Coming of Age: Volume 1: Eternal Life

by Thomas T. Thomas

  She was regaining feeling and controlled movement on her right side: tongue, arm, hand, leg, foot. She still had difficulty smiling on command—but then, hadn’t she always? She was able to form words more clearly, now that her tongue was working properly, or at least it did not curl around inside her mouth like a wounded snake when she tried to use it. But these were still only the words that popped into her head from that gray place behind her eyes. The words that she really needed, the words that lived out there among people and inhabited those twisting and branching graphic images, they still eluded her.

  So after those many days of waiting to get better—more than four, less than fourteen—Dr. Bajwa came to consult with two new doctors. And this time they included Wells in the conversation as a person rather than an object.

  “Ms. Wells, I’d like to introduce William Anderson and Peter Adamson,” said Dr. Bajwa. “They’ve come up from the Stanford Medical Center.”

  Antigone Wells nodded at the new men, immediately forgetting which one was which. She did not offer to shake hands, because her right hand was still not fully under control. Anyway, neither of them seemed to expect the social contact. They just smiled at her. She told them slowly, meaning it as a way of greeting, “Don’t … words …”

  “That’s because you’ve had a stroke, ma’am,” Bajwa explained quickly. He seemed to be speaking for Wells’s benefit, although he half-turned to the two other doctors. “We’ve mapped out the areas of—well, nonresponsiveness—in your left hemisphere. There’s some damage to the motor functions, accounting for the obvious loss of physical control. Overall, the darkest region of the scans touches on Broca’s area, which governs the brain’s ability to recognize and recall words and put them into speech. You’ve also acquired some spottiness in areas which might account for your alexia, or receptive aphasia with regard to text. We think you might have some damage in pathways connecting the visual cortex to Wernicke’s area, which interprets what you hear into language and what you see into the written word. Fortunately, Wernicke’s area itself seems to be unaffected.”

  Otherwise, you’d be talking to a brick, wouldn’t you? Wells thought to herself. But then again, maybe I am a brick, and these men are not really here.

  “Of course, Miz Wells,” said one of the others, perhaps Anderson, “references to ‘Broca’s area’ or ‘Wernicke’s area’ are merely generalizations from nineteenth-century anatomists and psychiatrists. Nowadays, with better neural imaging, we tend to think the actual processing of any function is more distributed—that is, it takes place over a much broader surface of the temporal lobes.”

  “Total blackout in either area?” asked the other one, perhaps Adamson.

  “Oh, nothing total,” Bajwa said. “The entire lobe shows remarkable activity.”

  “Good, good. We’ll need that to build on,” said the man named Anderson.

  Bajwa turned back to Wells. “These gentlemen have a new therapy we’d like to try with you. Because you’re in excellent health—I mean, other than problems resulting from the stroke—and you’re of suitable age, we all feel you would be a perfect candidate. You see, they propose to take some of the cells from your body and teach them to be new brain cells. Then those cells can help rebuild the parts that you lost in the stroke.”

  “You see, Ms. Wells,” Anderson began, “the brain is both ductile and resilient—”

  “Simple words, Doctor?” Bajwa prompted.

  “Ah, yes, by which I mean, the brain is … like plastic, it can mold itself, adapt, even repair itself and build new connections—given the right materials and a nudge in the right direction.”

  Antigone Wells tried to dredge up words from that gray place, from something she had read or heard sometime before the stroke. Her brain offered: “Stem …?”

  “Exactly!” Adamson said. “Oh, very good! Yes, stem cells.”

  “It’s a cellular regenerative therapy,” Anderson went on, “that has been in trials for some years and is now coming into general use.”

  “Oh … kay,” Wells said. “Give … words.”

  “Good. Now that we have your verbal consent …” Adamson laid a case on the tray table attached to her hospital bed and snapped it open. He took out papers covered with those twisting, branching images. His partner uncapped a fountain pen and handed it to him. “Next we must acquire what’s called ‘informed consent,’ which means that we ask you to read and sign these documents …”

  Antigone Wells smiled at the man expectantly, waiting for him to catch on.

