by Victor Koman
"I can't bother thinking that far ahead. I've got to arrange something for Renata." She blew a cloud of smoke off to the side. "May I use your phone?"
"Sure."
She called the hospital and paged their best pediatrician, who, though he was not a favorite of Dr. Lawrence's, carried considerable clout. He agreed to take over Renata's case, even giving Fletcher a brief rundown on her current condition.
"Look, Lon," she said. "All I have left is my personal pager. I'm sure Lawrence's shut my hospital one down. If her stem cells kick in or if her condition declines, let me know right away."
"In the same breath I'm telling the Chandlers," said a reso-nant voice on the other end.
"A breath sooner," she said.
"Sure, Ev. Sure. I'm sorry about Bum-"
"Forget it," she said. "Just take care of Renata. So long." She gently replaced the receiver in its tray. "DuQuette's a good doctor," she muttered. "She'll be all right."
"How about you?" Johnson stared at her as she flipped idly through the BMQA decision.
"It's less than thirty years of my life. I figure I've got thirty more." She stubbed the half-smoked cigarette until it disinte-grated into a crumbled pile of burst paper and dark shreds of tobacco. "Let's finish off this trial so I can decide on my career change."
XVII
The next few days consisted of a numbing series of inter-views with newspaper and magazine reporters, television talk-show hosts, and radio call-in shows. Fletcher discussed transoption with a growing fervor nurtured by her sudden fall from medical respectability.
"I'm free," she told one interviewer in her living room, "to discuss transoption without fear of losing my medical creden-tials. They're gone. I can step on all the toes I want." The reporter-a science correspondent for a midwestern newspaper-behaved differently from most of the people who had interviewed Fletcher. The majority were either openly hostile, surreptitiously hostile, or confused about just what she was trying to prove. The rest performed their jobs with a straightforward, emotionless technique that caused her to wonder whether they held any personal beliefs whatsoever.
This one, though-Lester Joseph Neilson from the Iowa New Dealer-was a small, tough-looking man in his forties. He ap-peared to have been built more for welterweight wrestling than for pounding a word processor. He watched her with iron-grey eyes under greying close-cropped hair, chewing on the end of his pencil between scrawls on a dog-eared notepad.
"You dealt with death continuously," he asked her with a voice like gravel in a gearbox. "Why should one more abor-tion have bothered you?"
He probed too deeply, she thought, reached too closely to truths she could not yet reveal. "I realized that abortion had to come to an end," she said. "That somebody had to be the first to find another way. No one else had taken the risk to use the new surgical advances available, so I did. It could have been anyone."
"Anyone with a conscience," Neilson muttered, making notes. "Do you feel morally superior to the doctors who didn't?"
"The first person to jump into a fire would be petty to chide others for not going ahead of her."
"And if they don't follow?"
"Only the hindsight allowed by history will determine whether they behaved with cowardly sloth or wise restraint."
Neilson flipped through his notes. "Good stuff, Dr. Fletcher."
"There's no need for the `Doctor' part anymore."
He smiled. "Let's keep it there just in case." He mused si-lently for a moment, then asked, "What if the medical estab-lishment finds it wise to restrain themselves permanently? What if research into transoption is banned outright?"
She smiled as she took a sip of coffee from her pale blue cup. "This isn't the only country in the world. And only natural laws last forever. Somewhere, sometime, someone else will pick up the scalpel and decide to save a life rather than end one."
"How do you feel," he asked gingerly, "about all the babies you aborted up till Renata?" The cup paused halfway to her lips. Her mind raced furi-ously; then, calmly, she said, "Catholics once believed that the souls of unbaptised babies dwelt in limbo, awaiting Judgment Day. That's how they exist... in my mind. In limbo, waiting for the atonement of sins. The sins of others." Neilson tapped the pencil against his teeth. "Pretty mystical stuff. Let's talk about your personal Judgment Day. Your oppo-nents have a medical expert going on the stand tomorrow. What do you feel about such testimony?"
Setting the coffee cup down, she said, "Without making any comments on the course of the trial, I can only say that I will be very interested in this person's opinions. I'll value his or her insight. A doctor's viewpoint has yet to be heard."
