Vampirzahn

Kapitel 5

After Yoshizumi carefully separated the two kidneys, Oda, wearing a green surgical gown, entered the operating room, carrying with her a special box for transporting the kidneys. She quickly took the container for the kidneys out of the box.

“Please take the one on the right,” Yoshizumi said. “I’ve checked it, everything is normal, there shouldn’t be any problems. Also, please tell the doctor there that it contains the urethra, an artery, and a vein.”

"What about time?"

"Twenty-eight minutes," the nurse replied.

“I understand.” Oda glanced at his watch, and Yoshizumi helped him place the kidney into the container.

Oda picked up the box, bowed slightly to Yoshizumi to express her gratitude, and then left the operating room to take a car to a hospital in a neighboring prefecture. This journey would take about two hours.

Just as Oda walked out of the operating room, the first assistant placed the remaining kidney into the perfusion preservation device, then quickly inserted a pre-prepared catheter into the renal artery and started the perfusion. Under the action of the perfusion pump, the cooled perfusion fluid flowed into the kidney, and the gauge displaying the perfusion pressure swung back and forth. The first assistant used the adjustment knob to set the pressure reading to fifty.

"Forty minutes," the nurse reported again.

"Okay, the removal surgery is over."

As soon as Yoshizumi uttered those words, the tense atmosphere in the operating room immediately eased.

But the surgery wasn't over yet. Yoshizumi and his assistant still needed to return to the Municipal Central Hospital to perform a transplant on Mariko Anzai. They quickly packed up their medical equipment and left the operating room. Then, Yoshizumi went to greet the attending physician at the university hospital.

"I'll leave the rest of the work to you. We need to get back to the Municipal Central Hospital immediately. Thank you so much for your cooperation this time."

"Okay," the attending physician replied somewhat vaguely.

So, Yoshizumi turned around, preparing to walk towards the hospital entrance with his assistant who was carrying the preservation device, when the attending physician muttered to himself, "Why do we still need to preserve the liver..."

"What?"

Upon hearing this half-sentence, Yoshizumi didn't understand what the attending physician wanted to say. He stopped and turned around, frowning as he asked.

"It was requested by the deceased's relatives." The attending physician also seemed somewhat puzzled. "The deceased's husband seems to be a researcher in the pharmacy department. He said he wanted to obtain the deceased's liver cells."

"Why?"

Yoshizumi stared wide-eyed, unable to comprehend the reason for this.

Liver cells?

"Dr. Yoshizumi!"

The assistant called out from the hospital lobby entrance. They looked somewhat anxious. Yoshizumi glanced at the assistant, then at the attending physician. Although he wanted to get to the bottom of things, there was no time now. "...Then I'll take my leave."

After saying that, Yoshizumi strode toward his assistant.

"Parasite Eve"

Section 13

Chapter Eleven

After the kidney removal surgery was completed, Shinohara Nobuo immediately went into the operating room to begin liver perfusion.

Around 2 PM, Shinohara received a call from Toshiaki, informing him that Seimi would be undergoing a kidney removal surgery that afternoon. After finishing his daily work, Shinohara returned to the lab to await further news from Toshiaki. Because Seimi's cells begin to die rapidly after her heart stops beating, it was crucial to protect and isolate her liver cells immediately after the kidney removal surgery to obtain highly viable cells. Therefore, Shinohara had a graduate student in the lab act as his assistant, preparing everything in advance so he could be on his way to the operating room at any time.

At 5:50 PM, Liming called to say that Seimei's kidney removal surgery had begun. Upon hearing this, Shinohara immediately moved the equipment needed for liver perfusion into the operating room with the graduate student and placed the culture medium in an incubator to maintain a constant temperature of 37 degrees Celsius. Then, they changed into green surgical gowns and waited in the adjacent room for the transplant team to finish the surgery.

At 6:15 p.m., the removal surgery was completed, and Shinohara and his assistant entered the operating room. Shinohara then explained the general steps of the surgery to the graduate student who was acting as his assistant, and instructed him to prepare the perfusion device and buffer solution.

