The Dismantling (8 page)

“She's my second cousin.”

“How did Maria learn about your liver condition?”

“Look at me. It isn't a secret.”

“How long ago was this?”

“Last year. I was in San Diego with Cheryl and our kids. On vacation. We met Maria for lunch at this Mexican place in San Clemente. She knew already from talk in the family, but she hadn't seen me herself.”

“Did you discuss your options at that point? With Maria, I mean?”

“No, not yet. I think she knew Cheryl wasn't a match though.”

“But you spoke with her about it afterward.”

“She called me a few weeks later,” he said. “She wanted to know what I was going to do.” He spoke in a monotone, as though these things were of no concern, as though they'd happened to someone else, which of course in a way they had. “I told her I would get on the list and pray.”

“The UNOS list?”

“Yeah. But I also told her I might never get off that list alive.”

Simon liked this line. He'd fed it to his second client, a middle-aged corporate executive whose kidney had been annihilated by hepatitis C. He remembered showing up at her mammoth suburban home, where she faced him across the dining room table in a pink cable-knit sweater, and wondering from what incongruous chapter of her past the hepatitis was making such a savage and unwelcome visitation. She never said; he never asked. He could sense her anger though, her anger that she should be found out and hunted down in this way by the exigencies of her youth. He didn't know if she ever used the line, and its corny machismo sounded better coming out of Lenny's mouth anyway.

“Maria called me about a month later,” Lenny said. “She asked for my blood type. I said, what for. That's when she told me she wanted to donate.”

Crewes groaned. “For Christ's sake, Lenny, you sound dead already.”

“Please,” Simon said. “Did you ever lead her to believe she would receive any compensation in return?”

“No.” Lenny shook his massive head. “Absolutely not.”

After the two men left, Simon stood at the window and lit a cigarette as he watched them limp their way up the block to Crewes's black Lexus. Would it matter if Lenny's performance in the actual interview was this horrendous? Would anybody care? DaSilva had managed to finesse Lenny's rickety body through the tests—had contextualized, cajoled, or outright lied enough to gain Lenny's acceptance into the transplant program—so Simon imagined that, short of assaulting his examiner or directly admitting the fact that the necessary portion of Maria's liver had been purchased, Lenny was probably safe, unconvincing zombielike demeanor or not.

He thought of what Crewes had told him about Lenny's “funks”: the headaches, the moods, the rejection of the world beyond the four walls of his darkened bedroom. He imagined Lenny sequestered in his bed, head throbbing in time with his pulse, the engorged blood vessels of his brain jammed up against the cramped interior of his skull. Simon knew something about how migraines could cripple a life. His sister had suffered from them throughout her adolescence, although the word “migraine” only meant something to Simon later. When they were growing up, he and Amelia just called it “The Pinch.” The Pinch meant a lot of things—visual glitches, nausea, numbness in her lips and tongue—but most of all it meant headaches, pulverizing, catastrophic headaches that lasted a day at a time.

Amelia hated talking about The Pinch almost as much as she hated the thing itself. She avoided the nurse's office at St. Edmund's, which always smelled of Lysol layered over the sweet, faint, ineradicable tang of vomit. She'd gone there with the first of her headaches one morning in fifth grade. The nurse had sat her down in a chair and given her two Tylenol. After an hour, it was suggested that she return to class. She hated having to say that, no, she'd rather stay, and actually, was there a dark and quiet room somewhere in which she could lie down? Saying these things made her feel shameful, weak; the nurse, an ancient nun named Sister Carolina, had no explanation for her suffering. Finally Simon was summoned out of algebra class and told to take his sister home.

He led her out of St. Edmund's, into the bright, slanting sunlight. She scrunched up her face, one hand covering her eyes, the other clammy and ice cold against his palm as he dragged her across Park Avenue, over to the subway on Lexington. They waited on the platform, the train's hot, stale breath rushing over them as it pulled into the station. She sat hunched in her seat, poking at her face, telling Simon she couldn't feel her bottom lip. After they switched trains at Fulton Street, she closed her eyes and stopped speaking. Simon sat next to her, still holding her hand, murmuring that they would be home soon, that she would be okay, but she didn't seem to hear him. She didn't seem to be aware of anything around her, turning her attention entirely inward. He looked at her face, the fine colorless down on her cheeks and upper lip, the sharp point of her chin. He reached out his free hand to stroke her forehead as the train burst out of the tunnel, sunlight slicing across the car. Amelia let go of Simon's hand and covered her eyes. At Broad Channel, he helped her off the train, and they waited on the platform for the shuttle, Amelia slumped against the wall.

