Tres fantasmas de la ciudad

Capítulo 4

Chapter Nine

Until the next morning, Shengmei's condition remained relatively stable. But after noon, her blood pressure began to drop sharply. By 1 p.m., it had dropped to only 95. An hour later, it had decreased to 80. The staff in the intensive care unit were thrown into a panic by this sudden change, with doctors and nurses constantly going in and out. Liming and Shengmei's father were forced to retreat to a corner. The intensive care unit suddenly became very busy, a stark contrast to the calm Shengmei had maintained when she was declared brain dead.

“The transplant team from the Municipal Central Hospital will arrive at the University Hospital at 2:30,” a doctor said to Li Ming while looking at his watch. “They will first insert a catheter to cool the kidneys, and then perform the kidney removal surgery after Miss Saint-Mei’s heart stops beating.”

"After Saint-Mei's heart stopped beating, will her family be able to see her one last time?"

In response to Li Ming's question, the doctor nodded and said, "We will allow five minutes for the family to say goodbye to Miss Shengmei. Then we will take Miss Shengmei into the operating room."

The ventilator was still making a faint "puffing" sound, but this sound was now drowned out by the other noises in the intensive care unit.

His blood pressure dropped to 75.

Yoshizumi, accompanied by two assistants and Oda, arrived at the university hospital on time with the necessary instruments and equipment for cooling the kidney during the kidney removal surgery. Although the hospital had the necessary equipment, Yoshizumi never forgot to bring his own tools. He believed that to remove the kidney quickly and efficiently, it was best to use the tools he was already familiar with. After greeting the staff at the university hospital, Oda stayed in the waiting room, while Yoshizumi went to the intensive care unit to observe the donor's condition.

Saint-Mei's blood pressure has dropped to around 65, and her heart rate has gradually decreased to 30. For ordinary people, once blood pressure drops to 50, blood can no longer circulate to every corner of the body, leading to the death of peripheral cells.

Since the family had agreed to the hospital taking certain measures to preserve the freshness of the kidneys of a donor in the final stages of life, Yoshizumi and his assistant planned to insert a catheter for cooling the kidneys into the femoral artery once Seimei's blood pressure dropped to 50. Yoshizumi carefully reviewed the patient information he had obtained from Seimei's attending physician, made a final confirmation, and then called Oda, who was in the lounge, to tell him that they would begin inserting the catheter into the patient's femoral artery immediately.

Fifteen minutes later, Yoshizumi and his assistant began preparations for local cooling. They first transported the perfusion device into the intensive care unit. Next, Yoshizumi made a small incision in Seimi's leg to insert the catheter. Then, one assistant immediately began adjusting the equipment; another assistant disinfected the area around Seimi's thigh and prepared the silicone double-balloon catheter. After disinfection, Yoshizumi stood to Seimi's right and carefully confirmed the artery and vein markings made at the groin of Seimi's right thigh. Subsequently, the assistant waiting beside the perfusion device, upon receiving a signal from Yoshizumi, inserted the tip of the balloon-equipped catheter into Seimi's body.

While closely monitoring Seimi's reaction, Yoshizumi slowly pushed the catheter into Seimi's body, where it visibly protruded from the inside of her thigh. The catheter had reached the intended position, and Yoshizumi nodded, approving of his assistant's work. Yoshizumi personally connected the end of the catheter to the infusion pump of the perfusion device. Next, Yoshizumi began inserting another catheter through a vein and connecting it to the perfusion device.

All preparations were complete. By this time, Saint-Mei's blood pressure had dropped to 62, and her heart rate had fallen below 30.

After Yoshizumi and his assistant finished, they left the intensive care unit. Now all they had to do was wait—wait for Seimi's blood pressure to drop to fifty. Dr. Yoshizumi informed Seimi's family that they could visit her in the ICU, and then headed towards the doctor's office. He didn't want to meet with Seimi's family. He felt that appearing so hastily before the deceased's relatives would be disrespectful, because in their eyes, transplant doctors might be as cruel as hyenas that prey on corpses.

As before, Yoshizumi only planned to meet with the deceased's family before the surgery. He left the rest of the work to the intermediary, Oda, not wanting to upset the family with his presence. Yoshizumi leaned back on the sofa in the doctor's office, drinking coffee and staring at the ceiling.

