My brother was ready, and he spoke without glancing at his notes, addressing his comments largely to Thomas Stone even though Vinu had asked the question. “Your estimate, Dr. Stone, based on cutting out one or more lobes from patients with liver trauma, is that the risk of death should be less than five percent for me, the donor. The risk of serious complications, such as bile leaks and hemorrhage, you said should be no more than twenty percent in an otherwise healthy donor.” Shiva pushed a single sheet to Deepak and Thomas Stone. “I had my blood drawn last night. All my liver functions came back normal. As you can see, I am not a carrier of hepatitis B or anything like that. I don't drink or take drugs that might damage the liver. I never have.” Shiva waited for Thomas Stone.
“You know that paper of ours better than I do, son,” Stone said. “Unfortunately, those were estimates, a pure guess.” He put his hands on the table. “We don't know how it might really work in humans.”
“And if we fail,” Deepak added gently, since Thomas Stone was finished, “we lose you who walked in here healthy and we lose Marion. Not to mention that we won't have a leg to stand on or that our careers could be over. Even if we succeed, we will be heavily criticized.”
If they thought Shiva was done, they didn't know my brother. Hema was seeing her son anew. “I understand your reluctance. I wouldn't think much of you as surgeons if you agreed at once. However, if you can do this operation and if it has a reasonable chance, even a ten percent chance of saving Marion's life, and a less than ten percent chance of ending my life, and if you choose not to do the operation, then in my opinion, you would have failed Marion, failed Hema and me, failed medical science, failed yourselves. You would have failed my brother not only as his physicians, but as his friend, and as his father. If you did the operation and succeeded, you would not only save my brother, but you would have advanced surgery by a decade. The time is now.” He looked his father and then Deepak in the eye. “You may never get a chance like this again. If your rivals at Pittsburgh were facing this situation, what would they do? Would they not be bold?”
The prosecution rested. It was time for the other side of the table to respond.
“Bold, yes,” Stone said, breaking the long silence, and speaking in an undertone as if only for himself, “but they wouldn't be operating on their own sons. I'm sorry, Shiva, I can't imagine this.” He pushed back from the table, put his hands on the arms of his chair as if he were thinking of leaving.
“Thomas Stone!” Hema's voice was sharp as a Bard-Parker blade and it nailed him in his seat. “Once before I asked you for something, Thomas,” she said. “It had to do with these boys. You walked away then. But this time if you walk away, neither I nor Ghosh can help these boys.” Stone turned pale. He sat back in the chair. Hema's voice broke. “Thomas, do you think I would want to subject Shiva to a risk he couldn't surmount? Do you think I want to lose my sons?”
When she had composed herself, and after blowing noisily on her kerchief, she said, “Thomas, please dismiss from your head the idea that they are your sons. This is a surgical problem and you are in the best position to help them, precisely because they were never your sons. They never held you back, they never slowed your research, your career.” There was no rancor in her voice. “Dr. Stone, these are my sons. They are a gift given to me. The pain, the heartbreak, if there is to be heartbreak, are all mine—that comes with the gift. I am their mother. Please hear what I say. This has nothing to do with your sons. Make your decision by deciding what you must do for your patient.”
After an eternity, Deepak dragged the yellow pad from Shiva's side of the table and turned to a fresh page. He uncapped his pen and said to Shiva, “Tell me, why are you willing to subject yourself to such a risk?”
Shiva, for once, did not have a ready reply. He closed his eyes and made a steeple of his fingers, as if to shut out their faces. It worried Hema to see him this way. When he opened his eyes, he seemed for the first time since his arrival to be sad. He said, “Marion always thought that I never looked back. He saw me as always acting only for myself. He was right. He would be surprised if I were to risk my life to donate part of my liver. It isn't rational. But … seeing that my brother might die, I have looked back. I have regrets.
“If I was dying, if there was a chance he could save me, Marion would have pushed you to operate. That was his way. I never understood it before because it's irrational. But I understand it now.” He glanced at Hema, then shouldered on.
“I had no reason to think about all this till I got here. But at his bedside … I realized if something happens to him, it happens to me, too. If I love myself, I love him, for we are one. That makes it a risk worth taking for me—it wouldn't be for anyone else, unless they loved him. I am the only one who is a perfect match. I want to do this. I couldn't live with myself if I didn't do this, and I think you wouldn't be able to live with yourselves if you didn't try. This is my destiny. My privilege. And yours.”
Hema, composed till then, pulled Shiva to her and kissed him on the forehead.
Deepak, pen poised, had yet to write a word. He put the pen down.
At that moment it sunk in that they were going to go ahead with what had never been done before.
Shiva said to Deepak, “You said there was a second reason you had initially dismissed the idea of a transplant. What was it?”
Deepak said, “Before he lost consciousness, Marion made me promise not to transfer him. This hospital was special to him. It was more than a place for us foreign medical graduates to train. It welcomed us when other places did not. This is our home.”
Hema sighed and dropped her head into her hands. Just when they had come this far, another obstacle.
“We can do it here,” Thomas Stone said softly. He had listened to Shiva without moving a muscle, and those blue and steady eyes were now shiny and bright. He pushed his chair back and stood up, his movements purposeful. “Surgery is surgery is surgery. We can do it here as well as anywhere if we have the tools and the people. Fortunately, the world's expert in splitting the liver is sitting right next to me,” he said, putting a hand on Deepak's shoulder, “and the tools, many of which he designed, are also here and will need to be sterilized at once. We have a lot to get ready. Hema, at any time if you or Shiva have a change of heart, all you need to do is say so. Shiva, please don't eat or drink anything from this moment on.”
As he walked past Shiva's chair, he clamped his hand on my brother's shoulder, squeezed hard, and then he was gone.
52. A Pair of Unpaired Organs
AHELICOPTER FROM BOSTON GENERAL landed on Our Lady of Perpetual Succour's helipad during the night. It brought special instruments and the key personnel from Boston General's well-oiled liver transplant program. The corridor outside Our Lady's operating suites, normally a desolate stretch where one might find an empty stretcher or a portable X-ray machine parked while the tech took a cigarette break, was now like battalion headquarters at the start of a military campaign. Two large blackboards had been set up, one labeled DONOR and the other RECIPIENT, each listing what had to be accomplished with a check box next to the task. Our Lady of Perpetual Succour's team with Deepak as lead surgeon would handle the donor (Shiva's) operation, and the Boston General crew with Thomas Stone as lead surgeon would staff the recipient (my) surgery. The Our Lady team wore blue scrubs, while the Boston General crew wore white, and just to be certain, the former had a big D (for “donor”) marked on their hats and scrub shirts with a black marker, whereas the latter had an R. The adrenaline flow kept these disparate teams in good spirits; one Bronx wag even suggested to his Dorchester counterpart that they could call the teams Crackers and Homeboys. Only Thomas Stone and Deepak Jesudass would be common to both teams, each man assisting the other.