His Kidney and His First Love, This Time I Save Neither

The pen hovered over the consent form, and I already knew the exact sound it would make when it touched the paper. A soft scratch, almost nothing, the kind of sound that had echoed through every quiet room of the rest of my life. I stood in the doorway of the transplant coordinator's office at Halloway Regional Medical Center, and the fluorescent light buzzed above us like it had the first time. The first time. I hated that phrase. It made me sound like one of those women in grocery store paperbacks, the ones with the torn dresses on the cover, whispering about fate and second chances. But there was no other way to say it. I had lived this day before. I had watched my brother sign that paper, and I had watched everything that followed. "Norah," Ethan said. His voice cracked on my name. He was twenty-four years old, six feet of stubborn muscle and varsity rowing shoulders, and he was crying in a hospital office with a pen in his hand. I looked at him. Same gray eyes as mine, same sharp jaw from our mother's side. He had shaved that morning. He always shaved before doing something he believed was noble. "You shouldn't be here," he said. "I didn't ask you to come." "You texted me." "That was before." He wiped his face with the back of his wrist. "I don't need you standing there looking at me like the family lawyer." Dr. Patel, the transplant coordinator, sat behind her desk with her hands folded. She had a folder in front of her with Ethan's bloodwork and the compatibility results and a page of risks she had already explained twice. She looked at me the way people look at a fire alarm that has been pulled for no reason. "Mr. Vale," she said gently. "You understand this is a voluntary procedure. No one can pressure you, and no one can stop you." "Nobody's pressuring me," Ethan said. He looked at me when he said it. Down the hall, in room 412, Claire Ames was lying in a bed with her hair fanned across the pillow. I had seen her that morning through the window before the nurse pulled the curtain. Pale, thin, twenty-three years old, waiting for a kidney that had never come the first time. Her parents had flown in from Seattle. Her mother had hugged me in the hallway and thanked me for being there for Ethan, and I had smiled and said of course, because that was what you did when someone's daughter was dying. That was the thing no one understood. I had loved Claire once. Not the way Ethan loved her, but close enough. She had been around since we were kids, the girl from the house two streets over, the one who showed up at our door every summer with a skateboard and a gap-toothed grin. She had taught me how to French braid my hair. She had sat with me at our father's funeral when I was fourteen and Ethan was gone at a rowing camp, and she had held my hand the whole time and not said a single word. Then she grew up, and so did Ethan, and somewhere in there she became the thing he could not live without. The first time, I had stopped him. I had grabbed his wrist before the pen touched the paper and I had said, Ethan, you can't do this, and I had pulled him out of that office and dragged him into the parking lot and screamed at him until he listened. He had hated me for it. He had not spoken to me for three months. Claire had waited for a donor. There had been a match in Sacramento, a man who died in a motorcycle accident, and the kidney was flown down and prepped and ready. But Claire had developed an infection the night before the surgery, and she had gone into septic shock, and by the time they got her into the OR it was too late. She died three days after Ethan decided not to donate. Three days. My mother had stood in the kitchen the morning of the funeral and looked at me like I was a stranger. You did this, she said. You could have let him save her. You chose to keep your brother whole and you killed that girl. My father had been dead for ten years by then, but I think she blamed him too, for leaving her with two children and one of them too selfish to save a life. Ethan had gone on to the Mitchell Fellowship that fall. It was the kind of thing that ended up in alumni magazines, a high-tech research program that paid for graduate school and gave you a lab and a mentor and a future. He was the youngest fellow they had ever taken. My mother told everyone at the funeral reception. She told the caterers. I had gone to community college for two years and then dropped out to work at a dental office, answering phones and filing insurance claims. I had a studio apartment on Delaney Street with a radiator that knocked at night and a landlord who did not fix things. I had a cat named Bishop who died two winters later, and I buried him in the yard behind the building and sat on the back steps for three hours afterward, and no one called. By the time I got sick, my mother had stopped answering my calls. Ethan had changed his number. I had a cough that would not go away, and then it was pneumonia, and then it was something worse, and I died in that apartment on a Tuesday in March with the television on and the radiator knocking and no one in the world who knew my name. I remembered the ceiling tiles. I remembered the sound of my own breathing. I remembered thinking, I should have let him sign it. And then I woke up. I woke up on the morning of the consent signing, in my old bed in my mother's house, with the same ache in my chest and the same buzz of the alarm clock at six forty-five. I lay there for a long time, staring at the water stain on the ceiling that looked like a bird. I had forgotten about the bird. I got up. I showered. I put on the same gray sweater I had worn the first time. I drove to the hospital with my hands steady on the wheel, and I walked down the same hallway, and I stood in the same doorway, and I watched my brother pick up the same pen. The first time, I had cried. I had begged. I had made a scene that people talked about for years. This time, I said nothing. "Norah," Ethan said again. He was waiting for me to fight him. He needed me to fight him, because if I fought him, he could be the martyr, and if I let him do it, he had to own it. I looked at Dr. Patel. I looked at the form. I looked at my brother's hand, which was shaking. "Okay," I said. Ethan blinked. "What?" "Okay," I said. "Sign it." The pen touched the paper. I heard the scratch. I felt something in my chest close like a door. Dr. Patel looked up at me, surprised, and then back at Ethan. "You're sure?" "I'm sure," Ethan said. He was crying again, but it was a different kind of crying now, the relieved kind. He signed his name at the bottom and pushed the form across the desk, and then he stood up and hugged me, and I let him. "Thank you," he said into my hair. "Thank you for not making this harder." "You're welcome," I said. I walked out of the office and down the hall and past room 412, where Claire was sleeping with her hand curled under her chin. I did not stop. I did not look through the window. I got into my car and I drove home, and I sat in the driveway with the engine off and my hands on the wheel, and I thought, This time I am not the one who pays. The surgery was scheduled for Friday. I had four days.