By Tommy Cheis
Chloe’s jaundiced face is bloated like a chipmunk’s. Her cracked lips are bloody from
puking. A pump pushes liquid nutrition into her heart through her subclavian vein. I asked the
pioneer of pediatric liver transplantation, Dr. Wilkerson ectomorph in a white lab coat, how long.
You understand it’s part science, part art? he said.
Just tell me, Doc.
Her PELD score is thirty-nine. Forty is the maximum.
Weeks then?
Could be days.
On the flip side, she’s high on the cadaveric transplant list.
But now there are other factors. You know Goldilocks and the Three Bears? Not too hot,
not too cold, just right?
I used to read it to her. She got mad when I unethically left the book opened spine-up.
The “just right” concept applies equally to hepatic transplants and porridge. Two weeks ago,
Chloe was “too well” for a transplant. Despite her disease condition, her one-year waiting-list
survival-probability was higher than many other children.
And now?
Her liver’s failing rapidly. Portal vein damage is severe. Thrombi form constantly.
Then bump her up on the list and find a donor.
We bumped her up, as you say. If we find a match, we’ll proceed immediately.
Doc, I hear a catch.
Chloe’s approaching the point where she may be “too ill.”
How in Hell is that possible?
“Too ill” is a determination that the risk of mortality during, or within one year after, surgery
exceeds the risk of mortality by doing nothing.
You’re scared she’ll die on the table.
We’ve never lost a surgical patient, Mr. Issa.
Because you cherry-pick them, Dr. Wilkerson. You want to retire with a perfect record, like
Rocky Marciano or Floyd Mayweather.
We don’t act subjectively. We use a standard national protocol. When a patient becomes
“too ill,” we place her on inactive status and work to get her healthier so her PELD score falls into
the “just right” and next-in-line category.
Sounds like forcing drugs into a death row convict to make him sane enough to execute.
I understand what you’re going through, Mr. Issa.
With all due respect, Dr. Dub, how could you?
I was eight when my four-year-old sister died of biliary atresia. No livers were available for
kids back then. No amount of begging would make the doctors take mine. I can’t save every child,
but I try. Aspies can cry. I do, for every child, win or lose. My record’s as close to perfect as I can
make it.
You’re a beautiful human, doctor. Level with me. Give me the over/under.
We’re moving her to PICU. Say a week.
But if she had a live donor?
We’d scrub in immediately.
I’ll be seeing you again. Count on it, Dr. Wilkerson.
Now Chloe’s abed with me. Later, they’ll tap her distended belly. When the TV show goes to
break, she solemnly says she’s been disabused of a willful lie about supernatural beings. “I know the
Tooth Fairy’s not real. You put the money under my pillow.”
“Even so. Don’t tell a soul you figured it out. Keep the liars buying teeth, you know?”
She, sadder but wiser, flashes a jack-o’-lantern grin, then winces and bleeds when her
desiccated d lips tear. Then she drops a dime on JoLene. “Mom told me.”
“She was just having fun. We miss her, don’t we? We’ll see her again in Heaven.”
“When, Abe?”
“For you, I think it’s going to be a long long time. For me, not as much. I’m older.”
“I hate that. I want to go together. Abe, is Heaven real?”
“It’s hard for me to know what’s real or not. Maybe we should believe and act like Heaven’s
legit so if it isn’t, we’re still brave, honest, and good while we were here.”
“OK. But if it isn’t real, how will I see Mom again? And you?”
“There’s so much I don’t know, sweetie. I’m sorry. When I find out, I’ll tell you.”
“Abe, you don’t lie like nurses and doctors do. They tell me I’m going to get better and be
able to leave and do fun stuff.”
“That’s all true, I swear to God. Ask me something else while you can.”
“Will I be able to ride a horse again?”
“You’ll lead a parade.”
“How about be in a play?”
“We’ll write and perform it in your room if we have to. Invite the kids on the floor.”
“OK. Let’s see. Um. Um. Are you afraid of monsters?”
“Only the ones pretending to be people.”
“There are monsters like that?”
“Indubitably.”
“Do they look like people?”
“Unfortunately, yes.”
“Do they have fangs and claws?”
“Regrettably, no.”
“How do you know if something that looks like a person is really a monster?”
“You find out when they bite you!” I burst into raucous laughter, tears, then rage I stifle.
“Monsters aren’t real, Abe. You’re being silly to make me feel better.”
“Is that what Sarah told you?”
“Yes. She’s sad. Do you miss her too?”
I linger like a middle-school creep so chickenshit to chat up a girl he farms the interest-
gauging task to a random dipshit. I can’t help it. “Does Sarah love me, Chloe?”
She looks confused then annoyed. “Duh! What a silly question! She wears your ring,” she
demonstrates, “on her finger. She’s in a different hospital. Will you come to Mom’s funeral?”
“Will Sarah be there?”
“She better! It’s in a graveyard after a party at a home. Dad knows where.”
“He’s mad at me.”
“Why? You’re his son.”
“Will you get a new dress?”
“I don’t get to go. But Nurse Singleton gave me a book about dying so I understand it
better.”
An orderly with hurry-up eyes puts up her bedrails. Chloe blurs.
I embrace her like it’s the last time, then she’s ushered wherever.
Tommy Cheis is a Chiricahua writer, medicine leader, veteran, and Cochise descendant. After traveling extensively through distant lands and meeting interesting people, he now resides in southeastern Arizona with his horses. His short stories (will) appear in The Rumen, Yellow Medicine Review, Carpe Noctem, ZiN Daily, Spirits, Red Paint Review, Pictural Journal, Little Fish, and other publications. While his first novel, RARE EARTH, is under submission, he is at work on his second.
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