The Janus Legacy

by Lisa von Biela

  As far as the Subject went, he’d decided to let the situation ride for the time being, uncomfortable as that would be. Amanda was right. He didn’t know enough about the Subject’s cognitive function to make an informed decision about what to do about him. He’d have to figure out a way to measure that, and then decide.

  CHAPTER 19

  “Thanks for rescheduling. I hope it wasn’t too much of a hassle.” Amanda glanced toward the packed, neon-lit bar at Becker’s Beach Club. All the denizens were dressed to impress—and most of them were likely there only for some drinks. Entry to the dining area was far more elusive.

  “I think we got a little lucky, only having to wait a couple of extra weeks to get in.” Rick smiled. “I’ve heard nothing but great things about the food.”

  “Right this way.” A razor-thin young man with a clean-shaven face and precisely trimmed short dark hair led them to their booth. He wore an old-school uniform of black matte pants and vest, and a crisp white long-sleeved shirt.

  Amanda felt like she’d stepped back in time, between the young waiter’s demeanor and the piped-in notes of Ol’ Blue Eyes Sinatra. She’d looked forward to trying out this restaurant for months, and had felt terrible for causing Rick to have to reschedule after snagging coveted reservations.

  She’d heard the owners wanted to create an experience that combined cutting-edge cuisine with an old-fashioned sort of class—the first of its kind in Rochester. As she evaluated her surroundings, she thought they’d certainly succeeded with the atmosphere. All the reviews said they’d succeeded with the food, too.

  The waiter seated them in a deeply padded black leather booth lit only by tiny track lights suspended above. He asked what they wished to drink in a tone that was cool and professional, yet inviting. Falling into an old-school mood, Amanda ordered a dirty martini—extra olives.

  Rick ordered the same and began to scan the enormous, leather-bound menu. “Finally, some great dining that isn’t in Minneapolis or St. Paul.”

  Amanda opened her menu and flipped through the pages. “No kidding. I’m going to have a hard time choosing. Look, they have sablefish. They put it on a bed of grilled asparagus. I’ll have that.” She took a sip of her martini. “Ooh, haven’t had one of these in a while. They make a mean one.”

  Rick took a sip of his drink. “That is good—best ever. Glad we finally made it here.” He smiled and reached across the table to take her hand. “So how’s your girlfriend doing?”

  “My what?”

  “Your girlfriend—the one you stood me up for a couple of weeks back.”

  Amanda took another sip and tried to hide her misstep. She hadn’t expected Rick to bother asking weeks after the fact. “Oh, she’s much better now.”

  Rick scowled slightly. “Well, that’s good. Must have been something pretty serious for you to skip town at a moment’s notice like that.”

  “Yeah, it was. It was kinda sudden and she needed someone to talk to pretty badly. Can we, uh, change the subject? It was pretty intense at the time, and I’d rather not think about it right now.” Amanda smiled at Rick. “I’d much rather enjoy our belated evening out.”

  “Sounds good to me. Maybe we should plan a weekend away together soon. Would you like that?”

  “I would. Let’s pick a place soon. So, what are you having?” Amanda was relieved Rick got off the subject of her little weekend away. She hoped he’d leave it at that and she wouldn’t have to come up with more supporting details for the lie. And she hoped she’d heard the last about it from Jeremy. She didn’t need to be involved in his crazy complications, and she didn’t want to risk derailing her relationship with Rick.

  CHAPTER 20

  Jeremy returned to his office after assisting Glen and Tim in a successful liver transplant. They had developed a truly impressive protocol for the cultivation and transplant processes prior to his taking over the company. The business nearly ran itself with the high demand and fees they were able to charge their well-to-do clientele. And the actual procedures had been honed to elegant simplicity.

  He gazed out his window at the grassy clearing and border of evergreens that comprised his view. The first serious snow of the season had dropped several inches on the grass and had coated the pine needles like trees in a Christmas postcard. He still intended to sell the house, but on days like this the extremely short commute was a nice perk. He wouldn’t have to fight snarled traffic for an hour or more, unlike most commuters in the area.