At that moment, Anzai Mariko's face suddenly appeared in front of him.

She had already noticed the change in Nagashima Seimi.

Nagashima Seimi's body is heading towards death. In fact, this change began when Seimi suffered her head injury; though very slowly, it had never stopped, and now it's simply accelerating. And there's no way to stop it now. Seimi will die, and her body will become cold and stiff. Seimi's brain center has begun to deteriorate, hormone secretion has likely ceased, and blood flow is weakening. Peripheral cells are beginning to rupture, then spreading from the inside out, finally dying. Everything is proceeding according to plan.

Making Saint-Mi suddenly lose her sight was incredibly easy; it was simply a matter of subtly manipulating her optic nerve. While Saint-Mi was blind, her hands were manipulated to control the steering wheel, causing her to change direction. The most challenging aspect was ensuring that Saint-Mi's body, except for her head, was unharmed upon impact. If her abdomen hit the dashboard, it could rupture internal organs, making a kidney donation for transplant impossible; therefore, she needed to be brain dead. So, at the precise moment Saint-Mi crashed into the lamppost, she manipulated Saint-Mi's feet to apply the brakes at the perfect moment; then, she applied pressure to Saint-Mi's waist to prevent her body from being thrown forward; and she ensured that Saint-Mi's hands gripped the steering wheel tightly to avoid unnecessary injury. As a result, Saint-Mi's head struck the steering wheel, and fragments of her skull pierced her brain.

Whenever she recalled that moment, she felt a sense of pleasure, even a thrill of triumph. Saint-Mei was dead. But she lived on, forever.

Saint-Mei's kidney will be transplanted into two patients. Ideally, one of them would be a woman, and the transplanted kidney would survive in her body. Everything is going so smoothly. Also, Liming should proceed with the initial liver cell culture as planned. She absolutely mustn't let Liming realize she was leading his thoughts. Thinking this, she subconsciously repeated Liming's name. Liming's voice and smile appeared before her eyes, and she couldn't help but tremble.

It will be soon. She recalled Li Ming's voice, expression, and body temperature, and her whole body trembled.

She had been waiting for a man like Li Ming to appear. Only Li Ming could understand her true self. She couldn't let such an opportunity slip away!

She wanted to become one with Li Ming.

A surge of excitement coursed through her body, causing her to spasm. Then, as she felt Saint's blood pressure continue to plummet, she remained immersed in the afterglow of pleasure.

After receiving notification that Seimei's blood pressure had dropped to 50, Yoshizumi and his assistant returned to the intensive care unit. An hour had passed since the catheter was inserted. Upon entering the ICU, they immediately began the process of cooling the kidneys. One of the assistants attached several IV bottles containing a mixture of lactate and Ringer's solution to the infusion device and connected them to the infusion pump. After carefully checking the condition of the double-balloon catheter once again, Yoshizumi began injecting air into the catheter protruding from the patient's body, causing the balloon located in the aorta to inflate rapidly. Soon, blood flow was stopped. The balloon appeared to be functioning well, without any abnormalities. Upon receiving Yoshizumi's signal, the assistant immediately started the infusion pump, delivering the kidney-cooling medication solution into the patient's body through the catheter at a controlled rate. Yoshizumi then placed his hand on the patient's abdomen to confirm that the medication solution had been successfully delivered to the intended site. The human body has two major blood vessels in the center: the abdominal aorta and the inferior vena cava. The kidneys are located slightly above the abdomen, one on each side. The renal artery, responsible for supplying blood to the kidneys, is a branch of the abdominal aorta. Similarly, the renal vein is a branch of the inferior vena cava. Both the abdominal aorta and inferior vena cava branch into two in the lower abdomen, continuing down to the legs. The catheter is inserted into the femoral artery, one of the branches formed after the abdominal aorta splits. The catheter's direction is opposite to the blood flow, and the two blocking balloons are positioned precisely at the bifurcation point between the renal and abdominal aortas. Therefore, the inflation of the blocking balloons interrupts blood flow to the abdominal aorta, thus stopping blood supply to the kidneys. Because a small hole is located in the middle of the catheter connecting the two balloons, the drug solution delivered here by the infusion pump can seep into the abdominal aorta through this hole. However, since the abdominal aorta is blocked by balloons at both ends, the drug solution used to cool the kidneys can only flow into the renal artery and then into the kidneys. In this way, the donor's kidney can be rapidly cooled, and any residual blood within the kidney can be flushed away. After circulating once within the kidney, the medication solution returns through the renal vein to the inferior vena cava, and then flows back into the perfusion device via the inferior vena cava. This is the entire perfusion process. Removing a fresh kidney is ideal, of course. However, compared to brain-dead individuals, organs donated from cardiac-dead individuals are often much less fresh. This is because the kidneys are in a state of ischemia from the time the patient's heart stops beating until the removal surgery, which can cause significant damage. To prevent this, most hospitals now immediately begin perfusion through the femoral artery after the patient's heart stops beating, cooling the kidneys promptly. Because the kidneys are cooled before the removal surgery, ischemia-induced functional decline is avoided, thus improving the survival rate of the transplanted kidneys. Cases like Seimi's, where kidney cooling is performed before the patient's heart stops beating, are not uncommon due to permission from relatives. The assistant reports the perfusion rate to Yoshizumi at regular intervals. Saint-Mei's skin gradually turned pale, and as blood circulation gradually stopped, her body temperature could not be maintained, and her body rapidly cooled down. Another assistant monitored Saint-Mei's heart rate. After about forty minutes of perfusion, the pulse monitor emitted a faint noise, which meant that Saint-Mei's pulse had stopped beating spontaneously.

