The Kidney is Exhibit A

by Shoilee Khan

Shoilee Khan’s fiction appears in the short story collection The Unpublished City (Book*hug, 2017). In 2017, she was longlisted for the CBC short fiction prize. Her work has also appeared in a diverse collection of magazines and journals, including Adbusters, Room Magazine, The New Quarterly, and Other Voices. She serves as a member of the Planning Committee for the Festival of Literary Diversity as well as the Creative Editor for Sister Fit. She studies disaster writing and is currently a doctoral student in English Literature at York University.

I


1

Diagram of a Kidney

If you look at a diagram of a kidney, it looks like a meal. Set on a plate, it is the cross-section of a delicacy, the meat finely marbled. There is a semicircle of small mounds embedded in the meat, like artisan potatoes or soft slips of sea scallop evenly browned. Depending on the diagram you are studying, these pyramidal mounds can look like disease, or they can look decorative, like an arc of seashells. These are the medulla, the innermost part of the kidney, the very core. If the diagram is detailed, drawn with fine strokes of coloured pencil, you can see that the shells are in fact soft, thin fibres feathering out over a network of braided blood vessels, red and blue. The fibres are nephrons that root themselves in the medulla ribboning out like delicate strands of pasta, siphoning salt from blood, balancing the palate. The meal is hearty and throbbing on the plate, every section sizzling.

If a small nub of blood embeds itself in the renal vein of a baby boy, then the blood will not drain from his kidney. He will grow sluggish in the womb, floating, latent, still. But his heart, the size of two thumbs, will beat too quick, the pulses like pummelling fists. When the doctor reaches inside and punctures the amniotic sac, the nurses will gasp.

Now, the bed is wet with bloody water and the baby must come out, right now, this very minute, he must, he must. A slice in his mother’s belly cut navel to groin instead of side to side like a smile saves four minutes. The baby is gone from the room, his mother still asleep, his father signing papers to send his baby to another hospital where they will inspect this tiny new body for signs of ruin.

He has a head full of thick black hair and a face like a doll and she sees him encased in a glass tub. He must go. Don’t cry, don’t cry, we’ll try to find out why. The room is hazy and wobbling, the light streaking. The glass tub is wheeled out. The baby inside it is hers with his head of black hair and his tiny face. There is a nurse at her side, with her pink, pink lips and a hand on her shoulder. Don’t cry, don’t cry. Here is a plastic cup of orange slices on a clean, white tray because a mother needs to eat; she needs to be strong.

Does it cost too much? How did she withstand it—the coming home with empty arms, the riding on the bus?

The mother—our mother—must climb through snow and take the bus to the hospital where her milk feeds other babies—not you—who are small and fragile and ill. She has pumped this milk with a machine, but her milk is not for your tender stomach, your sick baby body. Our father gives her money every week, bills she breaks into coins and carries in the pocket of her winter coat, a wool knit, bought at The Bay by our father for a birthday or an anniversary or an occasion where money could be spent. Our father is careful with money, the groceries always kept in check and clothing kept minimal and simple. How much does it cost to ride the bus each day for two months, morning and evening, arms circled around bags filled with bottles of milk that aren’t for your baby? How much is bus fare in Calgary in 1982? How much does it cost to do that—to come home from the hospital without a baby and then to ride the bus each day with bottles of your own milk? How much to ride down streets that were already empty, but are now forlorn, flatter than flat? Does it cost too much? How did she withstand it—the coming home with empty arms, the riding on the bus?

When she pumps milk, the sound is like a lizard coughing and she thinks of her mother standing by the low wall of their house in Old Dhaka, reading news of this baby boy on a yellow telegram card and smiling in the low yellow light. Our mother thinks of how her mother birthed a baby who slipped from her womb, slim and blue. She thinks of how her mother got up from bed the next day to move through the house and the kitchen and the garden, her hands still full of her other children. She thinks of when her mother had another baby boy and how this time he lived for two weeks. Two weeks of fingers curled tight and then he was gone. She thinks she knows how her mother moved in those days, like a woman in fog, with limbs tight and taut, something slowly fading.

They must pulverize the clot. They must keep the baby alive with intravenous lines that burst the thread-like veins in his arms and legs. His veins are like slivers and they are pricked so much that they swell up purple and blue. The nurses tell her that her baby is strong, that he kicks and punches and heaves when they try to go in with a needle, that two, three, four nurses hold him down, and they can all feel the fight like an angry fist tight in his belly. In the end, they shave the thick hair from his head and it drops to the white sheets in soft, silky thatches that she wishes she could have kept. She would have swept the hairs into an envelope made of yellow satin, the kind with a lace fringe and a snap-button closure that keeps her gold safe. They puncture her baby through the top of his head where his scalp rises to a point. She sweeps her finger over the soft stubble and whispers to him through the holes cut out in the sides of the incubator, holes for the faces and hands of doctors and nurses and mothers like her. Her baby’s body is a labyrinth of wires; she can slip her finger through and rest it on his shoulder. She can feel his soft, fine baby fur.

In two winter months, when his tiny body thrums with movement and colour, he goes home. It is March and the ground is still thick with snow and the air still snaps with cold. But, there is a new curve in the wind, something fluid and freckled with tonal colour. The mother steps out of the car with care and precision. She has dressed him in a blue knit cap and striped sweater and she can see his face through the gloss of the window. The trees reflect off the glass and she looks at him through the long black stripes of branches still heaving with snow. She looks at him and looks at him, her hands in fists in her pockets, her heart winding tight.


Exhibit A: The Kidney

[Medical records are unavailable, Calgary Grace Hospital, 1982]

The cause of the illness at birth is unknown. All paper records from Calgary Grace Hospital have been transferred to a different facility, were lost, or there may have been a fire.

