The Janus Legacy

by Lisa von Biela

  “Let’s have it, then.” Jeremy rubbed his temples where the last remnants of his headache lingered, and waited for Glen to get on with it.

  “We leave the pre-op protocols as they are, so we don’t eliminate potential clients. But, we change the implantation procedure itself. Right now, we presume a very short window between removing the old organ and implanting the new one. And for our clients who remain stable during surgery—all but Abbott, so far—this is appropriate. But if we simply alter our protocol so that the new organ remains bathed in the nutrient bath until it is fully resected into the recipient, we avoid the tissue death that must have been kicked off during the interruption in Abbott’s procedure.”

  Glen leaned back in his chair with a smug look on his face. Jeremy wanted to smack him, and not for the first time. “But how? I didn’t take that kidney out of the bath until you were ready for it. How do you propose to have it stay in the solution while you’re actively resecting?”

  “Shortly before surgery, we need to place a biofriendly wrapper around the new organ that would accommodate a layer of the nutrient fluid, sort of like a very thin wet suit. The blood vessels and other connecting points—like the ureter, in the case of a kidney—need to remain free for the resecting. We then remove the wrapper once the organ is totally resected. Any nutrient fluid that gets into the body cavity would, of course, be harmless.”

  Jeremy pictured the concept in his mind. “So it would be more of a self-contained little unit, then?”

  “That’s right. Granted, it will take a bit more dexterity to manipulate the slightly larger package within the implantation site, as well as to carefully break and remove the wrapper after resection. Given those factors, I suggest we use it for the higher-risk cases, not every single one.”

  The idea sounded brilliant to Jeremy. Had Abbott’s kidney still been in a nutrient bath, it would not have mattered that it wasn’t fully resected when the arrest interrupted the procedure. Besides that, the additional padding afforded by Glen’s design would provide transplant organs a layer of protection from any jarring or bumping that might occur, like when Abbott received his defib shocks.

  “That’s excellent, Glen. Let’s implement that right away for anyone near the borderline on their pre-ops, or who has any other pertinent risk factors that we might want to minimize. Thank you.”

  As soon as Glen and Tim left the room, Jeremy called Brad and explained the new protocol to him so he’d know they had solved the problem for future cases.

  Jeremy sat back in his chair and rubbed his face with his hands. Glen’s breakthrough idea was welcome news, but the Abbott matter could still inflict massive damage on SomaGene. He hoped Brad was a great negotiator.

  CHAPTER 41

  Jeremy was beginning to realize he shouldn’t have been so dismissive of his symptoms. They’d started out some weeks back. At first, they were mild enough he was able to convince himself they were simply due to stress and that he could safely ignore them. Then they’d increased in frequency and severity, a little at a time, until denial became just short of impossible. Lately, they’d become severe and routine enough that he began to fear that his Crohn’s was making a comeback. Even so, he really didn’t want to face that fact.

  Right now, he wished he’d at least taken an over-the-counter antidiarrheal before scrubbing for surgery. Another cramp passed through him as he tried to focus on the task at hand.

  “Clamp.” Glen held out his hand while keeping his gaze trained on the open chest before him. Today’s client was receiving a new heart with clear, unblemished blood vessels to replace his tired, atherosclerotic heart. “Clamp,” he repeated when Jeremy did not immediately snap it into his hand.

  Jeremy hastily provided the clamp with a trembling hand. He was relieved that Glen did not apparently notice the tremble and kept on with the procedure.

  “Vitals still good,” said Tim from his seat by the patient’s head.

  “All right, I’m nearly done resecting it onto the existing blood vessels.” Several minutes passed in silence. “Done. Now I’m going to start removing the wrapper.” Glen maneuvered a tiny surgical scissors to make the initial opening. “You know, this may work well to head off another Abbott-type incident, but I think we’d be better off coming up with a biodegradable wrap. I don’t much like the removal process. Too much room for error.”