Seimei's abdomen hadn't been stitched up yet, so her liver was visible from the outside. Although more than forty minutes had passed since her official death, Seimei's liver was still relatively fresh, brown, and glossy. Furthermore, thanks to the transplant team's quick and efficient surgery, there were no black spots or scars on the liver. Shinohara thought that, judging from this condition, they should be able to extract relatively fresh cells. Looking at Seimei's body, he suddenly felt a strange sense of emotion and couldn't help but exclaim, "Even Mrs. Toshiaki's internal organs are so perfect."

Shinohara carefully cleaned the area around the liver and located the hepatic vein, gently pressing it with his finger to check for any remaining elasticity. Meanwhile, his assistant swiftly prepared the perfusion apparatus and connected a tube in HKPES buffer solution to another polyethylene catheter via the perfusion pump. Shinohara then clamped the hepatic artery with surgical clamps, severed the left hepatic vein, and deftly inserted the polyethylene catheter into the cut, simultaneously instructing his assistant to start the perfusion pump. Under the flushing effect of the buffer solution, the residual blood in the left lobe of the liver slowly flowed out, and the liver returned to its characteristic earthy yellow color.

It seemed to be a good start, and everything was going smoothly. So, Shinohara instructed his assistant to keep the buffer solution circulating in the liver at this moderate rate for another twenty minutes.

Primary culture of hepatocytes is a widely conducted research project in laboratories worldwide. Its purpose is to understand the diverse metabolic mechanisms within the liver. The simplest method involves extracting hepatocytes from the liver, culturing them, injecting drugs and substrates, and observing the resulting reactions and changes. However, obtaining human hepatocytes for research requires close collaboration with clinical medical researchers, which is often difficult. Therefore, pharmaceutical researchers like Li Ming typically use mouse hepatocytes for experiments. While mouse hepatocytes are generally considered good experimental material, they differ significantly from human hepatocytes in several aspects. Firstly, the arrangement of enzymes within mouse hepatocytes differs from that in humans. Therefore, researchers studying enzymes often prefer to use human cells for their final studies. In recent years, due to significant advancements in science and technology, obtaining highly viable hepatocytes directly from humans for research has become widespread, with organ donors like Shengmei often providing the cells. However, since age is a significant factor affecting cell quality, most cells used in research come from donors aged 18 to 30. Furthermore, researchers carefully consider the donor's cause of death when selecting recipients. In most cases, researchers choose donors who died in traffic accidents. This is because, unlike donors who died from disease, the former's internal organs were not affected by drugs, allowing for the extraction of normal liver cells.

The perfusion proceeded as planned. Shinohara's assistant retrieved a second bottle of buffer solution from the incubator. Replacing the previous bottle, they would wait another twenty minutes. The previous HKPES buffer solution was a mixture of collagenase and calcium salts; the collagenase in it had a good relieving effect on liver cells. Shinohara stood beside the operating table, gazing at Seimi. Except for the incision site, the rest of Seimi's body was covered by sterile cloth, but her shapely curves were still faintly visible.

Looking at Seimi, Shinohara inadvertently recalled her wedding ceremony with Toshiaki. That was two years ago. Back then, Shinohara had given a somewhat clumsy congratulatory speech on behalf of a friend. Judging by his calculations, Seimi must have just turned twenty-three then, looking as innocent and adorable as a high school student, her eyes pure and clear. At the time, Shinohara had joked with Toshiaki, "She's such a lovely little bride," and upon hearing this, Seimi, standing on the stage, immediately blushed and shyly glanced at Toshiaki. After that, the two of them must have lived a very happy life, Shinohara thought. Ah, right, what was the design on the New Year's card Toshiaki sent this year? This question suddenly popped into Shinohara's mind. But no matter how hard he tried to search his memory, he just couldn't remember.

No, I need to focus on my work. Realizing this, Shinohara forced himself to pull his thoughts back and refocus his attention on Seimei's liver. He carefully examined Seimei's left lobe of the liver; it appeared to be in good condition, feeling very soft to the touch, indicating that the collagenase was working effectively.

