parasitism eve

Chapter 9

What do I want to do? I haven't seriously thought about it yet. I can't possibly go out to work and start earning money right now! I definitely need to go to university, but which major should I choose? What kind of job do I want after graduation? I haven't decided. Luckily, I still have time. I'll think about these things after I get to university! Right now, it's impossible for me to have any mature ideas all at once. However, perhaps it was precisely because of this that Zhijia's self-talk today touched Shengmei.

At least, Zhijia already has aspirations for her future career. But Shengmei doesn't have these aspirations—she doesn't even know what she wants to do in the future.

Shengmei felt that Zhijia was far ahead of her.

What will her life be like from now on? Saint-Mei pondered these questions. What kind of people will she be with? What kind of children will she raise? And how will she die?

Saint-Mei opened her eyes in bed, staring at the dim ceiling, lost in thought. The fluorescent light hanging from the eaves began to slowly rotate, and she herself didn't know if she was asleep or awake. She only felt countless questions surging in her mind, so many that they were overflowing.

"Parasite Eve"

Section 23

Chapter Six

"How are you feeling? Are you in a better mood?"

Yoshizumi Takashi asked Mariko with a dry laugh about her situation.

Five days have passed since the surgery.

The kidneys implanted in Mariko's body are in good condition, and no problems have been found. The suction tube at the top of Mariko's kidney was removed the day before yesterday, and the catheter inserted into her urethra was removed today. Now, Mariko only has one catheter remaining in her abdomen, connected to her bladder. However, this one will also be removed tomorrow.

Mariko glanced at Yoshizumi, then immediately turned her head away.

It still doesn't work...

Yoshizumi tried his best to hide his true feelings and smiled broadly at Mariko again, saying, "Your temperature seems to have gone down. Your C-reactive protein level has also decreased. Are you feeling much better? You're still a little anemic, though, so we need to adjust the IV fluid dosage."

Yoshizumi tried to explain the test results to Mariko as concisely as possible. He wanted her to understand her physical condition so she could actively cooperate with treatment in the future; and most importantly, knowing that she hadn't shown any signs of rejection or infection so far would surely put her at ease. Yoshizumi thought to himself.

In fact, the actual transplant treatment begins after the surgery. This is especially true for kidney transplants, where the surgery itself isn't particularly complex and can be performed by experienced surgeons. Yoshizumi believes the key issue lies post-surgery. For the patient, the newly implanted kidney is a foreign object completely incompatible with their own body. Therefore, the patient's body will produce an immune response, strongly rejecting the transplanted kidney. To minimize this rejection, HLA testing is performed before the transplant surgery to ensure the kidney most similar to the patient's own characteristics is implanted. However, this alone cannot completely eliminate rejection. Therefore, patients must also take immunosuppressants long-term. Previously, transplant treatment often used a two-dose approach to control rejection, simultaneously using an adrenocorticosteroid called prednisolone and an immunosuppressant called nitroimidazole. With this approach, the survival rate of the transplanted kidney was only mediocre. However, now, effective immunosuppressants such as cyclosporine and FK506 have been developed, significantly improving the survival rate. However, both of these drugs can have toxic side effects on the kidneys, so they are generally avoided when used alone and are instead used in combination with other medications. Based on years of clinical experience, Yoshizumi's medical team implemented a three-dose therapy for Mariko: a low dose of cyclosporine, supplemented with an adrenal steroid and an antibiotic called imidazolidin. Considering this was Mariko's second transplant, the dosage of the medications was adjusted accordingly. Immunosuppressants can reduce the body's rejection of the transplanted kidney. However, at the same time, patients become more susceptible to bacterial infections. For patients with suppressed immune function, infection by pathogenic bacteria is a life-or-death issue. This is why the post-operative period is crucial. After surgery, the patient's body must be continuously monitored to identify any signs of rejection or infection. Furthermore, the dosage of immunosuppressants must be adjusted according to the patient's recovery. Therefore, it is often said that transplant patients are walking a tightrope between rejection and bacterial infection.

Yoshizumi also realized firsthand that transplant treatment is not just a matter for the transplant surgeon. The success is guaranteed by the communication and close cooperation between doctors, nurses, clinical technicians, and pharmacists. Mariko kept her face turned to one side, and Yoshizumi glanced at Mariko's father standing behind her. But he ignored Yoshizumi.

What on earth is going on? Yoshizumi sighed inwardly.

