Lifeblood

by Penny Rudolph

The boys were all nodding.

  Rachel’s eyes narrowed. She had promised herself not to lead them into saying anything, and she hadn’t. “You are all here for surgery? For operations?”

  “They are here to eat, gain weight, save themselves, and in the process, save someone else.”

  The voice came from behind Rachel. How could she have been so stupid as to turn her back to the door?

  “And now I must ask you to come with me.”

  Chapter Fifty-two

  Rachel turned, not sure whether to be relieved or aghast. “Emma?”

  “I’m afraid so.” Emma turned to the boys and spoke in stern Spanish. “Get back to your own room.”

  They pushed past Rachel, then past Emma, and fled the room.

  “Soledad,” Emma said, “breakfast is coming. Chorizo and eggs and a tortilla. You must eat it all.”

  Soledad’s solemn eyes were very large. She nodded.

  “Now, come with me,” Emma said to Rachel.

  And Rachel, like the boys, obeyed.

  The nursing staff station was in the center room across the hall. Emma led the way through that into a small windowless space that might once have been a wheelchair-accessible bathroom. It was now furnished with a small desk, a table, and two chairs.

  She closed the door behind Rachel, turned the latch, then slowly and deliberately moved to the front of the desk and leaned against it. She was wearing a white lab coat, short navy skirt, black stockings, and flat black shoes. A turquoise and green scarf had been tucked into the neck of the lab coat. “What are you doing here, Rachel?”

  Back against the door, Rachel wondered how long it would take to twist the lock and make a run for it. Ignoring Emma’s question, she said evenly, “I thought you were out of town, out of the country as a matter of fact.”

  Emma’s face remained expressionless. “I was. I’m back.”

  “Did you bring more kids from Mexico so you could lock them up and steal their organs? Kind of like keeping a chicken alive until you want to eat it? That way you don’t even need a refrigerator.”

  “Dear God!” Emma drew back as if she’d been struck. “How can you say such things?”

  Their words hung between them like icicles in frozen air.

  A muscle in Emma’s jaw twitched. She raised her chin and turned her full blue gaze on Rachel. “I asked you what you are doing here.”

  “I came to find the child I brought to the emergency room. The one who went missing at this hospital.”

  “As I understand it, you are out on bail after having stolen some drugs from this hospital.”

  “I didn’t take that bottle of OxyContin, Emma. I think you, of all people, know that.”

  Two vertical lines appeared over Emma’s nose.

  “You want to tell me what’s going on here?” Rachel asked.

  Emma lowered her chin and stared first into the middle distance, then at Rachel. “I don’t think you really want to know. But I will tell you this: What we do here does far more good than harm.”

  “I’d like to believe that, Emma. I really would. But what are all these kids doing here? Why is there this secret, very busy ward with a closed sign on the door? Why did someone in this hospital plant a bottle of OxyContin on me?” Rachel paused, then said slowly, “Most of all, I’d like to believe you don’t intend to kill me right here in this neat little room with no windows and acoustical tile on the ceiling.”

  Emma’s brows drew down and her eyes snapped. “Rachel! How can you—”

  “Why would I think that? Because if you let me out of this tidy little room, I am going straight to the police.”

  “And what makes you think they would believe you?”

  Rachel stared at her. “Oh…my…God.” Her voice was barely audible. “So that’s why.”

  “We couldn’t very well let you go on nosing around. But now, I would like to save you some trouble—and embarrassment.”

  Rachel found herself nodding like a toy with a spring-mounted head. “Okay. What do I have to do to avoid trouble and embarrassment?”

  “Not a thing, actually. In fact you just might even find your arrest removed from the Rampart’s books.”

  “You could do that?”

  The doctor met her look and nodded. “I might.”

  “What is going on here?” Rachel asked again.

  “Sit.” Emma pointed at the chair in the corner.

  “I’d rather stand.” Rachel didn’t want to get that far away from the door.

  “Rachel, get a grip. The last thing in the world I want to do is harm you. This is not what you think.”

  “Just the same, I’d rather stand.”

  “Have it your way.” Emma went to the chair behind the desk and sat down.

  Rachel took a deep breath. She felt a little safer with the desk between them.

  Emma leaned forward, propped an elbow on the desk and her chin on her hand. Somehow that pose made her seem less threatening and Rachel allowed herself to relax a little.

  “This is the truth: The children in this ward are going to be better off because they were brought here.”

  “Better off? With an organ missing? A kidney or half a liver? Or what else do you relieve them of? A cornea or two? Jefferson Medical Center gives the term chop shop a whole new meaning.”

  Emma stared at her for a long moment, then said quietly, “Rachel, you don’t understand the kinds of places these kids come from.”

  “Well, at least they aren’t missing body parts. Not until they get here. How much do you sell them for?”

  “I am not going to dignify that with an answer.”

  “I hope it’s a lot,” Rachel said. “I would rather think you don’t risk their lives on the cheap.”

  “I, personally, don’t get a dime, not one thin dime, if that’s what you mean.”

  “Then why the hell do you do it?”

  “If I answer that honestly, will you listen?”

  “I don’t seem to have a lot of choice.”

