“I know, Mom. Dr. Anderson said all that stuff, but he’s not the one who has to take it.”
John moved next to Trisha. “What happens now? What does skipping his meds do to his transplant?”
“The doctor put Tommy on the immune suppressor to ready him for transplant. The chance of rejection would have been much lower if . . .”
“Will he still get the transplant? Where did the donated organ come from?” John said.
“John, don’t,” Melissa said.
Trisha crossed her arms and pinned the clipboard to her chest. “I don’t know. That will be the doctor’s call.” After an awkward pause, she continued, “Let’s proceed as if we are moving forward.” Trisha uncrossed her arms and held out a hand to Tommy. “Time to get you checked in.”
Tommy shut down his video game, stuffed it in his backpack, and hopped off the sofa. He took Trisha’s hand and followed her lead through the doors that led out of the lobby.
John gripped his son’s other hand as they navigated through a warren of sterile medical offices and patient rooms. Agonizing months of scans, blood tests, and biopsies ensured Tommy knew more about life and death than the average kid. The nine-year-old’s pale skin, thin limbs, and dark circles under his eyes concealed a strength that outweighed most grown men. A doctor was going to slice him open, tear out a diseased clump of flesh, toss someone’s leftover kidney inside, and sew him closed. To a nine-year-old, that should be the plot in a horror movie. Yet the boy moved on, only pausing to hitch up his pants, which had become too large for his withered body.
They turned down a corridor, painted a calming light blue but highlighted by anxiety-inducing signs with terse warnings about transmission of diseases to immune-compromised patients. At the far end, two scrub-clad nurses waited on either side of a doorway. Darla and Laura were Tommy’s favorite nurses, and they welcomed him with practiced smiles. Their eyes betrayed something less benign.
Tommy followed Nurse Darla inside, and the second nurse stepped in behind, blocking the door. “I need a moment of your time while Darla gets Tommy comfortable,” Laura said.
She guided John and Melissa to a small sofa in the corner of a bland waiting room within eyeshot of Tommy’s room. Melissa sat so she could watch the room for any sign that called for a mom’s immediate presence.
“I know you’ve completed all the preadmission paperwork, but I need to be sure that everything is up to date,” Laura said. She ticked off names, addresses, phone numbers, and dates of birth to verify each of them, barely waiting for a response. Her voice held a steady tone as she asked, “Do you have an advance directive in place?”
If John wasn’t sitting, the wave of fear that washed over him threatened to drop him to the floor. He heard his heart thump against his ribs, and he opened his mouth but couldn’t form any words.
Laura filled in the silence. “We need to make certain that we follow your wishes, should the need arise.”
She held out a small sheaf of forms. Bold letters on the visible pages outlined what happens when a patient is listed as DNR, do not resuscitate, and what procedures are considered extraordinary medical intervention to continue life.
No parent should have to make that decision. John couldn’t take the documents from Laura that would end his son’s life. Melissa grabbed them, tore them into small bits, and let them fall to the carpet. Not another word was exchanged, but the message was clear—we are not giving up on our son, not now, not ever.
Melissa’s glare broke when a curtain shifted in Tommy’s room. Tommy sat propped up in bed, his attention funneled into his video game. He’d changed into a pair of pajamas and was taking another hospital stay in stride.
Darla finished taking the boy’s blood pressure and folded up the cuff, tucking it away on a bedside tray. She motioned to John and Melissa. “The doctor will be in shortly,” Darla said as they passed in the hallway.
“How you doing, Tommy?” John asked.
The boy shrugged. “Fine, I guess.”
“Can I get you anything?” Melissa said.
“No.”
“Hi, Tommy,” Dr. Anderson said as he breezed into the room, his white coat flapping behind him.
“Hi,” Tommy said without looking away from his game.
“Well, you have a big day ahead of you. You all ready for it?”
“I guess so.” Tommy shrugged.
“You a little scared?” the doctor said, talking to Tommy and not his parents.