  Jeremy barely heard him as another wave of pain swept through his abdomen. He’d already had several painful and exhausting sessions in the bathroom before the procedure began, and he hoped he would be able to hold off until Glen closed up the patient. But he was already dehydrated from the morning and he was starting to feel lightheaded.

  “Damn it—I nicked it a little bit. Sponge.”

  Darkness crept in at the edges of Jeremy’s vision.

  He stepped back and leaned against the wall behind him, trying to steady himself.

  “Sponge!”

  Jeremy felt his knees begin to buckle, and he slid to the floor. He tried to breathe deeply to stave off the dizziness. The pain intensified.

  “Jeremy!” Tim jumped up and went over to him.

  “What the hell is going on?” Glen broke his gaze from the surgical site and glanced over at Tim and Jeremy.

  Jeremy mumbled to Tim, “Crohn’s attack, thought I could make it through. Dehydrated…a little dizzy.”

  “Christ, Tim! Leave him on the floor so he can’t hurt himself and help me wrap this up. Get me a couple of sponges.”

  Jeremy motioned Tim off. “Go.” He leaned forward, clutching his belly and trying to breathe through the pain. He glanced up and saw Tim assisting Glen in the final stages of the procedure. He groaned slightly and hoped nothing changed in the patient’s vitals while Tim abandoned his perch to assist Glen.

  “All right, I can suture the outer layer myself. Better deal with the anesthesia.”

  “Right.” Tim hurried back to his bank of monitors and dials. “Vitals still steady. I’ll prepare to bring him out of it as soon as you’ve closed.”

  Jeremy bowed his head and breathed a sigh of relief.

  Shortly after the patient had been taken to Recovery, Tim escorted Jeremy to a treatment room and started an IV running to counteract the dehydration. He added some drugs to the saline to help calm the intestinal spasming and pain. Alone now in the room, Jeremy lay on the exam table and gazed up at the ceiling as the saline dripped hydration and relief into his vein.

  He felt somewhat better physically with the help of the IV, but now the gravity of what had happened began to sink in. He’d nearly compromised a surgical procedure because of his condition. He felt chilled to his core when he imagined what could have happened if the procedure had been at a more delicate point when he lost it. He dreaded the idea of going back on the full regimen of meds he’d been on before his surgery, but he couldn’t let something like this happen again.

  The door opened and Glen strode in. He wore an emphatic scowl on his flushed face. “What the hell were you thinking? Do you realize what could have happened?”

  Jeremy shut his eyes. “I know. Believe me, I know.”

  “So what happened there? I thought you’d been doing great since the surgery.”

  Jeremy hesitated. He’d refused to admit to himself what was really going on. Answering Glen honestly would force him to admit not just to Glen, but to himself, that his Crohn’s was back, and his little honeymoon of well-being was over. He’d even worked hard to hide it from Amanda. But now, a patient’s life had been put in danger because of his denial, and he had no choice but to face it. He told Glen what had been going on.

  Glen seemed to weigh the information carefully before answering. “Well, before your procedure, you’d reached the point where the meds were barely working, and the side effects were mounting. You did quite well when we replaced just the particularly compromised section of intestine. We need to run some tests to verify, but I suspect there were other sections that were compromised—just not so badly at the time
—and they’re deteriorating. I don’t think you have a choice now. You need to replace the remainder of your intestinal tract.”

  Jeremy wasn’t surprised by Glen’s reaction. He’d wanted to perform the complete transplant all along. Nonetheless, hearing the words actually spoken felt like a physical blow. His mouth dry, he turned away while he frantically tried to think. He’d managed to sweet-talk himself into ignoring the ethical implications of the first, more limited, procedure because the Subject wasn’t doing too terribly badly as a result. But if they took the rest of the Subject’s intestinal tract…

  “Of course it’s your decision in the end. But I don’t see where there is any choice left for you in the matter. You can’t go on like this.” He folded his arms. “And you certainly can’t be relied upon in surgery any more until this is resolved. What happened today simply can’t be allowed to happen again.” He briefly checked and adjusted the IV flow. “You have a bit more of this left to go. Try to relax. I’ll send Tim in to check on you in a little while.”