Shinohara glanced at the stopwatch and stopped the perfusion. Then, he began preparing the Leibovitz solution and asked his assistant to inform Rimei, who was waiting outside, that everything was going well and the work would be completed soon, asking him to wait patiently a little longer. Shinohara then deftly severed the left lobe of the liver, measured its wet weight, and immediately placed it into the Leibovitz solution, which was being maintained at a constant temperature. He then gently agitated the flask, allowing the immersed lobe to slowly unfurl. Everything seemed to be going well; he only needed to continue gently agitating the flask. The subsequent work would have to wait until he returned to the laboratory. To prevent bacterial contamination, Shinohara capped the flask and then carried it out of the laboratory.

When Toshiaki, who was leaning against the corridor wall, saw Shinohara come out, he immediately sprang to Shinohara's side as if he had springs in his body.

Li Ming's face was ashen, and he looked lifeless. However, when he confirmed that the flask contained Saint-Mei's left liver lobe, his bloodshot eyes widened, his breathing became rapid, and he couldn't help but shout, "Great!"

"Everything is going relatively smoothly," Shinohara said, trying to appear calm, and then told Toshiaki some basic data. "We haven't done the washing yet. We need to use a centrifuge that can generate fifty grams of centrifugal force to slowly clean it, and then filter out the residue with gauze. You should be familiar with these steps, right?"

"Yes, of course."

Liming took the flask from Shinohara's hand, placed it in what seemed to be a pre-prepared refrigerator, and then carefully carried the refrigerator, not wanting to waste a moment longer, turned and left. He planned to return to the pharmacy department immediately to conduct cell culture. As for his parents-in-law, Liming no longer had the time to care about them. As Liming walked quickly, his eyes seemed glued to the flask, fixed intently on the left lobe of the liver inside, his vision gradually blurring with tears.

As Shinohara watched him leave, something felt off. Suddenly, he regretted not collecting any liver cells or asking Rimei what he was thinking. Watching Rimei's back recede into the distance, Shinohara called out, "Nagashima, are you really alright? Is this the right thing to do?"

Upon hearing Shinohara's voice, Toshiaki suddenly stopped, slowly turned around, and looked Shinohara in the eye. In a very deep voice, he asked, "What do you mean by that?"

"Don't you think your behavior is abnormal? Are you just going to abandon Shengmei's parents? And what about Shengmei's body? Are you just going to leave it there forever?"

"Remains? What are you talking about?"

A strange glint flashed in Riming's eyes. Shinohara felt a chill creep down his spine. Riming slowly turned his face, gazing at the refrigerated box he carefully cradled in his arms. His previous haggard expression had vanished, replaced by an unusual radiance. He gently stroked the refrigerated box and said, "I'll be back in three hours... And please, don't get it wrong, Seimi isn't dead!" With that, Riming dashed out, leaving Shinohara standing there, stunned. In the cold, damp corridor outside the intensive care unit, only the echo of Riming's footsteps could be heard.

"Parasite Eve"

Chapter Twelve

Section 14

The ambulance carrying Yoshizumi and his assistant sped back to the Municipal Central Hospital. The journey would take about thirty minutes. Each time the vehicle tilted as it turned a corner, the cooling perfusion device containing the kidney made a muffled "click-clack" sound. Yoshizumi sat in his seat, arms crossed over his chest, trying to close his eyes and rest. This thirty-minute journey was the only time Yoshizumi could truly relax and rest. Because the donor was from a hospital within the city, the time allotted for transporting the kidney was very short. If it were from another prefecture, sometimes an airplane would be used, taking two hours each way. For the surgeon, this time was as precious as an oasis in the desert. Although the surgeon couldn't afford to relax during this time—because the hospital had to perform the transplant immediately once the kidney arrived—a short break was allowed, as long as no mistakes were made during the surgery.

Before the development of cooling perfusion devices, hospitals used refrigerated boxes to transport kidneys, operating on the same principle as refrigerated delivery trucks—time was crucial during transport due to limitations. Despite everyone's best efforts to race against time, the results were often unsatisfactory. The survival rate of kidneys in patients was extremely low compared to today, which led to the development of cooling perfusion devices. Simultaneously, the perfusion fluid used to soak the kidneys was significantly improved. To better maintain kidney freshness, continuous improvements were made, eventually leading to the high-performance perfusion fluid now widely used. Because the practice of removing organs from brain-dead individuals is not widely accepted in Japanese society, transplant surgeons, as in this case, had to wait until the brain-dead patient's heart stopped beating and an autopsy was performed before performing the organ removal surgery. It is certain that the freshness of the organs removed at this point is significantly lower than when the patient was brain dead.

