He unfolded the flimsy hospital gown, sighed, and changed into it. Head bowed and shoulders slumped, he stepped to the swinging door, pushed it open, then entered the surgical suite.
A guilty chill ran up his back when he saw the draped and prepped Subject lying on the gurney next to his. Glen had told him that they were going to try to keep him alive after the procedure with some IV-based nutrition regimen. If he survived the procedure at all.
He gazed at the Subject for a moment longer before proceeding to his own gurney. He could see very little of him, actually, which was just as well. He was surrounded by wires, tubes, and monitors. The green surgical drapes placed around his abdomen framed his belly like a gift to be opened.
Jeremy supposed that was true in its own way. Whatever he thought of Ivan, and even if this was an ego-driven project at base, he had given him a gift. The gift of a new chance at life with a new colon and small intestine. Made just for him.
At least he tried to think of it that way, and not the other way—that he was stealing the lifesaving organs from an unwitting victim.
“We’re ready for you.” Glen motioned toward the empty gurney that awaited him. Jeremy had a brief, odd thought that he looked a little like a maître d’ waving him to his table.
He stepped over to the gurney, his feet feeling numb and uncooperative. He got on it, lay down, and turned his head slightly away from the Subject to try to keep him out of his line of sight.
Tim stood over him. “OK, I guess you know the drill.” He tried to smile. “I’m going to start the IV, give you a whiff of the gas to get you under. Then I’ll do the rest and we’ll get started. You ready?”
“Yeah, I guess so.”
Jeremy tried to relax as he felt the stick of the needle. He could feel the slight coolness of the IV solution as it began to flow into his vein. Odd, the little details that come to attention at times like this.
Tim placed the mask on his face. “Now just breathe normally. It won’t be long.”
Jeremy took a breath and felt the workings of the gas pretty quickly. He felt like he was wrapped in cotton, soft and quiet. A couple more breaths and he was out.
CHAPTER 49
Tim glanced once more at each patient’s monitors. He hesitated to make his announcement, because he knew that would mark the beginning of the dual procedures, the point of no return. He worried that, despite all their preparations and planning for various potential scenarios, something would happen that would be difficult to impossible for only two surgeons to handle. They’d managed just fine the first time, but this procedure would be so much more extensive, and such a transplant had never before been undertaken. What might they have missed in their planning?
“Well? Are you ready?” Glen sounded somewhat irritated.
“They’re both ready and stable.”
“All right, let’s go.” Glen stepped over to the Subject’s gurney. “I’ll open him up first, leave everything in place, then open Jeremy. Then I’ll work on the transfer.”
“We really could use another two surgeons for this—at least. It’s a lot to do in a limited timeframe.”
“Well, that’s not an option, so we’re just going to have to do our best. I don’t want to have to call on you to assist, given you’re trying to watch two patients yourself, but I may have to.”
“They’re both in pretty good shape, compared to some of our really elderly and infirm patients. But you never know, once they’ve been under a while. Things can happen.”
Glen paused before making his first incision and pointed his scalpel at Tim for emphasis. “Let’s be clear right now. If things get dicey with either of them, we focus on Jeremy. If it comes to excising the intestines and rushing to get them into Jeremy, I’ll forgo tying off the Subject’s blood vessels if need be. Is that clear?”
Tim didn’t want to shortchange the Subject’s care, but given the situation and the obvious tradeoffs, he couldn’t argue with Glen’s priorities. “Yep. It is.”
“Good. Note the time, and… Go.” Glen dexterously opened the Subject’s abdomen, and placed metal clamps to hold it open. Tim noticed he sped up the process by quickly using the electro cautery, rather than clamping the blood vessels more meticulously.
Tim wondered how well the incision would heal, given that approach—or if there would even be a need for that incision to heal by the time this procedure was over. He shook the thought from his mind and tried to focus on the immediate situation.
Glen selected a fresh scalpel and turned to open Jeremy. Tim noticed that he spent more time clamping the blood vessels as he worked.
“How are they doing?”
“All good.”
“Do you think you could work on removing the intestines from the Subject while I prepare to remove Jeremy’s? It would speed this up considerably if we could do that simultaneously.”
Tim glanced again at the monitors. “They’ve both been rock solid so far. Yeah, let’s do that. I don’t like the idea of them both under any longer than need be.”
He rose from his stool strategically positioned at the patients’ heads and went over to the Subject. The enormity of what he was about to do hit him, and he wondered if Glen had more in mind than merely speeding up the overall procedure time. He wondered if this was Glen’s way of pulling him in even further so his hands would be just as unclean should something go wrong or if anything about the program eventually leaked. He decided that was pretty damned likely and there wasn’t a thing he could do about it right now except to do his best to make sure both patients survived.
He readied his instruments and began lifting and separating the Subject’s intestines from the abdominal cavity. He tried to work as quickly and carefully as he could as he went along, locating the various blood vessels that would need ligation, as well as the connective tissue holding the intestines in place. He fully realized he had the easier job, since the vessels only needed to be tied off and the ends of the intestines stitched shut. Glen would have to splice the blood vessels from the Subject’s intestines onto Jeremy’s oh, so carefully.
