Nancy Szokan is an editor at The Washington Post.
Midway through her thoughtful and endearing memoir, Vanessa Grubbs shifts gears. The first half of "Hundreds of Interlaced Fingers" is largely a love story — an account of how the author, an attending physician and faculty member at a hospital in Oakland, Calif., fell for Robert Phillips, a former hospital trustee and aspiring politician with end-stage kidney disease. Within months, she was smitten enough to help him get off dialysis — and leapfrog the complex inequities of the organ-donation system — by giving him one of her kidneys.
Their courtship and marriage, told alongside their kidney surgeries and their aftermath, are related in a style both medically detailed and girlishly romantic. Waiting in pre-op, in a gown "with too few ties in the back to make my booty feel securely hidden," Grubbs seems as breathlessly excited as a bride; and later, when she and Phillips fear that his body is rejecting her kidney, she sounds more like a lover than a doctor. "I had to believe" the transplant would eventually take, she writes. "He had my kidney and my heart."
The book's second half, in contrast, is dominated by medical histories and the social and ethical issues that surround kidney disease. Inspired by her husband (who has survived with her kidney for more than a decade), Grubbs changed her career goals and embarked on a fellowship in nephrology. But her writing remains warm and conversational. When she gets her first electron micrographed view of a healthy kidney, she's "mesmerized" by the beauty of its blood-filtering apparatus, with key podocyte cells reminding her of "a mama octopus trying to hold all her babies at once, each tentacle with a set of fingers and each finger with another set of fingers." And the kidney as a whole is gorgeous: "Intricate. Curved. Complex. Multitasking. Like a woman, I thought. . . . She is a thing of beauty."
Partly because of Grubbs's unpretentious tone, the book's lengthy explanatory passages are eminently readable — whether she's describing the 400 years of scientific inquiry that led to the "miracle" of dialysis, or how a condition called focal segmental glomerulosclerosis, which can lead to chronic kidney disease, relates to a gene that evolved to resist the sub-Saharan African parasite that causes sleeping sickness.
That gene, naturally, is more common in people of African ancestry — and that's just one of many ways Grubbs explores the issues of kidney disease and treatment that confront people of color. She, like Phillips, is black; before she met him, she was head of her hospital's Office of Diversity Affairs, trying to recruit more nonwhite doctors to better mirror the Oakland population. As a nephrology fellow, she ran into problems funding research of racial and ethnic disparities in treatment. (Although blacks and whites each made up about a third of the kidney transplant waiting list at the time, whites received every other kidney and blacks every fifth one.) When Phillips had counseling before his transplant, it seemed that medical staff members were trying to discourage him: "African Americans reject kidney transplants more often," the transplant nephrologist warned, then apparently tried to cast it as a compliment. "Their immune systems are just so strong."
One of the book's more troubling passages reflects Grubbs's awareness of the unquantifiable attitudes that underlie health care. It describes how scar tissue from Phillips's previous hernia surgeries made it difficult to connect Grubbs's ureter to his bladder; rather than burrow through the tissue, the surgeon took a simpler route, linking the couple's ureters to each other. But the connection kinked, urine leaked, and the transplant appeared likely to fail until another surgeon corrected the situation. It was only later, after a white mentor of Grubbs's brought up the subject of race, that she wondered if the original surgeon would have tried harder, done the difficult burrowing the first time around, if the patient on the table had been someone he "more closely identified with" — someone of the same color.
The question is raised not with resentment but with concern, reflecting the general good humor that permeates this earnest, satisfying book — which, it should be noted, ends with a typically practical and readable appendix: Twelve pages of frequently asked questions for people who have, or fear they have, kidney disease.
By Vanessa Grubbs
Amistad. 261 pp. $25.99