It showed up on the ultrasound screen. The right lobe of the liver. Against a black background, gray dots had gathered. The dots were moving. Slowly. Like an amoeba. The doctor slid the probe across Yujin's belly. The gel was cold. Yujin flinched. The doctor apologized. The gel warmer was broken, he said. Yujin was looking at the ceiling. There was a fluorescent light on the ceiling. Beside the light was a yellowish stain. A water leak. “You see it here.” The doctor pointed at the screen. Yujin turned her head and looked. Gray dots. An irregular mass. The thing inside Yujin's liver. “This is Hepatobion.” “Hepatobion.” “Yes. An independent organism that lives inside liver tissue. Not a human cell. It has its own genome. A 0 percent match with the human genome. It was discovered in 2068. About 8 percent of the world's population carries it. Most are asymptomatic. In some, liver function actually improves.” “And I'm not asymptomatic.” “This is a case of rapid proliferation. That's 0.4 percent of carriers.” Yujin looked at the screen. Something that wasn't human was living inside her body. It might have been there since she was born. It might have been with her for 32 years. She had lived without knowing. Had it known her? On the screen it was moving. It was alive.
Yujin sat down in the exam room chair. The doctor turned the monitor to show her. The liver sequencing results. Graphs and numbers. “The Hepatobion colony is 3.2 centimeters. At your checkup 6 months ago it was 1.8 centimeters.” “So it's growing?” “Yes. The proliferation rate is on the fast side. It's classified as a rapid-proliferation case, that 0.4 percent.” Yujin looked at the numbers on the monitor. 1.8 to 3.2. Nearly double in 6 months. Something was growing inside her liver. While Yujin ate, slept, went to work. It too was eating, growing, spreading. “Does it have to be removed?” “The recommendation is resection. We'd have to remove about 30 percent of the right lobe along with it.” “30 percent.” “The liver regenerates. In 3 months it returns to its original size. The surgery itself is laparoscopic. About a week in the hospital.” “After Hepatobion is removed, does it come back?” “The recurrence rate is low. Under 5 percent. But it isn't quite 0.” Yujin gripped the armrest. The plastic was smooth. “Would you like to schedule the surgery?” “Let me think about it.” The doctor nodded.
Yujin left the hospital. At the reception desk she booked her next appointment. Two weeks out. The clerk printed her a confirmation slip. Yujin folded it and put it in her pocket.
It was May. Outside was bright. The sun was strong. Yujin squinted. She sat on the bench in front of the hospital. On her belly the damp of the ultrasound gel still lingered. She touched her shirt. It was wet. She laid a hand on her right side. Where the liver was. Under her palm was her liver. Inside the liver was the thing. She sat with her palm pressed there. The sun was warm. Her skin was warm. The liver beneath the skin would be warm too. And the thing inside it.
Yujin's phone rang. It was her sister. “Did the results come in?” “Yeah.” “What did they say?” “It's growing. They want to operate.” “Get the surgery. Right away.” “They have to cut out 30 percent.” “Cut it. The liver grows back.” Her sister's voice was quick. Her sister was always quick. Quick to decide. Yujin was slow. “I want to think about it.” “Think about what? There's a bug inside your body. What do you think Mom would've said if she were alive? She'd have told you to get it out this instant.” “It's not a bug.” “Bug or whatever, it isn't yours. Take it out.” Yujin hung up. Her sister was in Busan. Yujin was alone in Seoul. Their parents had died 5 years ago. Their father first, their mother a year later. Yujin had no one but her sister.
A bug. Her sister had called it a bug. The doctor called it an independent organism. In the academic papers it was called a 'commensal-capable unrecorded species.' Yujin didn't know what to call Hepatobion. It had a name. A scientific name. But she couldn't call it by name. To call it by name seemed to create a relationship. Yujin didn't want a relationship. With the thing inside her liver.
Two weeks later Yujin had her pre-op workup. A liver biopsy. The needle drove through her side. They'd given local anesthesia, but she felt the pressure. The pressure of something pushing in. Yujin looked at the ceiling. This time it was a different ceiling. A clean ceiling. No stains. The moment the needle reached the liver, her body flinched. She was anesthetized, but she felt the pressure. The feeling of something being drawn out of her. Whether it was her own cells being drawn out or its cells, Yujin couldn't tell.
The biopsy results came back. The doctor called Yujin in. The doctor's expression was different. Different from 2 weeks ago. The eyes had widened. The doctor turned the monitor toward Yujin.