They both worked in silence, side by side, to prepare their respective intestines for removal. After about an hour, Tim completed his task and placed the intestines into a waiting body-temperature nutrient bath in a stainless steel container next to the gurneys. “I’m done.”
“I’m maybe halfway through. This is tricky business because I have to leave all these vessels ready to resect onto the new organs. How about if they’re both stable, just going ahead with closure on the Subject?”
“Good idea.” Tim stepped over and carefully checked the monitors. “Still good. I’ll get to work.” He went back to the Subject and first verified that all the ligated blood vessels within the abdomen were holding properly. Blood vessels that would no longer be needed to nourish an intestine that would no longer reside in his abdomen. What a bizarre concept.
Other strange thoughts ran through Tim’s head as he prepared to close. The intestines took up a considerable amount of space in the abdominal cavity. Aside from the obvious impacts of their removal, would there be any unforeseen problems from the simple lack of their presence in supporting the rest of the abdominal organs within the cavity? Tim began to work in a sort of reverie as he pondered the potential implications. He didn’t hear the beeping.
“Tim—one of the monitors is going off! I can’t stop what I’m doing.”
Tim set down his instruments and rushed over to check the monitors. “It’s the Subject. He’s getting a little tachy.”
“How’s Jeremy?”
“He’s good.”
Tim rolled the crash cart over to the Subject’s gurney.
“What are you doing?”
“Getting ready in case he arrests.”
“Get that back over here. I don’t want any delays in case Jeremy needs it or any other quick response.”
“He’s in danger of arresting any time now. I can’t just stand by.”
Glen slamm
ed down his clamp and turned to Tim. “Dammit, Tim! I thought I made it clear before we got started—Jeremy comes first. Period. I can’t deal with this and focus on what I’m doing. You’d better not lose sight of Jeremy’s condition. I’m elbow-deep here.” He turned back to his work.
The alarm went off, indicating full arrest. Tim grabbed the paddles and shocked the Subject without hesitation. He glanced at the Subject’s monitor. One more. He hit him again. He glanced back and saw the Subject was back to a normal rhythm. He set the paddles aside and drew the back of his sleeve across his forehead to wipe away beads of sweat.
He picked up where he had left off—this time, using the electro cautery more frequently to secure the blood vessels as quickly as possible. He didn’t want the Subject open for a minute longer than necessary. He knew the risks of trying to monitor two patients in complex simultaneous procedures.
He next focused on tying off the cut ends of the intestines. Since it was something he’d never done before, he had to make it up on the fly. He stitched them shut with dissolving sutures, then applied adhesive tissue patches for extra strength during the healing process. It’s not as if the Subject will ever eat or drink again, so there should really be no stress on these sutures. But, just in case.
Tim then closed the abdomen, layer by layer, as fast as he could. Glen had made no effort to create the smallest possible incision. It was one long swipe from the bottom of the sternum to the top of the pubic bone. With all the electro cautery, this was going to be a large and ugly scar when all was said and done. Tim shook his head. The scar was the least of the after-effects the Subject would have to contend with.
He adjusted the IV, lightened the anesthetic just a bit, but kept the Subject under for now. He couldn’t leave the room to deal with him while Jeremy’s surgery was still under way.
“Done on this end.”
“Good. I’ve just clamped the last vessel here, and I’m ready to implant the new intestine. Help me with that, would you?”
“Sure.” Tim wheeled over the cart that held the steel container of harvested intestines. He glanced over at the monitors, and was grateful to see that all looked stable.
“All right, I’m ready.” Glen carefully lifted out Jeremy’s excised intestines while Tim extracted the Subject’s intestines from the nutrient bath. They switched positions. Glen dumped Jeremy’s intestines into the nutrient bath, then began to arrange the Subject’s within Jeremy’s abdominal cavity.
Tim moved closer to his usual station near the patients’ heads so he could more readily observe all the monitors. He felt some relief now that only one patient was open. Yet he was still anxious for the procedure to be over, as both had been under for several hours now and he was getting more and more uncomfortable as time ticked on. The Subject had already arrested. He might not be able to survive another incident. And the longer they were under, the more risk there was of Jeremy having some sort of incident.
After another hour that seemed like four, Glen proclaimed he had resected all the necessary blood vessels and it appeared the new intestine was properly infusing with circulated blood. “I’m going to connect the ends of the intestine now.”
Tim glanced at Glen and noticed he was beginning to look tired. They’d been at this procedure better than half the day now, just the two of them. It was insane to attempt such a thing with just two surgeons. Insane. But there was no way around that when only three surgeons were privy to the secret project, and one of them was under the knife.
Glen tossed a used clamp into a steel pan, sighed deeply, then did a small backbend to release the tense muscles along his spine. “Done. All that’s left is to close.” He bent down again to the task and worked swiftly, silently.
Tim continued to watch the monitors closely while Glen worked. He spotted an irregular beat or two on Jeremy’s readings. He was concerned, but not panicked. Even so, he would breathe a lot easier when they were done and bringing both patients out of the anesthesia.