Despite this, as a doctor, Yoshizumi felt regretful yet helpless. He thought that if the definition of brain death could be legalized and forced to be accepted by the general public, perhaps fresher kidneys could be extracted, thus increasing the survival rate of kidneys in transplant recipients. At the same time, the number of kidney donors would increase, providing more opportunities for transplant recipients. In this way, there might not be a need to transport kidneys from distant places in the future. Several years ago, staff from the Municipal Central Hospital made several special trips to the United States to retrieve kidneys from brain-dead individuals for transplantation, all because the Japanese public was not yet accepting of removing kidneys from brain-dead individuals. Yoshizumi thought to himself, the Japanese are truly a strange race. Whenever doctors remove kidneys from brain-dead individuals in their own country, it causes a great social uproar and is met with unanimous condemnation from the public. But when it comes to kidneys from brain-dead individuals in the United States, the Japanese readily accept them without hesitation. Frankly speaking, from a medical perspective, this method of transporting kidneys from the United States is not advisable, because it would take much longer to travel. Transplant patients typically prepare for surgery well in advance, awaiting its commencement. During this waiting period, urination is prohibited. As a result, the prolonged kidney transport time often causes patients immense pain and distress, sometimes even leading to uncontrollable weeping. Even if the surgery proceeds on time, and the patient believes they will live a better life, the devastating blow is the possibility that the kidney, due to its lack of freshness, fails to survive. Yoshizumi always feels a pang of remorse when informing patients of the need for a second surgery to remove the failed kidney. While some of these unfortunate patients do undergo a second transplant and are able to leave dialysis behind, most develop a profound fear of transplantation and refuse to undergo the procedure again.

"Doctor, thank you for everything you've done for me, but I think there's no need for you to continue."

A housewife's face flashed through Yoshizumi's mind. These were the words that the thirty-five-year-old housewife had spoken to him after her medical examination. She stood before him, her hair slightly disheveled, but she made no attempt to straighten it. A weary smile played on her lips as she said with a hint of self-deprecation, "I'm thirty-five this year. I'm not young anymore, and I won't be working again, nor do I plan to have any more children. So for me, dialysis is enough. Doctor, this faint hope is no longer necessary for me. Please don't tell me that I can resume a normal diet and lifestyle after the transplant, or that I can travel to the outside world, okay? Do you know what I was thinking when you told me there was hope for a transplant? I was thinking how much better it would have been if I hadn't known about transplants. If I had only known about dialysis, I wouldn't have held onto such high hopes. But the greater the expectation, the greater the disappointment. Everything I'm doing now is pointless. Doctor, I'm so tired, so weary."

The ambulance suddenly tilted violently, indicating a sharp turn ahead. Yoshizumi closed his eyes and let out a long breath. He knew that once past this sharp turn, the ambulance would be on the ramp in front of the hospital, meaning they would soon reach their destination—the Municipal Central Hospital.

Mariko Anzai, naked, lay horizontally on the operating table, her entire body covered with a green sterile drape and her face draped with an anesthesia mask. The other end of the mask was connected to an anesthesia machine, which the anesthesiologist was checking to ensure it was functioning properly. Mariko lay there quietly, looking as innocent and naive as she had two years ago. All pre-operative preparations had been completed before Yoshizumi returned to the Municipal Central Hospital. The surgical assistant had thoroughly washed Mariko's entire body to prevent bacterial infection. In the sterile room, the only source of bacteria is the patient herself—the various bacteria adhering to her skin. Therefore, to prevent infection, it was necessary for the staff to carefully disinfect the patient's skin before surgery. The surgical assistant first dipped a small brush, shaped like one used for cleaning in a bathhouse, into disinfectant and then repeatedly scrubbed Mariko's lower abdomen and thighs. Because the hair on her lower abdomen would cause inconvenience during the surgery, it had been shaved off the night before. At the same time, to prevent bacteria from entering through the razor marks, Mariko's lower abdomen was covered with a green antibacterial cloth.