Mariko showed no intention of reconciliation. It seemed she wasn't just targeting Yoshizumi, but also her father and Mamoru. She seemed desperately trying to forget or deny the fact that she had received a transplant. It's true that some sick children develop strong rebellious tendencies due to strict discipline from doctors or parents. Yoshizumi remembered seeing such cases among his patients, but Mariko seemed more complex. Yoshizumi couldn't understand why Mariko was so stubbornly resisting the transplant. Perhaps it was precisely because he hadn't understood her psychology that the kidney implanted in Mariko two years ago hadn't survived.

Yoshizumi had this thought in his mind. However, he quickly shook his head, trying to dispel it.

"I should be able to get up and move around the day after tomorrow. After walking around a bit, I'll feel hungry again, and food will taste better."

As he spoke, Yoshizumi stroked Mariko's head. The nurse beside him smiled and said, "Yes, Mariko will get better soon."

However, Mariko remained silent, completely ignoring Yoshizumi. Even Yoshizumi's hand on her head was something Mariko desperately tried to shake off; a rapid head shake forced Yoshizumi to withdraw his hand. Had Mariko given up hope of a cure?

She wasn't like this two years ago.

"Doctor!" Mariko shouted as she ran. She rushed over and threw herself into Yoshizumi's arms, thanking him profusely, tears welling in her eyes. Yoshizumi smiled at her and stroked her head, just as he does now.

Mariko underwent dialysis for about a year before her first transplant. Later, because her father offered to donate a kidney to her attending physician, Mariko received a transplant at the Municipal Central Hospital.

When Yoshizumi first met Mariko and her father, it was during the peak of cherry blossom season. From the room where transplant doctors met with patients, the cherry blossoms planted in the hospital courtyard were clearly visible. Mariko's attention was frequently drawn to the pink cherry blossoms outside the window. At the time, Mariko was in sixth grade, wearing a white shirt and a green skirt, with a high forehead, round eyes, and cute short hair; she was very obedient.

Whenever Yoshizumi mentioned something funny, Mariko would immediately burst into an innocent laugh. Perhaps due to kidney failure, her cheeks seemed somewhat sunken. However, overall, Mariko was a very cute girl, Yoshizumi wondered if her self-deprecating attitude stemmed from feeling too short. Her father said that Mariko's height hadn't changed much in the past two years. She used to be considered tall in her class, but now she always stood in the front row during PE class or morning assemblies. Mariko seemed somewhat bothered by this.

Before a transplant, the hospital where Yoshizumi works always provides patients with multiple, meticulous explanations. These include what a transplant is, its benefits and drawbacks, the procedure itself, and how to manage life afterward. Clearly explaining these issues helps eliminate any misunderstandings or anxieties the patient may have. This explanation is usually done by nurses, but when Mariko was hospitalized, Yoshizumi personally explained it to her. Mariko listened attentively to Yoshizumi. When she heard that she would still need to take immunosuppressants long-term after the surgery, Mariko was clearly somewhat taken aback. However, she quickly accepted this reality.

"Long-term? How long is long-term?" Mariko asked, staring intently into Yoshizumi's eyes.

“Long-term means living,” Yoshizumi replied, looking into Mariko’s eyes.

"—Until death?"

"Yes, can you do it?"

Mariko lowered her head. She remained silent for a moment, as if seriously considering the question. After about ten seconds, Mariko raised her head, her lips tightly pressed together, and nodded heavily. Having watched the videotape of the surgery, Mariko was extremely surprised. Upon learning that she would be undergoing such surgery, she couldn't help but tremble with fear.

Will it hurt a lot?

Yoshizumi told her that she would be given anesthesia, so there was no need to worry. Mariko smiled with relief.

The father's left kidney was moved to the right side of Mariko's lower abdomen. The surgery went smoothly, without causing acute tubular necrosis or thrombosis.

A few days after the surgery, Mariko became more talkative and seemed very happy. She greeted the nurses and Yoshizumi with a bright smile. This was typical of post-transplant happiness and increased talkativeness. Generally, patients experience a sense of relief after transplantation, feeling as if they've finally escaped the torment of dialysis. The greater the patient's hope for the transplant, the more pronounced this tendency. Seeing Mariko's smile, Yoshizumi felt gratified. For Mariko, her previous dialysis experience must have been a nightmare. After this transplant, she felt genuinely happy. The passing of urine thrilled Mariko—she was finally experiencing this long-lost feeling again.