"
Evelyn stared in shock at the man called to testify.
Dr. Ian Brunner, sworn in, sat in the witness box. Evelyn marveled at the way he had changed. He was still a tall man, with long-fingered, strong hands. The rebel in him, though, was gone. With a receding line of dark brown hair and glasses through which cool eyes gazed, he seemed every bit the im-age of the dedicated man of science. He wore a somber grey suit with a small gold lapel pin in the shape of a caduceus. When he spoke, his voice filled the courtroom with a Los An-geles-softened version of crisp New England diction. An af-fectation, she realized, that he must have cultivated over the years. He gazed at her without emotion. It was another man who sat in the witness stand. Not the Ian she had hurt with her choice so many years ago. Had she done this to him? His face revealed nothing. Has he waited this long for his revenge?
Ron Czernek stepped forward, flashing a feral grin at Johnson. Just try badgering this one, he thought. "Please state your name."
"Ian Wilson Brunner, the Third." His hands, fingers inter-twined, rested comfortably in front of him. Terry stood to say, "The defense stipulates that Dr. Brunner is qualified as an expert in medical ethics."
Czernek smiled, then asked Dr. Brunner, "Are you familiar with the work of Ms. Evelyn Fletcher, formerly a doctor at Bayside University Medical Center?"
"I am familiar with Dr. Fletcher's work through what I have read in the newspapers, from speaking to colleagues, and from reviewing her proposals as an outside consultant, yes."
"Are you sure you should call her `doctor?'"
"Objection!" Johnson said loudly. "Permission to approach the bench." Judge Lyang motioned him forward. Czernek followed.
"I move for a mistrial," Johnson whispered. "Informing the jury that BMQA pulled her credentials is incredibly prejudi-"
"I said no such thing," Czernek countered swiftly.
"You were lucky," Lyang said softly to Czernek, "that he cut you off when he did, or I would have had grounds to declare a mistrial. Keep calling her `doctor.' They've suspended her privi-leges, they can't revoke her degree."
Czernek nodded silently, turning back to the witness stand. Johnson smiled at Fletcher as he sat between her and Karen.
"Strike the last question from the record," Lyang said. "And proceed."
"Speaking as an expert in medical ethics," Czernek resumed, "do you think Doctor Fletcher behaved ethically in transfer-ring a fetus from the uterus of Valerie Dalton to the uterus of Karen Chandler?"
"I would have to say no."
Evelyn gazed at him with barely veiled misery. His words were those of an objective expert, but she knew that after so many years he still had not forgiven her.
"Why is that?" Czernek asked.
"What Dr. Fletcher has done is to move into a new medical realm that is so controversial, so loaded with emotion on both sides of the issue, that anyone working legitimately in the field-people with reputations to protect-would never risk their professional lives in something so dangerous not only to the fetus but to both women as well."
"Both women?" Czernek said, turning toward the jury. "The defense has maintained that Valerie Dalton received an ordi-nary abortion and suffered no additional risk."
"Well..." Dr. Brunner unclasped his hands and began using them for emphasis. He spoke at a slow, professorial pace. "As
I understand her technique, the suction device she used had been modified to remove the fetus intact, chorionic membrane and all. To do that without damaging the tissues would require a tube nearly an inch and a half in diameter." He looked at the female jurors. "Imagine inserting that past the cervix and you can see the added opportunity for trauma the proce-dure entails. To me, that qualifies as battery."
The doctor shook his head. "And the risk to Karen Chandler is unconscionable. She may have volunteered, even pleaded for such an operation to get pregnant, but she had no idea that a transoption had never been performed before, that there was no basis in animal research, no peer review, no approval by any committee of ethics. Nothing. Just one doctor saying, `What the hell, let's give it a try.'" Karen watched the jury during Dr. Brunner's interrogation. They all listened with rapt attention, many taking notes. They would give his testimony great weight. She glanced over at Terry, who took notes at a furious pace, his head hunched over the yellow pad. Dr. Fletcher seemed calm, almost detached. Her part, Karen thought, is over. But we still have to fight for Renata. She clasped David's hand tightly and gazed up at Dr. Brunner.
