The Dismantling (3 page)

Eight months, and he'd already put together a dozen deals; all kidneys and all medically and financially successful. This case with Lenny was his first liver, and livers, DaSilva told him, were where the real money was. It was the more expensive surgery, the more valuable organ. (Also the more risky surgery and grueling recovery, for both donor and recipient.) Liver transplantation was the field in which Cabrera Medical Center had decided to make its name and its fortune, and so it was the field on which Health Solutions would now focus. In addition, the few other domestic brokers DaSilva was aware of traded exclusively in kidneys, which made livers, he said, the definition of an opportunity.

So far Health Solutions had not been, for Simon, a particularly difficult job, at least not operationally. (Morally was perhaps another question.) The donors were always enmeshed in some pedestrian sort of financial trouble, and what concerned them were the hard figures: the payout, the time away from work, the insurance ramifications.
Is the surgery safe?
they'd sometimes ask, and Simon would tell them yes, it is. They'd nod, as though they hadn't researched this themselves before they found the courage to send an e-mail to the contact address listed on the slickly designed and factually scant Health Solutions website. That their sale might buy someone ten or twenty more years of life was understood as a kind of bonus, a renewable interest on their payout, the kind of thing they could turn to for some small measure of consolation when the new money ran out, which it nearly always did, DaSilva admitted, and often sooner than they expected.

Simon had found the buyers trickier. Some of them wanted to know everything about their donors; they wanted to be told exactly how their money would transform these people's lives. Others wanted to know nothing and seemed to prefer to think of the purchased kidney as the miraculous product of a lab.

When he first took the job, Simon wondered how he would possibly locate donors. Recipients he understood. These people talked to each other; there were message boards, forums, as well as old-fashioned word of mouth. Theirs was a community that traded in the currency of hope. Besides, Peter DaSilva had access, through his coordinating job at Cabrera, to two of the relevant waiting lists: the United Network for Organ Sharing's and Cabrera's own. He knew who needed a liver or a kidney, who wasn't going to get one anytime soon, and who could afford to pay a lot of money not to wait any longer. When someone fulfilled all three criteria, he might offhandedly direct the candidate to one of a few online message boards populated by the transplant community, where, under pseudonymous handles, Simon posted testimonials describing how a friend or a spouse or an uncle had found the answer to his transplant troubles by contacting the good folks at Health Solutions. That DaSilva himself was involved with this company—was, in fact, its proprietor—never occurred to the candidates, which was, of course, exactly how he wanted things.

Donors though? It wasn't as if Simon could just walk around Times Square, waving a wad of cash. This wasn't Chennai or Manila in the nineties, where whole neighborhoods of young men, he'd heard, would suddenly exhibit the exact same scar in the exact same location on their torsos. During his first meeting, before DaSilva had finished explaining how Health Solutions worked, Simon imagined he'd have to fly to Brazil, Turkey, Syria, Moldova, offering a few thousand dollars and a trip to New York City to whomever was willing to part with a kidney. He'd imagined skulking around the worst neighborhoods of New York like a drug dealer or a pimp, trawling for the desperate, the easy marks. He didn't know if he could bring himself to do it. The exploitation was too frank, the moral ambiguity of utilitarianism shading into the self-evident amorality of raw, unfettered capitalism.

But it turned out none of this was necessary, not anymore. Not in 2008. It turned out that plenty of people in what one might think of as the middle class—or people who were once in that class or who wanted to appear to be in that class—were open to the idea. Why not sell something that cost you nothing to own in the first place? It was a kind of entrepreneurship of the body, a utilization of previously untapped resources. These weren't people in need of food or shelter. These were people in need of a car, college tuition, debt relief. Simon's very first client wanted LASIK and a nose job; why not, she reasoned, let one surgery pay for two more? As the spring of 2008 slipped into summer, and now turned to fall, the list of people—American citizens, no less—who might be interested in the company's services grew longer and longer, and Simon's e-mail inbox began to brim with the kind of inquiries he'd feared he would have to sift through the most wretched corners of the third world to find. As the jobs accumulated, Simon's ethical queasiness over his role in these transactions was calmed by his donor-clients' embrace of a wonderfully mutable philosophy of self-empowerment, a worldview that made easy room for the conversion of flesh to cash, for the literal capitalization of the self. These people knew the score, knew what they were getting into, at least as much as they could without having gone through it already. Who was he to stand priggishly in judgment of them or of himself?

