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The Kindest Cut - A REPORTER AT LARGE THE KINDEST CUT...

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Unformatted text preview: A REPORTER AT LARGE THE KINDEST CUT fiflas‘ sari prmm giver as fixing}: ta :2 strgflgér? BY LAM-55A MAcFARQUHAR m 3 _®& a: AR .~ m 1'» ww'n. v» m-wmmuw...“ . - “WW4 . ~ - - bffi pm {3E1 he; He 3,311:- was an: mo her not :1 h: up, 7;le {hm but big ‘ pers H6 km) me: {hm : all. cud 2%. sh misi and kitd vim ifhi: sclfi 0; ti to 8} he: I: to i). imp. ‘ WMMMWWW v v V“".“.'\“W\.h¢omvwwwu u . WW . . . . nm-u-wm-u-u w ~ ~ ‘ ‘1 ‘ :1 M3 amflwvwwm.” v prod As a centz senic empi form Enter form “w ~ n. 4 v a - "‘~"\’1“".~fifla"am-V< H-W-w- v. . . v v ”aw-W cone} é It was the day before Thanksgiving, and Paul ltillagner was on his lunch break, reading the paper. He worked as a purchasing manager at PeircewPheips, in Philadelphia, a wholesale distributor of heating and air-conditioning products. He was fortyyears old and lived with his partner, Aaron, in a small apartment. He was pale and slightly built. He smoked and had a smoker’s porous skin. His mother had died six months before, in her late fifties, of sarcoidosis. They had not had a good relationship-she’d had a heroin problem while he was growing up, and he attributed his sanity and his values to the school for troubled youths that he’d been placed in as a teenager—w but her death had nonetheless affected him quite deeply. . ‘Nagner considered himself a “dry person”~—curt, moody, sometimes rude. He believed that, to people who didn’t know him, he came off as an unsenti» mental type, possibly even a bit mean, though in fact he was not like that at all. He. owned two cats and Mo elderly cecker spaniels that he had rescued from a shelter. He ran the United “lay fiind— raising campaign at work for three years and organized food drives for local soup kitchens. He regarded these acts not as virtuous hutas duties. He believed that if his needs were met and he found him~ seifin possession ofa surplus—~ofmoncy or time or wherewithalwhe was obliged to share it. Share it, not give it all away: he liked nice things-he wasn’t going to become Amish. But it was very, very important to him that when he met his Maker {he didn’t consider himself reli» gions, but he did believe in God} he could say that he gave more than he took. Before he was hired at Peirce~Pheipa Wagner worked in a bank He went from a job in a call center to managing a branch in just two years, but he quit, he says, be cause he believed that the incentive struc- ture in the bank was unethical, rewarding him for steering customers to financial products that weren’t in their best interest. As a young man, he worked at a day~care center, but one day he heard an. employee senior to him talk nastily about another employee. He took it upon himself to his form the latter about the former, but this intervention made everybody so unconv fortabie that he was fired. From this, he concluded that it was sometimes best to mind his own business and not try to do God’s work for him. Reading the paper, Iv‘r’agner noticed an article that described a YVeb site named MatchingDonors.eom, where people who needed a kidney transplant could post a message describing themselves and their situation, perhaps appending a phi)“ tograph. The hope was that a stranger would see the posting and be moved to donate. lVagner typed the name of the W’eh site into his computer. He clicked on the “search patients” box and typed in “Philadelphia.” rllhe first patient he saw was Gail Tomas, He enlarged her photo- graph on his screen so that he could cx~ amine every detail. She was sitting on stairs in what appeared to be her living room. She was a woman ofmixed race in her late sbdies. He stared at her, searching for clues to her personality in her hair style and how she wore makeup. He inspected the stairs behind her, trying to see how clean they were. Almost immediately, be felt that she was the one. He knew that his blood and her blood would snatch and that he would donate a kidney to her. There was no question of backing out: having seen her picture, he felt himself to be already involved. It was like seeing a car crashwif he didn’t help, he thought, he would cheapen himself. He went home and told his partner, “Aaron, there’s this ladyl read about that’s going to die if she doesn’t get a new kid» ney and l’ve decided to give one to her.” Aaron said no. Wagner told him sorry, but he was gong to do it anyway. He told his sister and she said, only halfjoking, “What if I need a kidney someday?” He thought that that was selfish. He told her that she had a husband and two children and she could look to them, but this lady was going to die now. Talking to his fa— ther was more difficult. Some years bee fore, his father’s second wife had had kid- neydisease. Wagner had offered to donate to her, but she and his father had felt that it was against their principles to ask so much of a person, even a son. So they rem fiised