Upon entering the operating room, Yoshizumi stood to Mariko's left, with the other staff members ready. In this surgery, besides Yoshizumi as the chief surgeon, there were two anesthesiologists, three assistants, and two nurses assisting him. The entire operating room was a uniform light green, creating a sense of unity. Apart from the operating table and several large medical instruments, the room was empty, making it seem almost too large. The doctors were all wearing carefully sterilized green surgical gowns. As the patient, Mariko's body, except for her lower abdomen, was covered with green sterile drapes. Therefore, under the lights, Mariko's lower abdomen, the only part not green, stood out prominently. Yoshizumi slightly raised his head and glanced at the operating light hanging from the ceiling.

This operating room was specifically designed for transplant surgeries, so it differs from ordinary operating rooms in many ways, even the shadowless lamps. Ordinary shadowless lamps are umbrella-shaped, with the bulbs embedded inside. But in this operating room, the shadowless lamp consists of six small spherical lamps surrounding a large central lamp, forming a hemispherical shape that resembles the bottom of a flying saucer. There are two reasons for this design. First, it facilitates air circulation. To maintain a sterile environment, this operating room is equipped with special ventilation equipment. In this situation, ordinary umbrella-shaped shadowless lamps would hinder airflow, so the designers used hemispherical lamps to solve this problem. Second, these shadowless lamps can diffuse light to every corner of the operating room. Instruments, doctors' expressions, and even the color of the patient's internal organs are all clearly visible under the light—even the unbroken foam of disinfectant on the patient's skin is clearly visible.

The first step of the surgery was to cleanse the bladder. At Yoshizumi's instruction, an assistant inserted a catheter into Mariko's bladder through her vagina and began to carefully cleanse it. Of course, this cleaning work had to be performed under sterile conditions.

"It is now 6:47 PM. Seventy-six minutes have passed since the donor officially died, and forty minutes have passed since the kidney was removed."

"OK. Let's begin the surgery now."

After speaking, with the catheter still inserted in Mariko's body, Yoshizumi began the work of cutting the skin. He first marked the skin on Mariko's left abdomen, above her genitals, and carefully cut along the mark with a scalpel. Then, he switched to an electric scalpel and continued cutting through the white abdominal fascia beneath the skin, exposing the external oblique fascia and rectus abdominis sheath. The external oblique fascia is a red muscle located on the lateral side of the abdomen, while the rectus abdominis sheath is a white muscle located in the abdomen. Yoshizumi used the electric scalpel to longitudinally cut one side of the rectus abdominis fascia along the line where these two muscles meet, and then continued cutting along the underlying fascial layers. Two years ago, when Mariko underwent her first transplant surgery, Yoshizumi placed the transplanted kidney on the right side of Mariko's body, but it was unsuccessful. Therefore, before performing this second transplant surgery, Yoshizumi carefully considered all factors and ultimately decided to place the transplanted kidney on the left side of Mariko's body this time. The transplanted kidney will not be placed in its original location, but rather below it, precisely midway between the lower back and groin. Instead of the abdominal aorta and inferior vena cava, it will be directly connected to their branches, the iliac artery and iliac vein. This location was chosen to avoid obstruction from other internal organs during surgery, allowing for a faster completion of the procedure. Yoshizumi carefully dissected the peritoneum, exposing the vascular bed of the iliac crest. He tied the lymphatic vessels attached to the iliac crest vessels with sutures and then severed them one by one, preventing lymphatic fluid from seeping into the surgical site and causing unnecessary complications. Next, Yoshizumi dissected the iliac artery and iliac vein from the vascular bed of the iliac crest, ensuring quick and accurate location of these vessels in later surgical stages. This pre-dissection method also prevents venous thrombosis during kidney transplantation. Yoshizumi deftly tied the iliac artery with sutures, clamped it with hemostatic forceps, and severed it after leaving an appropriate length. Next, the inside of the artery was flushed clean by injecting simplified heparin solution.