  “Oh, dear,” he said. “But how can you …?”

  “Verbal … contract …” She groped for a word, the name of an identity she knew she had once held close to her heart. It was only four days ago—certainly less than fourteen days. She tapped her breastbone. “… lawyer.”

  When he still hesitated, Wells reached for the papers with her good left hand and for the pen with her right. Her fingers flopped a bit as she tried to take the barrel from his unresisting grasp. She set the papers on her lap and flipped them over one by one, looking for something. She didn’t know what exactly, but she would recognize … a long straight line! With uneven pressure, and not sure which way the pen’s nib was pointing, she made a mark against that line. One way, then the other, leaving a long dent in the paper and a darkened hole, if not exactly a mark.

  “Consent,” she said clearly. She nodded at the other man and then at Bajwa. “Witness—ses …”

  Then she lay back, too tired from the effort to try anymore.

  * * *

  Inside the Induced Pluripotency Laboratory at Stanford Medical Center in Palo Alto, clinical technologist Tina Gonzales reviewed the list of the day’s setups. Among the twenty-one treatments to be prepared were three tissue samples from a patient identified as “Praxis_J” and one from patient “Wells_A.” All four had come in overnight on blue ice from the University of California - San Francisco’s Medical Center up at Mission Bay.

  In the old days, with dozens and sometimes hundreds of blood and tissue samples arriving at a lab like hers from around the country, mixing up patient identities would have been all too possible. Relying on just surname and first initial, or even the patient’s Social Security number, would have been a recipe for life-threatening disasters, because those tags existed outside of the tissue itself. You had to find some way to tell the anonymous tissues apart after they had passed through various containers in the various stages of processing.

  Each of these samples was now tagged with the thirteen genetic markers and sex differentiator of the Combined DNA Index System, or CODIS, which the FBI had originally created for forensic profiling. Before any culture was sent to Gonzales’s lab, it was profiled with a DNA test kit and the results were attached. Before she sent pluripotent tissue back to the implant center, she profiled and matched it to the donor’s CODIS identity. And the center that had shipped the sample in the first place performed another DNA test upon receipt, just to be sure.

  But after Gonzales had logged the samples into her computer and while they remained in her lab, they traveled in two-milliliter tubes, microtiter plates, and culture dishes marked with a Sharpie and using just the last name and initial. If anyone screwed up the plates along the way, they would simply toss that batch and start another. Tissue was cheap. The lab never consumed more than a fraction of the original cells extracted from the patient. And the chemicals and nutrients used in processing them were all bio-synthesized and stocked in liter-sized bottles. Nothing was ever lost, except time. Any mistakes that she and her co-workers might make never saw the light of day—although the Food and Drug Administration required them to log botched and restarted batches as a quality metric.

  The three samples from the Praxis patient were identified as muscle, vascular, and skin cells, with the notation that the latter were wanted to be made potent for a neural replacement. “I guess the heart project is finally taking off,” Gonzales murmured as she keyed the protocol requests into the appropriat
e boxes on her computer screen.

  The sample from patient Wells was from skin and also noted as a neural implant. “Somebody fell and hit their head,” she said, keying in the nerve-cell protocol for a second time.

  The other samples she processed without comment.

  In the early days, researchers working on cellular regeneration had thought to use stem cells from human embryos to build new organs in adults, because developing embryos were rich in cells that could potentially become many different cell types. Some were even “totipotent” and could become anything at all, provided you caught the embryo early enough, at the blastocyst or hollow-ball stage. But it turned out that taking stem cells from a baby was no better than drawing stem cells or a freshly harvested organ from another adult. The risk of incompatibility between the immune system antigens was just as great, and the patient still faced a lifelong regimen of immune-suppressing drugs. And then even research into embryonic stem cells had become clouded, because raising human embryos on a routine, assembly line basis made some people queasy—for, of course, the embryo did not survive the harvesting process. The only way to use a baby’s stem cells successfully was by freezing the patient’s own umbilicus at birth, saving the stem cells stored there against the day when they could be used to grow new organs.

