Cutting for Stone (64 page)

THERE WAS REJOICING
in the hospital, first that one of its own who had been near death was still alive, and second that Our Lady had made history. The Mass of Gratitude in the chapel was packed, Hema and Vinu in the front pew and the crowd spilling out to the cloisters.

Outside Our Lady of Perpetual Succour, the news vans were lined up—international as well as national. Every previous liver transplant in the world had its origins in a corpse-to-be, in someone who was brain-dead. A
living
donor—and an identical twin who had given half his liver to his brother—that was big news. The media didn't quite get that this technical breakthrough would be most meaningful to babies born with congenital biliary atresia—lack of bile ducts. Adult organs from people dying of trauma were scarce enough; a child donor was exceedingly rare. Stone and Deepak opened the way for a parent to donate part of his or her liver to save their infant.

By the second day, the ferreting journalists had connected Shiva to his fame as the fistula surgeon—”fixing holes is what I do”—and by the third day, they'd labeled Thomas Stone the “estranged father.” It was perhaps only a matter of time before they discovered the story of Sister Mary Joseph Praise, though it would probably necessitate a reporter traveling to Addis to unearth that tidbit.

I CAME AWAKE
on the fifth day. My first memory is that of floating up from the ocean bottom, my eyes still waterlogged and with what felt like scuba gear stuffed in my mouth and throat—I couldn't speak. As I broke to the surface, I understood that I was still in the ICU at Our Lady, but I heard nothing of what anybody said. I saw Hema and Stone and I looked for Shiva. He's decided not to come from Addis, I remember thinking, and I was disappointed.

Twelve hours later, in the late evening of the fifth day (though it was perpetual twilight in the ICU), I surfaced for good, relieved to see that Hema was there, and that I hadn't imagined her presence.

She stayed by my side, holding my hand. I craved her touch, fearful I might sink back into the abyss where it was all dark and from which there was no promise of return. But I would drift off into light sleep for short periods. Night turned to day, bringing with it a new bustle and energy and more traffic through our room.

On the seventh day, I was awake long enough for Hema to make the fantastic statement that half of Shiva's liver was in me. Sick patients need to have everything explained at least twice, because you can presume they will not have heard half of what you said. Hema repeated herself at least ten times, and it was only when she showed me the
Times,
and the picture of me and of Shiva, that I believed.

“Shiva is recovering,” Hema said. “He's fine. But you've developed pneumonia and there is fluid collecting around your right lung. That's why you are still on the ventilator. But it's getting better, so Deepak says you will be off the ventilator tomorrow. Your new liver is functioning well, and your kidneys have bounced back.” This was not the reunion I had imagined with Hema, but the expression on her face, her joy, her relief, were priceless. She rarely left my side.

I saw Deepak and Stone for the first time later that same day. I struggled with my emotions. I know I was supposed to feel gratitude. Sometimes I think we surgeons wear masks to conceal our desires, to hide our willingness to violate the body of another. Only the guarantee of amnesia, the fact that the patient will remember nothing but the anesthetist's saying “Sweet dreams,” allows us to be surgeons. They stood before me, these perpetrators of organized violence on my body. The fact that both men were shy and unassuming seemed almost deceitful given the ambition, the hubris, that had allowed them to risk Shiva's life for mine. It was the only time I was thankful for that evil tube going down my throat and between my vocal cords, because what I would have said to them would have sounded ungrateful:
It's a good thing Shiva made it, otherwise I'd be after your hides.

When I awoke sometime later, I forgot about the tube and tried to speak, which made me feel I was choking, which made me panic. My struggles triggered the ventilator alarm, and now I was terrified that the nurse would decide I was “fighting the ventilator,” which could bring an order for intravenous curare. That drug, derived from the poison darts of Amazon tribes, paralyzes all the muscles, leaving you still as death, so that the ventilator can do its work unimpeded. But God help you if you aren't given a strong sedative along with it, because then you are awake, alert, but unable to twitch or even blink. The thought of being in that paralyzed, locked-in state had always horrified me, even as I blithely ordered curare (
and
sedation) for hundreds of patients. Now that I was a patient, my curse was that I knew too much.

