The Honorable Thing to Do

Author: Mark Phillips

Editor’s Note: On a peaceful Saturday morning in early September I sat in my backyard, savoring the scene before me: the grass and trees and black-eyed Susans, all feeling different now — as the sunlight and scents took on an autumn mood. It reminded me of a memorable essay from years back, and that got me to conjuring a list of all-time personal favorites published in the magazine over the years. I decided to share them with you, a new one each Saturday morning until the calendar reaches 2024. Mark Phillips has written dozens of essays for us over the years and is an editor’s dream contributor — and one of this editor’s dear friends. This piece has long stayed with me. It’s partly the lead, but it is also Mark’s deliberations on bravery and manhood and what his sister taught him about true courage. And of course, the very writing itself.

My sister and I riding the old yellow school bus home over bumpy curvy country roads. Kids bouncing into each other and sometimes onto the aisle floor. A screaming cursing laughing shouting kissing spit-wad throwing canned jungle of yahoos. Brakes screeching, jerking stops. Kids sprinting across muddy lawns to farmhouses, bus doors swishing closed, the odors of manure and diesel fuel, gears grinding and engine growling, kids leaning out windows waving madly and popping the finger and laughing muted into the wind.

I recall one such spring afternoon when I was 14 and Kim 12. I am sharing a seat with Donnie, my best friend, who, because of his physical resemblance to the comic strip character, is nicknamed “Dondie.” But now, turned around in the seat in front of us, Kim is calling him other names. What began as teasing is now a contest of adolescent meanness. Donnie’s voice stretches high as he calls her fat. After a hurt laugh, she calls him bony and weird looking and adds that it’s no wonder he and his mother have to live with his grandparents — his father away because the poor man is ashamed of having a son who’s in a comic strip.

Donnie, who lives across the street from Kim and me, climbs down from the bus when we do. He plants his feet and stings one of her shoulders with a bony fist. She drops to the grass, wailing. Before I know it, I’m atop Donnie, pummeling him. When his cry is louder than Kim’s, I free him to run home. Kim looks up and thanks me. I don’t reply, I don’t help her up, just stand there rather surprised at myself. Donnie and I are best friends, and brothers and sisters are supposed to be enemies. Aren’t they?

That evening, when our father comes home from his job as a welder in a power plant, he learns what has happened and praises me for protecting my little sister. Then he turns to Kim, pulls off his belt and gives her a strapping.

Honor thy father and thy American courage. Your dad is a brawler, the toughest and best father in the whole wide world, and you proudly try to follow his example. When your best friend hits your sister, in a world where boys never play with dolls, you instinctively fight him. Years later, when your sister suffers kidney failure, in a world where men go to war for the Motherland, you give her one of yours. Having misread a little Hemingway, you think your code is one of American manliness. To hell with le courage. To hell with heart. To hell with the French. In American, courage means “to possess guts.” Your sister needs some of your guts, so you give her some. You give less out of love than because your code mandates it.

I did read poetry, belonged to Amnesty International, drove a 4-cylinder car, liked to cook, fed winter birds and occasionally wore pink. I never owned a pickup truck with NRA stickers plastered on the bumpers and guns hung on a rack behind the cab seat; never owned a mint ’56 Chevy with lacy garter belts dangling from the rearview mirror like fish on a stringer. No muscle shirts, no refrigerator packed with Grizzly-brand beer, or splayed-legged Penthouse centerfolds tacked above my workbench. No den bedecked with mounted heads of lions and tigers and bears, or portable gymnasium in my living room, Doberman pinschers in my front yard, Qaddafi target in the back. Never have been one of those men who chew up their sensitivity and digest it into intestinal fortitude. Nevertheless, I have sometimes thought I was.

Of course such thinking is crap. Still, it clings to many of us men until a personal cataclysm shakes it off. Until someone’s alienated daughter overdoses, or until his lonely wife leaves him, or until his son returns from war without legs. Or in my case, until I gave one of my kidneys to my sister and my sister died. Until in tragedy she gave me, as she put it in a letter intended to be read posthumously, something “intangible.” Kim, who never fought bulls, hunted big game in Africa, boxed or went to war, taught me about le courage.