"Please call the patient's family over," Yoshizumi said to the attending physician and nurse standing beside him.

"Let them say their final goodbyes."

At 5:20, the nurse came to the doctor's office and asked Liming and his group to say their final goodbyes to Shengmei. So, after the perfusion had been going on for fifty minutes, Liming and his group returned to the intensive care unit.

Upon entering the intensive care unit, Li Ming couldn't tear his gaze away from Sheng Mei lying there; he immediately noticed the changes in her body. Li Ming, gazing at Sheng Mei's face, slowly walked with the attending physician to her side. With each step closer, Sheng Mei's face became clearer. Li Ming circled halfway around Sheng Mei's bed, then stopped on its left side. Behind him, he could hear the sobs of Sheng Mei's mother.

"The data displayed on this monitor confirms that Ms. Shengmei's spontaneous pulse has completely disappeared," the doctor said, pointing to the electrocardiogram display screen. "In addition, although Ms. Shengmei continues to maintain a semblance of breathing with the assistance of a ventilator, her heart has stopped beating. Moreover, due to the continued drop in blood pressure, her body temperature cannot be maintained, and Ms. Shengmei's body will gradually become stiff and cold."

Liming looked at Shengmei. Her cheeks were almost translucent with paleness, and her lips were covered with a layer of frost. Liming seemed to see a stream slowly flowing through Shengmei's body. Shengmei's eyes were closed, her crystal-like eyelashes slightly curled, casting short, delicate shadows on her skin. Liming subconsciously reached out to touch Shengmei's face. But the instant his fingers touched Shengmei's skin, a numbing sensation clearly traveled through his arm, stimulating his central nervous system. At that moment, Liming felt as if he were holding dry ice; cold and heat rapidly intertwined within his body, causing a pain like being pricked by a thousand needles. Liming let out a whimper from deep in his throat, his hand trembling uncontrollably. He gently stroked Shengmei's cheek with his index and middle fingers, then slowly slid them over her jaw and neck, stopping at her chest, which was so pale that the veins were almost visible. Although covered by her clothes, Liming could still clearly feel that Shengmei's nipples were still erect and gradually becoming cold. Liming removed his hand from Shengmei's body, then tightly gripped the fingers that had just touched her with his other hand. Perhaps it was psychological, but Liming felt that the chilly touch still lingered between his fingers. "Thump."

Li Ming's heart suddenly pounded violently, breaking its steady rhythm. He felt his breathing become labored and quickly covered his chest with his hand.

"Thump." As if defying Li Ming's autonomic nervous system, his heart pounded violently again. Li Ming felt his whole body begin to heat up.

"Can we stop using the ventilator?" the doctor asked.

