Chapter 1: Account Management

I’ve had many last names over the years, but my first name has always been Jack. That makes it easier to remember who I'm supposed to be. I’ve been selling organs—mostly kidneys—on the black market for about eighteen years. Most of the business takes place overseas so the industry has come to be known as “Transplant Tourism”—and I’m the cruise director.

Last December I was making follow-up calls to some of my former clients like I've done every holiday season for the last six or seven years. It was comforting to check in with some of them around the holidays and learn that many were flourishing. Not all of them do. Making those calls was the one accommodation I allowed myself despite my relentless efforts at security. I called them to convince myself that it was justified, that I was somehow absolved. I wasn’t just doing it for the money.… I was saving lives.

I called Marlene Brown’s house last year anticipating a routine update. A woman picked up and said, “Hello?” It was quiet in the background.

“Hi,” I said cheerfully. “Is Marlene in?” Marlene was a pretty typical kidney. She had been on dialysis a long time and had a slew of other health problems by the time her family got desperate enough to find Wallace on the internet. Wallace is a buyer’s agent and we sometimes work together. Marlene was a standard transplant tourism trip to Royston, one of my best facilities, in South Africa. She was probably gone for no more than ten days and should have done fine. It had been less than a year since then.

“Uhh, who’s calling?”

“Jack. It’s Jack Martinelli. Is she around?”

“Jack, Marlene’s my mom. Are you a friend of hers?”

Yellow alert. “Yes.” Nothing more.

“Jack, I’m really sorry to tell you this,” she said quietly… Shit, I thought. Marlene’s dead. “My mom died on Thursday.”

“This… this Thursday? Just now?”

“Yes,” Marlene’s daughter replied. “I’m Kim. Her daughter. The funeral for mom is the day after tomorrow. Near their place in New Hope. Do you know where that is?”

“New Hope, Pennsylvania?”

“Yes. If you grab a pen I’ll give you directions.”

“Oh. Okay. About two hours from New York, right?”

“Yes. Do you have a pen?”

I took down the directions, but I had no intention of going. She wasn’t my friend. I had no personal connection to Marlene Brown. She wasn’t the first client of mine to end up dead soon after a procedure, but somehow it felt different. She'd hung on for years on dialysis, outlasted renal failure, and managed to get a replacement part. A year later she went and gave up just in time to complicate Christmas.

I felt rattled when I hung up the phone. Maybe it was the coincidental timing of my call. There was a clump of sadness hanging in my throat that I couldn’t seem to swallow away. And I called Wallace. Why the hell I made that slip I still don’t know, but I straightened my shoulders and breathed and only a half hour after I had gotten off the phone with Kim Brown I called Wallace and had what constituted, for me, a minor fit. When you’re playing with amateurs you can miss a putt or two, but not with a pro like Wallace. Calling him was foolish.

“Hello?”

“Wallace, Jack,” I said.

“Hey, New York,” or something like that, from him. Not too excited or glad but always friendly enough. Wallace claimed to live in Connecticut.

“How are you?”

“Good. Happy holidays,” he said cheerfully.

“You too.”

“Glad you called,” Wallace said.

“Oh, yeah?” Maybe I wouldn’t mention it, I thought. Maybe it’s not a thing to mention.

“I wanted to touch base and check your availability over the next month or two. Things always seem to get busier after the New Year and I have a few things I'm probably going to want your help with,” Wallace said.

“Sure. I’m good,” I told him. “The more lead time you give me, the easier—“

“I know that,” he replied.

“I’m just saying, sometimes sourcing things can be difficult. If it’s something hard to find."

“I’ll give you as much time as I can. That’s all I can do,” he said matter-of-factly.

“Thanks,” I replied. “Hey, Wallace, Marlene Brown. That was one of yours, right?”

“Why would you ask me that?”

“It’s just me,” I said. “It’s just that she’s gone and I thought you might want to know that.”

“Why would you say that to me?” Wallace asked abruptly. “That’s not a thing to say.”

“It’s Jack,” I said and forced a small chuckle. “I’m just saying, I thought you might want to know. They were a nice old couple, her and her husband. That’s all I meant.”

“I don’t care if they were nice or who is gone or not gone. Neither should you.”

“Fine. Forget it. All I really meant to say is that I happen to know that a woman named Marlene Brown called it quits and I thought that would be of interest to you. You talk to these people. I don’t. I just thought you‘d be interested. That’s all. Don’t over-react, Wallace.”

“Well it concerns me that you would have that information, and I don’t know why you’d be telling it to me. I don’t even know anyone by that name, Jack.”

There was a pregnant silence. “Okay,” I said. “Have a good holiday.”

He didn’t say anything right away and there was another pause, and I could almost feel him thinking through how to handle the uncomfortable tension I’d created.

“Jack,” he began quietly, “I need to know that we’re okay.”

“Of course.”

