She looked around the room, almost imploringly, at the others, and before anyone could speak, she resumed, addressing the group as well as Dr. Keller. ‘You all know me. I don’t have to lie. I’m not beautiful and I know it, besides I don’t think that’s the important thing because spiritual is more important. But we all know men hold more store by looks than anything, and Clarence—I’m not ashamed to admit it—I guess I’ve told you—he’s the first man who ever proposed to me, and besides he’s nice and I want to have a respectable husband, too, like everyone.’ She swallowed. ‘But what’ll I do with Mother?’
She sat back, and eyed the others hopefully. Dr. Keller straightened his bulk, put down his pencil, and pinched his broad nose. ‘Well, now, Miss Dudzinski, this anxiety—’
Before the analyst could continue, Adam Ring, from deep in his chair, swinging his rabbit’s foot still, spoke up. ‘I’ll tell you what to do with Mother,’ he said. ‘Drown her.’
Miss Dudzinski gasped and Ring was pleased, for he liked to shock. Irreverence was his attention getter and his protective barrier, Dr. Keller had told him several times. Before Miss Dudzinski could protest, Adam Ring went on. ‘Your old lady’s no different than all the rest, Miss D. She’s got you by the cord, and she’s not letting you cut it. Why should she? You’re her meal ticket. You’re also her nurse and full-time companion. You listen to me. Blow her off. Stick her in some sanitarium—your husband’ll pay to keep her out of his sight. She’ll be happier in the end, and you’ll have your guy. Look, you said it, kid, you’re no Miss V. di Milo. There’s at least one guy for every girl on earth. For you, figure that’s the limit. Here’s the guy. Grab. Hold him like a sweepstakes ticket. Let him go and what have you got left? Mother’s Day for the rest of your life.’
Mr. Lovato waved his hand in a flutter, and spoke in a gentle, effeminate voice. ‘Although I think Mr. Ring put it crudely, even threateningly, I concur with his sentiments all the way. As Dr. Keller has often implied, we can’t have our cake and eat it, too. I believe you have to approach your decision coldly and logically, Miss Dudzinski. If you leave your mother for your young man, your mother has an alternative. She can find some other elderly woman to live with or move into a sanitarium or busy herself in many ways. Moreover, she’s had a full life of her own and need not consume yours, which my mother tried to do, too. On the other hand, if you give up the young man, you may have no alternative. You may remain unwedded for a lifetime. I feel you simply have no choice but to accept your young man’s proposal.’
Listening, John Garrett determined to add his own opinion, which was no different from the others, only so that he could lead from his opinion into his own problem, and in that way, be sure that he would have his needed time. But before he could speak, Mrs. Zane, to his left, quickly made herself heard.
‘I don’t think it’s as easy as everyone is making out,’ said Mrs. Zane. ‘It’s all well and good for single men like Mr. Ring and Mr. Lovato to say make Clarence your choice and forget your mother—but Miss Dudzinski’s mother is a responsibility, a human responsibility, and must be considered. You all know I can speak feelingly of this, because I can see all sides. Miss Dudzinski’s problem is an exact parallel to my own. I’m caught between two people, also, and do you think it’s easy? Do you think I enjoy being forced to have sexual intercourse with Mr. Zane’s boss every night, while Mr. Zane is out of town?’
‘Well, cut it down to twice a week,’ Adam Ring called out cheerfully.
‘Oh, please, Mr. Ring,’ replied Mrs. Zane, ‘this is no joke. I know you think I’m sexually promiscuous—’
‘My only objection is that you don’t share the wealth, wonder girl,’ said Ring with a grin. ‘You’ve got me real curious about what’s under those panties. I’d like a piece of the action whenever you find time—’
‘I wouldn’t have you, you impotent egotist!’ flared Mrs. Zane. She turned towards the desk. ‘Dr Keller, why is he so hostile towards me?’
Dr. Keller, eyes hooded, remained imperturbable, and Adam Ring retained his set grin.
Mrs. Zane shook her head. ‘I know you’re thinking that, too, Dr. Keller. You’ve made it plain I should try to curb my outside actions during my therapy, and you think I’m only increasing my sex life to defy you.’