his offer, and, waiting for a cadaver kidney, she died. His father got very quiet for a while and then said he wished that he wouldn’t go through with it. But once Wagner had decided to {him nate he felt as though he had a calling. He was not usuafiy brave about medical procedures, but somehow with this he breered through all the tests. He was late for work almost every morning, hut he was on time {or every one ofhis hospital appointments. He wasn’t anxious about pain or complications. F or once in his life, he felt that God’s instructions to him were absolutely clear. Besides all the tests, there were other hurdles to be overcome. The transplant surgeon was puzzled by W’agner. He wasn’t sure that he was willing to do the surgerywwhe was concerned that it might be a violation ofhis Hippocratic oath to operate on a healthy person who wasn’t even related to the recipient. They met and talked for more than an hour, and, near the end of the conversation, Vii-lag- net was astonished to see that the sot“ gene was crying. W’sgner aSSunied that he and Tomas would not become friends after the sur— gery. He had given the matter some thought. How could they possibly have a healthy relationship, he reasoned. it Would be bad for her to feel beholden to him, and it would he bad for him to have her believing that he was some kind of saint. The whole thing would inst be way too freightecl and creepy and was better avoided. Tomas, however, had other ideas. Gail Tomas was a retired opera singer who had pedomied all over Europe, after being discovered. in a master class by Licia Albanese. If Wagner was dry, she Was the oppositemyivacious, chatty, candidly emotional. She had been looking for a donor for about a year. None ofher tank ily members matched her blood type, and she hadn't wanted to ask friends, so her daughter signed her up on MatchingDo— nors. At first, there were a few obvious no~ no’swa man wrote from lndia to say that he would get all his testing done locally if they would send him five thousand dole lars. Then, she says, there was a woman from Texas who seemed legitimate and eager to help, and they corresponded for months, but it turned out that her son, who was seven feet tall, had outgrown his liver and needed a transplant himself, and, with all that going on, the woman disapw peered. “It was like someone had taken you to the altar and then all ofa sudden new scenery came down and you say, ‘But l thoughtl was getting married: ” Tomas says. “1 thought, 'We’ll never find another person, because how many people wan t to do this?” Shortly before the surgery, “league: l'HE NEW‘ ‘r‘OIlezlL JULY 2?. 2009 ‘40 "i'A‘«NM“W311WM,“§'§V'.N,VN¢\NWMWKH w.»'~<vr.e, WWW-won w on... .. . . . "A K"\*J-:."..'\1~\"WII:1 w'vy ”a :1 w,- and Tomas met for the first time. They were both at the hospital, getting tested. Wragner had described himseltlas skinny, so Tomas looked around the waiting room, identified the skinniest guy in it, sailed up and introduced herself. For her, the meeting was wonderful: she felt that they’d known each other all their lives. Wagner managed to be friendly, but he was all churned up. He didn’t know what to make ofthis exuberant lady he was giv- ing his kidney to; he couldn’t figure out what emotions he should allow himselfto erperience. His mother had died less than a year before, and now here he was poten— tially entangling himself with another very sick older woman, and what did that mean? Donating a kidney to find yourself a new mother, what could be more obviw ously twisted than that? H e was also WGI‘" tied that he'd done a bad thing by allow" ing himself to meet Tomas at all. It made him feel guilty Did it diminish the value ofhis deed to accept her gratitude? VVouldn’t he be a better person ifhe hadn’t met her and had received no thanks? Had his donation now become just a matter ofgratifixing his ego? By the time he got home, he felt completely drained. T he surgery itself left him feeling bat- tered and exhausted. Aftemard, when he was sitting in his hospital bed, the phone rang. A woman on the other end, who had heard about him on the local news, told him that she hoped his remaining kidney would fail quickly and kill him, be~ cause her husband had been next in line to receive a kidney and he, Wagner, had given his to someone else. Wagner asked the hospital to turn his phone ofl‘" after that, but then someone wrote an article about him in the Philadelphia Drzifiswews, wondering whether it was fair for him to pick his recipient, choosing who lived and who died. He couldn’t understand it he had heard about a sick woman who lived near him and he had helped her. How could that make people angry? After he got home from the hospital, he started feeling very sad ail the time. He admitted to himself that it was difficult to come down or? the high ofbeing a hero. Before the surgery, everyone he knew had made a big hiss about him; there had been a lot of hoopla at the hospital, attention from the loeal media. lie had loved tellw lug people that he was