  After Glen left the room, Jeremy again stared at the ceiling without really observing it as he weighed his diminishing options. He knew on one level that Glen was right about what he needed to do to cure himself again. If only there were a way to cultivate intestines for transplant outside a human host. He sighed. It didn’t matter. Even if there were, he didn’t have the time to wait. His Crohn’s was making up for lost time in tearing him back down.

  He’d felt so great, so normal, once he’d recovered from his procedure. He had Amanda back, and they were so happy together. He had everything he wanted, until now. Jeremy felt shattered to have been cured and to have regained his life, only to have it snatched away again.

  In the meantime, Tim’s adjustments to the Subject’s food had worked. He was actually doing quite well now—so much so that Jeremy had been able to take his guilt, package it up, and tuck it away where he didn’t have to face it.

  That wouldn’t be the case anymore. No amount of special food or treatment would compensate the Subject’s loss this time if he went ahead with the complete transplant.

  CHAPTER 42

  Amanda clicked her opener and pulled inside the garage. She noticed that Jeremy had beaten her home, which was highly unusual. She stepped out of her car and went inside.

  “Jeremy—what are you doing home already?” she shouted as she set down her bag on the kitchen table.

  No answer.

  She shrugged. Maybe he was upstairs at the far end of the house. It was certainly big enough he might not hear her from there. She started up the stairs. “Jeremy!”

  “Up here.”

  She frowned at the odd tone in his voice. It sounded tired and muffled. “What’s the matter?” she asked as she quickened her pace and headed for their bedroom.

  She opened the door and saw him sitting on the edge of the bed, his head in his hands. The shades were all drawn, throwing the room into a murky gloom. She turned on the light and sat beside him. “What is it?”

  He turned to her with exhausted eyes. “I haven’t told you…”

  Alarmed at the expression on his face, she asked, “Told me what? What’s wrong?”

  He looked down into his lap, shoulders slumped. “It’s back. I’ve tried to keep it from you—and from myself. But it’s back, and it’s bad.”

  “What, your Crohn’s? I thought you just had a little stomach flu, is all. You’ve been doing great since your surgery.”

  “I was doing great. It started up a little at a time. I thought it was just nerves or whatever—you know, with that lawsuit and all. But it’s been getting worse.” He looked up at her again with bloodshot eyes. “Today I nearly passed out in surgery. I just sat there on the floor, helpless, while they closed without me.” He shook his head and stared down into his lap again. “That could have been a disaster,” he said softly. “Someone could have died.”

  “Why didn’t you tell me?” She put an arm around his shoulder.

  “Because I didn’t want to tell myself,” he snapped. He broke away from her, stood and began to pace. “Everything was going so well.”

  “Well, I suppose you’ll have to start back on the meds. Maybe you can try a different regimen. They come up with new ones all the time, don’t they?” She could feel his anguish, and she realized her comment sounded lame the moment it came out of her mouth.

  Jeremy stopped pacing and glared at her for a moment. “I had the surgery in the first place because it had gotten to the point where there were more side effects than benefit from the meds. No, even the most current regimen available wasn’t cutting it anymore.” He clenched his fists and pressed them against the sides of his head. “Oh, God, I wish it were that easy. Glen’s pushing me to get the complete transplant.”

  “Oh.” Amanda felt like someone had just knocked the wind out of her. She suddenly understood why Jeremy was so upset, why he’d been in denial and kept his condition from her. Somehow they’d both managed to set aside the ethical issues with the first procedure and enjoy the benefits for these past months. Now the stakes had been raised. She knew full well the implications of the complete transplant.

  Jeremy started to pace again. “Yeah, I see you get it.”

