The Janus Legacy

by Lisa von Biela

  Jeremy had wasted away to nearly a living skeleton. Life had become a series of days he waited out like someone serving a very long and indefinite prison term. He couldn’t eat; he couldn’t easily go out. His tether to the IV kept him from moving freely—as if he had the energy to do so anyway. Amanda had to wait on him hand and foot. She had been doing very well in her new job, but finally had to quit to take care of him this past year.

  And of course, she’d had to make up a cover story about why she had to care for him so intensely. She couldn’t reveal to anyone how hard it was caring for someone who had no intestinal tract—and especially why he was bereft of such a thing in the first place.

  And Glen. He wasn’t even looking very good these days. Since Tim left, he’d been solely responsible for not only all of the care and cultivation of Subject Two, but also all of Jeremy’s care. He’d had to manage the day-to-day operations of the business as well, since they didn’t dare let any of the SomaGene staff see Jeremy in his present condition. He had to stop performing commercial SomaGene surgeries because of the numerous burdens.

  No one had heard directly from Tim since the day he resigned, but there had been rumors that he’d snagged a research position out in L.A. Jeremy couldn’t blame him for wanting to get as far away as he could from SomaGene and all that had happened. He thought back to the last day he’d seen Tim. He’d found his moral compass—granted, a bit late, but at least he found it. In a way, Jeremy admired him. But he just couldn’t bring himself to turn down another chance at living, not after what he’d been through.

  He glanced at Amanda. She stood gazing out the window, her arms folded. She looked lost in thought, and so very tired. He wondered if maybe it would be best if he didn’t survive the surgery, then tried to wipe that thought from his mind before it took root.

  “It’ll be OK, Amanda.” Maybe if he said it aloud, he’d believe it as well.

  She turned to him, the dark circles under her eyes exaggerated by the angle of the light. “Will it? They never did figure out what went wrong last time. How do you know we won’t be going through this same little tableau in a year or so?” She shook her head. “I’m sorry. That was cruel. I didn’t mean to—” She started to sob. “It’s just been so hard.”

  He rose on unsteady legs and went to her, IV rack in tow. He put one arm over her shoulder. “I know. I know you didn’t mean it that way. Believe me, I’ve had the same thought.”

  They stood together, silent for several minutes. Then Jeremy’s phone buzzed.

  He picked it up. “Yeah, OK.” He looked at Amanda. “It’s time.”

  She went to him, kissed him. “I love you. See you afterwards, OK?” She tried to smile, but the tears gave her away.

  Jeremy did his best to smile, but knew he’d also failed. “Yeah. See you soon,” he whispered, then turned and made his way to the door while he could still maintain his composure, for both her sake and his own.

  Knowing that Glen would be busy with preparations, Jeremy understood he’d have to walk himself to the surgical suite unassisted. That was fine with him. He could be alone with his thoughts for a short while without wasting energy trying to put on a good front for anyone. But it seemed to take him forever to make his way there, between just feeling so tired and weak, and having to scoot the IV cart along with him.

  He glanced up at it. He was utterly sick of having it continuously connected to him for all this time. The site where the needle penetrated his subclavian artery was constantly sore and he didn’t even like to look at it. Didn’t like to touch it. He knew it repelled Amanda, too.

  He felt so very fragile. And now he knew firsthand that, though he couldn’t converse or otherwise express concepts verbally, the Subject had surely experienced all the same miseries, perhaps more.

  And now there was a second Subject to endure the same experience. Jeremy felt so guilty—yet so helpless.

  Finally he arrived at the vestibule outside the actual surgical suite. He was supposed to change into a gown, but that posed a challenge to accomplish unassisted. He would have to maneuver it over the tubing coming from beneath his collarbone. He tried to decide what to do. Certainly he couldn’t walk into the sterile surgical suite in his street clothes. Finally he removed his clothes, let them fall to the ground, and just draped the gown over himself as best he could and went into the suite.

  An all too familiar sight greeted him—aside from Tim’s absence. There was Glen, checking monitors and arranging his instruments.

  The Subject. Somehow Glen had managed to get him in there and sedated. He lay on the gurney next to the empty one that awaited Jeremy. He was hooked to tubes and wires and was already draped and ready to go.

  Jeremy averted his eyes from the sight. “Hey, Glen.”

  Glen looked up from his work. “Hey, Jeremy. You ready?”

  “Suppose so.” Jeremy dragged his IV cart over to the waiting gurney and lay down. He made himself as comfortable as he could, which wasn’t very. “All right. Let’s do it.”

  “OK, Jeremy. The Subject is ready. Let’s just get you under.”

  Jeremy welcomed the mask over his face as it delivered the gas that mercifully and quickly brought peaceful sleep.

  Glen silently cursed Tim for his attack of conscience. Now he had to perform the complex dual procedure solo—and hope nothing went wrong that would sidetrack him from simply getting it done as swiftly and precisely as possible.

  He’d put a delayed-release sedative in the Subject’s dinner the night before, so he had been easy to subdue in the enclosure and slide onto the gurney. So far, so good with his vitals. After all, he had not been weakened by prior surgery, so that would be on Glen’s side.