When Kim became ill, she was working as a waitress and maid at a country tavern. My mother wanted her to attend college, but Kim was far happier and better at her job than most people are at theirs; and what more should one want in a job? A working class girl, she was the perfect barmaid for the tavern’s working class patrons. She had a full, rolling and musical laugh the men loved. On the other hand, she knew when to look a man in the eye and tell him where to get off. Elbows propped up on the bar, she listed to her share of woeful tales, did her share of social work. She forced herself to work throughout a year of sickness, right up to a day when she almost died.

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Kim kept faith in her doctor though he persisted for a year in treating her for a recurring flu. Then one day — Kim’s temperature alternately soaring and plummeting, dry heaves, pain everywhere and her body covered with bruises of uremia — our mother drove Kim to the office of the doctor, who was on vacation. His associate saw that Kim had something far worse than influenza. Tests at the local hospital confirmed total kidney failure, and she was transferred to a hospital for hemodialysis.

Three days a week for five years, each session lasting hours, Kim was one with a machine. Patients in reclining chairs were lined up around the large room, the dialysis machines humming like a mass-production line. Rollers squeezed thick bright blood through clear plastic tubing, and visitors worried about leaks. Technician-nurses checked gauges and monitors, adjusted dials, took blood samples. Kim focused on the tiny black and white television suspended above her chair, trying to concentrate on soap operas and game shows. She weathered the sessions better than many patients but always was nauseated all the day she received dialysis and sleepless during the nights. Regardless, she considered the machines to be gifts from God.

Transplantation had been postponed because of Kim’s intermittent blood and tissue infections. However, the dialysis began enlarging her heart. She and I were perfect matches; “as good as perfect twins,” said the nephrologist, who told me that if Kim were to receive the kidney of a cadaver, the odds of rejection would be 50 percent, a parent’s 30 percent, and mine only 10 percent.

A donor’s remaining kidney tends to enlarge, its function increasing, and as far as researchers know, the donor’s lifestyle and life span are not affected. Still, many potential donors do deny kidneys to relatives, and the doctors lie for them, telling the desperate patient that the match was inadequate. Common sense says you should keep all the organs God gave you, and fear cries, “Amen.” Indeed, some of my friends and relatives tried to dissuade me. What if the researchers are wrong? What if the kidney rejects? What if something happens to your remaining kidney?

Coolly, I stated that I simply must make the donation. Code of honor and American courage. “I can’t just let her die.” I was uncomfortable when, in the cool sterile hallway outside the nephrologist’s office, following our meeting with him to set a surgery date, Kim hugged me and told me she loved me. I halfheartedly returned her hug and had to force out the truth, that I loved her too.

The morning of the surgery, as I was wheeled out of my hospital room, I sat up on the cart, gave my family the thumbs up sign and said, “See you on the other side.”

My mother hurried into the hallway to kiss me and said, “Mark, you’re so brave.”

Damn right.

When it roars in our ears — when the River that has nurtured and gently carried us startles us with the news that it will suck us under — courage all alone, flexing its sinking biceps, is a pathetic sight.

After the surgery, I woke in the haziness of the post-op recovery room to one of the surgeons, who sounded far away. “Mark . . . Mark . . . It’s all over, Mark.” Struggling to focus on his face, I recalled where I was and mumbled something about Kim. “The kidney began functioning before we had finished sewing it completely in . . . Kim’s fine.”

The next day I was refusing pain medication and accomplishing short walks, bent over my pillow and dragging along my IV unit. On the third day, I visited Kim in her room. I teased her about still being sick in bed and about taking a sleeping pill the night before surgery. When she’d heard enough, she bounced a plastic cup full of ice chips off my forehead. I shuffled back to my room, but we made up that evening. On the fifth day, because one of the surgeons had told me the soonest any of his donors had been released from the hospital was six days, I insisted on my discharge. To make my point I performed a toe touch, eliciting a strong warning but gaining my walking papers. And that was the last enduring good news I received.