donating a kidney to a stranger, just to see their reactions. Now all that was over. Worse, Tomas had 40 THE NEW YORKER. JUi)’ 2?, 2009 suddenly stopped returning his phone calls. ‘Nas she angry with him? he wort— dered. Looking for advice, he started posting on a Vv’eb site, Living Donors Online, and he discovered that manydty nors had to deai with peculiar emotions alter surgery. He read about one case in which a woman had donated to her sister, but the kidney was rejected and her sister died; sitter that, the rest of the family stopped speaking to her. One spouse do» nated to the other, then the recipient spouse left the donor, perhaps because the burden ot‘gratitude had left the marriage irredeernably distorted. That had hape period quite a few times, it scorned. Finally, worried, W’agrier started call— ing hospitals, and he found Tomas. She’d been very sick and hadn’t wanted to scare him, but now she was better, and she wanted Wagner in her life. Still smarting, he wasn’t sure. She invited him to her son’s wedding. He declined, several times, until finally she got angry and yelled at him, and that, somehow, for Wagner, made everything all right. lfshe couid yell at him, then he was not always perfect in her eyes and they could have a normal friendship. She wasn't his mother, he knew that, it would be fine. In fact, Tomas did consider herself his mother, more or less. She wanted him at her house on hol~ idays, she hounded him about smoking and taking his bloodwpressure medication. But it was fine anyway. So what do you make ofl’aul Wagner? Do you find the idea of donating a kidney to a stranger noble? Or freakish? if the latter, is it the extremity of the act that baffles you? Does it seem crazy, giving something that precious to some— one for whom you have no feeling, and whom, if you knew him, you might actu» ally dislike? Perhaps it’s not quite as crazy as it sounds. Kidneys are now often extracted laparoscopically, which leaves only tiny scars. A donor usually feels normal again in two to four weeks, the remaining kid” ney growing to compensate. And the risk of complications is low. lr‘a person gets kidney disease, it aftects both kidneys, so as {at as that goes a donor is not giving away his spare {though a spare kidney it useful it‘the other is damaged in a car as- cident, say, or if a person develops kidney cancer). Still, the carnality ofthe act, the violation of the body, stops people. its moral logic seems, to some, inhumanly rational, suicidaliy so: If we’re going to start thinking of bodies as repositories of spare parts for other people, wit} ’ not do~ oate all our organs and save many lives? 3405?; people find it uncomplicatedly admirable when a person risks his life to rescue a stranger from fire, or from drowning. What, then, is it about saving a stranger by giving a kidney, a far lesser risk, that people find so odd? Do they Feel there is something aggressive about the act, as though the donor were impliv itly rebuking them for not doing it, too? (There is no rebuke in saving a stranger ifrom drowningwyou weren’t there, you couldn’t have done it. And you can always imagine that you would have if you had been.) Or perhaps it’s that organ dona~ tion, unlike rescue, is conceived in cold biood, and cold—blooded altruism seems nearly as sinister as cold~blooded malev~ olence. Perhaps only the hotwblooded, unthinking sort can now escape altruism’s tainted reputation, captured in the suspi— cious terms for what people are really en" gaged in when they think they’ re helping (sublimation, colonialism, group selec» tion, potlatch, sociaiism, co—depen- dencymthe list goes on). Giving a kidney to a stranger is more common than you might think. Poten- tial donors register on MatehingDonors. corn aimed every days—anon: than seven thousand have signed up so {at (though, to be sure, many of them get no further than signing up). Either through Match— ingDonors or through a hospital, about six hundred have gone through with the surgery—each for his own reasons. MatcifingDonorscom was thought up five years ago by a fortywyear— old entrepreneur from Canton, Massa~ chusetts, named Paul Dooley, who had trained as a dentist and had previously founded a Web site that matched ern- ployers with job seekers. Dooley’s father had needed a kidney transplant but had been toid that he had no chance of reaching the top ofthe waiting list in ‘ "aw in d: dr 8% 1H Vii ”NWWWW».xwww.maqumyywwww. my. mwww-u . v w ”aw,«.wwnumvwmmwa V ‘1 u.