  All that was ancient history now. That early research with embryos had revealed the little bits of ribonucleic acid, called “microRNAs,” that were used to differentiate and make new tissues from stem cells. Unlike the messenger RNA that got translated into proteins out in the cell body, these tiny strands of genetic material never left the cell nucleus. MicroRNAs promoted complementary sites along the chromosomal DNA to express other bits of microRNA, and those bits promoted still other bits in a precisely timed cascade of cellular development and differentiation inside the embryo. Eventually, one of those branching cascades would lead to expressing the combination of proteins that determined what kind of bodily tissue the cell was to become.

  By studying embryo development, researchers working in laboratories and teams around the world quickly identified the microRNAs sequences needed to tell a developing epithelial or skin cell to become part of a lung, liver, or kidney. Or a developing cell in the connective tissue to become blood, arteries, and veins. And they learned that the process could be worked in reverse. By tagging these little bits of RNA, synthesizing them in quantity, and then introducing them into an adult cell of the right type, along with other compounds that would induce or inhibit cell growth, they could reprogram an adult cell and return it to a semi-developed state which would keep its options open. That state was called “pluripotency,” and the cells reprogrammed from adult cells were called “induced pluripotent stem cells,” or iPSCs for short.

  And that was all they did in Gonzales’s laboratory at Stanford: take tissue samples from adult patients, treat them with specific sequences of microRNAs plus those other compounds according to various established protocols, and multiply the resulting iPSCs by the millions and billions. Then they would pack the reprogrammed cells on ice, perform a final DNA test to make sure that tissue-in matched tissue-out, and send them back to the originating center.

  In the case of the Wells_A cells, a mass of pluripotent nerve cells was all the patient really needed. The surgeons would then open up his or her—Gonzales checked the CODIS tag for sex determination and discovered Wells was a her—braincase or spine or wherever the damage had occurred, inject a dose of the cultured cells, and let them begin knitting the neural network back together. Those new cells would then begin the longer process of learning from their neighbors and copying or adapting to new brain functions.

  In the case of the Praxis_J cells, the frozen and type-matched package would be walked down the hall to Stanford Medical Center’s newly dedicated Multiple Tissue Structures Laboratory. Pluripotent muscle tissue, connective tissue reprogrammed as potential arteries and veins, and epithelial tissue reprogrammed as nerve cells would be combined in proportion on a collagen armature to become somebody’s new heart. Then the organ would be DNA-tested once again, packed on blue ice, and sent up to San Francisco, where the surgeons would cut open Praxis_J’s chest, remove his old, damaged heart, and insert a new one.

  Gonzales looked forward to the day when her lab could do more than just extract and expand stem cells, when the medical center could do more than simply build new hearts and other organs on the pattern of the old ones. For those tissues retained the genetic flaws, the inherent susceptibilities, which had caused problems in the first place. One day researchers would have complete access to the complex relationship between genes and proteins, and between proteins and tissue function. Then they could correct the genes while making new stem cells. They could give patients fixed hearts, free of defects and more resistant to disease.

  Tina Gonzales knew that she and the rest of the medical profession were standing on the brink of revolutionary change. Evolution would soon take place outside the human body, under the direction of research scientists would could predict and control the entire chemical makeup of life’s processes. They would draw on genes and proteins not just from the human cell line, but from the heritage of the world’s animals, plants, and bacteria as well. With all of that knowledge, why not create a better heart? Why not program it to beat stronger, faster, longer, and all the while demand less of the body’s oxygen and nutrients? Why not give it properties that even Tina Gonzales and the doctors of today could not yet imagine?

  Do you fancy having purple eyes the exact, enticing shade of Elizabeth Taylor’s? How about silver eyes? Or golden eyes? Bah! We can grow those irises for you in a test tube today. Think bigger!

  Do you want strength equivalent to a chimp or gorilla—reckoned conservatively as twice that of a human—so you can punch through walls? Speed like a cheetah’s, to run the one-minute mile? Or legs like a grasshopper’s, to leap ten feet straight up in the air? We can program your metabolism, brain, muscles, lungs, and heart for that. Think bigger!