“You are my biggest supplier now. I come to you first on a lot of things now. I have to be certain that we’re okay. That you’re steady.”

“Steady, Wallace. You're right. It was the wrong thing to say. We’re all good. Just call me after the holidays when you know what you need.”

“Umm-hmm,” he said, and cleared his throat softly. “Okay,” he added and then hung up.

I should have never disclosed to him that I had talked to Marlene’s daughter. He probably began looking into it right away. That’s what I would have done. I’ve done it in the past. There are things I know about Wallace that he's not aware of. I’ve kept the information tucked away, available to me if necessary someday in the future. If Wallace uncovered other follow-up calls he might not necessarily have cared, but it could have cost me business or it could have created even greater risks for me.

It had been an uncharacteristic mistake on my part. And it was such a big and obvious mistake that it was hard to ignore the possibility that perhaps it wasn’t completely unintentional. I had that to look at too, and that required Scotch.

I got off the phone that day struck by the thought that maybe it was time to leave the industry, and maybe this time it was really, finally true. After all of those years, despite the way my business had grown and the ease with which we were doing standard kidney deals, perhaps the whole thing had run its course—like an illness. I hadn’t thought it through in a long time; hadn't considered what it was I actually did. I hadn’t been in a shanty-town in years. I hadn’t worried much about getting caught either. I laughed a little when I recognized for the first time that I had gotten a little sloppy. I had apparently also forgotten that I was one of the bad guys.

Chapter 2: The Funeral

Despite that awkward conversation with Wallace about having spoken to Marlene Brown’s family, two days later I found myself heading south on I-95. I’m not sure why. Maybe morbid curiosity. Maybe voyeurism. Guilt? I had the melancholy sense of making a trip back to my grandfather’s village in Ireland. I had no girlfriend then; it was just before I met Lizzie. I had nowhere to be.

At the cemetery, I waded through patches of snow in shoes I was ruining. I eventually came upon a small gathering in the middle of an endless parade of headstones all pointing up out of the ground at imperfect angles, resembling long rows of crooked teeth in the mouth of a shark lying dead on a dock. I stayed on the perimeter and a priest was talking and then a line formed and they threw shovelfuls of dirt down on the coffin that contained Marlene Brown. All the men wore black overcoats. Does every man but me own a black overcoat? I hadn’t attended a funeral since my father’s almost twenty years earlier.

I remembered Marlene being a large woman, obese even. That had probably inflamed her diabetes and made things a lot harder. I never got close enough to get a look at the coffin. It’s probably big, I thought. I wondered if they charge more if they need extra wood. The priest made a remark about how she had gotten a kidney transplant and how it had enabled her to spend a few more precious months with Joe and her eight grandchildren. I smiled inwardly, warmed by my own secret beneficence.

Marlene’s priest was leading them through the Valley of the Shadow of Death. People huddled around her fresh grave in small groups and held each other’s glove-covered hands. There was no wind but it was cold. We could all see our breath that day in Pennsylvania. White puffs of vapor constantly dissipated in the air in front of our faces as we stood in the graveyard. She had a South African kidney. It was standard issue, from a poor black woman who lived in a tin shanty home. The Browns had paid $150K. The South African probably got about fifteen hundred. No one ever made follow-up calls to the sellers. There was a good chance that the South African got no after-care. She might have gotten an infection or become unable to work.

In his eulogy the priest mentioned that Marlene’s husband had gotten a second mortgage to pay for her operation. It didn't fully cover it, but neighbors and fellow parishioners donated enough to make up the difference. I didn’t know that. I didn’t talk too much to Wallace’s buyers. From what Wallace had said, the guy didn’t really try to negotiate. He just paid us. It wasn’t the new knowledge of how the Brown’s had funded their purchase that struck me, but rather, the fact that I had been completely unaware of it.

“Traded his home for a few more months with his beloved wife,” that priest said, while the cold, wet snow started to seep through the seams where the soles of my shoes met the soft Italian leather. I didn’t know a thing about the Browns prior to that funeral. They belonged to Wallace. I had no idea about what they had gone through to buy my extraordinarily over-priced product which had, apparently, only extended her life for another few months. I realized then that I knew so little about any of them. I had stopped asking years ago. It caught me off guard. Standing there in the snow, in the cold winter sunlight, I thought about them all, and started to feel sick. I thought about the sellers in South Africa and Asia and South America, poor people living wretched lives all further cut off at the knees by the lies spewed by a network of finders that I had built and managed for years. I thought about all of our Americans and Europeans clients who we had charged triple a fair price. They all went on to lead Marlene Brown-like lives, in varying degrees. Her husband, Joe, was crying, constantly wiping at his nose and his eyes with the fingers of a black leather glove. Then I found that I was crying, silently. It was not for Marlene; it was for me. I was crying for the life I had lost because I realized clearly that day that I had not saved a sole, but instead, I had played a part in destroying all of us. The magnitude of that loss was pushing down on my shoulders, sinking me deeper into the soft snow, pushing me down into the magma in the core of the Earth.