Li Ming clutched his chest, staring intently at Sheng Mei, breathing heavily. Air was being drawn into his lungs, which mechanically expanded.

At this moment, Li Ming realized that Sheng Mei's body was collapsing!

The doctor pressed the switch on the ventilator. The machine immediately stopped operating, and the rhythmic "puffing" sound abruptly ceased. After a few seconds, with a hiss, the machine slowly expelled the last bit of air remaining inside. Saint-Mei's chest stopped rising and falling.

The doctor glanced at his watch and said in a low voice, "The final time of death is confirmed as 5:31 p.m.

Saint-Mei's father let out a long sigh.

Section 11

Thump. His heart pounded for the third time. This time, the sound was so loud that almost everyone in the room could hear it. Liming felt as if waves were constantly crashing against his chest, making it hard to breathe. Suddenly, a thought occurred to him: Could this be Shengmei conveying her last breath to him? Liming felt as if he could hear Shengmei's heart beating in her final moments, as if she were saying, "I don't want to die! I don't want to die yet!"

"Next, the police will conduct an autopsy, so please ask the relatives to leave."

The doctor urged Li Ming and the others to leave the intensive care unit as soon as possible.

As Li Ming left the intensive care unit, he saw three men who looked like doctors standing in the corridor, followed by a woman carrying a large suitcase. One of the men, who seemed to be in charge, immediately approached Li Ming upon seeing him. This man was about forty years old, but because he had few wrinkles on his face, he appeared quite young. Compared to the attending physician at Saint-Mei, who had been in contact with Li Ming before, he seemed much more energetic and vibrant.

The man walked up to Liming, bowed slightly, and introduced himself: "My name is Yoshizumi Takashi, and I am the head of the transplant team at the Municipal Central Hospital. I will be the chief surgeon for Miss Seimei's kidney removal surgery and subsequent transplant. Before the surgery, on behalf of all the staff of the transplant team, I would like to express my sincere gratitude to Miss Seimei's family for their understanding and support of our work."

"I see... Then I'll leave the surgery to you."

Rimei extended his right hand and shook hands with Yoshizumi. At that moment, Yoshizumi stared intently at Rimei's face, his eyes widening in surprise as if he had discovered something unusual.

"...Is something wrong?"

"Ah, no, no... I was a little out of line, I'm sorry."

Yoshizumi bowed to Toshiaki again, then lowered his eyes and walked towards the preparation room with two other men who looked like assistants and Oda.

The autopsy was over quickly. Shengmei was placed on a stretcher and taken to the operating room. At that moment, a nurse approached Liming and his group and said, "Please wait in the waiting room." But Liming and his companions seemed reluctant to part, remaining motionless as they watched Shengmei being wheeled into the operating room. Only after the nurse's repeated urging did they slowly make their way to the waiting room. Upon entering the cramped waiting room, Shengmei's parents collapsed onto the sofa, appearing utterly exhausted. After his parents-in-law were seated, Liming left the waiting room alone and went to the corridor to make a phone call. "Shengmei, just a little longer, just a little longer," Liming repeatedly murmured to himself, recalling Shengmei's pale face. "In a little while, I will take you to a warm place, where I will raise you. Shengmei, we will never be apart again."

After being anesthetized, Mariko Anzai was transported to the operating room on a stretcher. Her father, Shigetoku Anzai, held his daughter's hand tightly the whole time, running behind the stretcher.

Upon reaching the operating room door, a nurse assisting with pushing the stretcher carrying Mariko said to Shigenori, "Mr. Anzai, we've arrived at the operating room. Please stop here." As she spoke, she gently removed Shigenori's hand, which was tightly gripping Mariko's. Then, a young doctor responsible for transporting Mariko opened the operating room door, allowing the nurses to push the stretcher inside.

Everything happened very quickly. Before Chongde could even get a clear look at the layout of the operating room, Mariko's stretcher and the nurse pushing it had already disappeared into the depths of the operating room.

"Please don't worry, leave everything to us," the young doctor assured Chongde. Then, he followed him into the operating room. The operating room door closed again.

Shigenori sat outside the operating room, staring intently at the hand that had just held Mariko's, a sense of unease creeping over him. He felt the lingering warmth of Mariko's touch on his fingers fading away. No, he couldn't let it disappear. Shigenori thought, unconsciously clenching his fist.