“A little.” Buttons clicked away on the game console.
“That’s normal. What are you afraid of?”
Tommy paused the game and finally made eye contact with the doctor. “What happens if this doesn’t work?”
“No reason to think that it won’t work. We have a transplantable kidney on the way. It has been matched to your tissue type, and as long as you agree to take your antirejection medications”—the doctor winked—“you should do fine.”
“I will. I promise,” Tommy said with a quick glance at his mother.
Dr. Anderson turned to John and Melissa. “We’ll draw some blood work to make sure there are no infections or anything that would get in our way. Skipping the Tacrolimus wasn’t the best thing, but we can adjust the dosage after the surgery.”
Melissa stood at Tommy’s bedside. John took the doctor by the elbow and led him to the far side of the room, away from his family.
“Tacrolimus is an antirejection med, right?” John asked in a low voice.
“An immunosuppression medication. We started Tommy on it to get his system ready for the transplant.”
“Any other reason to give a patient that drug?”
“I’m not sure what you’re getting at.”
John rubbed the back of his neck. The bag of spilled medications when he brought the Cardozo girl and her mother to the hospital burned again in his memory. “Cielo Cardozo, is she a patient of yours?”
Dr. Anderson lowered his tablet computer, not expecting the question. “Mr. Penley, I cannot comment on another patient.”
“You just did. She is your patient then? Her mother told us she had cancer.”
“I can’t get into her treatment with you, just as I wouldn’t divulge Tommy’s treatment to anyone else.”
“Okay, hypothetically, if the girl had cancer, would a transplant treat it?”
“Many cancers include transplant as part of the treatment regimen.”
“Where did the transplant come from? The UNOS wait list?”
“Well, yes, that’s where a transplant comes from, after it is typed and matched.”
The timing of Cielo Cardozo’s rush surgery after her father’s murder ate at John’s mind. He should have caught that connection. Especially after the killer left a kidney gift wrapped for Tommy. Maybe he left a gift for Cielo, too. “Was the tissue HIV tested?”
The doctor’s eyes narrowed. “Why would you believe it was HIV positive?”
“So she did have a transplant. Did you test it?”
The doctor let out a breath, angry with himself for divulging the little girl’s transplant. “No, all the matching is done before we receive the organ.”
Melissa joined the two men. “What’s going on? What’s wrong?”
“How long until Tommy heads into surgery?” John asked.
The doctor glanced at some notes on his tablet computer. “The organ is expected here anytime now, so we will have Tommy in the OR within an hour. I’d say we’ll have the anesthesiologist put him under in about twenty minutes from now.”
“That’s fast,” Melissa said.
“Yep. I’ll bet you’re all excited to finally be at this point.”
“We are,” she responded.
“How do you know the kidney is viable and ready for transplant when it’s not here yet?” John asked.
Melissa shot a disapproving look at her husband.
The killer had connections inside the system. How much more inside could you get than a transplant surgeon, especially one who had a ha
nd in the Gunderson boy’s recent organ rejection? “How many people verify the donated tissue is viable? How many other than you?”
Melissa grabbed her husband’s arm.
The doctor noticed her reaction. “No—no, that’s a good question. When the organ is harvested from the donor, the surgeon who obtains it, wherever that is, examines the tissue, obtains a tissue type, and enters that information into the system.”
“UNOS?” John said.
Dr. Anderson looked at John, paused, and said, “Yes. The system alerts our transplant team that a match is available, and here we are.”
“How does the kidney tissue get matched?” John said.
“Actually, the kidney itself isn’t matched. The tissue match is determined by blood test, the HLA mismatch pairings. The harvesting physician also removes lymphatic tissue, and those cells are used for cross-match samples.”
“Where did the donated kidney come from?” John asked.
“Come from?”
“Yeah. Who was the donor?”
“I’m not sure I know, offhand. Let me check.” The doctor manipulated his tablet computer and pulled up the transplant records. “Says here the donor’s next of kin wished to remain anonymous.”