Czernek stroked at his beard. "Dr. Brunner, your work in non-surgical ovum transfer has given you a great deal of in-sight into alternative forms of pregnancy. Can you tell the court what ethical or medical value transoption has?"
"It has very little, I'm afraid. As a novelty, it has some value regarding microsurgical technique, but that is no reason to risk the health and reproductive potential of two women for the sake of doing something new simply because it is new." The spectacled man gestured as he spoke to the jury. "It would be like taking two people with healthy hearts and switching them in transplant operations. Well, you might say, they both got what they wanted-a healthy heart-but the surgical risk is incredible compared to the alternative of just leaving them alone." He was pleased with the analogy. A few of the jurors smiled, won over by the man's quiet charm. Czernek felt the tide turning in his favor again.
"And what is the ethical status," he said, "of novelty opera-tions performed on human subjects?" Brunner spoke with emphatic sincerity. "Completely im-moral. What Dr. Fletcher did was outrageous. She ignored every procedure designed to safeguard patients and protect the integrity of the hospital-"
"I object!" Johnson shot to his feet, missile-like. "Dr. Fletcher endlessly requested peer review from a slothful bureaucracy more concerned with avoiding litigation than with saving hu-man li-" A gavel bang silenced him.
"You'll have your chance to grandstand, Mr. Johnson." Lyang turned to Dr. Brunner. "Please explain to the jury how she ignored procedures."
Brunner nodded. "Certainly. I understand that though she requested an ethics committee to approve the concept of such an operation years before and then again months before, she proceeded before any final decision had been made, thereby effectively evading the extremely important medical process of review and approval."
Evelyn glared at him from her seat, fuming. She grasped a pencil with both hands, flexing at it. Terry patted her hand gently. "I'll take care of him on the cross," he whispered. He looked over his shoulder at the spectators to see Jane Burke and Avery Decker sitting nearly side by side. They both seemed to be having a good time. They should sell popcorn at these things, he thought.
"Dr. Brunner..." Ron looked his quizzical best as he framed his question. "Does transoption totally solve the problem of abortion, as Dr. Fletcher implies? Is it the moral solution to abortion that the world has been searching for?"
Brunner mulled over the question for a moment. The jurors leaned forward as if to hear the answer a few microseconds sooner.
"In some very few, rare cases, it might be an answer. It is not the answer to infertility, because virtually any problem a woman has in that department can be handled by non-surgi-cal ovum transfer, a highly advanced, medically approved, and ethical treatment. There you have professional ovum donors inseminated by the husband's own sperm. We can take that ovum and determine its sex, examine its chromosomes for genetic flaws, use a library of what we call probes to check it for proclivities toward over two thousand different diseases, and implant it into the recipient mother without any compli-cated, dangerous surgical techniques. It fastens itself to the uterine wall naturally, and grows there naturally. And if the recipient wants a few extra eggs set aside just in case, the fer-tilized ova can be frozen cryogenically and stored. They'll be viable for up to ten thousand years." Fletcher's fingers snapped the pencil in two. She looked around her as if awakening from a dream.
"With transoption," Brunner continued, "a woman whose, shall we say, significant other you know nothing about gives you an embryo she doesn't want. It's too far along in its devel-opment to use a lot of the probes and hence is an unknown quantity. Why use it when women today demand quality pregnancies?" He looked at Fletcher as if he had been delivering a lecture to her. His earnest desire that she understand him showed in the eyes that dwelt behind his glasses.
"And," Czernek asked quietly, "would transoption help the woman who seeks to terminate her pregnancy?"
The doctor shifted about in his seat as if wrestling with the question. "Most women," he said, "do not think about the con-sequences of an abortion. Most women who get abortions are young, late teens, early twenties. They want to end their preg-nancies and get on with their lives. Many abortions are the result of a liaison the woman would prefer to expunge com-pletely, right down to the product of that relationship. To insist that such a woman undergo an operation that has just as much-if not more-risk as an abortion does of damaging her reproductive potential, simply to save an eight-week-old em-bryo that lacks a full bundle of human rights, is asking too much of most women and of the medical profession."
"So," Czernek said, "transoption is no real cure for the prob-lem of abortion."