  Amanda flinched at his bitter tone. She knew she’d lost any hope of objectivity now that she was back with Jeremy. Before, she could at least try to consider the ethical considerations and take the high road—and then go home to her life. Too late now. She loved Jeremy too much to put the Subject’s interests ahead of his. She couldn’t bear the thought of watching him deteriorate when there was a solution. “Then that’s what we do.”

  He stopped pacing and turned to her sharply. “You think it’s that simple?”

  “It is, for me. It’s the only thing that will make you well.”

  “But what about—?”

  “We work with Glen and Tim to figure out how to make it as…humane…as possible.” She swallowed hard as she tried to think of how to make humane the taking of a person’s entire digestive tract for the sake of another. Involuntarily, no less. She tried to convince herself the Subject probably didn’t understand what was going on anyway. After all, he’d never been educated or socialized. He didn’t know anything of the outside world. She did her best to relegate the Subject to the status of an it, not a he. It was the only way.

  CHAPTER 43

  Jeremy looked up and down the hall, and was relieved to confirm he was alone. He’d come again on another pilgrimage of guilt.

  He opened the door and stepped inside the Subject’s home. He made himself really think about that for a moment, forced himself to open up and allow the guilt to freely wash over him. The Subject had never known another environment in his relatively brief existence. He tried to imagine what that must be like, and could not. Here was a human being whose entire life and environment had been that of a captive lab animal.

  He gazed at the Subject, who sat on the edge of his erstwhile bed and gazed blankly back at him. What else did he have to do? He couldn’t read, so books were of no use to him. He had no concept of sports or movies, so a television wouldn’t be anything more than a strange and useless curiosity to him.

  The more he thought about it, the more puzzled he became. What sort of mental or interior life did the Subject have? Did he have anything like that at all? Given his circumstances, it might be more of a mercy if he did lack those things.

  Despite Jeremy’s professed resolution to do so back when he first learned of the secret project, he’d never had the Subject tested for his cognitive capabilities. Somehow he never did get around to it, partly due to the logistics of finding someone qualified, given the needed secrecy, and partly because he simply didn’t want to face whatever the results might show. They didn’t even have an informal clue as to his mental capacity, because no one had ever tried to provide any sort of education or socialization beyond the minimum interaction to feed and care for him.

  Surely now no one ever would.

  I
t would be so much easier that way. Jeremy knew what he was doing. He was working hard to dehumanize the very human-looking Subject who sat before him. It wasn’t all that hard to do, really. For the most part.

  He decided it would be better to just leave, to not approach the enclosure and try to examine the Subject more closely. The more distance, the better.

  Jeremy had just turned to go when the door opened and Glen stepped inside.

  “Oh. I didn’t expect to find you in here.” Glen glanced at the Subject, then at Jeremy. He eyed him warily, then asked, “What are you doing in here, anyway?”

  “Nothing. Just checking in on things.”

  “Well, you can leave that to me. I’m going to do a pre-op check shortly to make sure everything is in good shape for transplant.”

  Despite his own efforts to objectify the Subject as nothing more than a donor, Jeremy winced inwardly at Glen’s choice of words.

  “You know, there is another issue for you to consider.”

  Jeremy waited, wondering if Glen had suddenly had an attack of ethics to wrestle with.

  “The nature of your disease. You know it goes on attacking the intestinal tissue. The transplant isn’t going to stop that; it’s only going to give you a new start, for the time being. There will undoubtedly come a time when it begins to compromise your new organs.”

  “Yeah, that sounds logical.” Jeremy wondered where Glen was going with this line of discussion.

  “So eventually you’re going to need another transplant, most likely. We have another batch of Ivan’s tissue preserved for this purpose. We should take a portion of it and start to generate another Subject for that eventuality. I’m assuming we won’t be able to regenerate the large and small intestine within this Subject’s body after the procedure—although we should certainly try so we can learn if it is possible or not.”

  Jeremy glanced at the Subject. He still just sat on the edge of his bed, watching them both with a neutral look on his face. As if he didn’t understand a thing that was going on.