  Good thing, too. He was tired and just not up for a tough drive home. As smoothly as the surgery had gone, it seemed to take more and more out of him these days to stand for several hours like that. His Crohn’s had been slowly ramping up since the fall, despite his returning to the full prescribed doses of his meds. He wasn’t sure any more if it was Crohn’s or the meds—or his poor sleeping patterns—that contributed most to his constant fatigue.

  His sleep had been troubled for the past several months as he continued to wrestle with the question of what to do about the Subject. No good answer presented itself, no matter how he approached the problem or how hard he tried to resolve it.

  For the time being, he was taking the path of least resistance and keeping the project under wraps. He still hadn’t even figured out the best way to conduct the cognitive testing that might help him decide. He was no expert in such things, and did not dare enlist outside assistance. So he kept spinning in circles—and his inability to decide tormented him daily.

  Jeremy considered just going home for the day and trying to rest. Suddenly, a pain seized his stomach that was so intense it took his breath away. He hunched over and tried to breathe deeply until it subsided.

  There was a knock at his office door.

  “Not now,” he said through clenched teeth.

  “It’s me—Glen. I need to talk to you about tomorrow’s scheduled procedures.”

  “Not now!”

  Glen entered the room anyway and cast a questioning look at Jeremy. “What’s the matter?”

  “Crohn’s is acting up.” Jeremy tried to pace his breathing to get through the pain.

  “You’ve been taking your meds, haven’t you?”

  “Yessss…but they’re not working as well as before, and the side effects are getting worse.”

  “Jeremy, you know there is a solution. It’s waiting for you. Tim and I can perform the procedure.”

  “I can’t…”

  Glen moved closer to Jeremy’s desk and spoke forcefully. “The whole point of Ivan’s work was to make this possible. Your meds are failing. You know as well as I do the longer you wait, the more debilitated you get, the bigger the risk. We should start planning the procedure. We’ll need to decide how much to transplant, for one thing.”

  Jeremy writhed in his chair. He didn’t want to have this conversation at all, let alone when he was in such pain. “What do you mean?”

  “I’ve given this some thought. There are two main approaches we could take. One is a minimalist approach. Just replace the segment that is most compromised, and leave the rest of the Subject intact. If—and likely when—you had another intestinal segment that became compromised in the future, we would use the same Subject to replace that segment, and so on as needed. Or we could transplant the entire small and large intestine in one procedure. It would provide more complete relief, but of course, your disease would eventually attack those tissues again. It would buy time until that day, though, and we could regenerate another Subject by then if we just plan accordingly.”

  Jeremy waved him away. “I just can’t talk about this right now, all right?”

  “OK. But let’s talk about it as soon as you’re up to it. I think it’s time to act.” Glen let himself out and shut the door behind him.

  Jeremy put his head down on his desk, clutched his stomach, and concentrated on taking slow, deep breaths to push Glen’s words from his mind and to get him through the painful spasms.

  Glen spotted Tim walking down the hall. “Hey,
wait up a minute.” He caught up to him.

  Tim stopped. “What is it?”

  “I was just in Jeremy’s office. He was in a lot of pain, looked terrible. His Crohn’s is getting worse and the meds aren’t working so well any more. I suggested we start planning the procedure.”

  “What did he think of that? He still seems pretty conflicted about the project in general. Can’t imagine he was too receptive.”

  “He pretty much shooed me out of there and wouldn’t talk about it. I think it will take some convincing, but the longer he waits, the worse his chances. Meanwhile, we need to decide on whether to transplant only the most critical segment, or the entire large and small intestine. There are tradeoffs, of course.”

  “Well, if we take only a segment, the Subject should be able to withstand that, given some additional nutritional support. But the entire intestine? That would kill him—or would put him on some form of life support that would be pretty ghastly to live with.”