‘You know better than to bait me, Mrs. Zane,’ said the analyst quietly. ‘Don’t try to speak for me. When it is necessary for your good, for what is best for you, when it is necessary for me to articulate for you certain emotions you do not understand, I will be less impersonal, I will speak. Now—you were saying, Mrs. Zane—?’
‘I was saying I’m tormented constantly by my situation.’ She addressed her co-patients imploringly, her temper receding. ‘You all know what I go through. I have Miss Dudzinski’s anxieties. What should I do? What is right? If I stop, Mr. Zane will be fired. I know that. He’ll be shattered. If I go on—well, I feel sinful. I lie awake nights, night after night, and ask myself all the questions. Am I being disloyal to Mr. Zane? Or am I truly helping him at great sacrifice? I pray to the Lord, and pray someday He will answer me. Heavens knows, I don’t enjoy the act that much. I can see Mr. Ring smirking—but I don’t, you all believe me. I’m exhausted. I have five children and a husband, too—and his boss, every night. I’ll give you an example. Let me tell you what happened last night—’
John Garrett knew that Mrs. Zane had done what he had intended to do—interrupt so that she might have the floor. His admiration was mingled with annoyance. He was impatient with Mrs. Zane’s prolific and perspiring acrobatics, and her secret pleasures and atoning guilts, and he wanted to voice the exigency of his own immediate problem. He glanced at his watch once more. There were thirty-four minutes remaining to the session. He hoped that Mrs. Zane’s indulgence of the night before had been brief, silent, hedonistic, but he doubted it.
Waiting his turn, he thought back to how he had got into this damn group thing. It had begun with the increasing periods of depression and the persistent headaches, of course, the pressures against his forehead and the back of his skull coming daily with regularity, intruding on his achievement, and work, and home life. He had seen his physician, and subsequently an ear man, and then a neurologist, and suffered all the tests, but nothing pathological had been indicated. At last, upon the suggestion of his physician, he had reluctantly called upon a psychoanalyst in Pasadena.
There had been three months on the couch, ridiculous and wasted. Then, one morning, the psychoanalyst had recommended analytic group psychotherapy. The reasons given for this suggested change, which Garrett found senseless, were that persons like him, who hated and retreated from social contacts, who performed poorly in social situations, could most benefit by group therapy. Moreover, Garrett learned, his hostility towards the psychoanalyst (an extension of his ancient resentment of his father, whom his mother had worshipped and to whom she had given all her time), made person-to-person therapy difficult. Garrett learned that, attached to a group whose members suffered similar hostilities and anxieties, his anger might be modified, and that more progress might be made. The Pasadena psychoanalyst had then suggested that a Dr. Keller, of Los Angeles, was one of the best men in the field. And so, after an undecided week, Garrett had joined the group.
True, with the months of group psychotherapy, despite his shame at the public exposure, and the frustrations of competing with others for time and Dr. Keller’s attention and approval, the head pressures had become more irregular, sometimes disappearing for several days in succession. But the source of the headaches still remained a partial mystery to him. Despite Dr. Keller’s occasional remarks to the contrary, Garrett chose to believe that his discomfort had started with the entrance of Dr. Carlo Farelli into his life.
Certainly, in the period before the advent of Farelli, John Garrett had reached a peak of personal happiness, a summit of satisfaction, that he had never dreamed of attaining. Now, daydreaming in Dr. Keller’s office, he had no trouble slipping backward into the recent p
ast, to the events that led to his triumph and the event that led to its decline and fall. You pushed a button in memory, and lo, you slid back . . .
He was, he knew (for now he could afford a certain candour with himself), a drab, colourless and withdrawn research workhorse in the Rosenthal Medical Centre in Pasadena. He possessed the degrees, and the knowledge and techniques that had earned him the degrees, but he was neither imaginative nor creative. Nothing about him soared. A thousand colleagues would have agreed that his epitaph would one day be one word: competent.
