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On the last day of 2008, a coworker at my local D.C. newspaper published a story about a woman who had turned to the city’s neighborhood message boards in search of a kidney. Years of lithium treatments for manic depression had wreaked havoc on Nora’s insides, and her renal function was now at 21 percent and falling. Her family and friends couldn’t donate, or wouldn’t. If she couldn’t find a stranger’s organ, she would spend the next four to seven years on dialysis, waiting for a cadaver with her name on it. After reading the story of a woman who got a new kidney from a stranger thanks to a Facebook plea, Nora decided to send an SOS to the wide world.
That night—with my girlfriend ringing in the new year with friends in Florida, and me spending it alone at the office—I sent out my own distress signal.
On paper, it had been a good year for me. I’d gone straight from college to an apartment and a full-time journalism job. In reality, I was bored and unmotivated. I spent my days entering data and smoking cigarettes on the parking deck behind the office, my nights picking bullshit fights with my girlfriend. I had zero desire to build a career or a credit score. I fantasized about walking away from everything.
Nora offered a more productive option. Her existence depended on finding one person with O blood and a clean bill of health between the ages of 20 and 60 who was willing to part with an excess kidney. At 3 a.m. on the first day of the new year, I emailed Nora and offered her one of mine.
We met a few days later in the bottom of a bookstore. Nora was tucked inside a baggy purple and yellow coat and galoshes that swallowed her calves. Her fingers were long and thin and white, her blonde hair streaked with gray. We talked for almost an hour—about writing, our families, where we came from. Nora smiled a lot, said “gosh” a lot, said “thank you” a lot. She marveled that someone so young would commit to something so permanent.
Over the next few weeks, we emailed back and forth about the transplant, and I slipped easily into my new role in her life. I met her husband, and she met my girlfriend. I hadn’t yet been officially vetted, though, and her doctor remained “noncommittal” about the surgery. “I think he's afraid I won't find the match before my kidneys fail,” she wrote to me. “I think he's trying to protect me.”
That changed after a blood test revealed me to be an ideal match. We charted out a summer surgery date, and I set to work making the physical preparations for the three small incisions into the bottom of my belly and the longer one above my groin. “I'm very lucky to have found you,” Nora wrote to me. I felt the same way.
But I soon found that I needed more than a positive blood match to surrender my kidney to Nora: I needed a reason, too. As I dangled my legs off the exam table, the tissue paper crinkling beneath my thighs, the hospital’s transplant coordinator asked me a battery of questions: How long had I known Nora? What was the nature of our relationship? Was I on any psychotropic medications? How did I find out about her? Why was I donating? Was I getting paid?
I bristled at having my motives inspected. But this line of questioning is also a part of a transplant coordinator’s job, which corresponds not just with the Hippocratic oath, but with the law, which is written so that volunteer donors may not give up their organs for any other reason than pure altruism. That's the answer I should have given. Instead, I got flip and said that I had two kidneys and needed only one.
The transplant coordinator looked at me blankly. She wanted reasons, not facts. She knew I was 23 and poor, and that Nora and her husband were in their late 50s and well off. Those details required the padding of some heartwarming story. (My newspaper’s report about Nora’s kidney search had attracted its share of unsuitable donors: “I want to sell my kidney for money,” one commenter wrote bluntly).
A gurney rolled by, then a wheelchair, and the coordinator waited for me to say more. So I said something about karma and inviting good by doing good. She nodded approvingly, and when I finished, she told me that a lot of donors offered the same motivations.
As our appointment ended, the coordinator told me that I could back out whenever I liked, and that Nora would be fine. I smiled like a lotto winner and told her I wasn’t going anywhere.
Outside of the examination room, my motivations were more difficult to explain. My body was already littered with physical evidence of my emotional impulses: I had, at one point or another in my life, felt compelled to cover my chest and torso in tattoos, pierce my nipples and septum, butt my head through walls, and brand my inner calf with a red-hot coat hanger.
My mother chalked up my decision to donate as an extension of a body modification addiction. My friends told me that I was just looking to score another experience. “This is the worst possible time in your life for anything like this,” one college friend wrote me. “You're just searching for bullshit right now.”
My girlfriend put up the fiercest defense. “I don’t know how I feel about this. What if you need it one day?” she asked me in a chat message soon after Nora and I met. Also: “It’s strange that this motivates you to take care of yourself, versus the person that lives with you.”
“I'm sorry that your disapproval wasn't enough for me to quit smoking,” I replied. “Sometimes it takes something big to help a person kick a habit.”
My health had always seesawed at the whim of these external influences. When I’m happy, I’m good to myself, which makes me happier. When I’m not, I turn into a skin bag of illicit substances and trans fats, which makes my highs higher, my lows seemingly bottomless.
When I met Nora, I was teetering toward some sort of balance. My recent move to D.C. had compelled me to stop abusing pills, my affection for which put me on probation my senior year of college. But I refused to quit cigarettes. Smoking was one of the few things that pleased me, and I didn’t have anything productive to put in its place. My girlfriend could never understand why the things we had were not good enough, why our life together was always accompanied by my hacking cough and stained teeth. It broke her heart that I could give it up for Nora, but not for us.