“Something unexpected turned up in the biopsy.”
Yujin looked at the monitor. It was a microscope image. Cells stained purple and pink. Yujin couldn't tell them apart. The doctor pointed to a spot on the screen.
“These pink cells are the Hepatobion. And this dark purple is liver tissue.”
“Okay.”
“You see these irregular cells? Here, here, here.”
The doctor tapped 3 spots.
“These are hepatocellular carcinoma cells.”
Yujin's back came away from the chair.
“Cancer?”
“Early stage. Stage 1. 0.9 centimeters.”
“I had liver cancer? Not the Hepatobion? It didn't show up at the checkup 6 months ago.”
“No. But look here.”
The doctor zoomed in. Yujin looked at the screen. The pink cells were wrapped around the purple ones. Not wrapped around. Eating. The edges of the pink cells had burrowed into the purple cells. The boundary was collapsing. The purple was being consumed by the pink. Like paint bleeding. Slowly. But surely.
“The Hepatobion is devouring the cancer cells.”
Yujin couldn't take her eyes off the screen. 2 lives were fighting inside her body. One a life that wasn't Yujin's. The other a life trying to kill Yujin. And the life that wasn't Yujin's was eating the life that was trying to kill Yujin.
“If we remove the Hepatobion, the cancer stays behind. You'd need separate cancer treatment.”
“And if you don't?”
“The Hepatobion could keep eating the cancer. But at the same time it keeps growing too. The consumption of the liver goes on.”
“So the liver—”
“Yes. Liver function drops. Worst case, liver failure.”
“Remove it, cancer. Don't, liver failure.”
Yujin couldn't rise from the chair.
“Is there time? Time to decide.”
“Since the cancer is early, you have about 2-3 weeks. But you can't let it go past 2 months.”
“That's right.”
Yujin sat in the chair. Either way, it was the liver. Either way, it was Yujin's liver.
Yujin came home. A studio apartment. One pair of shoes at the entrance. Yujin's sneakers. Yujin took them off and went into the room. Dishes were piled in the sink. 3 days' worth. Cup-ramen containers mixed in with rice bowls. Water sat cold and stagnant. 2 cup-ramen containers, 1 rice bowl, 1 soup bowl. Yujin left the dishes and lay down on the bed. Looked at the ceiling. Yujin's ceiling. The ceiling of 3 years since moving in. Yujin laid a hand on the right side. The place where the liver was. Inside it, the Hepatobion. Inside it, the liver cancer. Yujin was 32. Worked at a logistics company. Clocked in at 8 every day, out at 6. An ordinary life. An ordinary body. The company put everyone through a checkup every year. Normal until last year. This year the Hepatobion turned up. Yujin thought about the 3 things inside this body. Yujin's liver. Yujin's cancer. The life that wasn't Yujin's.
She called her sister.
“It's liver cancer.”
“What?”
“Early stage. Stage 1.”
“Oh, for real. Get the surgery. Now.”
“The thing is. The Hepatobion is eating the cancer.”
“What? Eating it?”
“It's devouring the cancer cells. Remove it, the cancer stays. Don't, the liver falls apart.”
Her sister was silent for 3 seconds. Her sister going silent for 3 seconds was a rare thing.
“What did the doctor say?”
“Told me to choose. Me.”
“That's insane. Why would a doctor make the patient choose?”
“Because both are dangerous.”
Her sister let out a breath. Yujin could hear it through the phone.
“Should I come down? To Seoul?”
“I'm fine.”
“Fine, my ass.”
“I just want to think it over.”
“Think again? And what if they both get bigger while you're thinking?”
Yujin hung up. Her sister was right. As time passed, both grew. The cancer grew, and the Hepatobion grew. While Yujin was thinking, 2 things were growing at once inside Yujin's liver.
It was night. Yujin lay on the bed. Sleep wouldn't come. The side seemed to throb. Whether it actually hurt or the nerves had just gone raw, Yujin couldn't tell. The doctor had said the Hepatobion causes no pain. And still it seemed to hurt. Yujin wondered whether the body was lying to itself. Touched the side. Nothing there to feel. Under the skin were the ribs, under the ribs was the liver, and inside the liver were those things. Yujin couldn't feel them. They could only be seen by ultrasound. Only confirmed under a microscope. A place that was Yujin's own body, and yet a place Yujin couldn't reach.