There is the kidney, the mother, her baby.


2

Belly Rising

My mother lifts her head from prayer, the room gauzed in thatches of shadow and light, her face small and bright. This is a quality of her face, that light exudes from it, that her skin is flushed like the cheeks of a peach that I want to hold, my hands against her skin forever, on and on. I have confidence that I will never look old, that my face will never fall, because my mother’s face is supple and full and boisterous with something liquid and luminescent. This is why the welts beneath her eyes, these blackened ripples of skin that have developed and darkened over the past few months are patches I try to wipe away with my thumb. If she sits at breakfast, her orna wrapped loosely around her head, her toast crumbled in droplets of tea, I can see it, the pull of life, the deadened fog of it tugging her down. But she is always there with her tea and her toast, the morning clouding in, crumbs on her teeth as she bites into bread, as she blinks the morning in.

On this night, I stand outside her door and I tell her that I have eaten my meal, that I am full, that my belly is tight. It is almost midnight and I will wake at four to shower with an antimicrobial soap given to me by the hospital. It sits in a little plastic pharmacy bag on the bathroom counter and there is an instruction sheet folded inside. A total of two years of testing have ensured that my insides are shining, the bones and valves and blood all error free, the organs voluptuous and primed for service. My body must be pristine. My mother rises from her prayer mat, her face rumpling.


Exhibit B: Night

“Surgery Information.” Pre-Admission Facility: Patient Information.
St. Michael’s Hospital, 2012.


Why have I eaten such a big meal, so, so much? I have treated midnight like a deadline, cramming everything in. It occurs to me, as my mother brushes past me, scolding, that anything—a belly too full of food, a patch of unclean skin—anything, anything, anything could make everything go wrong.

I had imagined bowls of soup. The broth, light-filled and glossy, steaming in clear, shiny bowls that I hold with two hands. When I sip, the flavour is potent; it fills my mouth and clouds into my chest, everything muffled with warmth. In my mind, there are many bowls of soup, the broth orange, green, a deep fishy brown, and all of it hot, filling my belly to the top. I’m a body of diaphanous soup, my organs splashed and smothered with gossamer liquid, everything nourished and vibrant with shine. For this night, the night before I will go into surgery to have my kidney removed and placed in my brother’s body, I had imagined soup.

On my plate, I’ve piled brown rice, daal, vegetables, and chicken pulled from the bone. The plate is heavy and I am hungry and there is no soup that can sustain me; no soup that will be enough. It is 11:30 p.m. and I’ve waited too long to eat. Under the yellowed stovetop light, the plate is full and I balance it on my hand to feel its weight. At midnight, I’ll put my fork down, I’ll lick the water from the rim of my mug, and then I’ll lay down to sleep. There is urgency now; the food must go in. The hunger weaving in stitches through my stomach pulls tight, and if there is breath it tells me: eat now! Do it, before it’s too late.

It’s like eating shadows, engulfing forkfuls of substance that dissolve into viscous grey matter that for the rest of the week will harden into boulders in my belly.

I finish, scraping my fork across the plate, licking the daal off the tines, smashing the last pea. This daal should be bright, should be yellow like the sun and I want it to shock against my tongue, for the chicken to tingle, for the rice to form a cloud of softness in my mouth. But everything is muted, the flavours dull, the colours meshed in grey. It’s like eating shadows, engulfing forkfuls of substance that dissolve into viscous grey matter that for the rest of the week will harden into boulders in my belly. The morphine will glitz through my veins and cap my nerves in stickiness, the pinging of pain from the hole in my belly, from the torn webbing of fat and fibre, from the tiny tubes cauterized and stapled and set aside to dangle inside me, all snuffed. Here, the organs, the system, the management of my body stunned.

I am full and my belly is tight. My belly rising, I’ll sleep.


3.

Sibling

When you throw up on an empty stomach, bile the colour of egg yolk spurts from your gut into the sink and sticks against the gleam of the white ceramic. I enter the bathroom barefoot and sleepy and curse at what you’ve left behind. I drop handfuls of water over your phlegm and watch it disintegrate piece by piece, the tail of it swirling from the nucleus, gliding halfway down the drain. You are my brother. And so, if you dry heave every morning, the sounds erupting from a closed bathroom door, I am not wrenched with worry—I am annoyed that I must wake from sleep each morning to the sound of your stomach spiralling out of your body. I am your sister. So there are no gentle feelings that lap over my heart as I stand in the bathroom, in your leftover heat. I am angry that you leave remnants of your body behind in this bathroom—curls of hair, and globs of spit, and once, a bathtub full of vomit, the mass of it alarming. We are siblings and so we are a relationship defined by losses and gains. You will protect me from the boy at school who threatens me in art class; you will say hello to me in the hallways though you are popular and I am not; you will keep your mouth shut when you see me walking to the mall with a boy; you will give me your debit card when I lose my expensive sunscreen and am afraid to tell our mom; you will do all this and more and so, I will work through my rage alone in the bathroom, withstanding this bodily affront.

This retching is an echo from your infant brain. You retch every morning before school, the sound cracking through the house, and you don’t know it, but inside your body there is a shift, a slow, consistent application of death. The doctor is speaking, but your head is puffed and the sounds are cloudy and warm. You are 16 and your body is wired, your jaw a pulse. This is Sick Kids hospital; this is not a place for you, a young man with meaty calves and arms roped with throbbing veins. This is not a place for you, this place incubating the bodies of small children. Your body is grown, hair moving in soft spirals across your chest, powdering the top of your lip. This is not the place for you, but you are here because you are not yet 18 and so, you are still a child. The cost of this visit is a section of your pride, the slice of solid confidence that belongs only to the young. The cost is the understanding that your life is not impenetrable; it is as tender as a baby, as its tiny delicate limbs.