“Mr. Anqi, please don’t worry, please go to the lounge and rest for a while,” a nurse said to Chongde with concern. She then led Chongde to the lounge, had him sit on the sofa, and bought him a cup of hot coffee from the vending machine.

Chongde gratefully accepted the paper cup filled with coffee with both hands, then sat there quietly, reflecting on everything that had happened the night before.

First, he spoke with Oda on the phone to discuss some specific matters. Then, he immediately took Mariko in a taxi to the designated hospital. On the way to the hospital, Mariko was very emotionally unstable, appearing extremely agitated and trembling uncontrollably as if having convulsions. Although she calmed down slightly after arriving at the hospital, she soon began to sob again.

Shigetoku recalled that during the previous transplant surgery, Mariko hadn't shown such strong rejection and resistance. What was wrong this time?

Upon arrival at the hospital, Mariko was immediately taken to the intensive care unit for a comprehensive physical examination, including confirming her dialysis history, measuring her blood pressure and potassium levels, and undergoing several dialysis sessions and blood transfusions. The doctors then focused on checking for any infections caused by pathogens. Regarding Mariko's agitated behavior, the doctors attributed it to pre-operative anxiety and deemed it unnecessary to worry. Finally, after providing a brief explanation of the surgery, the doctors prepared to consult with Shigetoku for his final opinion. At this point, Mariko stopped her outburst, gradually calming down and entering a semi-conscious state.

"Do you agree to let Ms. Mariko undergo the transplant surgery?" Yoshizumi asked.

Chongde replied, "Of course I agree. I'll leave everything to you."

After receiving an affirmative answer, Yoshizumi looked at Mariko's face and called out, "Mariko, what about you?"

Instead of answering Yoshizumi directly, Mariko asked, "Is that person really dead?"

When Mariko asked him this, Yoshizumi thought that the person she was referring to was the kidney donor. So, he succinctly explained to Mariko the fact that the donor was brain dead and could not be revived.

Soon after, the test results came back, and Mariko was a perfect candidate for the transplant. So, in the following days, the doctors began preparing Mariko for the surgery.

First, they shaved the hair off her lower abdomen; then, they immediately covered it with a sterile white cloth to prevent infection; and then, they injected her with a drug that temporarily suppressed her immune system.

All of this happened last night. Out of the hospital's goodwill, Shigetoku was allowed to stay by Mariko's bedside during the long wait before her surgery.

That night, Shigenori sat on a chair by Mariko's bedside, too heavy-hearted to fall asleep.

Oda, who was in charge of coordinating the transplant, was a kind and understanding woman who stayed by Mariko's side. Whenever Mariko became agitated and about to throw a tantrum, Oda would gently coax her, talk to her, and help her gradually calm down.

Watching all this unfold, Shigetoku felt a surge of gratitude towards Oda, but also a growing concern for Mariko's unusually resistant reaction. It seemed that only the attending physician, Yoshizumi, and Oda could effectively communicate with her. At 1:30 PM that afternoon, Yoshizumi went to the intensive care unit to inform Mariko that she would soon undergo surgery and to prepare herself mentally. Mariko stared intently, her eyes wide, unmoving as Yoshizumi stood by the bedside. Shigetoku, watching his daughter, felt a pang of unease; her eyes seemed about to pop out of their sockets.

Mariko's lips trembled, and her teeth clenched so tightly they made a grinding sound.

"Don't be afraid, just like last time, it won't hurt. And this time it will definitely succeed, don't worry," Yoshizumi said softly, gently stroking Mariko's head.

Mariko's eyes remained wide open, her entire body stiff. She asked again, "Was the person who donated her kidney really dead? Was she really, really dead? Would she really never come back to life?"

However, Yoshizumi is no longer at the Municipal Central Hospital. He has gone to the university hospital to retrieve a kidney from the body of someone who is actually dead, and then bring it back for Mariko to have a transplant.

Chongde looked up at the nurse. The nurse looked back at him gently. In that instant, Chongde unconsciously glanced past the nurse's face and drowsily looked at the clock on the wall. It was 5:35 PM.