Paranoia set its roots deep. “Do you know where the organ was harvested?”
“John, stop. You’re scaring Tommy.” However, Tommy wasn’t paying any attention to the discussion; the boy’s focus had fallen back to his video game. Melissa was pale and hugged her arms around her waist.
Dr. Anderson tapped on the tablet’s display. “The transport team is picking up the organ at the cargo terminal at Executive Airport.”
“Not from a local hospital?”
The doctor glanced at his tablet. “It originated from outside our region. UNOS paired the organ with Tommy because of the match and his medical necessity.”
“What’s wrong? Don’t ruin this, John,” Melissa said.
John rubbed his temples and tried to ward off the mother of all tension headaches. The harder he pressed into the thin bands of muscles around his head, the deeper the suspicion and doubt went into his brain.
“It’s something I’ve been working on,” he said.
“Can’t that wait?”
“I think they are connected.”
Melissa’s face betrayed a combination of confusion and fear. The sparkle vanished from her blue eyes, and her lips tightened, thin and pale. “John . . .” she started.
“Doctor, is there any method to retest the donated organ before the surgery?” John asked.
“We—we examine the tissue. It will be sealed in a cold-storage bag, and while we warm up the donated tissue, we’ll do a cross match for antibodies. The cross match won’t prevent the transplant. It will tell us if we need to put Tommy through a course of pheresis and immunoglobulin infusion. The primary concern is the tissue type, and that matching is done before we take possession. It saves time and risk to the patients,” the doctor said.
“But can you retest to verify the tissue type?”
“I don’t see a reason we need to, Mr. Penley.”
“John, please stop this,” Melissa said.
“I need you to reexamine the organ before you put in inside my son’s body. I don’t think that’s a lot to ask.”
Dr. Anderson lowered his voice. “I understand what you’re going through. You’re worried and you want to make sure everything goes smoothly. The UNOS registry makes certain that the right donated tissue goes to the right patient. That’s the reason for the system.”
“Like the Gunderson boy? The UNOS data have been compromised,” John said.
“That’s simply a theory,” Trisha Woods added, coming in from the hallway, drawn by the escalating conversation.
“This is the first I’ve heard of this. Why hasn’t the transplant committee been informed?” Dr. Anderson said.
“Because it is only a theory—one Detective Penley has yet to prove,” Trisha said to Dr. Anderson. She turned to John and said, “You haven’t come up with any proof the data have been compromised yet, have you?”
“Not yet. But the timeline of the transplants—”
“Stop it! Stop it! This is our son we’re talking about, not the ghost of some nameless victim you drag home from work every night!” Melissa turned away, went to Tommy’s bedside, and sat.
“Do you have a suspect? Who tampered with the registry?” the doctor asked.
“I don’t have a name,” John said. The mental list of people who could manipulate the transplant data was a short one, and two of those people stood in front of him now.
“Can you tell me with absolute certainty that there is anything wrong with the kidney donated for your son?” Dr. Anderson said.
“No, I can’t,” John answered.
The doctor’s cell phone chirped. He glanced at a text message on the screen. “The ambulance team picked up the kidney. They’re on their way. ETA is fifteen minutes. We need to get Tommy prepped. Unless you’re telling me that you’re refusing the surgery.”
John looked at his son. The boy suffered so much and missed out on what it meant to be a kid; medical appointments instead of sports and medication regimens taking instead of camping trips. Frail, pale, and weakening each day, Tommy’s ability to survive without a transplant had reached its limits. Had paranoia fogged John’s perception?
“Melissa?” John said in a wavering voice.
“Let’s do it. Please be careful, Doctor,” Melissa said.
The doctor put a hand on John’s shoulder. “We will. Don’t worry. We’ll take good care of Tommy.” Then to Trisha, the doctor said, “Let the nurses know they can get him ready. The anesthesiologist will be down in a few minutes.”