Yujin searched the internet. 'Hepatobion cancer cell phagocytosis.' 3 papers came up. A 2068 paper. 2 papers from 2069. The title of the most recent one: 'The Selective Phagocytosis Mechanism of Hepatobion Against Hepatocellular Carcinoma and Its Clinical Implications.' Yujin read it. Only the parts that could be read. The abstract. The conclusion. Looked at a graph in the middle. A time-course graph of Hepatobion colony size against hepatocellular carcinoma size. The 2 lines were crossing. As the Hepatobion rose, the carcinoma fell. A mirror image. When one grew, the other shrank. A seesaw was rocking inside Yujin's liver.
'Hepatobion recognizes the surface proteins of hepatocellular carcinoma cells and phagocytoses them selectively. No direct attack on normal hepatocytes was observed. However, the physical expansion of the Hepatobion colony compresses normal liver tissue and induces functional decline. The balance point between Hepatobion's anticancer function and its encroachment on the liver varies from patient to patient, and at present no predictive model has been established.'
The balance point. Yujin looked at those words. Varies from patient to patient. Cannot be predicted. It meant that no one knew the outcome of the war being waged inside Yujin's liver.
For 3 days Yujin worked. A logistics company. Sorting shipping invoices, checking delivery routes, processing returns. Yujin's coworkers didn't know Yujin was going to the hospital. Yujin didn't tell them. No one knew that something was growing inside Yujin's flank. At lunch Yujin ate in the company cafeteria. Soybean-paste stew. Rice. What Yujin ate went to the stomach, went to the liver, went to it too. Eating the stew, Yujin wondered whether it was eating too.
3 days later Yujin went back to the hospital. Met a different doctor. A hepatology specialist. A woman doctor who looked older than Yujin. She wore glasses. She was looking at Yujin's test results.
"I came to hear your opinion."
"As you've probably seen, it's a rare case. Rapid Hepatobion proliferation and hepatocellular carcinoma diagnosed at the same time. There are 7 reported cases in the country."
"Of the 7, which ones did most of them do?"
"3 had the Hepatobion removed and then treated the cancer. 2 chose watchful waiting. 2 haven't decided yet."
"And the 2 who did watchful waiting?"
The doctor looked at Yujin.
"For 1, the Hepatobion eliminated the cancer completely. It took 8 months. But 41 percent of the liver was replaced by Hepatobion. Liver function is at 55 percent of normal. Can't drink, has to limit fatty food, and because drug metabolism has slowed, even cold medicine has to be given at a reduced dose."
"They're alive?"
"They're alive. Managing with dietary restriction and medication."
"And the other 1?"
"The Hepatobion didn't eat the cancer fast enough. The cancer metastasized."
Yujin sat in the chair. 1 lived. Giving up nearly half a liver. 1 lost. To cancer, no less.
"And in my case?"
"Judging by the growth rate, the Hepatobion is fast. But I can't guarantee it."
"Guarantee."
Yujin rolled the word around in the mouth. Guarantee. No one could guarantee it. The outcome of what was happening inside Yujin's liver.
"In medicine, guarantee is a hard word to use."
Yujin left the hospital. Got in the elevator. There was a mirror. Yujin's face was reflected in it. Yujin looked at the face. An ordinary face. A little drained of color. Dark circles under the eyes. From not sleeping well. The Yujin in the mirror looked at Yujin. Beneath this face, beneath this skin, beneath these ribs, there was a war.
Home again, Yujin made a cup of instant noodles. Poured in the hot water. Waited 3 minutes. Ate the noodles. Drank the broth. The broth went down to the stomach. Beside the stomach was the liver. In the liver was it. Drinking the broth, Yujin thought. If the nutrients of this broth reach the liver, does it eat too. What Yujin eats, does it eat too.
Yujin set the chopsticks down. Noodles were left. No appetite. The liver had to process what was eaten. If the liver wasn't whole, then eating wasn't whole either. Yujin put down the cup of noodles. Broth was left in the cup. Yujin laid a hand against the flank. It was warm. Whether from the broth or from body heat, Yujin couldn't tell.
For a week Yujin slept every night with a hand pressed to the flank. It was a meaningless gesture. A hand couldn't feel the Hepatobion. Couldn't feel the cancer either. But with a hand pressed there, Yujin could remember that something was there. Yujin didn't want to forget. What was happening inside the body.
A week later Yujin told the doctor.
"I'll wait and see."
The doctor looked at Yujin.
"Watchful waiting?"
"Yes."
"You understand the risks?"
"Yes."