- >1 NV, [1']? dt to w: sit W", v.” ,, .. - u "x’vv‘. mm th 5 he 3 flE {- ‘ 0‘ db (9 f—Lr-etiq D (ewe: " ”9 “U ! r—nwu time. After he died, Dooiey wondered whether a matching Web site like the }obs site could have saved hire. He asked his doctor what he thought. The doctor, Jeremiah Lowney, thought it was a him zarre idea. Why would anyone donate his kidney to a stranger he found on the Internet}> It made no sense. But then he logged onto the National Kidney Foun— dation Web site and discovered a survey in which nearly a quarter of the responw dents said they would be willing to donate a kidney to a stranger. Lowney called Dooley hack, and together they started up the site. {owney’s being a doctor gave the cone pany credibility, hut in fact MatchingDo~ nors offered no medical services. It pro— vided a forum for patients and donors to meet; that was ail. Once a patient and a donor found one another, it would be up to each to figure out whether the other was telling the truth. Was the patient as sick, or as heraldry, as he claimed? VVonid the donor try to extort money later? W as he as nice as he seemed? It was the lntee netwnobody knew. (A couple of years ago, a middle~aged woman from Michiv gan' donated a kidney through Matching“ Donors. Two months later, she was ar— rested for trying to have her husband killed.) The first patient to list himselfpubiicly on the site was Bob Hickey, a psycholo~ gist in his rnidwfifties who’d learned he had kidney cancer. At first, he’d done what his doctor told him to do: he went on dialysis, signed up on the official wait~ ing list for a cadaver kidney in his region, and hoped that he would reach the top of the list before he died. His chances of doing so were middling. Since he lived in Colorado, he would likely get a kidney sooner than in most parts of the counw {1'}! at that point, in 2000, the median waiting time where he lived was around two and a halfyears, less than halfwhat it was in New York, for instance. But his transplant center told him that he should expect to wait about four years. You couldn’t survive on dialysis forever, and many people did die waiting for a kid- ney—wan average ofneady nine a day. The national list was about fifty thousand names long. Dialysis can he a kind of death-he a. ‘ ' 9W titration-w life. The treatment itself is gruesome, sometimes painfiilwyon are attached to a machine for several hours at a time, usually three or four times a week, while the machine siphons oil all your blood, cleans it oftoxins, and injects it back into your body. Often the process leaves you too exhausted to work, or do much of anything besides recover. After four and a halfyears of dialysis, Hickey, still waits ing on the list, decided that he’d had enough. He would rather die. He told his wife, and she accepted his decision. He told a religions friendm—a little men vously, thinking he might try to dissuade hirer-and the religious friend said, gust give it one more month. Less than a month later, Hickey saw an article in the Denver Post about a new company that was starting up, MatchingDonorscom. He phoned, and Dooley told him that for a patient the service cost two hundred and ninety— five dollars a month, five hundred and ninety~five dollars for iife. Hickey told him he was a carpetbagger and a rip of? and hung up. After another week of dialysis, he called hack and signed THE. NEW“ WORKER, 3ULY 27, 2009 4i ammw-wm-s-uw-wvw . . .. .. .. aux»mmnmmuamwww was,vhnfinnwflvfiwfiwvswfvyxw a “Nev-‘1,” on, Wlirhin a month, he had dozens of offers. About fifteen per cent of them were from people loolring for money or a green card, but the rest seemed iew gitlmate. He had no idea how to sort through. them, and Dooley had no idea, eitherw—he hadn’t anticipated that an excess of donors would he a problem. Hickey asked his transplant center, Pres— byterian! St. Loke’s Medical Center, in Denver, for advice, and was told that since he was such a big man, six feet five, he should try to find someone around his. own size; that eliminated all the women. Then he eliminated all the men over .f'iftywfive, pot the rest of the names in a hat, and picked out Rob Smitty. Roi) Smitty was thirty— two years old, from Chattanooga, Tennessee. He was in a bad place in his life. He had dropped out ofhigh school and done some time for possession ot‘llSD. He was divorced and was behind on his childwsupport payments. He worked as a door—to~door salesman for a meat company. One day, he was playing spades on the internet when a pop~tzp ad asked him to register as an organ donor. He googled “organ donation” and discovered that all sorts of people were trying to find kidneys ooline, some of whom were willing to pay. Seing paid to donate a kidney sounded good to himwone person wanted to pay him a quarter ofa million dollars. Then he found not that selling a kidney was illegal, and he ligated that with his luck he would definitely get caught, but by then he was hooked on the cause and he decided to donate {or nothing. it seemed to him that he hadn’t done all that much with his life so far, and this was something worthwhile that he cocld accomplish and feel better shout himself. Smitty wanted to pick his recipient, so he spent months online, searching. He was touched by one posting he read on a ‘Neh site about a fifteenwyeaoold kidney patient named Joshua, so he called the number. The woman on the phone told him it was too late%}oshua had died. “Well, I Felt like id just taken a hoge crap and stepped back into it," Smitty s...
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