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Flesh & Blood

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Michael Bynum's sister, Nadine James, needed a new kidney to survive.

It didn't matter that the surgeons told him they'd have to remove a lower rib when they cut him open. It didn't matter that he'd have to undergo months of testing or that even after that Nadine's body might still reject his kidney. They warned him that recovering from a transplant operation is often very painful. They told him he could die.

"None of it matters," Michael said the day before the transplant operation. "I told her when we first went in I was going to be the donor. It was just something I felt--because we're that close."

"Michael has been very enthusiastic from day one," says Dr. Michelle Josephson, Michael's kidney specialist, adding that not all donors are so willing to undergo a painful operation that has no guarantee of success. "He actually said point-blank to me that he considered this an honor."

Michael, a 42-year-old unemployed former postal worker, has a different father than Nadine, 29, whom he still sometimes calls his "baby sister." Neither is married. They have always been close and they both say they learned strength and perseverance from their mother, who died of cancer three years ago. Nadine and Michael say they were brought even closer together during their mother's ordeal, a closeness they say helped them confront the medical emergency that was to strike Nadine.

Two years ago Nadine began experiencing chronic fatigue, headaches, and erratic blood pressure. "Sometimes it was so bad I wanted to sit down and just cry," she says. The doctors at Saint Joseph Hospital puzzled over everything from her red blood count to her bladder, but none of her symptoms necessarily pointed to kidney failure.

Fortunately, Nadine works as a medical lab technician at Freilich & Greenberg in the Loop, where she was able to get more constructive advice. After the doctors there examined her urine they told her she had some kind of nephritis--serious problems with her kidneys. A biopsy determined she had contracted an unusual and incurable kidney disease called IGA nephropathy, which is rarely found in African Americans.

A year went by as various doctors tried to balance Nadine's blood pressure and hold off the inevitable kidney failure as long as possible. But soon Nadine's symptoms had expanded to include nosebleeds and constant nausea. In January of this year Nadine began regular visits to the University of Chicago's Bernard Mitchell Hospital.

Michael, Nadine's fiance Joe Lige, and shifts of cousins and in-laws took turns accompanying her to the hospital. Before long her kidneys were in total failure, and she was forced to begin dialysis.

The kidney's functions of regulating acid-base concentrations and maintaining water balance in the tissues, not to mention metabolic waste disposal as urine, are so integral to the body's health that kidney failure can result in a total failure of body functions.

One of Nadine's options was being hooked up to a dialysis machine via a catheter running into her jugular vein--three painful visits a week, each trip taking nearly six hours, for the rest of her life. Yet even dialysis never entirely rids the body of its poisonous waste and people don't often last more than about ten years on this kind of therapy. Another option was a transplant. But despite the success of the relatively new science of kidney transplantation, many transplant patients die within about ten years as well. Still Nadine decided she had nothing to lose and began looking for a kidney.

Besides having an absolutely healthy body, a potential organ donor must be specially suited to donate to the recipient. According to Suzanne Bolz, who coordinated the testing, three crucial factors determine whether a donor will qualify: blood type, genetic matching, and cell acceptance.

"Everyone in the entire family went to get checked," Michael remembers. "Tyrone, Wilbert and Gilbert--the twins in the family--our sister Sheree, some nephews, even our sister's boyfriend." The family also had a "second team" ready to go for tests if no match was found for Nadine in the first group. "I didn't even have to ask them," Nadine says. "It was unbelievable. They were just flowing in."

Both Michael and Tyrone passed the first test, for blood type, with O-positive blood, the same as Nadine's. (Michael says he wanted so badly to be the donor that he actually became jealous of Tyrone at this point.)

The next test involved comparing tissue types. The closer the genetic match between Nadine and the donor, the smaller the chance that Nadine's body would react to the new kidney as if it were an infection. (If the match isn't perfect, the donor isn't necessarily ruled out; immunosuppressant drugs are used to help persuade the recipient's body to accept the invader.) Both brothers turned out to be "half matches."

The third major test was something like a cockfight in a test tube. Blood cells from Nadine were introduced to cells from each potential donor In the tube containing Nadine and Tyrone's cells, Nadine's antibodies destroyed his blood cells. Her system would never accept one of his kidneys. Michael's cells fared better--Nadine's left them alone--and Michael began to look like a strong possibility.

More tests were made--urine tests, blood tests, X rays--to determine the general health of Michael and his increasingly precious kidneys. Finally, a surgical transplant team, led by Dr. Richard Thistlethwaite, evaluated all the data that had been collected on Michael and determined that he could withstand the surgery and that his kidney was a good bet for transplant.

According to staff at the U. of C. Hospital, the genetic matching of transplant patients is the easy part. They say the social factors are even more delicate. How will the person giving away a vital body part react to the trauma? Will he feel guilty if the organ is rejected by the recipient's body? Is this person being coerced? Or talking himself into doing something he'll regret later? Over the last couple of decades, hospitals have become exceedingly careful when dealing with the emotional fabric of those who go under the knife. For example, at the U. of C.'s Bernard Mitchell Hospital the recovery rooms for donors and recipients are placed in different sections or sometimes on different floors. "They start fighting with each other if it doesn't work, even brothers and sisters," said a technician from Mitchell. Patients often feel guilty, angry, unbalanced, or hurt after a transplant, successful or not.

