In Transplant, Washington, DC, writer and poet Bernardine Watson recounts her harrowing search for a new kidney. Her personal and professional journeys are compelling, and her overview of the devastating health impacts of racism on Black and brown people — particularly around kidney disease — forms an important throughline in the memoir.

Transplant opens in a belowground dialysis center in a posh Dupont Circle office building. As the primarily white professionals take the elevators upstairs, mostly low-income Black people descend to the windowless basement where Watson ends up three times a week for five years to undergo dialysis. The racial disparities seen in the building play out across the United States.

Watson grounds her story in her family of origin. She grew up poor in South Philadelphia with a strict and punitive father, a mother who stood by him, and siblings whose relationships were impaired by the family ethos of jealously guarded privacy. When Watson became pregnant at 19, her father threw her out of the house and into the arms of her future first ex-husband. “I’ll handle it” became her motto, meaning, “I’ll handle it alone.”

She describes her dogged and impressive drive to finish college and graduate school and make a comfortable life for herself and her son, Robert. She was living in Minnesota, in the process of ending her second marriage, when she received her diagnosis. It was 1984, and she was 33 years old. She learned she had the relatively rare focal segmental glomerulosclerosis (FSGS), which can lead to permanent kidney damage and failure. She’d “already been through a lot in [her] life — poverty, welfare, teen pregnancy and two disastrous marriages” and was stunned by the news. In keeping with her family’s values, she decided to hide her illness and power through it alone.

For 15 years, as she moved back to Philadelphia from the Midwest, she pulled it off. Watson hewed to a regimen of diet and exercise and kept the disease at bay. Her career blossomed, and her son grew up.

Eventually, however, FSGS caught up with her, and a transplant became urgent. Spoilers prevent disclosing all the details, but her descriptions of her day-to-day life dealing with multiple doctors, biopsies, and dialysis — which, at its best, fulfills only 15 percent of kidneys’ function — taught me about the trials of kidney disease. I was aware of the always-challenging search for a donor, but I found Watson’s focus on the relentlessness of dialysis, which is never a cure, to be especially important. She describes the urine smells and side effects of vomiting and weakness and shares the gallows humor of fellow patients. Since no privacy is accorded, a strange, rarified camaraderie develops among this community.

Transplant is equally a memoir about love, for during this fraught period, Watson met her now husband, Joe, the true love of her life. “My therapist…had assured me that ‘real love would come when I was ready for it,’ and she’d been right.” Watson weathers a long period of adversity with Joe at her side. Wired to be self-reliant, she nonetheless also opens up to friends and relatives, some of them once estranged. After great hesitation, she brings her son in on her terrifying secret, too, trusting he’ll balance the news with building his own life and finding his way in the world.

In light of her longtime zeal to handle things alone, Watson’s book itself is an act of bravery. She paints in it a realistic picture of what kidney disease truly means for individuals and families, and she lays bare the physical and psychological details of her journey. Transplant is a generous gift to the reading public. I urge you to pick it up and travel with Watson as she makes the arduous trip through America’s byzantine healthcare system.

Martha Anne Toll is a book critic and a novelist. Her prizewinning debut novel, Three Muses, was published last fall. Her second novel, Duet for One, is forthcoming in early 2025.

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