breathing tube. It was real. She couldn't help herself, and began to weep silently, forgetting Thomas Stone was there, or not caring one way or the other. She was only conscious of him when he tentatively offered a handkerchief. She snatched it from him, as if he'd been slow to offer it.
“It feels as if this is happening because of me,” Hema said. She blew her nose. “I know that sounds selfish, but to lose Ghosh, then to see Marion like this … You don't understand, it feels as if I have failed them all, that I let this befall Marion.”
Had she turned, she might have seen Thomas Stone stir, seen him rub his knuckles against his temples, as if trying to erase himself. He spoke, his voice hoarse. “You … you and Ghosh never failed them.
There it was, Hema must have thought; it was both the sorry and the thank-you that was so long overdue, and the funny thing was that at this moment, she didn't care. It no longer mattered. She didn't even look his way.
SHIVA ENTERED, and if he saw Thomas Stone, he didn't acknowledge his presence. He had eyes only for me, his brother.
“Where were you?” Hema said. “Did you sleep at all?”
“In the library upstairs. I took a nap there.” Shiva surveyed me, then he studied the settings on the ventilator, and then the labels on the fluid-containing bags hanging over my bed.
“There is one thing I didn't ask Vinu,” Hema said to Stone. “How did Marion get hepatitis B?”
Thomas shook his head as if to say he did not know. But since she wasn't looking his way, he had to speak. “It … was probably during surgery. Nicking himself. It's an occupational hazard for surgeons.”
“It can also be acquired by sexual intercourse,” Shiva said, addressing Thomas Stone. Thomas Stone stammered assent. Hema glared at Shiva, one hand on her hip. She didn't get a chance to speak, because Shiva had more to say: “Genet was at Marion's house, Ma. She showed up there six weeks ago. She was sick. She stayed for two nights and then disappeared.”
“Genet … ?” Hema said.
“There are two people in the waiting room you need to meet. One is an Ethiopian lady, Tsige. She used to live opposite Missing. Ghosh took care of her infant years ago. Marion met her again in Boston. The other is Mr. Holmes—he is Marion's neighbor. They want to speak to you.”
BY MIDMORNING, Hema knew the whole story. Genet had been ill with TB. But Appleby had his hands on the prison health records and they showed what we had not known before: Genet was also a silent carrier of hepatitis B. She contracted it (or so the prison doctor postulated) from an improperly sterilized needle or a transfusion or a tattoo when she was in the field in Eritrea; she could also have acquired it sexually. Genet had bled readily when we slept together, and I had been generously exposed to her blood and thereby to the virus. The incubation period of hepatitis B fit Shiva's hypothesis: it was six weeks from her visit to my falling ill.
Hema paced the waiting room, cursing Genet and bemoaning my stupidity in letting Genet get close to me again after everything she had put us through. Had Genet appeared just then, I would have feared for her life.
WHEN DEEPAK AND VINU made rounds together that afternoon they shared the latest lab results: my kidneys were failing; my liver, normally the source of clotting factors, wasn't producing any. If there were any viable liver cells left, they were showing no signs of recovering. There was not a bit of good news they could convey. They withdrew, Shiva following them. Thomas Stone and Hema stayed, silent around my immobile form. Now it was a watching game, a vigil to the end. There was no hope. The two of them as physicians knew it all too well, but if anything, experience made it even less palatable.
AT NOON, an ICU nurse paged both Deepak and Vinu to a Stone family conference. They came to find Hema and Shiva seated across from Thomas Stone in the small meeting room.
Hema, weary, head in her hands and elbows on the table, gazed up at the two young doctors in white coats, her son's peers. “You wanted to see us?” she said impatiently to Vinu and Deepak.
Deepak looked puzzled. “I didn't call this meeting.” He turned to Vinu, who shook his head.
“I did,” Shiva said. He had a stack of photocopied papers in front of him. A yellow legal pad was covered with notations in his careful script. Hema noticed an authority to his voice, a sense of action and energy and initiative that no one else seemed capable of displaying in the face of my terrible prognosis. “I called the meeting because I want to talk about a liver transplant.”
Deepak, who found it difficult to sit face-to-face with Shiva and not feel he was speaking to me, said, “We considered a transplant early on, Shiva. In fact, Dr. Stone and I talked about transferring Marion to Mecc—I mean to Boston General, Dr. Stone's hospital. Dr. Stone's team does more transplants than anyone on the East Coast. But we decided against it for two reasons. First of all, transplants are notoriously unsuccessful when the liver is being destroyed by fulminant hepatitis B. Even if we found a cadaver liver of the right blood group and size and we did the transplant successfully, we would have to use massive doses of steroids and other drugs that suppress the immune system to prevent rejection of the new liver. That would give the hepatitis B virus a field day and the new liver would be destroyed and we would be back to exactly where we are now.”
“Yes, I know,” Shiva said. “But what if the transplant is a perfect match? Not just the same blood group, but all six HLA antigens and other antigens you don't even measure—what if they
“Theoretically, yes, but …,” Deepak said.
“A perfect match is what you would have if you took the liver from me,” Shiva said. “His body would see it as self, not as foreign in any way.”
The air had been sucked out of the room. No one spoke for a few seconds. Seeing Hema's expression, Shiva quickly explained, “I mean take a
“Shiva …” It was on Hema's lips to apologize for Shiva—this clearly was not his field, or hers for that matter. But then she changed her mind. She knew something about his tenacity when it came to medical situations that others thought impossible. “But, Shiva, has that ever been done—transplanting part of a liver?”
Shiva slid one of the articles over to her. “This is from last year. A review by Deepak Jesudass and Thomas Stone on the prospects for
Shiva wasn't reading, but reciting word for word from memory. It didn't surprise Hema, but it astonishmed the other physicians at the table. Hema felt proud of Shiva. She was reminded how often she took Shiva's eidetic gift for granted. She knew he could draw the page he was reciting from, reproduce it on a blank piece of paper, beginning and ending each line just as it was on the original, down to the punctuation, the page number, and the staple marks and photocopy smudges.
Shiva, sensing that he had quieted Hema for the moment, addressed Thomas Stone and Deepak, the two surgeons: “May I remind you that the first successful kidney transplant by Joseph Murray involved a dying twin who received a healthy kidney from his identical twin brother?”
Deepak spoke, because it appeared that Thomas Stone was in a state of shock, “Shiva, we also state in the paper,” Deepak said, “that there are ethical and legal implications—”
Shiva interrupted. “Yes, I know. But you also say ‘in all likelihood the first donors will be a parent or sibling, because such a donor has a pure motive and takes on the risk willingly’ “
Deepak and Thomas Stone looked like defendants whose alibi had just been shot down by a surprise witness. The prosecutor was moving in for the kill.
But the attack came from another quarter. Hema said, “Thomas, tell me the truth: in the last four days, given that