With Hema's help, her soothing voice, I did my best to calm down, to let the machine push air into me, and the nurse retreated. When I felt better I wrote,
How is Shiva?

She didn't have to reply, because just then my other half came in, led by Thomas Stone.

My brother, whom I had not seen for seven years, looked haggard, not at all like the picture in the
Times.
I felt vertigo in seeing my reflection moving independently of me. Shiva wore a hospital gown, one palm resting carefully on his belly, the other hand pushing his intravenous pole ahead of him, and using it as a walking stick. My brother wasn't given to laughing and most jokes were wasted on him, but when he saw me, he grinned like the chimp who'd locked up the zookeeper.

You monkey, you,
I wanted to say, and I reached hungrily for his hand, our fingers interlocking.
You should laugh more, it suits you: see how the furrows around your brow vanish and your ears ease back?
I felt fluid running down my temples, and his eyes were full, too. I squeezed his fingers, a Morse code to convey what was in my heart. He nodded—
You don't have to tell me anything
is what he was saying. He bent forward gingerly, and I wondered what he was up to, surely not a kiss … He clinked his skull against mine. It was such an unexpected, jarring, and surprising act, a throwback to being little boys, the softest of
testas,
that it made me laugh, which made that horrible tube scratch the inside of my throat, and so I had to stop.

I pointed to Shiva's belly. He pulled aside his gown and I could see some of the incision, though a gauze pad with a drain passing through it hid the remainder. I raised my eyebrows at him, asking if it hurt. And he said,
Only when I breathe,
and we both laughed and both had to cut that off because of the pain. Stone stood looking on at this silent dialogue, amazed, a strange expression on his face.

Little did I know that Shiva's recovery had been complicated by a bile infection requiring antibiotics. Or that he had developed a blood clot in the vein in his right arm through which he'd been getting fluids. He was on a blood thinner, and the clot was resolving.

I held his hand for a long time, content to look at him, to thank him with my fingers, but he kept shrugging off my thanks. I reached for my pen, and Hema pushed the pad in front of me and I wrote,
Greater love hath no man—

He didn't let me finish. He held my pen. He said,
You would have done the same.
I had my doubts, but he nodded.
Yes, you would.

That evening, Deepak drained fluid from around my right lung, and my breath expanded in that direction. Then he took the wretched tube out of my throat. My first words were “Thank you,” and when that ugly blue machine left my room, I fell into a deep sleep.

The next morning was full of small miracles: being able to turn and gaze at the window and see sky, being able to say “Ouch” when the movement pulled on my incision. Hema wasn't around. The ICU was quiet. My nurse, Amelia, was unnaturally cheery. I assumed it was still early morning. “We have an X-ray to do downstairs,” she said, unhooking me from the tethers, and readying my bed to roll.

In Radiology I was lifted into the doughnut for a CAT scan, but oddly, it was of my head and not my belly. Surely it was a mistake. But no, the order was from Deepak, and it read, “CAT scan of the head with and without contrast.”

Back in my room and by noon, still no sign of Hema, or Stone, or Shiva. Amelia said they would be along presently.

The physical therapist helped me stand beside my bed for a few seconds. My legs felt like Jell-O sticks. I took a few steps with assistance, then sat in the chair, exhausted, woozy, as if I had run a marathon. I dozed there, ate what little I could. After lunch, I took a few more steps, and even peed upright. The nurses helped me back to bed. In retrospect, they seemed pleased to get out of my room.

IT WAS 2:00 P.M
. when Thomas Stone appeared at my door. There were dark circles around his eyes. He sat self-consciously on the edge of the bed. He touched my hand. His lips parted.

“Wait,” I said. “Don't say anything yet.” I looked out of the window at the clouds, at distant smokestacks. The world was intact now, but I knew once he spoke it wouldn't be so.

