Romalyn Ante
Wolverhampton, England

My mother is right—my brother’s blood is getting dirtier. A nurse like me, she had read the result of his glomerular filtration rate, a test that measures how well the kidneys clean the blood. It had dropped below 15, an indication that his chronic renal failure was reaching its end stage. Some facts hit you with the pang of a sudden snow. The dialysis treatments would not treat my brother’s condition but they could preserve his life.

I spring up from my chair at the nurses’ station and it swivels. My gut churns as I sprint to the treatment room, past the sluice machine that whips with the stench of disposable sadness, past the bay that peals with medical equipment and random radio songs. I lock myself in the treatment room and focus on the view beyond the window—the field is dressed in a gauze of frost.

As I close my eyes, I cannot help but hear the splashes of water echoing from the four corners of our bungalow back in Lipa, Philippines—my mother scrubbing my grandmother Nanay Lola’s feet.

Twenty years ago the leaves of our mango tree were perforated by the bites of salagubang beetles and Nanay’s blood had been unfiltered for four days. She had missed two dialysis sessions, and each morning she would lift her eyes to a haze of faces. Each night she would jump out of bed in her delirium, her blood too toxic with urea. Her shadow quivered across the wall as she stooped, smacking invisible cockroaches on the floor.

When we migrated to this country, my family brought nothing with us but Nanay Lola’s faulty genes.

Her weak kidneys, the only inheritance she willed us, we joke.

As my brother’s sibling, I want to tell my mother that I could donate my kidney; but whenever I try, something stops me as if there was a lump of rice lodged in my throat.

My mother works in a local hospital where my brother receives his dialysis. I work a town away. I imagine the snow where my mother is—how its dry light settles on her face, fills the valleys of my brother’s ribs. Day by day, my brother’s blood thickens with grit, ours with grief.

Grandma’s genes are the only inheritance she left us, we joke at the dinner table, my brother’s food as saltless as our days. Do we poke fun at our pain to bully our bodies into laughter?

To be a nurse is to have grit, my Nanay Lola used to say. My mother says Nanay wanted her to be a nurse because she knew the job would be “in demand” and give her the key to “the land of opportunities.” My mother has always been haunted by the image of Nanay Lola’s edematous feet, and the English breeze sometimes sounds like the wheezing expiration of her fluid-filled lungs.

Once, in the kitchen, as I stirred the soup of chicken tinola (no salt for my brother), my mother started retelling the tales of our old lives in the Philippines.

She said that when Nanay Lola was strong and her clothing shop at the market was booming, her friends would visit her during fiestas, gifting her with porcelain plates and leather shoes. But as she got sick and her cells were steeped in unfiltered blood, the once illuminated windows of our friends’ and relatives’ houses turned dark as the night sky. Most of them did not even respond to our knocks, pretending they were not home.

I saw the unfinished typhoon in my mother’s eyes as she poured chopped chunks of green papaya into the bubbling broth.

To be a nurse is to have grit. But all I have is the coarseness of this nursing uniform, once worn by my mother.

What is even harder than being a nurse is taking care of people with the same conditions that affect your loved ones. The Latin aphorism Scientia potentia est means “knowledge is power,” but if you’re not careful, that power could make you feel God-like. I fortune-tell my brother’s case. Would he be like the old man in the corner room, who on the way out of the unit plummeted, skull first, until the ground glistened with spilled blood? Would he be like the patient who, in the last twenty minutes of his dialysis, belched out coffee-brown granules of vomit, an indication of an internal injury or an organ rupture?

Earlier today, my patient on dialysis passed out. I sprinted to his bedside to tap the screen that flushed fluids back into his veins until he was hydrated back into consciousness. The adequacy of dialysis may be improved if the pump speed is high—the more blood goes out of the body, the more it gets filtered through the dialyzer. But the speed-rate also makes the heart work harder; the more volume comes out of a body, the higher the risk of hypovolemia or heart attack. Still, I want to believe some hearts can take a greater loss, and that what leaves returns transformed.

I have no grit, and I grew up trying to feign courage. When I was little, my mother was the one called whenever there was a medical emergency in our village. I ran after the flutter of her skirt; its floral patterns like clots of blood.

In the season of paper kites, a neighbor found her daughter slumped on the toilet seat—some onlookers said she had a heart attack, others argued she strained too much. My mother leapt with the certainty of a jaguar towards the unconscious young woman and pumped her heart with her steadfast hands, elbows locked. Sweat studded her forehead like little diamante only women with grit in their blood could generate.

Every night after a shift, I stop by the cavernous mouth of the hospital chapel, wondering whether I should go in or not. It is difficult to say Hello there to your fears. Today, I tie a maple-leaf paper for my brother at the chapel’s Tree of Prayers, and I swear I could almost hear my grandmother’s voice saying, To be a nurse is to have grit.

Maybe like the grit in my grandmother’s unfiltered blood, in a country that could not save her from dying. Perhaps the grit of my nurse-mother, who stops in the middle of a road to help the village drunk, who imbibes the words of her colleague (my brother’s consultant) when he reveals that even if my brother were to have a transplant, the organ would only last for ten years. There are sacks of rice I must eat before I become like my mother.

My brother once told our mother, “I want to see my son grow old.” I have been feigning courage all this time, but I still could not say, “I will donate my kidney.” For many months, I have watched my mother fall into the silence of snow.

In an ideal transplant, not only should the donor’s blood match the recipient, but the tissue type should match too. My brother, who is a minority needing an organ in a white-majority country, is at a serious disadvantage. Transplant success rates improve when organs are matched between people of similar backgrounds. Here in the United Kingdom, only seven percent of deceased organ donors are from the minority ethnic group, making it extremely challenging to find matching kidneys for ethnic patients on the transplant list.¹

My mother sits down in the consultant’s office, head bowed, and from the corner of her eyes, she catches a glimpse of a man’s lap, soaked in light.

She later tells me that what she has seen is God’s lap.

Useless inheritance, we joke again today.

Do we make jokes, hoping our lungs will rupture into something that will last longer than laughter?

I am experienced in caring for renal patients and I always reflect on how I could make every session efficient, or how could I become more knowledgeable of the treatment side effects to lessen my patients’ risk of suffering. I thought I understood enough, but I understand nothing.

I did not know that all this time, my mother has been holding onto God’s bright lap, onto the memory of her mother waking up in the middle of the night, gripping a sandal that glinted with the plasma of invisible spiders; and onto the view of my brother’s son sprawled on the carpet as he piles up blocks of blood-red Legos until the tower’s color ignites the whole lounge.

Soon, my mother’s abdomen will be sliced open, and the stitches will look like rows of fire ants binding her wound, carrying crumbs of dried blood. I know only this: true grit coagulates from love.

Reference

1. National Health Service Blood and Transplant (2017) Organ Donation and Transplantation data for Black, Asian and Minority Ethnic (BAME) communities. Accessed on: 17 December 2019. Available at: https://nhsbtdbe.blob.core.windows.net