout that stood on a street corner with a bullhorn preaching the gospel and traveled to Africa rapping it. I was surprised that beyond-devout’s love and charity for all God’s children seemed to end with immediate family in this case.
Truthfully, it didn’t matter what any of them said. I was going to do it, because my heart was invested. I wanted, needed, Robert on the planet for as long as possible. I knew that my fresh, living kidney, as opposed to one from someone who had died hours earlier, would give him the best chance that “as long as possible” would indeed be long. I believed at my core that giving Robert a kidney was the right thing to do and that everything would be all right.
I was sitting in a pediatrician’s exam room when I got the sign that my belief was true. Avery was four years old and at his well-child checkup. He sat on the floor moving green, yellow, red, and blue wooden balls around a maze of yellow wires, his hands and mouth in constant motion as usual. I picked up an old magazine from a basket on the floor. A Woman’s Day or Family Circle or the like, just something to flip through to help pass the time. But . . . then . . . about four flips into it . . . there it was: a story about the fiftieth transplant anniversary for The Other Robert Phillips. There was my sign.
It never occurred to me that anything would go wrong. Of course the surgery would go smoothly and Robert would live free of dialysis for the rest of his life. Never occurred to me that I would be the one in ten thousand who died trying to donate a kidney, leaving my four-year-old motherless. I’d be three times more likely to be struck by lightning over my entire lifetime, so of course I’d be back to Avery in just a few days, I believed. It didn’t bother me that I’d lose half my kidney function until my remaining kidney had time to compensate for its missing mate. I didn’t even know that about two weeks later my right kidney would plump up to provide about 70 percent of my total original kidney function and up to 85 percent over the long run. All I needed to know was that I could live just fine with my one kidney as long as I continued to take good care of myself by not getting so fat that I developed diabetes or high blood pressure or by not starting to smoke cigarettes or crack or shoot up heroin.
I wasn’t aware that the kidneys were involved in fertility. I knew other women had babies after donating. After the transplant surgery, of course Robert and I would make that baby I hoped for.
Incredibly naive, I know, but also not surprising that I felt so sure of the outcome, as I tended to be a glass-half-full person in my day to day. But somehow I’ve always just expected to get what I really want in life—from college and medical school acceptances to residency program and after-training job offers even though I was far from a star medical student or resident. I didn’t always get what I wanted, at least not at first, and occasionally not at all. And each time I didn’t get what I wanted, I wouldn’t just be disappointed, I would be dismayed, incredulous even, like an early American Idol reject.
I remember the day I found out that I could be Robert’s donor. After multiple phone calls trying to find somebody who could tell me, the news was given to me in very basic terms—there was no clotting when my blood was mixed with Robert’s. We were, therefore, compatible. Of course we already felt compatible at the relationship level, but it was good to hear we were compatible at the DNA level too. It was years later that I learned we were a match at only one of six genetic markers considered at the time. Maybe I wouldn’t have been quite so cocky had I known this detail. In that moment of knowing only that the answer to the simple “compatible yes/no” test was in our favor, I burst into happy tears.
Back in pre-op, I smiled to myself as I thought about how far we had come since dinner at Melanie’s just nine months earlier. My skin felt tingly with my nervousness, yet I felt at peace. The thick blue curtain separating me from the patient to my left slid abruptly down its metal track as my nurse appeared with a syringe in her hand.
“OK, almost time to go. Here’s 10 milligrams of Valium,” she said, smiling, as she pushed the clear liquid into the IV at the crook of my left elbow.
I smiled back at her and shivered a little, more from her words than the cool surge in my vein. It’s almost time to go.
Moments later, three young surgeons swarmed in and unlocked the wheels of the bed I lay in. Click. Click. Click. Click. They started to roll me toward the operating room.
“Are you feeling sleepy from the Valium yet?” asked one, his clean-shaven beige face hovering above me.
“No, not at all,” I said, feeling wide awake and wondering if they would have me count backward from twenty with the mask over my mouth and nose as I inhaled the vapors of anesthesia, like I’d seen them do with patients when I was in medical school.
5
Peanut in a Box of Worms
Operating Room 17 was like a refrigerator, but I was unaware. I was unconscious and paralyzed.
A plastic mask was taken away from my face and a hand tilted my head so that my jaw jutted forward. Two fingers, in an exaggerated snap, pried my mouth open to make room for the sickle-shaped blade of the laryngoscope. Once it was in place with its tip at the back of my tongue, the left hand lifted the handle so that my vocal cords were exposed. A breathing tube slid between them into my windpipe and the metal rod that gave the breathing tube shape was removed. With the bell of a stethoscope against my rib cage on the right, then left, the anesthesiologist listened as air moved through each of my lungs. She was satisfied that the breathing tube was correctly positioned. She connected the end of the tube to the machine that would do my breathing for me and secured the tube with white tape to my face. The machine displayed my blood pressure. My heart rate. The settings from turned dials that continually pumped drugs through the IV to keep me unconscious and immobile while my left kidney was being removed.