“That’s it.” Glen dropped the suture needle and clamp into the steel pan. “Note the time and start bringing them out of it.” He rubbed his eyes with the back of his sleeve. “Jesus, I’m exhausted.”
Tim took his cue and started to alter the gas composition. He could feel the tension lifting from his shoulders as the patients’ anesthesia lightened and waned. Whatever happened next, at least they made it through the grueling double procedure.
CHAPTER 50
“I’m so thirsty.” Jeremy rubbed his cracked lips together. “God, it hurts,” he croaked out.
“Here, the doctors said to suck on an ice chip. They didn’t want you swallowing yet.” Amanda offered a small ice cube and stared at him with a concerned furrowing of her brow.
He took the cube, worked it around in his mouth. He’d never been so grateful for a little chunk of ice. When it had fully melted, he tried to smile and thanked her.
He shut his eyes. He felt like he was swirling downward in a mix of drug haze and pain both inside his abdomen and in the skin. The incision had to be longer than last time to get the job done—and it felt like it. He felt fragile, like he might break open if he tried to move. “Hurts.”
“I’ll call them and let them know.”
Moments later, he heard footsteps. He opened his eyes to see Tim approach the side of the bed opposite Amanda. “How’re you doing?”
“Hurts bad.”
“I can give you a little more pain med.” Tim reached for something on the tray next to the bed, and slid a needle into the port on the IV tube. “There. That should take the edge off in just a minute.”
“What happened…to him?” he whispered.
Tim leaned closer. “You mean the Subject?”
“Yeah.”
Tim hesitated, looked at Amanda.
“Tell me…”
“He’s in recovery as well. Sedated. We’ve started special nutrient IVs for him to make up for his… loss.”
Jeremy looked from Tim to Amanda, and just noticed her face blanch before the room began to swirl, the pain began to lift, and he succumbed to the drugs.
CHAPTER 51
“You go ahead and go home, at least for a while. I’ll stay on site in case there are any problems. Assuming nothing comes up, you can relieve me in the morning.” Glen rubbed his eyes, took another sip of coffee, then leaned back in his chair and stretched.
“Are you sure? You look beat.” Tim sat slumped in one of Glen’s office guest chairs.
“Can’t have both of us wearing ourselves out. We need to trade off. Jeremy’s looking pretty good, all things considered. I think it’s safe enough. Go home and rest.” Glen waved his hand as if shooing Tim off.
Tim rose from his chair. “Well, thanks. I’ll be back early tomorrow morning, unless I hear otherwise from you in the meantime.” He turned to go.
Tim stepped outside the SomaGene entrance and blinked in the bright sunlight. He hadn’t so much as looked out a window all day. The last he recalled, it had been raining buckets in the morning. Now the clouds had broken up and the late-day sun beat down on the moist ground and raised a curtain of humidity.
He shuffled out to the parking lot and got into his car. He slipped the key into the ignition, then paused. What was he going to say to Katie? He was completely exhausted and hadn’t yet come to terms with the day’s events, and she had been hammering on him lately about his work. She seemed to suspect he was keeping something from her—and she likely wouldn’t rest until he gave her something to stop her questions.
He glanced at his face in the rear-view mirror. He looked every bit as haggard as Glen had. Maybe he could just beg off and go to bed when he got home and dodge her questions at least for tonight.
He started the car, backed out of his space, and left the parking lot. Once out on the main road, he realized he’d managed to pick the worst time of day to leave. The road was a main drag through this portion of Minnetonka, and the four-way stop sign at the next intersection guaranteed a long backu
p at the slightest provocation. Tonight was no exception. He leaned back in his seat and gritted his teeth. The city really needed to dump the stop signs and install traffic lights there.
Finally he got up to the intersection and broke free of the backup. His house was only a few miles from SomaGene, but at times like this, he might as well have had a long commute through Golden Valley. He grunted and pressed the accelerator to make up some time.
After what seemed like days, he pulled into his garage and went into the house. Something smelled good in the kitchen, but he wasn’t quite sure what. He went in and found Katie stirring a pot of something and Johnnie rolling around in his playpen in the nook area.
“Hey, Katie.”
She turned to glance at him, and the look on her face instantly changed to one of concern. “What happened to you today? You look awful.”
“Long surgery. A bit touch and go for a while.” He left it at that and hoped that summary would satisfy her.
Katie put down the ladle. “I’ve never seen you look this bad. What is it, really?” She put her hands on her hips.
“I’m really too tired.” The cooking smell was making him especially hungry, but he thought the best plan would be to simply go to bed. He was certainly tired enough, and that would avoid further discussion that he wasn’t up for. Once Katie put her hands on her hips, he knew from experience he’d be in for a long interrogation if he didn’t cut it off pronto.
“No. Something’s been going on for a while now, and I need to know what it is. You can’t just come home looking all beat up like this and avoid the subject.” She motioned for him to sit at the kitchen table.
“Really, Katie. I just want to go to bed.” He started to leave the kitchen and head for the stairs.
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