Yoshizumi let out a soft breath, examining the area he had cut open with the electric scalpel. At the site of the surgery, all the lymphatic vessels were sutured, and some blood vessels were secured with hemostatic forceps. His assistant continued wiping away any remaining blood from Mariko's body. Everything was going very well. The blood vessels in the intestinal tract were now clearly visible, and there was no sign of severe bleeding. It seemed the surgery could smoothly transition to the second stage—the stage of suturing the donor's kidney to Mariko's body. But just then, Yoshizumi suddenly felt a burning sensation.

He jerked his head up, but found nothing unusual. His assistants around him were working as efficiently and methodically as before. Yoshizumi glanced around; it seemed no one had noticed anything amiss with his body.

Seeing Yoshizumi's strange behavior, the first assistant standing opposite him asked in surprise, "What's wrong?"

"Ah, it's nothing..." Yoshi answered indistinctly from under his mask.

The burning sensation persisted. Yoshizumi temporarily shifted his attention from the surgery back to himself, trying to find the source of the heat. The room temperature didn't seem to have risen, as everyone around him appeared normal. Yet, Yoshizumi felt as if he were on fire. A nurse came over and wiped Yoshizumi's forehead. Only then did Yoshizumi realize that beads of sweat had formed on his forehead. Fortunately, the burning sensation soon subsided, and his body temperature gradually returned to normal. Yoshizumi breathed a sigh of relief, and as he came to his senses, he noticed that his assistants were all watching him. Yoshizumi quickly waved his hand gently to indicate that he was alright, then turned his gaze back to the operating table.

What exactly happened? Yoshizumi pondered the events as he prepared to suture the kidney. It wasn't dizziness from standing for so long, because the burning sensation wasn't just in his head, but throughout his entire body. This was truly strange.

Just as Yoshizumi was sketching the image of the donor's kidney in his mind, that burning sensation suddenly swept over him again, as if echoing his previous experience. This reminded Yoshizumi of Rimei's hands, which were also burning hot, and Yoshizumi had almost cried out in surprise back then. But now, thinking about it carefully, Yoshizumi felt that it was very likely because Rimei had also experienced a similar burning sensation inside him at that time.

What exactly was this burning sensation? Yoshizumi was so troubled by this question that he couldn't concentrate on the surgery.

The kidney remained in the cryopreservation device. It had been in this device since Yoshizumi removed it at the university hospital until it was transported to the municipal central hospital. Furthermore, the perfusion status and changes in kidney weight were constantly being recorded. Yoshizumi had checked this data before the surgery to confirm that the kidney was in normal condition. Now, just in case, Yoshizumi checked the data again with his assistant, and the result was: the perfusion rate was 117 milliliters per minute. This indicated that the kidney was still in good condition. Yoshizumi and his assistant removed the kidney from the perfusion device and began suturing the blood vessels.

The first step was suturing the renal artery of the transplanted kidney to Mariko's internal intestinal bone artery. The suturing had to be done with extreme care. After confirming the positions with his first assistant, Yoshizumi began suturing. They first anastomosed the cut surfaces of the two vessels with proline sutures, and then completely sutured them while maintaining the anastomosis. The operating table was constantly adjusted in angle as needed for the suturing, which prevented Yoshizumi and his team from experiencing discomfort from constantly changing their wrists, and also eliminated concerns about arteriosclerosis and intimal shedding in the transplanted kidney. After the renal artery of the transplanted kidney and Mariko's internal intestinal bone artery were sutured, the assistant slowly placed the kidney into Mariko's body. At that moment, Yoshizumi subconsciously exhaled.

Next, Yoshizumi first determined the positional relationship between the renal vein of the transplanted kidney and the osseous vein of Mariko's intestine. Then, after confirming that the vessels were not bent or broken, he determined the specific location where suturing would be performed. He then clamped the vessel below this location with two hemostatic forceps, made a small incision at the suturing site, and cleaned the inside of the vessel through the incision. After completing all this, Yoshizumi, with the assistance of an assistant, began suturing the vein.