Yet, for some inexplicable emotional reason, he became interested in a dramatic phase of medicine—that which dealt with tissue transplantation, the technique of replacing the missing or damaged parts of a human being’s body with new parts. Mulling over old medical journals, Garrett learned that the field was not a new one. Almost two thousand years before, a Hindu surgeon, Suśruta, had used cheek skin to help create new noses for his patients. In more recent times, in 1870 to be exact, Dr. J. L. Reverdin, of Paris had introduced modern free skin grafting. Early in the twentieth century, Dr. Charles Guthrie, of St. Louis, had successfully grafted the head of a donor dog to join the head of a host dog, thereby fashioning a two-headed canine.
To Garrett, in his earliest enthusiasm, it appeared that anything was possible in this field. But not until he left his reading, and participated in actual experiments, did he fully realize the nature of the obstacle that hindered progress. The obstacle was not in surgery, where advance in techniques had been sufficient to make possible the replacement of an old, dying organ in the human body with a new, living organ. The obstacle was biochemical. As a self-defence against germs, the human body threw up an immunological barrier that not only warded off invading diseases but also destroyed foreign tissues that might be helpful.
Once he perceived the problem, Garrett devoted more and more of his energies and time to studying it. Figuratively, Saralee became a widow, and the children orphans, due to his work. Where colleagues were satisfied with eight hours given to research, Garrett was not satisfied with twelve or fourteen or sixteen hours. The medical laboratory became his Santa Maria, Pinta, Niña rolled into one, and he was as single-minded in his exploration as had been their admiral.
Soon, he was sated with knowledge of the human body’s rejection or immunity mechanism. This was the reticulo-endothelial system. It consisted of antibodies and powerful white cells known as lymphocytes in the blood that protected man by killing off bacteria, viruses, or any strange or foreign cells that entered the body. This rejection mechanism was everyman’s friend, but Garrett came to regard it as his personal enemy. For if the rejection mechanism warded off diseased cells, it also murdered healthy new cells, since it could not tell the difference. This, then, was the difficulty. If a man were dying for want of new kidneys, or small intestines, or lungs, or heart, you could not transplant a fresh vital organ for the old, because the rejection mechanism, antagonistic to foreign tissue, would murder it—and its host.
The rejection mechanism became Garrett’s target. And what confirmed his aim were the exceptions to the rule. Toiling side by side with his colleagues in the Medical Centre, he found that transplants of pieces of artery, sections of bone, the cornea of the eye were long-practised grafts that had nothing to do with the rejection mechanism. A new cornea in place of an old one survived because antibodies and assaulting white cells could not get at it. As to transplanted blood vessels and bones, they did not need to survive for they were merely scaffolding across which normal host tissue could grow.
What interested Garrett even more was another exception to the rejection mechanism. There had been case after case of successful organ transplantation in identical twins. Chemically, identical twins were the same person. They emerged from the same fertilized egg. Their tissues were not foreign to each other. A kidney from one identical twin could be grafted into his ailing brother, and it would endure, because the rejection mechanism would not recognize it and would leave it alone. But the moment that the same transplantation was tried on non-identical human beings, the kidney, or any other organ, would die.
During 1958, in Boston, a risky non-identical transplantation had been desperately attempted. A young woman from Ohio had lost her only kidney and was dying. A courageous team of physicians had taken the healthy kidney of a four-year-old and grafted it into this young woman. To thwart the rejection mechanism, the physicians had given the young woman massive treatments of X-rays. The young woman lived twenty-eight days. The rejection mechanism had, indeed, been neutralized, but the excessive radiation was fatal.
For a brief period, Garrett was discouraged. Then came a major breakthrough. Sir Macfarlane Burnet, of Australia, and Dr. Peter B. Medawar, of England, proved that the rejection mechanism in one human being could be taught to accept tissue transplants from another, under certain circumstances. Experiments with rodents showed that if a mouse embryo were injected with cells from a non-identical donor mouse, then later, when the embryo was an adult, it could accept skin grafts from the same donor without rejection. For this, Burnet and Medawar won the Nobel Prize in 1960. And, at once, John Garrett, along with hundreds of others in his field, was encouraged to believe that soon it might be possible to make a homograft of legs, kidneys, lungs, and hearts.