A week after the surgery, when she returned to the hospital for a follow-up appointment, an excited Mariko rushed to Yoshizumi. Mariko was so happy that tears streamed down her face; she kept calling out to the doctor and pressed her face against Yoshizumi's white coat. Yoshizumi gently stroked Mariko's head.

After being discharged from the hospital, Yoshizumi met with Mariko several times and gave her a diagnosis. Although Mariko's face had become rounder due to the side effects of the steroid medication, she was still as lovely as ever.

Mariko felt especially happy to be able to eat with everyone at school. Previously, due to dialysis treatment, Mariko's diet had always been strictly controlled. Now, Mariko always smiles and says, "The food is delicious."

"Great! The transplant was successful, and dialysis is over!" This has almost become Ma Liyu's catchphrase.

"Doctor, I'm all better now, right? I'm not a patient anymore, am I?"

Once, after chatting for a while, Mariko asked this question with a smile. At this moment, the corners of her lips turned up, and she looked at Yoshizumi with her big eyes.

Why would Mariko ask such a question?

For a moment, Yoshizumi didn't know how to answer. He didn't know what Mariko was thinking.

“You could say that. Because you can now live a life like any other person,” Yoshizumi replied. “However, you can’t be careless about transplants. You’re taking immunosuppressants at home right now, right? You absolutely cannot forget that! If you don’t continue taking your medication, the kidney that survived with such difficulty won’t be able to function. So, never forget that you’ve received a transplant. Didn’t we agree before? You must take your medication! Can you do that?”

"All right……"

Section 24

Mariko nodded at that moment.

Yes. She nodded.

However, four months later, Mariko returned to the operating room.

"There is currently no indication that Mariko has been infected by pathogenic bacteria."

Yoshizumi and Mariko's father, Shigenori Anzai, came out of the ward together. Then, the two went to Yoshizumi's consultation room in another building. Yoshizumi felt it was necessary to let Mariko's father know some details about the post-operative period. He urged Anzai to sit down, and then sat down on the sofa opposite the coffee table.

“The nurses collect blood, urine, and sputum samples from Mariko every day and send them to the lab for testing. This will help determine if Mariko is infected with bacteria. We haven’t found any suspicious signs yet, so please don’t worry!”

Anqi wiped the sweat from his forehead, feeling a great weight lifted from his shoulders.

“However… Mr. Anzai,” Yoshizumi wanted to ask Mariko’s father some questions, and he seized the opportunity to speak calmly, “why did Mariko become like this?”

Anqi's gaze remained fixed downwards.

“Mr. Anzai,” Yoshizumi asked again.

"Well... I'm not too sure either."

Anqi hesitated. Yoshizumi remained silent, urging him on without a word.

"After the last transplant failed... I don't know what Mariko is thinking. She doesn't want to show her feelings. Maybe I just can't tell..."

Does Mariko dislike transplantation?

No, that's not true.

Anzai suddenly raised his head. His tone was firm, but his voice trembled slightly. Yoshizumi tried his best to maintain a gentle expression.

“Mr. Anzai, please tell me the truth! Of course, I understand that you parents all hope your child can receive a transplant and recover as soon as possible. That's only natural... But, Mariko herself doesn't think that way, does she?”

“Sigh…” Anzai lowered his head. “It’s really unfair to the doctor that I’m only bringing this up now… Mariko looked just like this when I received the call from the transplant coordinator. She answered the phone at first, but she didn’t tell me anything. I only found out about it later, so I quickly called her… At that moment, Mariko expressed strong opposition and even had a spasm… It was really abnormal.”

"Something's not normal?"

“She said, ‘I don’t want to be a monster…’”

"…………"

Yoshizumi wondered: What on earth is going on?

“Mariko has been having nightmares ever since her surgery. What do you think is going on?” Yoshizumi changed the subject.

“I don’t know either.” Anqi shook his head in despair.

“Mariko seems to be afraid of something. Could it be that the transplant left her with a bad impression, causing her to be resistant to the surgery and often have nightmares at night? Also, Mariko's attitude towards me is very different from before. Compared to the transplant surgery, she seems to hate the transplant procedure and transplant doctors like me more. What do you think? Think carefully, do you have any clues?” “I'm really sorry, I don't know anything.”

Anzai kept his head down, as if to say: I want to know too! Looking at Anzai, Yoshizumi felt sorry for him.