Days later, centuries later, they arrived at the house. Inside it was cool and dark. Simon led Amelia up to her room. She lay on the bed, and he sat on its edge, holding her hand and talking, saying whatever came into his mind. He thought, without quite believing it, that if he let her fall asleep, she might never wake up. She squirmed against the mattress as he talked, and then suddenly she stood and pushed past him to the bathroom in the hall, pulling the door shut behind her. He stood at the door, his hand on the knob. He heard her retching, then the flush of the toilet. He withdrew his hand and stood in the doorway to her bedroom. He didn't know what to do. A few minutes later, she came out of the bathroom, limp and flushed. She slipped past him and collapsed onto her bed. She said she felt a little better and asked if he would please call Dad now. “Okay,” he said, and he went downstairs to the phone in the kitchen. He stood there, leaning against the refrigerator, looking at the phone, then up at the wall clock. It was four thirty. His father would be leaving work in an hour, home an hour after that. He looked at the phone again, and then he went back upstairs and sat on the edge of his sister's bed and watched her drift in and out of sleep.

It was dark when he heard his father's key turn in the lock. He hurried downstairs and told Michael that Amelia was sick, that she'd thrown up, that she said it felt as though something inside her skull were drilling its way out.

His father put down his briefcase and frowned at the ceiling. “You brought her home from school?”

Simon nodded.

“Why didn't you call me?”

“I did. At the office. Nobody answered.”

His father looked at him. “And you didn't leave a message? Don't bullshit me, Simon.”

“I'm not.”

Michael shook his head and walked up the stairs. Simon waited in the kitchen, turning the dials on the stove, watching the blue flames blossom and die. His father returned a few minutes later and put the teakettle on. He said it was a migraine and nothing to worry about; their mother had suffered them too, the entire time he'd known her. He brought the steaming cup upstairs, and Simon followed him and watched from the doorway as he placed the cup on Amelia's bedside table, drew the blinds, tucked her under the blankets. Michael placed a pill in her hand, told her to swallow it down along with her tea. Simon slipped down the hall to his own room and closed the door. He felt a gnawing sense that he'd failed his sister, that he'd been exposed as ineffective, dispensable.

One Saturday morning in December, during Simon's senior year of high school, Amelia woke up with the left side of her mouth and tongue entirely numb; by noon she'd vomited everything in her stomach, but still her brain remained incandescent with pain.

Simon sat on the bed as she thrashed around under the sheets. She told him again that he didn't have to stay with her.

“It's okay,” he said. “You shouldn't be alone.”

She abruptly sat up and glared at him. “No,” she said. “It's not okay. You're not helping. I want to be alone.”

“I thought you wanted me here.”

“When did I ever say that?” She fell back against the pillows. “Please, Simon, just go.”

She closed her eyes and turned away from him. He went into the hallway, closing the door softly behind him. He sat all afternoon in his room, trying to read, but instead he found himself staring at the wall that separated his room from Amelia's and picturing her suffering. She'd described it to him and he'd witnessed it himself so many times that he felt he knew its course, its cunning movement: the aura, the numbness, the lull, the arrival of pain, the hatred of light and sound, the nausea, the vomiting, the pain's slow abatement, and the collapse, finally, into sleep. He tried to align his imagination with what was happening at that moment on the other side of the wall. He was angry about what she'd said but more frustrated that he couldn't experience the pain along with her, frustrated because it was during these episodes that he felt most acutely how he could never know what it was like to be Amelia.

 • • • 

L
ENNY
'
S
performance had been painful, but at least Simon didn't have to worry about Maria. She'd shown up at the office earlier that morning—still-damp hair piled atop her head, skin smelling of apricot soap—with no trouble understanding what Cabrera would require of her. She was expansive and emotional, her eyes widening as she described the “moment of clarity” she'd been struck with while sitting in traffic on I-5. She'd realized she had a “moral obligation” to help anyone she could. She described the San Clemente restaurant, its patio overlooking the Pacific. She described Cheryl's “tired eyes,” young Gregory and Daniela's “devotion” to their father. She remembered, as a kid, tossing a football with Lenny at a family reunion in Long Island, how she knew even then that he was one of those lucky people who were able, if only for a brief while, to do the thing they most loved to do.