"No, it is not."
"Thank you, Dr. Brunner. I believe I have no further ques-tions." Czernek turned to send a challenging glance at Johnson.
Terry looked down at his notes, thinking. There wasn't much he could nail the doctor on, but he decided to try. "Defense wishes to cross-examine, Your Honor."
Judge Lyang made a gesture to proceed.
He approached the witness stand slowly, assembling his thoughts and developing a tactic for handling the doctor. It was obvious that the jury was impressed with the man, so an outright assault would be useless.
"Dr. Brunner, you are a gynecologist and an obstetrician, the same as Dr. Fletcher, correct?"
"Yes."
"So you see a lot of pregnant women every day. And women who want to be pregnant, and women who don't want to be. Correct?"
"That is correct." Dr. Brunner, half expecting theatrics, grew calmer at Johnson's mellow pace. He sat back in the chair, adjusted his glasses, and set his arms on the rests.
"Have you ever encountered a woman who wanted an abor-tion but wished she could do something other than kill her unborn child? I use the word `kill' as a concerned, uninformed pregnant person might." Brunner nodded. "I have had several women come to me with such a request. One sees it in women in their late twen-ties or so. Something happens to them around the age of twenty-seven that makes an abortion a very traumatic experi-ence. Eighteen-year-olds barely notice; they use abortion al-most as a form of contraception. In fact, when the abortifa-cient RU 486 becomes more readily available, morning-after contraception will put the whole question of surgical abor-tions to rest once-"
"Please just answer my question, Dr. Brunner. Are there women who would prefer to have their pregnancies termi-nated in such a way as to avoid harming the fetus?"
"Yes, there are. Generally older women who sense their bio-logical clocks ticking away and fear they're missing what might be their last chance at motherhood."
"And," Johnson asked, pacing between the witness stand and the jury box, "have you seen women who are not able to be-come pregnant by any means, including ovum transfers?"
"Yes, even though such a woman is rare. We can t
ake a woman who has no ovaries at all, implant a donor egg, and bring her to term using supplemental hormones until the fe-tus takes over producing them."
"So there are women who might benefit from a transopted fetus?" Brunner sighed, shifting in the chair. "I don't dispute that there might be someone, somewhere, who would benefit from transoption. It is clear, in retrospect, that Mrs. Chandler ben-efited from the procedure. But this is an extremely rare case that does not justify such a risky, unresearched, unapproved operation."
"Could it be," Terry said evenly, "that it is unresearched and unapproved because the medical establishment finds abortion to be easy and lucrative compared to making any effort to save the life of a tiny human being?"
The surgeon hesitated for a moment, frustrated that the whole question of fetus rights kept bubbling up like gas in a swamp. "When you say `tiny human being,' you're packing a lot of emotion into three simple words. Deciding when a fetus becomes a human being with full human rights is one of the hard questions of medicine. Is a full-term baby human at birth? Only a cynic would deny that. What about five minutes before birth? If birth confers humanity, abortion should be completely legal and available all the way up to that point. And even though it technically is, the standard is that abortion is generally inadvisable after the second trimester. But then comes the ques-tion of exactly where in the second trimester. Is a fetus human at twenty-six weeks but not at twenty-five? Is it human at one thousand grams' weight but not at nine hundred ninety-nine?"
"Thank you, Doctor, for-"
"May I finish? I think this illustrates Dr. Fletcher's fallacy." Johnson began to speak, glanced at Judge Lyang and the jury, and then nodded. "Be my guest," he said, trying to mask his trepidation.
"These line-drawing arguments are used with astounding effectiveness by the pro-life groups. Some people, such as Mr. Decker-and, I presume, Dr. Fletcher-reach back as far as the point of conception to declare that that is when a human being with full human rights is created. I thought so, too, at one time. But the more you discover about fertility, the more trouble you have finding a distinct point of change. Concep-tion takes place over several hours. Do an egg and a sperm become a human being at the point that the sperm fuses to the outer membrane of the egg? When the egg finally admits the sperm that has survived its immunological attack? When their respective DNA intermingle? When mitosis begins? When the blastocyst nestles in the uterine lining? When?