After the suturing was completed, Yoshizumi gestured to his assistant with his eyes to proceed to the next step. The assistant nodded and began to gently remove the hemostats. First, the one clamped above the ileocecal vein was removed, then the one clamped at the end of the ileocecal vein was removed, and finally the one clamped at the ileocecal artery was removed. With the hemostats removed, blood began to flow into the transplanted kidney. Although a small amount of blood still seeped from the suture site of the artery during this process, it was immediately stopped after the nurse's intervention.

The transplanted kidney turned red shortly after receiving Mariko's blood, and its surface gradually regained its elasticity. Yoshizumi gently rubbed the surface of the kidney with his fingers to help it circulate blood. Although Yoshizumi had seen this many times before, this was the first time he had witnessed such a rapid and noticeable change—the kidney seemed to immediately revive and begin to function normally within Mariko's body. Then, a clear liquid gushed from the urethra of the transplanted kidney; it was urine. The assistant quickly clamped the urethra with forceps and collected the urine in a special container.

In living donor kidney transplantation, the phenomenon known as "initial urine" usually occurs two to three minutes after the blood vessels are sutured. However, in dead donor kidney transplantation, the "initial urine" phenomenon generally does not occur quickly after the blood vessels are sutured.

Since joining the Municipal Central Hospital, Yoshizumi had been performing kidney transplant surgeries, and this was the first time he had ever seen "initial urine" appear so quickly after a necrotic kidney was transplanted. Therefore, Yoshizumi firmly believed that the surgery had been a success. Suddenly, as if he had been flicked by something, Yoshizumi jerked his head up.

here we go again!

That scorching heat is back!

"Thump! Thump!" Yoshizumi could hear his heart pounding twice. Then, a very strange feeling washed over him; he felt as if his heart was being manipulated by something, completely out of his control. This was accompanied by a burning sensation, as if his entire body were being roasted on fire. Yoshizumi instinctively began to gasp for breath. Fortunately, no one noticed his unusual behavior. While trying his best to endure the burning pain, Yoshizumi repeatedly asked himself: What is happening? But of course, Yoshizumi had no answer. He only knew that the instant Mariko's blood flowed into his kidneys, he immediately felt that burning heat again. Why was this happening? It was almost like… Thinking of this, Yoshizumi was startled. He stared intently at his kidneys, as if trying to find some clue.

Could it be...? No, it can't be. Yoshizumi quickly dismissed the thought, realizing he was becoming increasingly confused.

Yoshizumi shook his head vigorously, reminding himself that he couldn't afford to be distracted at this moment; the surgery wasn't over yet, and the urethra hadn't been sutured.

Yoshizumi took two or three deep breaths to calm himself down. Then, while being careful not to let his assistant notice anything amiss, he began to suture his urinary tract. However, deep inside his body, the burning sensation never subsided and continued to cause Yoshizumi a burning pain.

The suturing of the urethra began. Yoshizumi first moved the incision instrument down slightly to make the bladder more clearly visible. Then, he used an electric scalpel to make a longitudinal incision in the middle of the bladder, draining the saline solution that had been injected for cleaning, so that the internal structure of the bladder could be seen clearly under the operating light.