You are here because there is something that taps sustenance from your kidneys, your blood thickening with toxins, your urine bright with molecules of protein. It will tap, tap, tap, tap for 15 more years and then it will be done. The tap is consistent and measurable and when it is done, when your kidneys are done, when those succulent organs are shrunk with dead tissue, then it will be time. They will plant a new one inside you, a kidney so fresh, so plump, so vibrant with glistening energy, it will breathe your blood in a gurgling rush, hungry to do its job. An organ that breathes blood—can you believe it? The doctor makes this calculation, a projection, something better than a guess. In 15 years, you will need a new kidney. It will be unearthed from my belly and replanted in you.


Exhibit C: Sibbian

Photograph: Siblings, Calgary, Alberta, 1984.


4.

Consume

We have switched from beef to lamb, from white bread to whole grain, from white rice to brown. This is how a family maintains its health. The drawers in our fridge are filled with green leafy things, and we have an abundance of bananas, so many bananas. But now, when our parents go to the store, they must adjust their grocery list. There is your dietician and your book: bananas, cantaloupe, honeydew, kiwi, mangoes, oranges, orange juice, papaya, dried beans, pumpkins, potatoes, spinach (cooked), tomatoes (sauce and all), ice cream, yogurt, milk, butter, (anything dairy), chocolate, nuts, seeds, beef, chicken, salmon, shrimp, tuna: these are the foods that are high in potassium or protein and if you would like to prolong the life of your kidneys, if you want to avoid the desiccation of your kidneys too quick, too soon, you must pay attention. You must limit these good foods because your body cannot withstand their vigour: they have too much to give.

We can offer you an apple, some pineapple, grapes, peaches in the summer because that’s when they are best. Do you like eggplant? Cauliflower and beans? Those are things you can eat, in moderation. Some carrots and cabbage, too. But, if you want to eat whole grain bread because it is unprocessed and hearty, brown and good, you cannot. But, white bread! Fluffy, melting on our tongues—it has nothing in it but a conglomeration of magic molecules that taste good. You can have that. Our parents buy you a loaf each week and sometimes you eat it four slices at a time out of anger. Our mother adjusts her cooking—some green, but not too much. No daal, no tomatoes, a little bit of meat. Your lean body is changing, softening. For the preservation of your kidneys, you will eat less, or you will eat more of the things that we cut out. I sneak slices of your bread at night, standing alone in the kitchen bite after bite.

Look at this book, these pages with charts, with lists, with diagrams that articulate in pictures and words what a person is to do. A person who is concerned about the health of their kidneys, a person who is now in pursuit of preservation, of prolongation, of relieving their kidneys of a job they cannot do, will sit this book in their lap, will drag their finger across the text, will press their nose to the page so they can smell it, the solidity of this thing in their hands, this manual for accruing life through selective consumption, they will consume this thing with all their being, their fingernails lined with paper and ink, with this residue of life.


5.

Compensation

In 2010, a round trip ticket from Clarkson GO Station in Mississauga to Union Station in Toronto cost around $15.50. Over the course of two years, I travel from my home to St. Michael’s Hospital innumerable times, requisitions and checklists for rigorous testing folded carefully into my purse, my fingertips grazing the edges of the pages to make sure they are still there because they feel irreplaceable, like tickets to the most essential, pivotal events in my life. The tests are thorough, my body mapped for every possible infraction, every awaited test result a measure of my body’s worth. There’s urine collection—I carry a plastic container of my urine, collected over a 24-hour period, and pass it through a window to a woman who calls me up by a number. I’m 73 or 34 or something, something—it doesn’t matter, I don’t matter, no one in this waiting room matters—we are numbers that these two women behind the window must handle with brusque efficiency. So when I give her my giant container of urine, so meticulously collected, so carefully transported in a paper bag on the train where it sat on the seat next to me, my hand on the lid—the moment is anticlimactic and over so quick. I want her to understand the importance of this sample. I want her to hold it in her hands and look me in the eyes, her face solemn. I want her to set it down with a knowing nod, and maybe pat it. That would tell me that she understood, that she knew. When my EKG comes back with some abnormalities and I am sent to get a stress test, I begin working out in my basement, determined to walk the hospital treadmill with smooth, calm, efficiency, my heart vital and alive and perfect. When they send me home with a 24-hour blood pressure monitor, I am wary of my love of salt and I wonder if that will be what ruins this, what ruins me. There’s a CT scan to check the structure of my kidneys, a chest x-ray to study my lungs, and a renal nuclear scan to assess the function of my kidneys in precise detail.

I use each successful test result as a marker of the pristine state of my body: I have done nothing in my life—no rowdy sexual affairs, no drugs, no alcohol, not even a cigarette. My body is untouched and ready: it was made for this. I want to save all these papers and keep a track record of everything collected from my body, all these morsels, these vials of blood, these containers of urine, these electro-magnetic measurements of reverberations that echo out from my organs—my heart, my lungs, my kidneys, my liver, my brain—and I want to gather them all up, those carbon copy pages with numbers and lines and symbols I do not understand and I want to lay my hand on top of them, feel the thickness of the pages under my palm and know that they exist, that they measured something, that they calculated my existence and assigned it a number and that that number was scanned by a doctor who said, yes, yes, she’s okay. She’s pristine—her body is pristine—her body is perfect for this—her body was made for this—it was made for this.

How much does a story cost?

Lillian, the RN in charge of coordinating my work-up, asks me if there are any claims for compensation I need to make—money spent on transportation or lodging while I’ve undergone testing. I think about my train fares and how I’ve declined work for the summer so that I can devote myself to writing, to this. This is donating my kidney, yes. But it is also a deep, vacant desire to do the thing that promises me purpose. I want to be a full participant in this process; I don’t want to give up a thing. I pay my ticket fares and I don’t worry about not having a paycheque during the summer—I live with my parents, work awaits me in the fall, I’ve saved money, I don’t need money, I don’t need a thing.