There is one thing that all priests and atheists have in common—they all hope the priests are right. But standing in the remnants of snow on the frozen grass in New Hope I certainly did not believe that priest when he said that Marlene Brown was in a place called heaven.

About twenty people in the US who need a kidney transplant are going to die today. They’ll die waiting. A handful of others will die while waiting for a liver, heart, lung, pancreas, or for bone marrow. Twenty more will die tomorrow. The ones with the most money and the most determination are my potential customers. For them, greed for more life is a powerful motivator and that makes for incredible profit margins in my business. The rest spend days, months, and then years waiting, withering away in dialysis centers. The average wait for a kidney on a legit list these days is over seven years. That’s no way to put up a fight.

What Wallace had said about things usually picking up in January was true. After the New Year I was usually required to spend more time attending to some of the mundane and dirty details of my profession. This year was no different. Over the last decade or so, as I built up the business and became more efficient at safely getting things done, it seems like I’ve been a little busier each year. Over the last few years it has also been accompanied by a sickening feeling, an apprehension of a coming closure, of an end—of getting caught, maybe. The more successful I am, the more deals I do, the more I am exposed to risk. It escalates.

In the car on the drive home I thought about the church I went to, growing up in Queens. We took “Religion” classes on Wednesdays afternoons. Sometimes my father picked us up in his big Oldsmobile, collecting us from the nuns and then distributing my friends and me to our respective houses for supper. We always left Religion feeling giddy. We snickered and elbowed each other in the ribs. The rides with my dad were strange, with a pervasive tension filling the quiet interior of his big car, his cigarette burning down gently in the ashtray. “Trayner’s dad’s such a hard-ass,” the others would say at school. My dad drove without speaking. When we piled into his car he might have managed, “How was it tonight?” sort of rhetorically, to which I guess I said, “Good.” That was all. I didn’t believe those nuns. He didn’t believe them either, not at 5:45 on a winter Wednesday, the sky overhead already devoid of light.

A few days after Marlene Brown’s funeral I was back at home in New York, thinking about her husband Joe. It was just after New Year’s. For a long time I had been aware of what I was doing, but I felt justified. I had endured an abusive father and an uncaring universe—as if that was special. Every kidney transaction I closed felt like another act of debasement that I was somehow forced to suffer, like a martyr. And each life-saving transaction became a small deposit I made in a karma savings account that I thought I could draw upon later. It turns out they were withdrawals, not deposits. When I tally it now it’s impossible to deny the magnitude of the mess I have made.

I pulled out some cash from under the luggage in my closet that I would have otherwise taken to the safe deposit boxes. I placed stacks of hundred dollar bills into the cutouts I’d made with a box-cutter in the middle of a two-volume set of the “Complete Works of William Shakespeare.” I wrapped the books in tin foil and then wrapped that in bubble wrap and tucked them into a box with a typed note that said: “Joe, Enclosed is $50K. It is for you and you deserve it. You also need it, so don’t do something stupid and give it to the Church. Don’t try to deposit it in a bank or it will cause big problems for you. Don’t tell anyone about your windfall for reasons obvious enough. Just use the money so you can do a little better than you might have done. I am sorry for your loss.” That was it. Of course when he read the last sentence, “I am sorry for your loss,” he would know that his anonymous benefactor was referring to Marlene. In years prior to that, if I had said, “I’m sorry for your loss,” I probably would have just been referring to the fucking money. But not anymore. I hardly felt worthy of making reference to Marlene, but I sent my condolences anyway. I thought about that poor guy spending every last penny and then some, and having her go and quit just the same. It was too late to buy her a new kidney. And I found myself shaking my head and fighting off crying while I wrapped those books up in a shroud of bubble wrap. I decided to book a flight to Johannesburg and go see a farm for the first time in many years.

That was the first time that I considered the mechanics of what I am now preparing to do. In addition to quitting, I'm going to have to stop Wallace as well, which is much more complicated. He has been my associate and sometime-partner for over ten years. My plan is to have him meet me in the lobby of the emergency room at Columbia Presbyterian—one of the best transplant centers in the world. Wallace and I have met in person only on infrequent and important occasions. I’m confident that he will come and what I feel much more than anxiety is resignation.

I guess that the way you’re going to feel about all of this depends on whether you place a greater value on kindness or on honesty. It’s more important to me now to tell you the truth than spin the story to try and somehow make you see it my way. The hospital doesn't have a machine to filter out the impurities in one’s soul, but in a way that’s why I'll meet Wallace there. I think that what I’m looking for, perhaps for the first time, is the same as most people: a little bit of meaning. I only hope it’s more than a symbolic gesture. view abbreviated excerpt only...

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