Also, he was making badly needed money—and fast—which didn't hurt.

 • • • 

I
MMEDIATELY
after visiting Lenny, Simon told DaSilva about Howard Crewes's role as sponsor and planner. He also told DaSilva that Lenny was still drinking. But Peter didn't think this would be a problem: “Can this Crewes guy really pay?”

“He's got the money, yeah.”

“All right.” DaSilva's voice came through the pay phone clear and strong, Bronx street traffic fulminating somewhere behind him. “Then unless Leonard Pellegrini dies before I can get him into the OR, we'll make it happen.”

“Peter,” Simon said. This attitude seemed unusually aggressive for DaSilva, who for the last eight months had preached nothing but risk management, turning aside dozens of candidates, both donors and recipients, because of one irregularity or another. Maybe the success of the last run of deals had emboldened him, or maybe landing a lucrative liver job was incentive enough to bend his own rules. “The guy's an alcoholic. There's no hiding it. Forget six months. It probably hasn't even been six hours since his last drink.”

“What did I say? I'll get him in there. Those regulations are too conservative anyway, you know they're just there to protect the hospital's ass. Just make sure he tells Klein he's been clean four or five months and I'll do the rest.”

“What about the piss test?”

“I said I'll fix it. Worry about your own job.”

And so a week after his excursion to Long Island, Simon sat in the office, scrolling through a batch of applicant e-mails. Crewes had called Simon the day before to inform him that Lenny was going forward with the transplant. He was doing it, Crewes had said somewhat melodramatically, for his children's sake, not his own. Crewes and Cheryl, Lenny's estranged wife, had returned to Lenny's house the day after Simon's visit, and they'd sat with him in the kitchen, turning the screws and refusing to leave until he deigned to allow them to help save his life. It was now the morning of Lenny's physical exam at Cabrera; Lenny and Crewes were due at the office any minute. Lenny was scheduled to undergo a battery of laboratory tests—liver function, electrolyte levels, blood typing, coagulation—as well as radiographic studies of his liver and an EKG. The point was to determine his general fitness for surgery, as well as what sort of characteristics Simon would need to look for in his donor. Simon hoped DaSilva hadn't exaggerated his ability to massage these test results, or at least to place them into some kind of more favorable context (which most likely meant emphasizing Lenny's financial solvency by proxy), since Simon was fairly sure the machines would paint an internal picture of widespread alcoholic waste and ruin.

 • • • 

T
he two men buzzed from street level. Simon let them into the building and waited in the hallway. They exited the elevator, Lenny stuffed into a pinstriped suit like a parody of Mob muscle, Crewes wearing black slacks and a fitted purple sweater, and it was as though the hallway had suddenly shrunk, squeezing in around them. They carried a presence beyond their height and weight, a
largeness
that must have been a residue from their playing days. It wasn't arrogance or swagger. It was almost the opposite: a carefulness as they made their way down the hall, a delicacy of motion, as though they were afraid of damaging anything with which they might come into contact. As Simon shook Crewes's hand, he thought of Alvin Plummer's body, lying broken on the turf, and was immediately ashamed of the thought.

He ushered them into the office and sat them on the two chairs facing his desk. He explained the tests, and then asked if the hospital had been in touch regarding the day's schedule. Lenny said that the transplant coordinator, “a guy named DaSilva,” had called a few days earlier to introduce himself. “He said he'd meet me in the lobby and escort me through the procedures.”

Simon nodded. “You'll be in good hands.” He wrote the name and address of a diner on a slip of paper and slid it across the desk. “When everything's finished, Howard and I will meet you here for lunch. It's just a few blocks from the hospital.”