How much does a story cost? You can tally up my family’s parking fees at the hospital, the money spent on gas, my train tickets, the sandwiches and the tea and the shawarma plates my father purchased to feed bellies turned in and in again from waiting, the pyjamas I bought on clearance the night before the surgery because I wanted something new, something soft, something pretty to comfort the quiet urgency that wound itself up in pebbles in my chest. You can check receipts and tally up these personal costs, track how all these tiny things accrue into a number you can verify with precision.

You can stand in the hospital corridor and look around—at the machines beeping out blots of incremental life, at the nurses checking charts and the contents of toilets, at the rooms with beds and trays and blankets and pillows and clean sheets, at the IVs running into our bodies and the catheters running out, at the architecture of a hospital and all the people that inhabit it and you can count, to the penny, what it costs to keep a renal floor running, to revive collapsing bodies with precision diets, with machines that do the jobs of meticulous organs, with organs from other bodies, live ones and dead ones, tragedy lurking along the edges of light. There’s a number for that.

You can count hours. You can count the hours I took off work, willingly, hungrily, aching for time away from the tedium of my own life, the blankness of it, a desire for accumulation—fill me up, please, please—driving me forward with relentless focus. You can count the hours it took to fill out benefit forms for my brother so that he could access funds to purchase the anti-rejection drugs that would prevent his body from dismantling this new being in it, drugs that could only be accessed through the approval of this application mandated by the government before the surgery could take place—no benefit, no surgery. No surgery? What do you mean, no surgery?

You can count the number of minutes I spent from my pay-as-you-go cell to make a call from a waiting room, my mind exploding as we finished our final blood test—a cross match test to confirm that we’re a fine match, that things were practically perfect, that all was a-go, green lights blinking all the way to the operating room—because my brother told me that he didn’t know if his benefit application had been approved. They had promised to let him know, but he didn’t know, he didn’t know, he didn’t know.

You can tally up the cost of those drugs, the amount of money required to suppress a person’s immune system, to keep it quietly asleep so you can keep that person alive. You can try to quantify the number of phone calls I made to the outsourced staff of the Ontario Drug Benefit program on a Friday, surgery scheduled for that Tuesday, my mind ravenous for certainty: tell me now that the application has been approved, that you’ve done your job, that you won’t delay this because of a bureaucratic oversight, that you’ll give me what I need, that you’ll stop telling me you don’t have it, the power, the ability, the motivation to do what is required to ensure that this happens, because my God, lady on the phone, I need this to happen.

… no, don’t even try to quantify it, don’t even try to repay it, don’t even try. The only thing this transaction demands is that you live. You must live.

You can count and quantify and the numbers will mean something, the dollar amount will tell you what it takes to donate a kidney with finite accuracy. This is the comfort of numbers, of transferring coins and bills from one hand to another. This is what it costs, this is what I owe, this is the beginning of our transaction and this is the end. Here, you need a kidney? Here, take my kidney. In this country, no money will ever exchange our hands, no monetary value can ever be placed on this thing they call the gift of life—no, don’t even try to quantify it, don’t even try to repay it, don’t even try. The only thing this transaction demands is that you live. You must live. The one outcome I will not fathom, the outcome for which I have no collateral, is if the transaction fails. If your body rejects the deposit, then where does my kidney go? What do they do with it then? Can I keep it? Can I tend to it? Can I curl up with it in my bed and hold it? Let it sop into my pillow where I can tuck it under my chin and keep my flesh against my flesh, feel the last impressions of warmth lift from its slick body and release into my small room, into the heat of every childhood want and worry, to stay there like I stay there, immovable, cocooned, warm, safe.

I will give you my kidney and you will take your medication and you will have more children and you will raise them with your wife and you will live for years—just years and years and years and years—and that is the end of our transaction. The end. That’s how it should go.


Exhibit D: What an incredible thing


6.

Yes

In the PATH, the underground mall connecting Union Station to the city centre, I meet my father at a Japanese restaurant. We sit sipping from bowls of miso soup and I spin the white chunks of tofu around the muddy broth, my fingertips electrified. I have just met with my surgeon and a medical student for my final appointment before the surgery. The student is seated and in scrubs, a fog of sleep so heavy it acts like deadweight, her eyes struggling to stay open. Has she seen a thousand of these? Yes, she’s sat through so many of these appointments that it’s regular, nothing monumental, another thing she has to learn. She wants it to be over, another task checked off her list so she can go home and slide under her sheets, fall face first into her pillow and sleep, her brain a blank. The appointment is a run-down of the logistics, a laparoscopic surgery—an entry of a camera through one incision in my torso, tools through another incision just below it. A larger incision in my lower abdomen to pull my kidney out, a slice right along the bikini line, so that if I were the kind of gleaming girl who wore a bikini, the scar would be inconsequential, slim, a nice fine line effortlessly disguised. They have chosen to extract my left kidney because it is easier to reach and because the right kidney would require an open surgery, an impressive slash down my torso, an excavation below the liver, staples to cinch me shut, and a long recovery. My recovery will be a short stay in the hospital, maybe three or four days, and then I will go home a little lighter, the management of this new arrangement of organs, this vacancy, entrusted to my body, my volcanized brain.