Dr. Anderson nodded at Melissa and Tommy, turned, and disappeared around a hallway corner.
“We have some work to do,” Trisha said, hefting her clipboard.
The next ten minutes were filled with paperwork, consent forms, inserting an IV line in Tommy’s thin arm, and more blood samples. A tall, thin woman in a lab coat it looked like she borrowed from her father entered the room and introduced herself to Tommy.
“I’m Dr. Mason. I’ll be giving you something to make you sleepy so we can get you off to surgery. Do you understand what you’re here for today, Tommy?”
“Yeah. I’m getting a new kidney.”
“That’s right. So I’m going to give you something to make you sleep right through it, and when you wake up, you’ll have your new kidney and you can start feeling better. Okay?”
The boy nodded.
“Any questions?” the doctor looked to the parents.
John and Melissa shook their heads.
“All right then. Tommy, let’s take a nap,” Dr. Mason said.
“We’ll be right here when you wake up, sweetie,” Melissa said as she planted a kiss on Tommy’s forehead.
John held his son’s hand, and in a voice that sounded calmer than he actually felt, said, “It will be over before you know it.”
Dr. Mason pulled a thin syringe from her lab coat along with a vial filled with a milky-white liquid. “This is called Prophofol, and it will make you really sleepy.” She plunged the needle into the vial, withdrew some into the syringe, and then stuck the needle into the valve in the IV line.
Within seconds, Tommy drifted off into sleep, and for the first time in months, the boy’s face looked relaxed, completely devoid of the tension and stress that he had grown to tolerate.
Dr. Mason called in an orderly, who unlocked the gurney wheels and pulled the bed out into the hallway.
“I’m going to be with Tommy the whole time,” Dr. Mason said. “I’ll be giving him something a bit stronger before the surgery so he doesn’t have any pain. He’s in good hands now. Dr. Anderson is the best.”
John and Melissa walked with the gurney as far as the doorway to the operating rooms. Melissa reluctantly let go of her son’s hand as he slipped behind the doors into the surgery suite.
“I hope we did the right thing,” John said.
“Can you tell me about this?” Melissa unfolded a sheet of paper and handed it to John.
“Where did you get this?” John held the printout of his laptop screen, a photo that featured the demand for a ten-thousand-dollar payment. “It’s not what you think, Mel.”
“You bastard! You had this at your fingertips and you didn’t tell me?”
“It’s not like that. The case I’m working—”
“Why couldn’t you tell me that you could have had Tommy moved up on the transplant list?”
“You can’t be serious. We couldn’t do that. People could get hurt.”
“Isn’t Tommy more important than some damn case?”
“Melissa, what are you saying?”
Her eyes flashed. “I always believed, in my heart, that you’d do anything to protect your family. Now I know differently.”
John reached out for her, and she jerked away. “Mel, that’s not fair. You know I would give my soul for Tommy.”
“Apparently not.”
“You don’t mean that—”
“Don’t tell me what I mean, John. We could have talked about this together and come to a decision.”
He crumpled the printout so hard that his knuckles went pale. “This wasn’t an option. The people behind this kind of operation don’t care about what happens to Tommy. I’m sorry I didn’t tell you about it.”
“It doesn’t matter now anyway. Tommy’s getting his surgery,” Melissa said. The fight was out of her.
They found an empty space on a sofa in the waiting room where they could ride out the four-hour surgery. Their hearts froze in midbeat when, less than an hour into the allotted time, a grim Dr. Anderson appeared.
In his surgical garb, complete with a mask draped around his neck and head covering perched in place, Dr. Anderson surveyed the waiting room until he found John and Melissa. By the time he reached them, both were standing, waiting. The surgeon’s abrupt, early appearance meant bad news. Something had happened to Tommy during the surgery.
Melissa reached out and grabbed the doctor’s arm. “What is it? Is Tommy all right?”
Dr. Anderson took her hand gently. In a hushed tone, he said, “Why don’t we go somewhere more private?”
At What Cost Page 13