  “Tim, remember why the Subject is here: to potentially cure Jeremy. That’s what Ivan intended. So if we need the entire intestine, then that is what we use. If it kills him, we clone another so we’re ready in the event Crohn’s eventually compromises the transplanted organs.”

  Tim paled.

  “I’d better not have to fight both of you on this. We need to move soon to get the best odds of success, and we need to take whatever portion is going to provide the best relief. Simple as that.” Disgusted with Tim’s unprofessional attitude toward the Subject and unwilling to listen to any more protestations about the project, Glen stalked off toward his office.

  CHAPTER 21

  The procedure Jeremy, Glen, and Tim were performing was going so smoothly, it was as if it were the most mundane of surgeries. Jeremy never dreamed he would think such a thing of something as complex as a heart transplant.

  Thanks to the unique clean-room environment, there was no need to pump the patient full of antibiotics. And of course, because the organ was autologously generated from the patient’s own source tissues, there was no need for the dangerous and debilitating antirejection drug regimen, either. Side effects and recovery time were stunningly minimal.

  SomaGene’s transplant success rate was nearly 100% due to careful patient selection and the unique protocols. No other clinic came close. Jeremy smiled a little behind his surgical mask. At least this part of the business was smooth and noncontroversial, except for the have-and-have-not aspect of providing such a service to well-heeled clients while people of normal means waited, dying a little each day, for a donor organ they might not reject.

  “Jeremy…clamp!”

  Glen’s urgent demand snapped Jeremy’s attention back to the present task. He chided himself. No matter how honed the protocol, inattention was still unacceptable and dangerous.

  He passed Glen the clamp.

  Tim sat by the patient’s head, managing the anesthesia. “Looking good.”

  “Ready to switch to the artificial heart.” Glen turned on the machine that would pump the patient’s blood during the brief time between clamping off the defective heart and connecting the new heart. Moments passed as they all watched the monitors.

  “Stable,” said Tim. “Vitals good.”

  “New heart, please.” Glen removed the diseased heart and dropped it into a stainless steel pan, then reached out, palms up, to receive the organ and gently place it in the patient’s chest.

  Jeremy turned to the special container that held the precious organ, bathed in nutrients and warmed to body temperature. He carefully lifted it from its protected glass environment and placed it in Glen’s outstretched hands.

  Glen accepted the organ, turned back to the patient and began to place and connect it within the chest cavity. Despite the nearly commonplace occurrence of such procedures within the walls of SomaGene, all three men were reverently silent as Glen made the placement.

  Jeremy felt his stomach clench, then the familiar and increasingly frequent searing pain cut through him again. He felt a little dizzy, and wished he could get off his feet and try to breathe through the pain for a few minutes. But there was no way he could do that. The procedure was at the most critical juncture—the switchover from the artificial heart to the new one. He just had to hang on through the pain for a little while longer. He grimaced, but thought neither Glen nor Tim noticed. He surreptitiously reached for the far end of the surgical table to help steady himself.

  “I’ve got all the vessels connected and ready. How’s he doing?” asked Glen.

  “Vitals good. Go ahead with the switch,” said Tim.

  Jeremy flipped the switch to shut off the artificial heart, just as Glen administered a shock to start the new heart.

  “It’s beating. Watch…”

  Tim scowled at the various display screens that surrounded him. “Good…good…”

  Another wave of pain seized Jeremy. Darkness crept in on the periphery of his vision for a moment, but he thought he recovered pretty quickly from it.

  “Blood pressure dropping!”

  “Shit! One of the vessels isn’t holding. Clamp!” Glen waited for a brief moment. “Clamp, Jeremy!”

  Jeremy had only heard their words in a sort of fog. He shook his head to try to clear the haze, grasped the edge of the table a little harder to try to steady himself and get back into what was happening.

  Glen turned to Jeremy and snapped, “He’s going to bleed out—hand me a goddamned clamp!”