My father, who had taken the afternoon off so he could join me at this final appointment, has missed the meeting—it was over and done before I could call his office from the waiting room and ask him to walk the few blocks to the hospital. The relief I feel is tinged with guilt. He was eager to attend, had a list of questions he wanted to ask. The process is too far along and everything is set—I should not be afraid. Still, I worry about the kinds of questions he would ask; I worry about my father’s doubts infiltrating the appointment, his questions opening up voids in this meticulous tapestry I’ve spent the last two years weaving. This is a story that must continue without interruption or fault. What would he ask? What response would make him falter? What question could possibly make the surgeon pause? Would the appointment end with my surgeon making a note to contact my team of medical professionals, to alert my social worker, and with one flick of his pen unravel it all? This girl isn’t ready—her family can’t sustain this kind of event. Put the surgery on hold; this isn’t good for her, this isn’t good for anyone. And then? And then what would I do? What would I have left?

Information was my currency; I used it to delegitimize every argument from every well-meaning, well-intentioned, ill-informed person who wanted to keep me safe, wanted to keep me still, wanted to keep things within a sphere of familiarity and comfort because that was where nothing changed.

Two years prior to our surgery, when my brother received the test results that told him his kidneys were functioning below 10% and that he should either get a fistula in his arm to begin dialysis or find a donor, I sat with my father in the Walmart parking lot by our home and told him that despite his reservations, I would begin the testing process, that I wanted to be my brother’s donor, that this was the right thing to do and that I was going to do it. I spoke gently, reassuringly, but with precision. I had an answer for every question: was it safe? Why now? What about dialysis? My output was more than his input. I had studied this possibility from the moment my brother received his diagnosis when we were teens. I had pored over the hospital pamphlets, had read and accumulated information like a commodity. Information was my currency; I used it to delegitimize every argument from every well-meaning, well-intentioned, ill-informed person who wanted to keep me safe, wanted to keep me still, wanted to keep things within a sphere of familiarity and comfort because that was where nothing changed. When there was no change, there was control. There was only safety, a fortress against calamity. Siblings are the best chance, I told him, the best, best, best chance at a successful, long lasting match. I told him that dialysis was no easy option, that the longer the body is on dialysis, the more difficult it is for the transplant to succeed. The donor list was an indefensible option when I was healthy, I was available, I was ready. A cadaver kidney would not last as long as a kidney from a live donor, a kidney from me. I pulled up all the facts I had held in reserve and I told my father outside the blaring blue of a Walmart sign that this was the only way, the only option. He sat and looked at the steering wheel and said softly, very softly:

“I don’t have five children.”

He has two children—my brother and me. And so it became a question of economics. How many children do you have to spare? What do you do if both are in the hospital, their stomachs open to the light?

You hold on to what you know for as long as you can. And what you know is this: your son is sick. Your son will die. Do you know this? Do you know that your son will die? Your son will die. Your daughter, young, unmarried, inexperienced, and obstinate will slide into the operating room where they will open her up and what does that mean? Are you afraid of what it will do to her, this rearrangement of organs? Are you afraid that this extraction will create a hole inside her that can never be filled, that will ruin her? What will that vacancy do? Will it swallow her up? Will it take her away? Will it deplete her inch by inch, the way it did to your son, his kidneys throttled at birth, blood clots from nowhere that set his world spinning from the start?

You hope for a miracle. What will save the life of one child without dismantling the sphere of safety for the other? What will it cost for you to place your trust in something you do not understand? What would it take for you to embrace this curve around death, the meatiness of it, its weight—fleshy and heavy and burdensome?

My assigned social worker tells me stories to make me feel less alone, to make me understand how a successful transplant is not just a physical arrangement of blood cells and organs, how it is the careful management of many hearts, many minds. But please, do not tell me stories of family members showing up at the hospital on surgery day in protest, arms splayed open in the hallway, hospital staff in crisis mode. Here is a person who, for whatever reason—there are so many reasons—wants to stop this movement of an organ from one body to another. No, no, they must say, desperate, entitled, obstinate, heart bursting. No, no, no.

But I say, yes. I said yes at 14, flipping through the information booklet that came home with my brother from the hospital. I said yes at 26 and went through my first round of testing, my brother unsure, reluctant, resistant to a surgery that would have him on anti-rejection drugs for the rest of his life. I said yes even as he withdrew from the process and pursued a last, desperate, holistic cure through a naturopath. I said yes again at 27 and went through a second round of testing when my brother told me over saffron chicken at our favourite restaurant, that yes, he needed a transplant, that yes, there was nothing else left to do. I said yes as we spent the fall months watching his body vacate itself, weight dropping in chunks, his body slowly shutting itself down.
I said yes a few days after my 28th birthday, rising from morning prayers in a jolt of panic, my sister-in-law telling me calmly over the phone that my brother had collapsed, that she had called the ambulance, that my two-year-old nephew was with her, startled, quiet, eyes wide. I said yes as my mother cried, tossing aside blankets in the dark, my voice urging her to get up, she and my father must get up and get in the car and we must go, we must go, now, please, now. I said yes, yes, yes, as I drove my parents through rain-soaked morning traffic to my brother’s basement apartment, my father saying quietly from the back that I must be careful, that it wasn’t worth getting into an accident, not when we were on our way to confront a calamity—that one disaster was enough, just one, let’s keep it to one.

I said yes while waiting at the hospital for the inevitable, emergency surgery to put a fistula through his chest to get him on dialysis, to get him stable, to keep him alive until, until, until…

I said yes as I kissed my nephew’s small hand and left for work later that morning, as I rocked him to sleep that night, as I looked at the smallness of his limbs, at the shape of his head, at the tiny square that was his chest. How did this small body, this tiny heart withstand such pangs, such reverberations of panic and grief, how did it sustain the tension of a collective breath never exhaled in relief?

Over miso soup, in a restaurant my father picked because it was clean and classy and because he knew I liked sushi, I told my father, yes. Yes, on Tuesday, June 19, 2012, I would donate my kidney to my brother.