"...I heard that another transplant patient experienced a facilitating acute rejection reaction."

Yoshizumi suddenly blurted out this sentence.

What does "promote..." mean?

"This refers to a rejection reaction that occurs within 24 hours to a week after the surgery, caused by the patient having pre-sensitized antibodies against the donor's allogeneic antigen. The patient is currently receiving treatment."

"..."

"Fortunately, Mariko is doing relatively well. However, I'm not sure how her condition will develop in the future. Of course, we will do our best... However, if Mariko herself cannot actively cooperate with the treatment, she may eventually succumb to the bacteria. Let's all think of ways to improve Mariko's mood no matter what!"

"...If only it could be like that..."

Anqi's voice was so soft that it was almost inaudible.

"Parasite Eve"

Section 25

Chapter Seven

Liming sat before a confocal laser scanning microscope, manipulating the mouse to input measurement conditions. Culture flasks sat on the reagent stand. He had just finished staining "Eve1" with basic erythromycin-123. These past few days, Liming had cloned Saint-Med's hepatocytes "Eve," naming the most proliferating clone "Eve." He planned to culture them to proliferate a large number of cells for experimental use.

This spring, the communal laboratory on the second floor of the Pharmacy Department acquired a state-of-the-art confocal laser scanning microscope—the ACASULTIMA. It's a device about the size of a desk. On the left is an inverted microscope, and on the right is a monitor for inputting commands and displaying analytical data. The laser illumination tube is located at the rear. There's a computer under the desk. Liming wanted to know the structure of mitochondria in "Eve1" cells. Basic Resin-123 is a fluorescent dye that can reveal the specific structure of mitochondria within cells. The cells under the microscope have already been stained with this reagent. When placed under laser illumination, the fluorescent reagent reacts and emits light of a specific wavelength. By observing the cells through a filter that only transmits this wavelength of light, the structure of the mitochondria can be seen. The unique feature of this ACASULTIMA is its ability to precisely focus on different parts of the cell. Because cells have a certain thickness, ordinary microscopes cannot focus on the entire cell, resulting in unclear, resolving images. The confocal laser scanning microscope successfully solves this problem. The monitor of this device can display dozens of images of cell slices at various levels from top to bottom. After computer graphics analysis, these images can be synthesized into a complete three-dimensional image of the cell. In studies of nerve cells that rely on the analysis of the cell's three-dimensional structure, the power of confocal laser scanning microscopy is evident.

Li Ming clicked the "Start" button at the bottom of the screen, and images appeared one after another on the monitor. Against a black background, thin green stripes of objects appeared—mitochondria inside the cells. After the data import was complete, Li Ming issued a series of commands to synthesize the three-dimensional structure of the mitochondria.

A vivid image appeared on the monitor. At that moment, Li Ming couldn't help but cry out.

This was a shape Liming had never seen before. Its three-dimensional structure was winding, intersecting, and intricate, resembling both a labyrinth within a cell and a superhighway for transporting energy built into the cell. Liming suppressed his excitement and extracted other cells from the flask for observation. The results were the same.

The mitochondria of “Eve1” underwent incredible morphological changes!

After printing out the analysis results, Li Ming immediately turned off the power to the confocal laser scanning microscope and returned to his research room on the fifth floor. A small amount of "Evel," stained with basic erythromycin-123, remained. He planned to analyze it using flow cytometry.

Liming removed the stained "Eve 1" from the flask and cleaned it with a centrifuge. After the buffer solution became turbid, Liming took it back to the communal laboratory and turned on the flow cytometer. Soon, the start screen appeared. Liming entered the measurement parameters. A flow cytometer is a machine that measures the intensity of cell fluorescence. A pipette containing the cell suspension is placed at the protruding opening at the bottom of the machine, and the cells are drawn into the machine and sent to the laser irradiation section. Because this section is made of extremely fine tubing, cells can only pass through the tube one by one, receiving laser irradiation sequentially. Cells irradiated by the laser emit fluorescence. The intensity of the fluorescence depends on the degree of staining by the fluorescent reagent. In other words, the measured index reflects the number of mitochondria in the cell. This device differs from a microscope in that it can quantitatively measure the staining degree of each cell and display it in graphical form.

Liming installed the pipette and clicked the "GO" button on the drawing screen. In the blink of an eye, countless tiny dots reflecting cell size appeared on the monitor. Liming stared at the bar graph. The bars displaying fluorescence intensity flashed rapidly. "This..."