"You'll have to be examined every 2 weeks."
"Understood."
Yujin signed the consent form. A watchful-waiting consent form. At the very bottom it read: 'This patient defers Hepatobion removal surgery and chooses watchful waiting. Responsibility for any medical consequences arising from this rests with the patient.' Yujin picked up the pen. The pen didn't hesitate above the signature line. Yujin signed right away.
Yujin waited. Went to the hospital every 2 weeks. Had an ultrasound. Hepatobion: 3.6 centimeters. Liver cancer: 0.7 centimeters. The cancer had shrunk. By 0.2 centimeters. That was what it had eaten. Yujin looked at the ultrasound screen. It was moving. Bigger than the first time Yujin had seen it. Moving more. Watching it on the screen, Yujin felt a strange emotion. Not disgust, not gratitude. An emotion there was no name for.
4 weeks later. Hepatobion: 4.1 centimeters. Liver cancer: 0.4 centimeters.
My sister called.
"How's it going?"
"The cancer's shrinking."
"That bug's eating it?"
"It's not a bug, I told you."
"What's it called?"
"Hepatobion."
"Hepato-what?"
"Hepatobion. It means life within the liver."
"Pretty name. For a bug."
6 weeks later. Hepatobion: 4.8 centimeters. Liver cancer: only traces remaining. The doctor spoke.
"The cancer cells have almost entirely disappeared."
Yujin looked at the screen. The cancer was vanishing. That thing had eaten it. A life that wasn't Yujin's had eaten the thing that had been trying to kill Yujin.
"But the Hepatobion colony is 4.8 centimeters. It occupies about 22 percent of the liver. Once it finishes the cancer, the growth may stop—or it may keep growing."
"Does it stop when there's nothing left to eat?"
"Of the two monitored patients I mentioned, one stopped. At 41 percent. The other didn't."
Yujin nodded.
"22 percent."
"If the growth continues, it affects liver function."
Yujin walked out of the hospital and sat on a bench. The same bench as on the day of the first diagnosis. What had been May was now July. The sunlight was stronger. Yujin laid a hand against one side. The 4.8-centimeter thing was living inside Yujin's liver. Six weeks ago it had been 3.2 centimeters. In six weeks it had grown 1.6 centimeters. While Yujin went to the hospital, talked with his sister, ate cup noodles, and lay awake, it had grown steadily. And it had eaten Yujin's cancer. It had grown by eating Yujin's cancer. It was saving Yujin while it consumed Yujin.
Yujin touched his side. Nothing could be felt. Skin. Muscle beneath it. Ribs beneath that. The liver beneath that. That thing inside it. Yujin couldn't feel it. But it was there. It was alive. It had saved Yujin, and it was eating Yujin. Yujin didn't lower his hand. The sun was shining on the back of his hand. It was warm. Inside Yujin's liver, too, something would be warm. Yujin didn't know—whether it was warm or cold. Yujin sat on the bench with his hand raised. The phone rang. It was his sister.
"How were the results?"
"The cancer's almost gone."
His sister was silent for 3 seconds. This time it was a different kind of 3 seconds.
"Really?"
"Really."
"That bug ate all of it?"
"It's not a bug, I told you."
"What did you say it's called. Hepato."
"Hepatobion."
"Are you supposed to be grateful? To that thing?"
Yujin didn't answer. He looked at the hand over his side. Whether he was grateful or afraid, Yujin didn't know. It seemed like both.
"Sis."
"Yeah."
"I'm okay."
His sister let out a breath. The sound of breathing on the other end of the line.
"Good. As long as you're okay."
In the roadside trees in front of the hospital, a cicada cried. A July cicada. Listening to the cicada, Yujin didn't press the hand over his side. He just let it rest there. Beneath the skin, nothing could be felt. Yujin's liver was quiet. The thing inside it was quiet too. Yujin was feeling that quiet. The next test was 2 weeks away. Then he would know how much it had grown. Yujin would wait the 2 weeks. While waiting he would eat, go to work, sleep. Inside Yujin's liver, it too would eat, grow, and live. Yujin stood up. From the bench. He walked along the road in front of the hospital. At the crosswalk he waited for the signal. The green light came on. Yujin crossed. Yujin's liver crossed too. That thing crossed too. The three of them crossed the crosswalk together. As he walked, Yujin smiled. He didn't know why he was smiling. The laughter just came. That there were two wars inside his own body, and he was crossing a crosswalk. Yujin walked, smiling.