Kim’s new kidney was functioning, but her blood pressure was elevated. For three weeks and despite strong medications, it mysteriously continued to rise. Then one evening a nurse found Kim unconscious, the result of a hypertensive convulsion. In the ICU, a doctor informed my mother that the convulsion may have damaged Kim’s brain or new kidney. For two days, Kim gradually regained consciousness but frequently hallucinated. When the hallucinations ceased, a neurologist declared her fully and miraculously recovered. She was returned to her old room in the nephrology unit. But late that night she spiked a temperature. The doctors decided she, somewhere, had an infection.

Returned to the ICU, Kim received massive doses of antibiotics but weakened daily. Finally the nephrologist told me that he believed the elusive source of infection to be in Kim’s new kidney. That the kidney might eventually be removed. That even then, because antirejection drugs had suppressed her immunological system, her ability to fight the infection, now in her blood stream, would be minimal.

When it roars in our ears — when the River that has nurtured and gently carried us startles us with the news that it will suck us under — courage all alone, flexing its sinking biceps, is a pathetic sight. In a letter we would discover after her death, Kim wrote, “Some things in life are intangible. I’ll remain with you in love.” She earned no college degrees, but she was far from stupid. When the waters swirled around, her courage inhaled love, became buoyant, kept her afloat until she released it to drift intangibly away.

In the ICU Kim is on a refrigerated mattress, her face bloated. She stares at the ceiling. A tube runs to a catheter bag. Three tubes run to three bottles of the IV unit. Wires run to a vital signs monitor. Although she is shivering, she is perspiring. After saying hello, I can utter no words. Minutes pass and then she slowly turns her head on the pillow and asks about my wife: “How’s Margaret?”

The infection has worsened for weeks. Her arms and legs are grotesquely black and blue from the hundreds of needles. As a nurse approaches with yet two more resting on a tray like a meal of cacti, Kim whimpers, turns away her face and stiffens. After the nurse is done, Kim turns back to her visitors and apologizes for “being a baby in front of you.”

Although it has not rejected, under the stress of the infection the kidney has ceased to function. Kim has resumed receiving dialysis. I visit and finder her unusually talkative, asking about my friends and wife and pets. Finally I ask how she is doing and she replies that the doctors have assured her the kidney is functioning well and the infection subsiding. Later I find one of the doctors and suggest that the reality is too much for Kim and that she needs the help of a psychologist. The doctor appears surprised and informs me he has noticed no such problem. That night at home, Margaret asks, “Do you think maybe she was trying to protect you?”

They cut out the kidney, place it on an operating room table, slice it up and find nothing abnormal. Pieces are sent to a lab, but no infection is located. They decide the source of infection is a heart valve. They hope Kim can strengthen enough for another operation. They hope to replace the infected valve with one taken from the heart of a pig.

I cannot sleep and am desperate to feel something other than anger. One night after 2 a.m., I decide to reread the Book of Job; but when God gives back to Job all of Job’s blessings I throw the Bible against my wall. I feel only anger until I drink so much whiskey that I feel nothing at all.

I visit for the first time in several days, since before the kidney was removed. Kim awakes coughing, pushing aside her oxygen mask so our youngest sister can dab the blood from her mouth. When Kim sees me she opens her arms; I bend over the bed and we embrace. She says she is sorry I gave my kidney for nothing. I say I needed to lose a pound anyhow. Weeping, she tells me she loves me. Now there is nothing left to do but feel the truth. I tell her I love her too, and we embrace and weep until a nurse, fearful for Kim’s heart, like a gentle current tugs me away.

Mark Phillips, a regular contributor to this magazine, lives in southwestern New York. His essays have appeared in Commonweal, Salon, The New York Times Magazine and other journals.