The kidneys are like the Rodney Dangerfield of vital organs—they get no popular respect. I blame Hollywood and the music industry. With the exception of that scene in Steel Magnolias where Shelby told everyone in the beauty shop that her m
ama was giving her a kidney so she could stop looking like she was driving nails into her arm for dialysis, the kidneys have been pretty much glossed over. We have countless love songs about hearts aching and breaking, brains that can’t stop obsessing, and lungs that can’t breathe again—but not one about the kidneys. Nobody was singing “If I only had a kidney . . .” in The Wizard of Oz.
But it wasn’t always this way.
Early translations of the Bible valued the kidneys. The reins as they were called then, from the Latin rēnēs, were central to the soul, the stimulus for moral yearning and righteous action. According to the Masoretic text in the Holy Scriptures: “I will bless the Lord, who hath given me counsel; Yea in the night seasons my reins instruct me.” It was through the kidneys that God examined the moral worth of Man: “Examine me, O Lord, and try me; Test my reins and my heart.” And they were the target of punishment for immoral behavior: “He cleaveth my reins asunder, and doth not spare. . . .”
And Hippocrates, the father of medicine, believed the kidneys’ secretion of urine held the most important clues to what was making a person sick. And just like people think “physician” when they see a white coat and stethoscope today, it was the matula, with its clear glass bottle rounded at the bottom, like a bladder full of urine, held up to the light that symbolized physician well into the Middle Ages. Pee was the shit.
But then things changed.
The kidney and its secretion fell from the virtuous pedestal they enjoyed for thousands of years to one of ridicule and caricature—all because too many physicians tried to do too much with their patients’ pee. Many stopped bothering to examine the patients themselves because their urine alone was all that mattered to them. Translations of medical texts from Latin allowed those with no formal medical training to get in on the action, with lay healers diagnosing disease solely by the color of the urine. Soon they began telling fortunes and predicting the future—by urine. Physicians joined in. Even witch hunters started using urine to identify their targets. Eventually it became so ridiculous that a medical rebellion against all uses of urine for diagnosis ignited. In the early 1600s, The Pisse Prophet was published. It called out all those who pretended knowledge of disease by urine as engagers in “piss-pot science.” This reputation stuck. More than a century later, a caricature depicted a dozen “quack heads,” one of whom had his finger in a matula—literally poking fun at the pseudoscience of disease diagnosis by urine. The kidneys came to be viewed as mere producers of waste. Modern translations of the Bible replaced the reins with the “mind” and “soul.”
It wasn’t until kidney transplantation became a reality that the kidneys began to regain even a portion of their past glory. But even though the kidney was the first solid organ transplanted, the concept of transplantation was nothing new. According to folklore, transplantation was attempted as far back as the second century in ancient Rome, when twin brothers and physicians Cosmas and Damian transplanted the black leg of a dead Ethiopian man onto a patient’s white body. Supposedly the patient, whose own leg may have been destroyed by ulcers, did well. The brothers, on the other hand, were beheaded, but this may have had more to do with martyring themselves for their Christian faith than the transplant.
Nevertheless, kidney transplantation didn’t really get started until 1900, after overcoming several technical hurdles. French surgeon Alexis Carrel is credited with figuring out how to connect the blood vessels that would allow blood to enter and leave the transplanted kidney through a series of transplant experiments in dogs in 1902. Before him most surgeons used glass tubes to connect blood vessels. In 1905, N. Floresco, a physiologist in Bucharest, was first to suggest connecting the donor ureter to the recipient bladder. However, for many years, surgeons feared the stitches between the two would come undone, so they connected the ureter to a hole they made in the skin. Early experimenters transplanted kidneys into arms and thighs before landing on the pelvis. Since kidneys in these early experiments actually produced urine for only about an hour, I imagine no one had to consider the awkwardness of having to pee out of one’s armpit.
They didn’t realize that the rapid failure of kidneys was because of rejection—the recipient’s immune system behaving as it should, destroying the invader, not realizing the invader had come in peace with the intention of saving its life. This was the fate of the first human-to-human kidney transplant, performed by Dr. Yu Yu Voronoy in the Soviet Union in 1933. The recipient died two days later. The first successful human kidney transplant was performed by Dr. Joseph Murray in Boston in 1954 when Richard Herrick received his identical twin brother, Ronald’s, kidney. Here rejection wasn’t an issue because it was like moving a part to another location in the same body. It was this avoidance of the immune system altogether that allowed successful kidney transplantation to depend upon surgical technique only, a technique that has changed very little to date.