She was, in short, an entirely convincing liar.

Simon asked if she understood the risks of the operation, the unavoidable scarring of her abdomen.

“It's all right,” she said. “I don't plan on wearing a lot of bikinis.”

There was that sarcasm again, a way of talking that reminded him so much of Amelia in her teenage years, and again he tried to read whether it was a defense mechanism—an affectation—or an honest expression of not giving a fuck. Probably, he decided, a bit of both. Just like it had been with Amelia.

He handed her a photocopied sheet of paper showing one hundred stick figures arranged in rows of ten. Thirty-one of the figures, scattered throughout, had been stamped with black dots over their midsections.

“The social worker is going to give you something like this,” he said. “About thirty-one out of a hundred donors have some kind of complication after surgery. Usually it's not anything serious—abdominal pain that lasts longer than usual, a bile leak, sometimes a minor infection. These things would be addressed at Cabrera before discharge. We'll also set you up with a doctor in LA, for follow-up.”

“Why don't they just say thirty-one percent?”

“The idea is that percentages are too abstract. Just listen to the social worker. His name is Klein. Listen to him, let him talk. Pretend to think it over. Then tell him what he wants to hear.” He passed her another sheet with a similar graphic, this time with ten dotted figures. “He'll show you this too. About ten percent of the people like Lenny who have this surgery die within a year. The idea is for you to understand there's some chance this won't save him even if the surgery itself is successful.”

“And you want me to pretend to be upset?”

“I want you to look as though this is new information. Absorb it, then say you're comfortable moving forward. Be confident but not too brash. They want to see that you're committed but also that you're not some kind of martyr.”

“Heroic donors.”

He looked up at her, surprised. The phrase was a piece of hospital jargon, not something he thought was in common usage. The gray tooth winked as she smiled.

“You've been doing your research,” he said. “Right: no heroes. Just autonomous, compassionate individuals. You see the difference, right?” He pushed another sheet across the desk. “Here's the last of these graphics. One thousand figures. Two are dotted. This is the 0.2 percent living donor mortality rate.”

She glanced at the paper.

“No,” he said. “Look taken aback. Nobody's mentioned
death
to you before. But then recover quickly. After all, it's a tiny percentage, and it's not going to happen at a hospital like this, to someone healthy like you.” He caught her eye. “That's true, by the way. In case you really are worried and are just hiding it well.”

“I'm not.”

“You shouldn't be. Now, here are a few questionnaires. He'll give you these at the end of the interview, to make sure you've understood everything he's said about the surgery, the recovery, and so on. To demonstrate that you've been fully informed. Here's a pencil. You read the documents I e-mailed you? Then you shouldn't have any trouble.”

He stared out the window and fought the urge for a cigarette as she filled in the bubbles. He had to admit he liked this part of the job. He liked being responsible for a process that provided measurable results, clear successes and failures. And he couldn't be too bad at it, because they'd all been successes so far. Every pair he'd selected and prepared had been approved by the hospital and come through surgery without any unusual difficulties. He could honestly say that he'd helped to save the lives of people who most likely would have otherwise died before their names hit the top of the UNOS list or else pursued a far riskier brokered transplant overseas, in South Africa or Turkey or the Czech Republic. (Thoughts like these assuaged periodic flare-ups of guilt about his role in the flow of organs from poor to rich, in the commodification, quite literally, of people's insides. Say what you want, he thought, there are individuals who would be dead now if it weren't for what he did.) It was true that he'd never worked on a liver case before. Also true that he'd never worked with an active alcoholic like Lenny—all the other clients who'd drank their kidneys to ruin qualified as ex-alcoholics, having logged time in AA or sobriety programs of their own devising before coming to him—but the surgeons had given their authorization, so he had to assume Lenny's condition wasn't something they couldn't handle. He also assumed that DaSilva had tampered with Lenny's records, giving Klein the impression that their patient had been sober far longer than the few weeks of half-assed abstinence the man could honestly put to his name.