“Okay,” I said. “What happened to Shiva?”

“He had a massive bleed in his brain,” he said, his voice hoarse. “It happened last night, about an hour after we left your room. Hema was with him. He suddenly clutched his head in pain … Then, in a matter of seconds, he was … unconscious.”

“Is he gone?”

Thomas Stone shook his head. “He bled from an arteriovenous malformation, a cavernous tangle of blood vessels in the cortex. He has probably had it all along … He was on anticoagulants for the blood clot in his arm … In a week we would have stopped.”

“Where is he?”

“Here. In the ICU. On a ventilator. Two neurosurgeons have seen him.” He shook his head. “It isn't feasible to evacuate the bleed. They think it's too late. And that he's brain-dead.”

I didn't register much of what he said after that. I remember he said that my CAT scan showed a similar but smaller spider knot of vessels, but mine wasn't bleeding, a miracle of sorts, I suppose, since I'd bled from everywhere till I got Shiva's liver.

A few minutes later, Hema, Deepak, and Vinu came into the room. I understood now that Stone had been delegated to break the news.

Poor Hema. I should have tried to comfort her, but I was too full of grief and guilt. I felt so very tired. They sat around my bed, Hema weeping, bent over, resting her head on my thigh. I wanted them to leave. I closed my eyes for a moment. I woke up when a nurse came in to silence one of the intravenous pumps. There was no one else in the room. I had her walk me to the bathroom and then I sat in the armchair. I wanted my strength back.

WHEN I AWOKE,
Thomas Stone was by my chair. “He can't breathe on his own, and there are no pupillary or other reflexes,” he said in response to my silent query. “He's brain-dead now.”

I said I wanted to see him.

My father wheeled me down the hall where Shiva lay. Hema was with him, her eyes puffy and red, and when she turned to me, I felt ashamed to be alive, ashamed to be the cause of her sorrow.

Shiva looked asleep. It was his turn to sport the spike coming out of his skull—the intracranial pressure monitor. The endotracheal tube skewed his lips, angling his chin up unnaturally. The rise and fall of his chest from the ventilator offered a spot on which to rest my eyes, and my ifs were coming in that rhythm: If I hadn't come to America. If I hadn't seen Tsige. If I hadn't opened the door for Genet …

HEMA WHEELED ME BACK
to my room, helped me back in bed.

I said to her, “It would have been better if you and Shiva had buried me. Youd be on your way to Missing now with your favorite son.”

It was a stupid, churlish thing to say, a primitive and subconscious urge to wound her so as to assuage my pain and guilt. But if I expected her to strike back, she didn't. There is a point when grief exceeds the human capacity to emote, and as a result one is strangely composed—she had reached that point.

“Marion, I know you think I favored Shiva … And maybe I did. What can I say but that I'm sorry. A mother loves her children equally … but sometimes one child needs more help, more attention, to get by in the world. Shiva needed that.

“Marion, I have to apologize to you for more than that. I thought you were responsible for Genet being mutilated, circumcised, and all that followed. I held that against you. When we came here, Shiva told me everything. My son, I hope you can forgive me. I'm a stupid mother.”

I was speechless at this news. What else had gone on when I was unconscious?

Outside a siren drew closer and closer, an ambulance coming to Our Lady.

“They want to discontinue the ventilator on Shiva,” Hema said. “I can't bear for them to do that. As long as he is breathing, even if it is the ventilator breathing for him, he's alive for me.”

The next morning, after the nurse seated me in the shower and helped me with my first bath, I put on a fresh gown and I asked to be wheeled to Shiva's room.

“Stop here,” I said, well before his room, because I saw through the half-open door that Thomas Stone was seated by Shiva's bed, just as I was told he had sat by mine. His fingers rested on Shiva's wrist, feeling the pulse. His hand lingered there long after he had registered the heart rate. I wondered what he was thinking. I watched him for a full ten minutes before he stood up and came out, his eyes haunted and red. He didn't see me as he walked off in the other direction.