"Parasite Eve"

Section 12

Chapter Ten

Yoshizumi, accompanied by an assistant, entered the operating room's changing room and changed into a green surgical gown. Wearing these sterilized gowns was routine for Yoshizumi, but he always felt they were stiff and uncomfortable. After dressing, Yoshizumi went to the adjacent restroom. The restroom contained two stainless steel sinks. Yoshizumi stopped in front of a sink and carefully examined his reflection in the mirror, wearing a mask and cap. He turned on the tap and thoroughly rinsed his hands under the sterilizing water; then he squeezed disinfectant into his palm and rubbed it in; next, he picked up a sponge hanging nearby and rubbed his hands repeatedly until fine foam covered them; finally, he rinsed them clean with sterilizing water and used a small brush to thoroughly clean his fingertips and under his nails. Yoshizumi and his assistant repeated this washing procedure three times. Surgeries are generally performed in a sterile environment, and transplant surgeries have even stricter environmental requirements. This is because transplant recipients are injected with a drug that temporarily suppresses their immune system before surgery. This drug reduces the patient's rejection reaction to the transplanted organ, but it also lowers their immunity to bacteria. If the transplanted kidney becomes infected, it can be life-threatening for the patient. Therefore, careful disinfection before surgery is essential. Upon entering the operating room, the nurses helped Yoshizumi and his assistant put on gowns and rubber gloves. Yoshizumi then repeatedly moved his fingers to make the gloves more flexible and better accommodate his finger movements. During this time, another assistant had already completed the full-body disinfection of the donor. The donor lay on the operating table, his abdomen, which was about to be operated on, covered with several layers of green antiseptic drapes called "coverings" to prevent infection from bacteria attached to other parts of the body. The patient's face was also covered to prevent the doctors from being distracted by seeing the patient's face during the surgery. The drapes are green because they make the blood less noticeable when it splatters. Yoshizumi stood to the left of the donor, while the first assistant, who had entered the operating room with Yoshizumi, stood to the right. Yoshizumi made eye contact with him, then looked around to make sure the other assistant and the nurses in the operating room were ready.

At this point, the nurse reported to Yoshizumi, "The patient's heart has stopped beating for seventeen minutes."

Yoshizumi nodded to show he understood. Then he said, "Alright, let's begin the kidney removal surgery now."

As soon as she finished speaking, the nurse deftly handed the scalpel to Yoshizumi's right hand.

Then, a round hole was opened in the green sterile cloth, revealing the area where the deceased was about to undergo surgery. Yoshizumi pressed one hand against the deceased's abdomen, while the other hand gripped a scalpel and made a longitudinal incision. Bright red blood immediately gushed out. Yoshizumi deftly clamped the severed blood vessels with hemostats to prevent blood from entering the abdominal cavity. He then pressed down on the incision, widening it, and then cut along the outer peritoneum of the intestines, immediately clamping several small hemostats. Even so, some blood still flowed into the abdominal cavity from the severed veins. However, due to the precious time, Yoshizumi only performed the necessary hemostasis before proceeding to the next steps. As the incision widened, the deceased's digestive organs were exposed. To make the inside of the abdominal cavity clearly visible, Yoshizumi used a retractor to lift the deceased's liver and handed the retractor to his assistant standing opposite him, instructing him to maintain this position. At the same time, Yoshizumi glanced at another assistant standing beside the perfusion device, who was periodically changing the medication.

Just then, the face of Rimei, with whom he had just exchanged pleasantries, suddenly flashed into Yoshizumi's mind. No, he couldn't afford to be distracted. He immediately snapped back to reality, shaking his head, trying to banish Rimei's image from his mind, but to no avail. Rimei's expression was so strange. His eyes were cloudy, somewhat lost and dejected, as if possessed by something, making him appear extremely clumsy. And what shocked Yoshizumi most was that when he shook hands with Rimei, he felt Rimei's palm was burning hot, as if it had just been taken out of boiling water, almost making Yoshizumi scream. However, Yoshizumi managed to maintain his composure, not showing any further signs of distress before leaving. What was going on? What was wrong with that man?