  Chapter Fifty-three

  “I think you mentioned you’ve never been to Mexico,” Emma said.

  “No, I haven’t.”

  “Do you know much about Mexico?”

  “No.”

  “I thought maybe since your name is Chavez….”

  “I wish I knew more about the Chavez end of things, but I don’t.”

  “Okay, for the moment, you’ll have to take my word for it,” Emma said. “Where these kids come from there is more poverty—abject poverty—than you can probably imagine.”

  “Are they from the area where your clinic was?”

  “Some. All are from places where the men feel helpless and that makes them angry. The women feel betrayed, so they, also, are angry, and when they are not angry, they are depressed. At least a quarter of the boys will not reach thirty. Their lives are likely to be cut short by a knife in a bar room brawl. The girls live in a fantasy world until they are old enough to bear children. Then they become betrayed women. I don’t take girls, by the way.”

  “Why not?”

  “Because things are not exactly rosy here in the land of milk and honey either. A lot of kids take some hard knocks here. Chicanas, Mexican girls can easily fall into prostitution or worse, become sex slaves.”

  “How thoughtful of you to refuse to take them.”

  “I don’t take boys under the age of seventeen, either.”

  “A couple of the boys out there don’t look much more than thirteen or fourteen.”

  “They’re small for their age. You can imagine the nutrition. Or maybe you can’t. I don’t do surgery on anyone underage or seriously underweight.”

  “You fatten them up for the kill.”

  “I feed them, they gain weight. They become more healthy. Is that bad?”

  “Maybe. Especially if you then remove some of that weight and sell it.”

  “Rachel, we do not, repeat, do not, sell anything.”

  “That’s hard to believe.”
r />   “Why?”

  “Because when criminal, corrupt, unethical things are done, it’s almost always for money. Why else do it?”

  “I am proud of what I do,” Emma said. “You simply don’t realize the desperation, the terrible need for transplantable kidneys. The Global Organ Sharing Network has more than a hundred thousand on its waiting list and that list grows by at least ten percent per year. And far too many of them die waiting.”

  “What about that little sticker on my driver’s license?”

  “Those stickers provide only about eighty-five hundred transplantable kidneys per year. Don’t take my word for it, look it up. Less than ten percent of those needed. That’s common public knowledge. Don’t you know anything about this?”

  “I didn’t know it was that bad. I’ve heard about people offering kidneys on eBay. I’ve read that there’s a regular organ market in India, that China sells the organs of executed criminals. But this is Los Angeles. Using poor Mexican kids….”

  “I swear to you, Rachel, those kids are better off. And for the people who receive an organ or tissue from them, it’s the difference between life and death. This is not a crime, it’s a win-win situation.”

  “Really.” Rachel eyed her for a moment. “Exactly how does it work? Who pays for it—the running of this whole ward, all of it?”

  “The transplant team, mostly. It comes out of our budget.”

  “The transplant team is part of Jefferson Medical Center?”

  “Yes.”

  “And everyone at Jefferson knows what’s going on here?”

  “Of course not.”

  “Everyone must know. The kitchen sends up trays, the O-R receives these kids for surgery and sends them back, the janitors have to clean the place.” Rachel hesitated a moment before adding, “The pharmacy has to provide pills.”

  “Of course a lot of people know these rooms exist. But this is a big hospital. The kitchen sends up trays, they don’t ask where the patients came from or why they’re here. The cleaning staff mops floors, they don’t know anything about the patients in these rooms. We kind of imply that it’s a charity ward for young Latinos, and people have no reason to believe otherwise.”

  “Even the O-R staff? They don’t question anything?”

  “They know Jefferson has a big transplant program. They look after surgical patients, they don’t ask exactly how it was decided that someone should have a particular procedure. They assume the admitting doctors, the surgeons, are responsible for that.”

  Rachel was remembering how Gabe had described the pharmacy’s big volume in sales of immunosuppressant drugs using the same words: Jefferson has a big transplant program. “What about the hospital administration?” she asked.

  “Of course, a few of them know. They have to. A few very near the top. The ones who sign the papers, the checks. You think hospitals aren’t capable of a little Enron-style bookkeeping? They tell us fairly frequently that Jefferson is not an altruistic organization, it’s a business enterprise.”

  “Some others must guess what’s going on.”

  “A few probably do, but they look the other way.”

  “Why?”

  “Probably partly because they know we are doing so much good and so little harm. In other cases, okay, it may be because their pay envelopes are pretty fat.”

  “And you’re not worried about law suits?”

  “Filed by whom? Certainly not one of the kids. They know they’re better off. They also know they are in this country illegally. The last thing they want to get involved in is a law suit. The transplant recipients don’t know anything about the donors, and even if they did, they are desperate. They are very literally dying. They want to live.

  “Last but certainly not least, our medical practices here are on the cutting edge, among the best anywhere.”

  Rachel shook her head. “What’s the money angle? How can you pay higher staff salaries, pay the people who smuggle these kids across the border? If there’s no big profit, where does all that money come from?”

  “The revenue from roughly three thousand additional transplant procedures per year.”

  “How much is that?”