Lenny looked at him very seriously throughout this conversation. Beads of sweat puckered on his upper lip; he slipped a gold wedding band on and off his finger. Under the suit jacket, his white shirt was stippled with moisture. Was he nervous? Maybe, but Simon didn't think that was it, or at least not all of it. Then he realized Lenny probably hadn't taken a drink yet that day, or maybe for the last few days, as though he could trick the hospital's instruments into believing his body to be clean and blameless.
Well, good
, Simon thought.
Better to start late than never
. At least he'd have a week of practice at being sober before the screening interview.

They left Crewes's Lexus parked on the street and rode the tram across the river. The tram car lifted out of the station and swung above the traffic on First Avenue, climbing alongside the bridge's vaulted underbelly. As they rose above York, they drew even with the higher floors of an apartment building; Simon caught a glimpse of a cat sunning itself in a window, a curtain tangled in the needles of a cactus. They crested the midsection of the bridge, and he pointed out the curve of the United Nations Headquarters a dozen blocks downtown, the ruined smallpox hospital at the southern tip of the island. Back on the ground, he led them toward Cabrera, stopping a few hundred feet from the entrance. Clusters of nurses and staff sat on the grass outside the hospital, eating their lunches in the sun, smoking, laughing, their scrubs pink, baby blue, lime green—pieces of candy scattered across the lawn. Simon shook Lenny's damp hand, told him he'd be fine. Lenny nodded, saying nothing; then he walked away, stolid and deliberate.

 • • • 

N
OW
Simon turned the monitor back around to face him, the last of DaSilva's cigarette smoke drifting across the office. He stared at Maria Campos's fake smile and wondered what particular variety of financial misfortune could have pushed her to this decision. She was so young; usually it was the middle aged, the overextended and overleveraged, whose cagey, probing e-mails piled up in his inbox. He'd have to be careful not to reveal his curiosity. He didn't want to risk scaring her off, and, besides, DaSilva paid him not to pursue these things, to leave the inessential questions about his clients' lives unasked.

He dialed her number. Just as he was sure it was about to go to voice mail, she picked up: “Yeah?”

“Ms. Campos?”

“What?”

“It's Simon Worth, an associate at Health Solutions.” For a few long seconds, he listened to her breathing, the faint murmur of a television in the background. “We've been e-mailing.”

“Simon,” she said. “Right.” Her voice was raspy, as though she'd just woken up.

“I'm calling to tell you that our initial evaluation of your candidacy is positive.”

“That sounds like a good thing.”

“It is. We'd like to do some testing to assess your compatibility with our client. I have the number of a lab you can visit for some additional blood work and liver imaging. Is that something you want to do?”

“Livers are worth more,” she said, “aren't they?”

“I'm sorry?”

“I looked it up.” Her voice straightened, sloughing off its sleepiness. “Liver transplants, they cost more than kidneys. So a piece of liver—a piece of
my
liver—it's gonna be worth more than a kidney, right?”

“In theory, yes.”

“In theory? Either it is or it isn't.” She paused. “I'm sorry. I just need to know if this is worth it to me before we go any further.”

“If you qualify—and I can't make any promises yet—but if you qualify, we can offer you $150,000.” Silence. “Plus we'll pay for your travel, which includes two weeks in a Manhattan hotel.”

“One fifty.” Her voice was neutral, but Simon thought he heard a tremor of the effort required to keep it that way.

“Yes. You would receive $5,000 in good faith when you arrive in New York. The rest follows the operation.”

“I'm not trying to be rude, but how can I be sure this isn't a scam?”

“You can't. But what would we get out of flying you across the country and putting you up on our dime?”

“Not that. I mean how do I know you'll pay me the rest after the operation?”

“I suppose you can't know. But think of it this way: we don't want anybody angry with us. The way we arrange things, everybody wins. The hospital. The recipient. You, the donor. Everybody's happy.”