The spring brought our first setback: Nora’s kidneys were failing, but not fast enough. Between barely functional and shot-to-hell is a sweet spot in which the body is less likely to fight off a new kidney, but still strong enough to host it. Nora was declining toward that place, but she wouldn’t be there by May. “Hope the waiting isn't a problem for you,” she wrote in an email. “I'll still be here, come May, come fall, come whenever,” I replied. “Please don't worry about that.”
But the delay was the first of many. Soon, Nora discovered that her illness was not relegated to her kidneys: She had cancer, and the transplant would need to wait another two years to allow for her recovery. When Nora’s closest friends gathered for her mastectomy “pre-op party,” my girlfriend and I met them at a swimming pool in Chevy Chase. We nibbled on chips and sipped flat soda while Nora’s friends quizzed her. She seemed zen and rattled at the same time. She smiled and laughed. She got stern and told them that they caught the cancer just in time. She smiled again and said that I would be there at the end of it all. Her friends cooed. I nodded and said, “Of course I will be.”
The next time I saw Nora, it was cold and wet. I took a cab to her place and laid on the doorbell. She answered with her bald head wrapped in a scarf. When we hugged, I felt like I was wrapping my arms around a tall, young girl. She fixed me a cup of coffee and we watched the Bears game. Nora looked at me sideways and asked if I was still up for the transplant. When I told her I was, she called me an angel.
My mother, an expert at prodding me in my pressure points, once asked if I had a case of Knight in Shining Armor Syndrome. She was searching for a way to diffuse my compulsion, to help me reconsider my decision. She wanted to know if rescuing Nora would be like rescuing everybody I’d ever wanted to save but couldn’t. Her question scraped at something deep. Whenever Nora was up against the ropes—after her cancerous breasts were removed, after her mother’s dementia upended her life, after she learned her father was dying—I wanted to be sure that when she looked down, she would be able to see me just outside the ring.
Over the next year, I occasionally looked after Nora’s home when she and her husband went away. We emailed about the books she was reading and the effects of chemo and the lives of her cats. I tried to keep her up to speed with my job changes and what I was writing. But we got together for coffee and dinner less and less often. Her hair grew back. We went months without talking about the surgery. The longer we waited, the further away it felt.
When Nora called again, last September, to say that it was time to finally get the ball rolling, I had all but stopped thinking about it. My girlfriend and I had moved out of our tiny unit in a depressed D.C. neighborhood and into a massive apartment in the suburbs. I had a job where I got to write every day and made enough money to pay my bills.
I also had enough money to buy the thrills I wanted. I was stoned all the time. I cut off all my hair and stopped shaving my face. I broke plans and refused to make new ones. My girlfriend and I fought constantly and agreed on nothing. It got to where looking in the mirror made me cry. I stopped looking in the mirror.
“Do you still want to do this?” Nora asked me that night. “I can understand if you don’t.”
“Of course I do,” I said. What I wanted to say was, “Please let me do this.” Vaulting from emotional peak to peak was exhausting, and trips to the valley floor were terrifying. At that moment, the only thing I wanted was to do something objectively good. We set another surgery date, and I set about making some internal renovations. This time, I threw everything out.
In February, I started the screening process again from the beginning. When the hospital social worker asked me if I used recreational drugs, I could tell her that I had quit. When she asked me how often I drank, I could say that I drank only a few times a month. When she asked me if I smoked cigarettes, I could say that I had switched to Nicorette and indulged only once in a blue moon. And when she asked me why I was donating, I was able to say with an incredible degree of internal congruity that I wanted to do something for a friend.
Before I left the hospital that day, my donor advocate—my appointed advisor throughout the process—told me that I could back out of the transplant without Nora ever knowing that I had changed my mind. My advocate could simply report to the transplant coordinator that my application had been rejected. No one would be the wiser.
I smiled, less like a Cheshire cat this time, and said I was in it for the long haul.
In my required donor psych evaluation, the hospital-appointed social worker told me this: That I must find a way to be OK regardless of what happens once the kidney leaves my body. It could be rejected. Nora could get cancer again. She could stop taking her immunosuppressive drugs. She could get in a car accident the next day. Also, that no matter what happens to Nora’s body, my own will be changed forever: There will be one less organ working tirelessly to mitigate the costs of my decisions. Can I be the person I’ve become in the last few months for the rest of my life?
Nora called me a few weeks ago to tell me that the surgery had been delayed again. While she hadn’t suffered a recurrence of cancer, her surgeon felt that she needed to wait a little longer to see if it returned. He stressed to her that if the cancer resurfaced while she was on immunosuppressive drugs, Nora would die. She cried as she told me that the surgeon said there was no point in getting a second opinion. We had three more years to wait.
When she hung up the phone, it occurred to me that I did not know what I would have said if Nora had asked me if I would be waiting for her in three years. I contacted Nora when I was 23. I'm 26 now. This won't happen, if it happens, until I'm 29. That's a long time to stay faithful to an offer I made eight months out of college. What if I move? What if I decide to get married and have kids? What future commitments supercede the one I made to Nora?
Somewhere between faith and resignation is a sweet spot, where we are wise enough not to demand that reality conform to our expectations but bold enough to want it to, and capable of adapting when it doesn’t.
When I think about what’s happened in the last three years, and what might happen in the next three, it feels unfair to say out loud that I'll still be there for Nora, and untrue to say out loud that I won't. For now, I won’t say either.
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