Exhibit E: A Note from the Curator

I was going to do it.
I was going to do it.
I was going to do it.
I would do it.
I would.
I


Exhibit F. Serology

Crossmatch: Before you and your intended recipient are considered a match, you must undergo HLA Testing. You each have antigens you’ve inherited from your parents. They are proteins that protect the very foundation of who you are; these proteins can tell you are you. When something is not you and it enters your system, your antigens will attack. They will protect you. They will preserve you. That’s their job. There are six antigens—two each of A, B, and DR antigens—that are important in organ transplants. When the doctors perform HLA matching, they identify these six antigens in your body and determine how many you have in common with your intended recipient. The more you have in common, the more familiar your organ will be to a foreign body, and thus, more likely it will be accepted as its own. It is possible to perform a successful transplant even if you are not a perfect match. You could score 3 out of 6 and with immunosuppressant drugs, still do very well. If you score less than 2, a better match is desired, and if you score the beauty of a 6 out of 6, then please step forward, this is the dream. You are an identical twin. Or you are me and my brother and you are a perfect match.

Curator’s Note: The tests, they all came back and told me the same thing: I was made for this.




II


Summary

[Text reads: Ms. Khan is a 28-year-old female who volunteered to donate her left kidney to her brother who has end-stage renal disease secondary to proteinuric glomerulonephropathy. She was cleared medically to donate and underwent a CT-angio renal donor protocol to evaluate her anatomy. This showed evidence of a single left renal artery with branching approximately 2 cm from its origin and a single anterior renal vein. There was evidence of at least two lumbar veins which appeared to be communicating. Review of her CT scan at our renal donor rounds confirmed that she was suitable for a left laparoscopic donor nephrectomy.]

Keywords: volunteered to donate[1]; appeared to be communicating[2]; confirmed that she was suitable[3], cleared medically[4]; evaluate her anatomy[5]


1 volunteered to donate

I am on the operating table and the anesthesiologist has blue, blue eyes. They are large and clear and he is kind. Whatever they drip into my veins burns like it’s tearing through my skin. The burn is a rush through my arms and I wonder how long it will go on, how much I can withstand. This fire is the last thing I feel before I am asleep.

But shouldn’t the last thing I feel before sinking into a dead-heavy sleep be like succour, like honey, like breaths of light flowing in clean lines into my body? The story I made in my mind told me that this moment should be one of beauty and light; the last thing I remember before the blank should not be the burn, it should never be the burn.

When I wake, I want grapes, I want explosions of bright water in my mouth. I will die if I don’t have it, this rush of water down my throat to fill me up, to douse the inside of my body with light-flecked liquid, never-ending. I tell the recovery nurse I am sorry—my breath must be foul, it feels foul, like something is dry and dead—but, please, please, could I have water? I am given ice chips that dampen my tongue and I ask again and again and again for more, more, more. I could drink litres of water, just tip a bottle between my lips and let it pour into me forever. My mouth is full of ice chips that melt in trickles down my throat and I am thinking only of the next mouthful, the next hit of chips when my parents come in to see me. My mother’s face is one of wonder, of softness, of wilting edges. My father’s is of sadness and fear. My surgery has ended and my brother’s has just begun. I don’t realize until later, when I am out of recovery and assigned a room, that my face is bloated and lopsided. I take a selfie to see the shape of my face and realize that I look like I have been beaten. My lips are swollen, my eyes bruised, the right side of my face is inflated and misshapen. I try to convince my night nurse, Greg, that this is not my face, this is not what I usually look like—Greg, listen to me, this face is not completely mine.

As they wheeled me from recovery to my room, my friend Anika stood at my bedside in a floral printed dress—pink and blue petals, maybe violet—streaking across black cotton. I tell her it’s beautiful, that she looks beautiful; she is lovely in that dress, in a floral printed dress in the middle of June. I tell my nurse Beth that her smile is beautiful; it’s placid and peaceful and I know that Beth was destined for this vocation. She could either be an elementary school teacher or a nurse and nothing else; her raspberry-hued smile, the soft gleam of those lips, they are for consolation and comfort, for all things pleasing. Beth jokes that I am full of compliments and I want to tell her no, no, no, it’s all true, everything I say is true. Beth, listen. I am not handing out compliments like loose change. I am giving them to you and you and you like petals in a basket, like innumerable splashes of velvet colour handed to you from palm to palm, like a small animal you must hold to your heart.

I am on morphine, but there is no high. The drug overwhelms my nerves and a migraine clenches the base of my neck, my head whirling through black skies full of spinning stars. My brother is fine, they tell me. He is in recovery. He is doing well. My kidney—his new kidney—is nestled inside him now, plump and pumping. My family visits me every day, my nephew in his stroller, his little body constantly in transit—from home to car to hospital, from room to room, from arm to arm— and I want to touch him, to tell him I am still here. My friends gather at my bedside every evening and I am hungry for their company, for someone to be by my side as I try to grasp the faltering state of my own body. I am dry heaving every few minutes, spitting out wads of clear phlegm into a cardboard tray and trying to grasp the arm of my nurse to tell her to please, please, please make it stop. There are two words that come to my lips over and over again: SubhanAllah and Sorry.

I am at once lost in the feeling of my body trying, trying, trying to retrieve itself, lost in the desperate yearning to escape that feeling.

I say SubhanAllah. I only know that this phrase is soft and it leaves my lips like a breath. I exhale it when I am reverberating with nausea, when I am doubled over breathless—God is Perfect, God is free from imperfection, Glory be to God—it is all this at once and it is the sound that moves me like stitches from moment to moment to moment. I am at once lost in the feeling of my body trying, trying, trying to retrieve itself, lost in the desperate yearning to escape that feeling. This is trying physically manifested in my body and it is a feeling I cannot endure, not like this, not for long. And so, SubhanAllah becomes a point of focus, of submission. I cannot do this, not forever, not for a second longer, my God, please.