  Do you want to endure exposure to microbes and viruses, eat raw poisons, take bruising, bone-breaking impacts and never get sick? Do you want to grow back lost limbs like a chameleon or salamander? Breathe under water like a fish? Grow a working set of wings like an angel? Do you want to … live forever? Ah! That would be the trick, wouldn’t it?

  Thinking about all the good things that might one day grow in her two-milliliter tubes and incubators, Tina Gonzales started the tissues from Praxis_J and Wells_A on their way through her lab.

  * * *

  Antigone Wells opened her eyes in the recovery room. She thought her vision was clearer now, in both eyes. She tested it by staring up at the ceiling panels, with their pattern of little holes, and slowly closing first one eye, then the other. No change. Or not much. But then, her vision had been getting steadily better all the time before the operation. So that was not proof.

  She lowered her eyes and lifted her head slightly to look at the doorway into the hall. It had the mandatory lighted sign above it. She stared hard at the bright-orange symbols. She knew they made up a word, because the nurses had explained to her that the sign told people where to go if there was trouble and they had to leave the building. It was a short word. But still the symbols were just a branching and a crossing, a single stripe and a thing whose lines met in a T-shape.

  So the operation had not given back her words.

  But then, she wondered where she had gotten that notion of a “T-shape.” Had somebody told her once? Was it from memory, like the way she could identify a cat, a football, a bird on the therapist’s flip cards? Or was her brain, even now, making new connections?

  The doctors had said the process would take a long time. She would get her words back slowly. She might even have to learn how to read all over again. Start with Dick and Jane … See Spot run! … Run, Spot, run! Feh! It might have been easier to die back there in the ambulance.

  And as the new brain cells took over, what about the old ones? What parts of h
er life—her former life—were now gone forever, beyond the retrieval of memory? Oh, what the hell! As an attorney, Antigone Wells had always been one to make it up as she went along. Whatever she didn’t have now, she would simply be forced to invent all over again.

  From nowhere, from somewhere, from that gray place, a story floated into her brain, about a scarecrow who knew he was stupid because his head was stuffed with straw. So he went to see a wizard, who removed the straw and stuffed his head with pins and needles, to make him sharp. And afterwards, the scarecrow really did think he was smarter.

  Better or just different? she wondered. And does it matter?

  She laid her head back, and tears started behind her eyes.

  * * *

  As they prepped John Praxis for his second—and hopefully last—surgery, he wondered what it would feel like. As they shaved ten weeks of stubble from his chest and abdomen, where the thing inside him whirred and clicked, he wondered what it would be like to have a human heart again. To not be aware of his body unless he bothered to take his pulse or something. To be able to walk, run, dance without dragging around a cart carrying his battery, air pump, and monitors.

  He had asked the doctors if it would still hurt, the way the incision over his mechanical heart still pained him sometimes. They said the sternum, which was the bone they had to crack open to reach inside the chest cavity, as well as the ribs that they spread apart in the process, would all heal in time. As for the heart itself, it wouldn’t feel like anything. It was his heart. He wouldn’t feel the sutures that held the organ inside its web of arteries, veins, nerves, and connective tissues. Those sutures would slowly dissolve and the tissues would grow together. The new heart wasn’t going to fall out or flop around. It was part of him and, on a cellular level, always had been.

  From out of nowhere, probably from his actively groping subconscious, Praxis recalled the scene in The Wonderful Wizard of Oz, where the wizard—who had proven to be a humbug from Nebraska, another visitor from the outer world, and no more magical than Dorothy herself—gave the Tin Woodman the heart he so fervently desired. It was nothing but a big, red pocket watch in the shape of a heart, which Jack Haley hung on the outside of his barrel chest. No, wait. That was the Judy Garland movie. In the original book, the wizard cut the Woodman’s chest open with a pair of tin snips and hung inside it a heart made of red velvet stuffed with sawdust.