It would be another several years, with the discovery of methods of defeating the immune system, before any extended survival could be achieved in the greater population. The first was radiation, but because it killed the entire immune system, the body was left with no natural defenses and as a result would succumb to horrible infections. Next was azathioprine, a derivative of mustard gas. Initially it was considered to be an antibiotic, though a very weak one because it actually weakened the immune system—but this was a feature that could be exploited for use in transplantation. The addition of prednisone a few years later allowed lower doses of azathioprine, which meant lower infection risk, but still kidneys lasted just shy of two years. It wasn’t until cyclosporine was discovered in 1976 that the balance between preventing rejection and avoiding infection greatly improved. That plus simultaneous efforts to figure out how to better match donors to recipients and the discovery of newer, better drugs over time has created the current reality in which more than two-thirds of all kidney transplants are still working after five years, while little more than a third of dialysis patients are still alive in that same time span. Some kidney transplants last twenty, thirty, forty, even fifty years.
I hoped Robert’s new kidney would be among those still working after fifty years.
My pale blue gown was whisked away and I was naked for all to see. But to them, I was just another body. All that mattered was how much fat there was to cut through, how much pee was coming out of me, and that I woke up in the same condition I went to sleep in—minus one kidney.
Gloved fingers spread my labia apart. Swab, swab, swab, the area was cleaned. The narrow, floppy yellow catheter was lifted out of clear lubricant and its end was guided to the opening of my urethra and pushed in deeply enough for its surrounding balloon to be inflated with saline to keep the catheter from slipping out of my bladder.
The transplant surgeon, Matt Frank, walked in as if the plunge of the syringe filling the balloon was his cue. He wore metal-framed glasses, a surgical mask, and a periwinkle bouffant cap like mine that covered a mane of thick silver hair. His presence added an intensity to the room. His surgical assistant, the fellow who had completed his general surgery residency and was now learning the specialty of transplant surgery, suddenly stood taller and moved into action. He, Frank, and the nurse worked quickly, methodically, to position me. The nurse attached a brace perpendicular to the right side of the table and lined it with thick blue foam. My right arm was laid in its cradle. I was rolled onto my right side and more foam was placed along my backside. The nurse attached another brace to the bed and lined it with more foam for my left arm to lie on, suspended above the right. I looked like the mummy of old movies tipped over. Wide white cloth tape wrapped around, securing it all in place. Foam between my knees and ankles. More white tape. I would be like this for two hours. All the careful padding ensured that no nerves would be pinched, so that when the anesthesia wore off, I would be able to move all my parts.
A swab soaked in brown Betadine landed on my belly. The fellow’s hand swept the swab in ever-widening concentric circles until I was pain
ted a deep yellow from just beneath my breasts to just below my C-section scar, now traced in purple from the surgical marker. A new soaked swab painted again. A third for good measure, to ensure that all the bacteria naturally living on my belly skin was dead. The fellow wondered why Frank still used Betadine, while the other attending surgeons he scrubbed in with used a clear alcohol-based solution.
As if reading his mind, Frank said, “I like Betadine because it doesn’t wash off our markings,” though part of him realized this made him seem old school.
I was left to air-dry. Then a thin plastic film impregnated with iodine—just in case the Betadine didn’t get all the bacteria—was stretched over my belly like yellow plastic wrap over a leftover ham.
Frank and the fellow stepped back to don sterile gowns and gloves. The scrub technician was in the corner, already cloaked in sterile garb. He arranged all the scissors, clips, clamps, needles, and gauze sponges rolled like cigarettes on the table before him. Counting. Counting again.
The nurse held an open pack for the fellow to retrieve its sterile thick blue paper contents. The paper was spread all over me so that only about a square foot of my belly skin was exposed under the transparent yellow plastic. The table was tilted so that my left hip was higher than my right.
A laparoscopic left nephrectomy was under way.
Four horizontal cuts were made on my belly, each about an inch across. Three in a line about three inches apart like nipples on a sow’s belly. The fourth about three inches left of the middle cut.
I was lucky. Had I donated a kidney a decade earlier before laparoscopic nephrectomy had been developed, I would have had an open nephrectomy—pretty much sawed in half, waking up to an incision a foot or so long and possibly one lower rib lighter. I could have expected to spend up to a week in the hospital, be in a lot more pain, and need an extra month to get back to work. With the laparoscopic technique, I might be in the hospital as few as two days and back to work in a couple of weeks. I could even dare to dream that I’d wear a bikini again.
Hundreds of Interlaced Fingers Page 5