"The unique thing about being a donor in a kidney transplant is that, if you think about it, in most operations there's a risk but also a benefit to be gained for the person undergoing the operation," Dr. Josephson points out. In this context, she says, at best the benefit is only psychological, the satisfaction of knowing that you've helped someone close.

"Nadine has been crying," said Michael the night before the operation. "At times she says she feels bad, especially if something were to happen to my other kidney."

In a sense, the donor and recipient become opponents before the operation, each with a team of doctors advocating his or her side. Josephson's only concern before the operation was the health of Michael, the donor; she dealt with him exclusively. She did not even meet Nadine prior to the transplant.

Josephson has observed that in some circumstances it is obvious that the donor would have been just as happy if the match hadn't worked out. Some potential donors have confided to her that they didn't really want to go through with it. "I had a situation where there was a lot of pressure on the sister to donate but she really didn't want to donate. She had her own family at home--responsibilities to other people. Her father really wanted her to donate, her husband did not want her to donate."

One confidential safeguard doctors offer donors is the last-minute option of bailing out. The explanation given to everyone else is simply that the would-be donor has been deemed medically unable to donate. Josephson is understanding. "It's scary enough going into the operating room."

Michael is wheeled out unconscious under a plastic oxygen mask, his head rolled to one side. An attendant carries a sterilized Igloo beer cooler filled with ice into operating room number ten. Inside the antiseptic white room the surgical team led by Thistlethwaite is opening Nadine's body and draining the blood into clear plastic buckets on the floor.

Brilliant neon and purplish black lights bathe the operating table in bacteria-murdering ultraviolet light. An anesthesiologist tends to Nadine's head and a white curtain separates the life-support instruments from Nadine's lower half. An intravenous tube runs into her night hand, which hangs loosely off the top of the table.

Isotonic solution is pumped into her veins to increase blood volume, and a ventilator machine breathes for her through a tube running into her mouth and down her trachea. Rising over the table is a blood pressure machine and several other vital-sign monitors with digital displays.

Blankets cover Nadine's body, save her abdomen, which has surgical plastic stretched over it. The total count of people in the room is near a dozen, including the three surgeons at the table, the anesthesiologist, Nadine's two coordinating nurses, a medical student, and various other staff; all are wearing light blue scrubs, shoe protectors, hair nets, and face masks. "It's taking a little longer to get down to her blood vessels than normal," says Thistlethwaite from behind his face mask and horn-rimmed glasses. His gloved hands, and those of the two assistant surgeons, poke through fat and muscle Into the gaping blood-soaked hole that is Nadine's abdomen. He speaks slowly as he carefully snips away bits of crimson flesh with stainless steel blades. The constant beeping of the heart monitor mixes with the clank of the metal tools and the soft orders for various instruments that come from the surgeons. An FM rock station softly, almost inaudibly, plays Eric Clapton in the background. The waste can is filled with blood-soaked rags, and a plastic bag hangs from the operating table where the attendants drop the discarded flesh.

Nadine's fiance, Joseph Lige, sat with Michael in his recovery room. "He lay there for about five minutes," Lige recalls, "then he wanted to brush his hair. He did that for 45 minutes." When Michael was told Nadine was in recovery he jumped out of bed and walked down to the recovery room.

Nadine found it difficult to believe that her brother was standing over her bed only hours after having one of his kidneys removed. "I just wanted to tell you hi," Michael said to his sister. "Hi," Nadine told him. "Now go back to bed. Go back!" "But I just wanted to let you know I'm fin-e-and say hi," Michael repeated with excited but somewhat glazed eyes. Later, after Nadine was transferred from recovery, Michael made his way over to her new room. It was about one in the morning. "He was pumped up, overwhelmed, ecstatic," said Nadine. Only after four days did he begin to realize how his body had been traumatized. But nurses said that his highly excited state was normal--part of the reason recipients and donors are kept at a distance after such operations.

A week after the operation, Nadine is. still in some pain from the catheter that remains buried in her body to drain the postoperative internal bleeding. But thanks to antibiotics and immunosuppressant drugs, Nadine says she feels none of the symptoms that can make some transplant recipients wish they had never left dialysis.

"I feel wonderful. I feel great," Nadine says. Her blood pressure is still high--160/90--because of the Cyclosporine, one of three immunosuppressants she's taking. "But they promised to control it," she says. Nadine and Michael have become virtual experts on kidneys and transplantation, reading up on the subject in the medical journals at Freilich & Greenberg and the library, and in as many pamphlets from the hospital as they could carry.

Following the operation, Joseph Lige takes on most of the care duties, bringing Nadine food or running errands. At one point Nadine broaches the subject of how important the kidneys are to hormonal functions. This is another social side effect of kidney failure--"especially when the sex kind of fades away," she says. "A lot of guys start going the other way when they find out their wife or girlfriend has kidney problems," Lige says. "It's been nine months." "You didn't have to say how long," Nadine scolds with a smile. They both laugh. it's a family joke.

Art accompanying story in printed newspaper (not available in this archive): photo/Robert Drea.

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