Sorry, I say. Sorry I’m doing this to you, I tell my friends. Sorry I’m making this so hard. Sorry I’m here like this, in inexplicable pain. Sorry I cannot overcome this, cannot rise from it in grace and be in your presence in peace. Sorry my body is fragmenting from the inside; sorry there is an entire ocean on my back; sorry I cannot be the girl in the story, the one who rises like an angel from her bed, the one who bears the pain in silence, with pleasing smiles, with altruistic glory. Her face is luminescent and everyone loves her. She is the one people want. She is the story that we want to tell, that we want to hold and keep. She is grounded in strength, she is not an encumbrance on your time, on your empathy; she does not take up space.

I’m sorry.

After two days, when my morphine-induced migraine has torn my head from my body, the doctor on-call switches me to a new drug and SubhanAllah, my brain descends from the cyclones of space back into my body and I am still.

It is more difficult to be the observer, the one at the bedside who is witness to the suffering and can do nothing but hold your hand, clasp your chin, draw you to their soft chests and say, I love you. I love you so much. They can bring you an egg salad sandwich from the vending machine in the hospital lobby at 11:00 p.m. and watch you eat it—a glorious sandwich, the eggs creamy, the bread soft—and they can feel comfort in that. You are eating, you are falling asleep. This is good, this is what they need, they need to see you getting well.

But, I cannot stop crying. I cry when my mother and father visit, their hands on my hands, their faces in the morning light. I cry as my sister-in-law grasps me and tells me to try not to cry, that my mother goes home in tears and is inconsolable on our living room couch, the summer light flooding in. I cry as I sink into a wheelchair and a hospital assistant hurtles me down maze-like corridors for a lung x-ray, every curve, every bump, every movement unstitching my body from the inside, tears falling and falling, sobs becoming how I breathe. The x-ray technician crouches next to me and I know she means to say it with compassion, but I am attuned to every frequency and it is exasperation that lines her words when she asks with a sigh:

“Why are you crying?”

There are doctors who specialize in pain who are sent to my bedside. I have been asked to lift myself from bed, to lower myself onto my feet, to grab the pole that feeds me my IV and carries my catheter bag, to try walking. I am seated on a chair after rising for the first time and my body, all it knows how to do is cry. One of the Practical Nurses rubs lotion on my back, her fingers gliding up and down its plane, and I swear that I love this woman, that I love her for doing this. The doctor leans down and she asks me like I should know the answer—why, why am I crying? The answer I give is the same: I am crying because I feel awful. I feel awful. I feel awful. The awful is consistent and foundational; it does not move. I feel awful. I am awful. My surgeon visits me and I ask him, “Dr. Honey, why is it like this? Why do I feel so awful?” His answer is simple and direct: “Well,” he says, “you’ve had a very large operation.”


2 appeared to be communicating

When they take your kidney out, they hand it over to the waiting transplant physician who prepares it for its new body. Then, they sew up your incisions with invisible, dissolvable thread and they send you into recovery. The anesthesiologist stays with you, ensures that all things are normal, and then you are sent to your room. You reside in this room for 3–6 days and when you reach the end of that time, when you’ve practiced walking and have regained some strength, are no longer nauseous and dizzy, when you can walk a straight line without wobbling, when you have no fever and your incisions are healing nicely beneath their dressings, they send you home.

At home, I will sleep for days. I’ll read The Hunger Games. I’ll take short car trips with friends and return home exhausted. I’ll try not to pick up my nephew, I’ll drink lots of water, and I’ll rest. I’ll rest for weeks under my covers and I’ll let the summer pass in a quiet fog, cocooned in the blue shadows of my warm room where I have lived since I was three.

In that time, there is no intervention. There is no medical procedure to jolt my body into functioning correctly, to compensate for the loss of a major organ. They sew me up, I go home, and my body adapts to this new circumstance: Something is missing; something is missing; something is missing; compensate, compensate, compensate.

Alone in my hospital room, I feel sorry for my body. How must if feel for it to wake to this kind of horror—something just gone? The system is compromised; the system is in deficit. Something is missing; where did it go?

On my third day in the hospital, I open my eyes and my brother is at my bedside, his hand resting on the pole that carries a bag of his urine.

Thank you, he says.

It is just urine, but it is golden and it is bright and it is rushing from his body into this bag. It is his kidney expelling the toxins from his body; it’s his kidney doing its job. It’s a good kidney. It was mine.

Thank you, he says again. The bag fills and I’ve coloured his urine in my memory as a golden liquid that is brilliant with light. He is bent over in the chair. He looks at me, eyes intent.

There is life rushing into his body and I hope what the nurses said was true—that when the patient’s new kidney begins working, they feel a rush of energy that spreads through their body and it’s like breathing for the first time.

Thank you, he says again. I know he wants me to hear him.

But, I want the story of life breathing into your limbs. I want the story that ends with triumphant life. That story. That one.

What is it like for a newborn, when it opens its mouth and inhales, its tiny lungs filling with earthly air for the first time? What does that feel like? Maybe a kidney rushing blood, expelling toxins, the molecules sparking silver in the bloodstream felt like that, like a baby and its first breath—that’s the story I want. So yes, maybe you are angry and resentful from the bowls of pills you must take, maybe you are in pain, the staples in your side boring into your gut, maybe your head is a fog and you are deeply depressed. There is a new kidney in your body, but maybe you are still angry that all this had to happen at all. Maybe that anger stiffens your limbs and you can hardly look a doctor in the face without rage and resentment locking hands. But, I want the story of life breathing into your limbs. I want the story that ends with triumphant life. That story. That one. So yes, yes, yes—maybe a new organ felt like that. Maybe it felt like life.