  Jeremy stumbled to the instrument tray, selected a clamp, and slapped it into Glen’s gloved hand as decisively as he could—which wasn’t very much so.

  Glen snatched the instrument and silently bent to the task of stopping the bleeding.

  Tim stared at Jeremy, but did not speak.

  Glen wiped beads of sweat from his brow with his right gown sleeve and sighed. “All right, got it. What do you see, Tim?”

  Tim viewed his monitors for several moments before answering. “Looking better…better. OK, all good now.”

  Glen bowed his head for a moment. “Good. Good.” He glanced briefly at Jeremy. “You look like shit. Get out of here. We’ll close.” He turned back to the patient’s open chest and began to meticulously stitch the various layers of tissue, then skin.

  Jeremy, still feeling weak, tottered backward, then quietly made his way out of the surgical ward and into the little atrium where they scrubbed and gowned for the procedures. He stripped off his gloves and flung them into the receptacle. Then he sat heavily in a chair, lowered his head, and breathed deeply to try to ward off the pain for a while.

  After several minutes, the worst of the pain subsided and he could see and think clearly again. My God, I nearly blew it in there. I wasn’t paying attention. That patient could have died because of it. He put his face in his hands.

  A little while later, the surgery door burst open and Glen strode toward him. “What the fuck was that? Where were you? That patient could have bled out waiting for a simple, fucking clamp!” He jabbed his index finger in Jeremy’s face. “That can never, ever happen again!”

  Tim pushed the gurney out the swinging doors of the surgery. “He’s ready to go to the recovery suite. Someone want to help roll him?”

  “I will.” Glen took one end of the gurney and helped guide it out and to Recovery.

  Jeremy watched them go, knowing Glen was right—and hating what he’d have to do to keep this from happening again.

  CHAPTER 22

  Jeremy stumbled slightly and leaned against the hallway wall for support. Darkness stole in at the edge of his vision as he fought off a wave of dizziness. Running his hand along the wall to guide himself, he faltered toward his office, just a couple of doors away. Once there, he gripped the door jamb like a lifeline, pivoted into the room and quickly took the last few steps to his desk, where he flopped into his chair.

  He rested his head on his desk until the spell passed. It had only been a few days since he had the attack during the heart transplant. He l
icked his cracked lips, then reached for the tumbler of water he kept on his desk. He drank cautiously.

  He’d just returned from his fourth visit to the bathroom that morning. Each visit had been more agonizing than the last, as Crohn’s viciously attacked his intestines. His meds seemed to be doing nothing to fend it off, and he knew after this morning’s activity he must be significantly dehydrated. He sipped some more water, then set the tumbler down with a trembling hand.

  Jeremy raised his head, leaned back in his chair and tried to sit up fully. He winced as another spasm racked him, and hoped he could stay out of the bathroom at least for a while. He felt empty, torn apart.

  And he realized a decision was being forced upon him—a decision he wanted no part of.

  He sipped some more water, hesitated for a minute, then picked up the phone and dialed Amanda. He leaned forward again, resting his elbow on the desk and his forehead on his hand.

  Mercifully, she picked up on the second ring. “Amanda, it’s me, Jeremy. I…um…sorry to bother you, but…I don’t know what else to do.”

  “What’s wrong? You sound awful.”

  Jeremy explained how much his Crohn’s had worsened since they last spoke. “I don’t want to do it.” He closed his eyes and slowly shook his head.

  “What, Jeremy? Are you thinking of going ahead with the procedure?” Amanda paused. “I know how you feel about it, and I have my reservations, too, but if your condition has really degraded that much, well, I don’t see any other solution.”

  “Do I have the right?” He forced himself to say the words aloud. “It could kill him.”

  Amanda sighed. “I still don’t know, and I really can’t be the judge anyway. It’s your life. I don’t know what I would do if I were in your position. I do know that if your meds aren’t working any more…your mother, you know.”