The bladder is a soft, white organ located behind the pubic bone, with two urethral tubes connecting to the patient's own kidneys on its inner side. After Yoshizumi made a longitudinal incision in the middle of the bladder, the urethral openings on the inner side of the bladder were exposed. In kidney transplant surgery, the urethral tube of the transplanted kidney is generally not connected to the patient's original urethral tube, but rather a new urethral opening is created next to the urethral tube on the side of the patient's original bladder. Therefore, Yoshizumi first had his assistant use forceps to lift the innermost mucosa of the bladder wall. Then, he inserted a power scalpel into the mucosa, making a small hole, and continued to advance the scalpel, drilling a small hole in the bladder wall muscle as a marker. This step had to be performed with extreme care; when marking the bladder wall muscle, it was crucial not to puncture it. This is because the newly opened urethral opening could not be perpendicular to the bladder wall muscle; it had to be at a certain angle, otherwise urine leakage would occur after suturing. After making a small incision in the mucosa, Yoshizumi inserted a right-angled forceps through the incision and used the tip of the forceps to enlarge the marked hole on the bladder wall muscle. Then, he used another, longer right-angled forceps to slowly separate the mucosa around the incision from the bladder wall muscle, and continued to penetrate deeper through the small hole in the bladder wall muscle, drilling a channel with a certain angle, and finally using an electric scalpel to open it from the outside. In this way, the tip of the right-angled forceps inserted from inside the bladder could reach the outside of the bladder, and its exit point was on the inside of the bladder. The urethral tube of the transplanted kidney had been pre-reserved for sufficient length when it was cut. Yoshizumi pinched the cut end of the urethral tube with the tip of the forceps and carefully guided the urethral tube into the inside of Mariko's bladder, while at the same time having to keep the urethral tube straight. After guiding it to the appropriate length, Yoshizumi cut off the excess part. Next was the suturing of the urethral opening. Yoshizumi turned the urethral opening that had been guided into the inside of the bladder over and pressed it tightly against the inner wall of the bladder, and then sutured it with thread. After the suturing was completed, Yoshizumi inserted the tip of the right-angle forceps into the new urethral tube to confirm that the urethra was open. Because there had been incidents where the urethral tube had been blocked due to errors during the suturing process, Yoshizumi, after confirming the urethra's openness, inserted a thin tube into the urethra to check its patency, to ensure that everything was in order.

Everything seemed to be going relatively smoothly. The suturing of the transplanted kidney and the patient's blood vessels was finally completed, and Yoshizumi felt a little relieved, as only the suturing of the surgical site remained. Yoshizumi really wanted to finish the surgery quickly. The surgery entered its final stage. Yoshizumi first sutured the bladder wall from the inside, then moved the incision instrument back up to check the condition of the kidney. Just in case, he collected some biopsies from the inside of the kidney to make tissue sections for later examination. In fact, not only the kidney, but the hospital would also regularly perform biopsies on the patient's entire body after the surgery to understand the patient's postoperative recovery.

After collecting the living tissue cells, Yoshizumi began the next step of suturing. With the assistance of his assistant, he first checked whether there was any bleeding at the surgical site; then he carefully cleaned the surgical site and surrounding area with saline solution, and placed several suction-type drainage catheters around the kidney and bladder, with the other end of the catheters pulled out of the body; subsequently, he sutured the cut muscle.

"It is now 10:36 p.m. It has been four hours and twenty-nine minutes since the kidney was removed."

Once the suturing was mostly finished, the air in the operating room suddenly felt more relaxed, and all the staff felt a great sense of relief. Yoshizumi also breathed a sigh of relief.

The suture marks were clearly visible, and the transplanted kidney was placed below the suture site.

What on earth happened to this kidney? Yoshizumi stared intently at the stitches, unable to look away. The burning sensation had subsided; Yoshizumi no longer felt the searing pain, only a warm, comforting feeling throughout his body. However, the pounding of his heart still echoed in his ears. Now, only one thought occupied Yoshizumi's mind: it was all caused by that kidney, the one now transplanted into Mariko's body that had caused his heart to pound so violently and made him feel this unusually hot all over. Yes, it must be that kidney causing all this trouble!

As is customary, patients are transferred to special wards after surgery for a period of observation and undergo a series of meticulous examinations. Therefore, after completing the suturing, Yoshizumi began preparations for transferring Mariko to the special ward. Normally, Yoshizumi would have completed this final task efficiently. But today, his movements were somewhat hesitant. This was because Yoshizumi's attention was no longer on the surgery; now, he was most concerned about the lingering heat within his body, as if it had been burned, and the accompanying slight dizziness. Although Yoshizumi knew clearly that now was not the time to rest, and that observing the patient's post-operative condition was crucial, he simply couldn't suppress the intense urge to escape. He wanted to get away from here, even just a little distance from that kidney.

He had a persistent, ominous feeling that the kidney would bring misfortune and disaster. Although he didn't understand why he thought this way, the strange idea just wouldn't go away from his mind. At that moment, Yoshizumi's heart began to pound violently again, as if mocking his contradictions and foolishness.

Section 15