3 confirmed that she was suitable

In my room at home, sitting on the edge of my bed, my mother feeds me by hand. She holds a plateful of food that she has cooked; it’s her daal, her rice, her chicken. I am hungry. For the first time in a week, I want more. My body knows that it is home and my senses have released themselves; they are no longer on high alert, electrified. My mother sweeps her fingers across the plate, the daal sopping into the rice. She tips rounds of it into my mouth, her fingers efficient, just clipping my lips. Her hands don’t linger; she is economical with her touch. She feeds me and I eat. This is the simplest thing; there is a need and she fulfills it. She feeds me and I eat and eat and eat.

I am in bed, awash in blue light that glows in from the window, my cerulean blue curtains tinting my room into an ocean. I read, watch movies, and text my friends through these summer weeks. I do not write. I make plans to visit my cousin in California. I will write there, in the heaviness of Los Angeles heat, walking through neighbourhoods lush with sun and thick leaves, on and on over sidewalks and cigarettes, an evening in a Brazilian restaurant that will serve me a whole fried fish, its eye looking up at me shiny and crisp. When the summer lay before me, I had a goal. It was clear; it appeared in my mind with sharp lines of colour. I did what I intended to do. I had given my brother my kidney. The rest of it was always a mist.

What was I if I couldn’t give? What was I without this story?

There is a dark moon-curve in my chest and I lie with it for days and days and then weeks and weeks. I tell my friend that it is too dark and I do not like it here. The here is in me. She tells me I should consider counselling and I only hear that I am too much for her, that I am too dark, that I am pushing her down, that she needs to breathe and so I should go, go, go with my darkness and my breath caught in my chest and I should go away, I should be away. I gave my brother a kidney. That’s what happened. I gave it to him. But I am still here and my world has not changed and I have not risen from the blank stillness of my own life with some unparalleled wisdom. I have not gained a profound sense of self that will drive me to unwind my body from the blanket wrapped around my ankles and my waist, that will make me get up and shower for the first time in two weeks, that will make me step outside and greet the day with my fist to the sky. A kidney should do this. Couldn’t it do this? It could, it could. Surely, it was the missing plot point in my life; it was the only thing that could make my life worth the space it took to live it. What was I if I couldn’t give? What was I without this story? I wanted this story. This one. My brother needed a kidney. I gave him one.


4 cleared medically

At my six-week check-up, my nephrologist is pleased with my test results. My kidney function is not what it was before the surgery, but that was never expected. But, it was good enough. It was better than good enough. My surgery was practically imperceptible.

“No one would know the difference,” he says, spitting numbers. “If someone looked at these test results, they wouldn’t know that you’ve only got one kidney.” I am happy for my mother who sits in the doctor’s office with me. I am relieved that the kidney left behind, the one still nestled tight behind my liver, has plumped and grown so it can compensate for its missing mate. I am glad it is doing such a good job. I want to place my hand on my back and warm it from the outside. I should be kinder to it; my mind is always thinking of the other one, the one that left, the one everyone has their hopes on.


5 evaluate her anatomy

My scars are fine, silver-white lines that look like stretch marks. Maybe someday they will look like threads, like barely-there scratches on my skin. I wish they were dark scars that slashed across my flesh like paint streaks. I want them to be deep, immovable marks that distort my body. I want this fragmentation of my flesh to bear witness: I was needed I was wanted I was useful.

I want you to know that I came into this world with a little organ that was destined to reside in the belly of my brother. They snipped it out of me and they placed it in him. It’s been done thousands of times to thousands of bodies. Maybe millions, all over the world. So many bodies opened and closed and sent home weary. Some bodies holding organs harvested and paid for, no big deal. Give your kidney, sell your kidney—it’s all easy, it’s all been done. Prolong your life with money or with good deeds, it doesn’t matter. What matters is that it can be done. I want my body to obstruct any understanding of this event as ordinary. The removal of an organ from one body and its placement in another, a body that grasps it and pumps it into something that functions again—this, no matter how many times it is done, can never be ordinary.

The scars shine, and my body ripples beneath them. I want my body to say every day that this happened. I want it to tell me: don’t forget, don’t you forget that this happened. But, at a glance, the scars are like the other lines on my body that indicate movements of fat and muscle, of skin stretched and released, of the body always shifting to accommodate the way I move through the world. Be extraordinary, I tell the lines when I pull my skin up to look at them. When they flash in the mirror before a shower, they are smooth, barely there. Come back, I want to say. Tell me that something happened, that I was in it. Tell me that I matter.


An Uncomplicated Left Laparoscopic Donor Nephrectomy

[Text reads: Ms. Khan underwent an uncomplicated left laparoscopic donor nephrectomy on June 19. She was stably transferred to the general urological floor where she convalesced without complication. She was febrile on POD2 but cultures were negative. Prophylactic ceftriaxone and ampicillin were discontinued. She was discharged home on POD5]

Curator’s Note: You! Understand this: this is no triumphant end, the music will not swell, the credits do not roll. You’re here, you’re here, you’re here, you’re here, you’re here. It is extraordinary and it is dark. It is rudimentary life marked with sharp lines of light.



Shoilee Khan’s fiction appears in the short story collection The Unpublished City (Book*hug, 2017). In 2017, she was longlisted for the CBC short fiction prize. Her work has also appeared in a diverse collection of magazines and journals, including Adbusters, Room Magazine, The New Quarterly, and Other Voices. She serves as a member of the Planning Committee for the Festival of Literary Diversity as well as the Creative Editor for Sister Fit. She studies disaster writing and is currently a doctoral student in English Literature at York University.

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