  “I don’t know exactly.”

  “Roughly.”

  Emma thought for a moment. “It could be as much as thirty million.”

  Rachel stared at her. “A year.”

  “Yes.”

  “You’re telling me you don’t sell the organs, you transplant them into other patients right here at Jefferson?”

  Emma nodded emphatically. “I am unequivocally telling you we do not sell organs. Period. We do, however, keep quite a few transplant surgeons busy.”

  “But the shelf-life, so to speak, of say, a kidney, can’t be very long. How do you work that fast?”

  “For one thing, we can do tissue matches with our own transplant patient waiting list before the donor’s surgery. And, secondly, we trade.”

  “Trade?”

  “The closer the tissue match, the better chance the graft will survive. We send kidneys, for example, all over the country, and receive others from all over. Our patients have some of the best odds for survival anywhere. That’s because we trade some of the organs we remove. If they don’t provide our own patients the very best match, we trade for organs that do.”

  “How can you transport organs that quickly?” Rachel’s eyes widened as she realized the answer. “Omigod. They leave and arrive by helicopter.”

  “Yes.”

  “And what about the kids who happen to lose a kidney, or whatever, in your self-styled philanthropy?”

  “First, I assure you that we are absolutely state-of-the-art here. Organ excision by laparoscopic surgery may not be risk free, but it is quite low risk.”

  Emma bit her lower lip and determined eyes drilled into Rachel’s. “You may have heard that kidney donors are neglected at some transplant centers. There was a TV special about that a year or so ago. That does not happen here.

  “Our donors get the best of everything, food, treatment, medical care. I, personally, see to that. Even with ordinary care, the odds of the remaining kidney ever failing are small. Most kidney donors live long and normal lives. And, I repeat, the kids in this ward come from unimaginable destitution. They are much more likely to die in that environment than from having only one kidney here.”

  “How do they get here? Are they kidnapped?”

  Emma picked up a ballpoint pen from the desk and rolled it between index finger and thumb. “Not one comes here by force or coercion. Every single one volunteers. They are carefully chosen for their age and general health.”

  “And they enter the country legally?

  “Of course not, Rachel. Don’t be naïve. You’ve heard the guessed-at statistics. Hundreds of thousands, maybe a million undocumented foreigners crossing the Mexican border every year. A tiny percentage are boys brought to us here before they enter new and better lives. A coyote is hired to have them smuggled into this country. As I understand it, the coyote hires a brincador who brings them through a tunnel under the Arizona/Mexico border. I don’t much care for all the middlemen, but that is how it’s done.”

  “That van in my garage was hardly testimony to how well the kids are treated on the way here,” Rachel said.

  Emma turned her head sharply as if she’d been slapped. Her cheeks reddened. “That was inexcusable. The man responsible will never do another job for us.”

  “He should be in jail.”

  “If I could figure out how to make that happen, I would. But thousands of farm workers, restaurant workers, hotel workers, have come to this country through that same tunnel, in the same way. And in their case, it’s because American corporations want illegal workers who can’t protect themselves from exploitation. That’s far worse that what we do.”

  “Are you saying you’re not exploiting these kids?”

  The doctor shook her head. “Instead of spending years running from the authorities, and ruining t
heir backs crouching over strawberry plants in order to be paid a pittance, our boys are brought here where we feed them, care for them, and do every possible test to be sure they can be donors with minimum, absolute minimum risk.”

  “You say they volunteer. What do they volunteer for? To come to California? I’ll bet they don’t volunteer to donate a body part.”

  “As a matter of fact, they volunteer to do exactly that.”

  Rachel gave Emma a doubtful stare. “I would bet they don’t understand.”

  “I assure you, they do. I insist that it be explained. They volunteer because they want to better their lives. They want to become American citizens.”

  “And just how do you manage that?”

  “Once they’re well enough, and strong, we send them to what could be described as halfway houses in east LA, where they learn English. We give them some money. Not a huge amount, but enough to tide them over until the people at the halfway house help them find jobs. A couple of our kids have even taken the GED and started community college.”

  “How do they get around the citizenship questions?”

  “Where do you think birth certificates are generated?”

  Chapter Fifty-four

  Rachel’s mouth dropped open.

  “That’s right,” Emma said. “Birth certificates usually originate in hospitals. On forms signed by doctors and notarized. Copies are sent to the state. But of course the system isn’t perfect. And a small stack of the forms went missing a while back. It was assumed they were somehow thrown out by mistake.”

  “How can you get away with that?” Rachel asked. “Aren’t there cross-checks?”

  Emma shrugged. “You would think so, but it’s really remarkably simple. And a notary’s stamp isn’t all that hard to come by.”

  “You said you don’t take girls, but there’s one out there. Alone in a room. Soledad.”

  “As I said. The kids who are here want to come here. Some have a friend or relative who did it. Others hear about it from someone who knew people who came here. Some want to come here so badly they lie about their age and even their sex. Soledad originally arrived here with another girl. Both had their hair shorn, hoping to pass for boys. Naïve, yes. They have good intelligence, but little or no education. Both the girls were way under age. They may have been sold to the coyote by their parents.”