Yoshizumi shook his head violently once more, reminding himself that he must now concentrate on the kidney removal surgery. He forced his gaze back to the deceased's abdomen, desperately trying to erase Toshiaki's face from his mind. Most people believe the kidneys are located in the lower back, but in reality, they are located further up, just behind the twelfth rib from the top. Therefore, to remove the kidneys, the stomach, pancreas, intestines, and other digestive organs blocking the way must first be removed. Yoshizumi tied the clearly visible celiac artery and superior intestinal mesenteric artery in the pancreas and colon with thread to cut off blood flow, and then severed all these vessels. At the same time, his assistant began activating a special device to suction out the remaining debris from the stomach through a catheter. After the deceased's stomach was thoroughly cleaned, Yoshizumi severed the deceased's esophagus. In this way, almost all the connections between the digestive organs and the upper body were severed—only under these conditions could the kidneys be successfully removed. Of course, in the case of removing a kidney from a living donor, the donor's life must be considered, so this method of focusing solely on kidney removal without considering other factors is not feasible. However, when removing a kidney from a deceased person, time is the top priority, and everything else is secondary. As in the surgery before us, during the incision process, only the main blood vessels need to be stopped to minimize the time required to remove the kidney; this is the general method for removing a kidney from a deceased donor.

"Twenty-three minutes." The nurse continued to tally the time elapsed since the deceased's heart stopped beating.

Yoshizumi and his assistant removed the deceased's digestive organs, turned them over, and placed them on a sterile cloth covering the lower abdomen. Next, they cleaned away any remaining digestive organs that might obstruct kidney removal. Then, the assistant used his right hand to hold down the organs while his left hand widened the incision. At this point, the abdomen was almost empty, and both kidneys were clearly visible. Because they hadn't wasted much time, the kidneys remained pink and shiny. Yoshizumi was very satisfied. With the obstructing organs removed, the renal arteries and veins were clearly visible, as was the double-balloon catheter inserted from the femoral artery into the abdominal aorta; the two inflated balloons were precisely positioned at the bifurcation of the renal artery and the abdominal aorta. All of this indicated a successful perfusion procedure. Below the kidneys, a thin tube connected to the bladder—the urethra. To facilitate kidney removal, Yoshizumi first dissected the tissue surrounding the kidneys, and then severed the urethra near the ileum. Now all that remained was to sever the arteries and veins of the kidney. But Yoshizumi dared not be careless, because if the severance was off, it would cause immense difficulty for the subsequent transplant surgery. Yoshizumi carefully dissected the blood vessels.

Thirty minutes.

When removing two kidneys from a donor at once, as in this case, the general procedure is not to separate the two kidneys first and then remove them separately. Instead, the two kidneys connected by blood vessels are removed simultaneously, and then separated later. At this point, Yoshizumi instructed his assistant to prepare the perfusion cooling and preservation device brought from the Municipal Central Hospital. This was so that after the kidney was removed and separated, one of the kidneys could be quickly placed into the device and taken back to the Municipal Central Hospital for transplantation. After the assistant installed the perfusion fluid, which mimicked extracellular fluid, on the perfusion device, Yoshizumi severed the inferior vena cava slightly above the bifurcation point of the inferior vena cava and renal vein, and simultaneously instructed the assistant to stop the kidney cooling perfusion. Next, Yoshizumi severed the abdominal aorta above the bifurcation point of the abdominal aorta and renal artery. This left only the lumbar artery and lumbar vein connecting the kidney to the deceased's body. The assistant carefully pulled the kidney downwards with both hands, while a nurse nearby helped to hold the blood vessels to prevent them from becoming tangled and difficult to identify. Then, Yoshizumi deftly severed the remaining two blood vessels as well.

OK. Yoshizumi breathed a slight sigh of relief.

The first assistant removed both kidneys from the deceased's body and placed them on a stainless steel tray.

"Thirty-six minutes," the nurse continued, reporting the time elapsed since the deceased officially died.

"Okay, I understand. Please call Miss Oda over for me."

"Okay," the nurse replied, hurrying towards the door.

Yoshizumi walked to the tray, picked up the kidney placed on it, and carefully observed the position and length of the blood vessels and urethra. Because each person's kidney has subtle differences, sometimes the blood vessels preserved in the kidney cannot be successfully anastomosed with those of the transplant recipient. Therefore, to avoid panic during the transplant surgery, it is necessary for the doctor to have a comprehensive understanding of all aspects of the kidney's condition before the operation.