In that optimistic period, Dr. Robert A. Good, of the University of Minnesota, was saying, ‘Though much more basic research is needed, the first successful organ graft between non-identical human beings could conceivably, with luck, take place tomorrow.’ And Garrett, one midnight in bed beside Saralee, was telling her, ‘I believe it, I absolutely believe it—and I’m going to be the one to do it—with a living heart.’
The days spun ceaselessly past, and he had no knowledge of date or week or month. It was as if he were on a perpetual hamster’s wheel. He isolated himself from his colleagues, because he had no time for small talk or relaxation. He went ahead alone against the enemy, trying to find a weapon to overcome the immunological barrier, the rejection mechanism. He experimented with massive X-ray treatments, with steroids, with nitrogen mustards. Each led to a dead end. No matter how slight or drastic the modifications that he made, these weapons, while they did indeed neutralize the rejection mechanism, also destroyed white cell production, stripped the body of immunity to disease, killed in other ways what he was trying, after all, to save. The problem remained as large as ever: to discover a treatment or serum that was selective, that would not destroy all reactive or immunity mechanisms, that would neutralize whatever it was that rejected a foreign graft, and leave unharmed that which protected the body against disease.
Once, depressed by the impossible maze, Garrett tried to find a path around it. In that time, he fancied that he could simply ignore the rejection mechanism by circumventing it, by inventing a compact artificial heart of plastic material, that could be grafted inside the chest cavity and that would be accepted because it would be non-reactive. For months, the idea excited him. A plastic heart replacing a failing or damaged natural heart inside the human body would give its host—literally—a new lease on life.
Methodically, he studied all the mechanical hearts then in existence. These ranged from the heart pump and oxygenator created by Dr. Clarence Dennis in 1951, to a two-chamber pump run by batteries (it had kept a dog alive nine hours) produced by a team at the University of Illinois. Garrett saw that these mechanical heart-lung devices all had one factor in common—they were used outside the patient’s body to keep the patient alive during cardiac surgery. What Garrett envisioned was such a device inside the body—the natural heart removed, the machine heart substituted—located in exactly the same place: orthotropous transplantation, with an external power pack. But there were question marks here, too, not the least being how to keep the plastic bag, between the two lungs, contracting and relaxing without failure. It might be resolved in the future, Garrett decided, but he preferred to grapple with the present, the probable.
Unhappily, he returned to his maze
. He must find his way on the battlefield where the familiar enemy, now so well known to him, was the rejection mechanism that barred his transplantation of a living heart, either animal or human. He abandoned the radiation treatments, the nitrogen mustards, and plunged into unknown byways. And then, it happened, came to him, as simply and undramatically as waking or walking or laughter.
It was late morning. He had been toiling over his laboratory specimens—the mice, dogs, calves—checking, noting, noting again, modifying, when he discovered the new substance that apparently—yes, it was clear, plainly evident—neutralized the rejection mechanism but did not, at the same time, destroy all immunity. For a week, Saralee and the children knew nothing of his existence except on the telephone, and after that week he was almost certain. He had a serum—the serum—and with Lincolnian simplicity and straightforwardness he christened it Anti-reactive Substance S.
Once he had his serum, and having proved it out on lower mammalian creatures, not yet on man, he gave parallel devotion to surgical techniques of organ grafts. He considered all aspects of the homograft—an organ moved from one human into another human—and vetoed it as too formidable. More logical, more probable, and his skittering mice and tractable dogs and climbing simians supported him, was the heterograft—the transplantation of an animal heart into a living man. Exulting months followed, and by then he had settled upon the heart of a calf, a calf weighing what a potential patient might weigh, as the likeliest possibility for success.
Twice, he grafted calves’ hearts into dogs, and one dog died and one lived for a while. More modifications of the serum and the surgical technique, and on a black and forbidding winter’s night in Pasadena—he had already telephoned Saralee that he would not be home for dinner, and that she need not wait up for him—he prepared for his third transplantation of the heart of a calf into the chest cavity of a huge dog. He had assistance now, and by eight o’clock all was in readiness. The donor calf’s heart was under perfusion and cooling. The host dog had been treated with improved Anti-reactive Substance S, and was already hooked to the heart-lung bypass machine. What remained was the crucial surgery. But Garrett never accomplished it, not on the dog, at least.
(1961) The Prize Page 6