  Jeremy, however, was another story. He’d spent over a year living off nothing but IV-delivered nutrients and limiting his activity because of the omnipresent IV rack that constrained him. His general physical condition had seriously degraded just due to those factors. Glen also suspected Jeremy was depressed—perhaps not clinically so—but nonetheless depressed. Who could blame him, really? He’d been doing so well, then that newfound health had been taken from him so suddenly and so dramatically.

  Glen thought for a moment as he intubated Jeremy and adjusted the anesthetic gas flow. He’d never been able to figure out why the implanted intestines had just suddenly died like that, long after Jeremy had recovered from the procedure—and that worried him. If he didn’t know what happened, how could he avoid repeating it? Was it something he could have prevented with some change in regimen, or how the organs were transplanted? He shook his head. Better stop mulling over that and focus on the present. Jeremy and the Subject were ready, and he had to work quickly yet pay careful attention, because no one had his back today.

  He’d leave Jeremy intact until the organs were ready for transplant, even though that meant a delay in the implantation. He felt he’d rather minimize the risk of Jeremy being open longer than necessary—the organs would wait in a body-temperature nutrient bath in the meantime. It would have to do.

  Heedless of aesthetics, he swiftly made a lengthy incision in the Subject’s abdomen and hastily cauterized all the blood vessels, rather than taking the time to apply clamps. He reached inside and began to lift the intestines up and out, cauterizing a path behind them as rapidly as he could.

  The thought occurred to him to simply take the organs and skip the cautery in the interest of time, but he decided to preserve the Subject if he could. He still wanted the opportunity to attempt an in vivo production of a new intestinal tract in the Subject’s living body.

  He worked quickly, glancing at the monitors periodically to check on vitals. At last, all the blood vessels were dealt with. Then he cut the end of the small intestine just below the stomach and tied that off. He cut and tied off the final portion of the large intestine, then lifted the ungainly mass and lowered it into the waiting nutrient bath. He drew his sleeve across his forehead and took a breath before turning to Jeremy.

  Glen st
ood over his patient, his scalpel poised. Jeremy’s abdomen sported evidence of the prior procedures in the form of three long, dark pink, ropy scars. He calculated a tradeoff between speed and ease of healing, and decided in favor of speed. He made a longer incision than before so he could work quickly and close as soon as possible to minimize the risk of complications. Jeremy would just have to live with yet another major incision and some additional post-op healing.

  He used the electro cautery liberally, then applied metal clamps to hold the flaps of abdomen open and out of his way while he worked. His jaw clenched as he viewed the surgical field and grasped just how tedious this was going to be. Thankfully, he’d had the forethought to use special clips on the ends of the blood vessels when he removed the failed transplant. That would make those vessels easier to spot and grasp and hopefully easier to resect onto the new organs. However, he would still have to carefully snip each vessel just behind the clip before resecting because the opening would be sealed shut permanently at the actual site of the clips.

  Tedious, yes, but at least those vessels would be resectable. He worried about the ones that had been too small to clip in the prior surgery. Those had been cauterized. He wondered how many of those he would be able to resect today, and if it would be enough to perfuse the new organs with adequate circulation to avoid tissue death. He shrugged and got started. He would just have to work with what he had.

  He glanced up at the monitors. Jeremy’s pulse had become a bit rapid and weak. He looked back into the abdominal cavity and spotted one blood vessel that was leaking. He quickly clamped it then checked the monitor again. The pulse steadied, but he knew every minute Jeremy was open was risky.

  Wishing he somehow had more than two hands, Glen lifted the intestines from their nutrient bath and gently laid them in Jeremy’s abdomen. He decided to connect each end of the intestines first, then work from left to right, top to bottom to get all the blood vessels properly attached. He knew he was going to be exhausted after this procedure, and that there would be no rest for him because he was the sole person who could do the post-op monitoring. He groaned to himself and kept working. No point in focusing on that. Not now.

  Hours later, he straightened up and stretched his back while taking another look at the monitors. Jeremy’s vitals could look stronger, but they weren’t out of line with his general condition and the fact that he had been under for some time now. Glen bent back down and made sure all the blood vessels were properly sealed and connected, no leaks. Satisfied, he began to close, stitching and cauterizing as fast as he could.

  Then he turned to the Subject. He had delayed closing him in favor of getting through Jeremy’s procedure as quickly as possible. He hastily closed the Subject’s abdomen with as few stiches as he could get away with.

  Glen realized he was in a quandary. Who to bring out of the anesthetic first? He couldn’t handle both of them at once. He decided to bring Jeremy out first. He could put him in Recovery and let Amanda stay with him while he brought the Subject out and set him up in his enclosure with his permanent IV. It would have to do.

  CHAPTER 62

  Amanda had parked herself in one of Jeremy’s office chairs, and had barely moved since he’d left. She knew a lot of time had passed, but had no idea how much. She didn’t really want to know, and so deliberately hadn’t looked at her watch. She’d just sat and stared into space the entire time.

  She knew he was absolutely miserable in mind and body, and that he harbored a lot of guilt for what had happened to the first Subject. If this procedure didn’t restore his health, she wasn’t sure he would want to come out of the anesthetic. She wasn’t sure she would want him to—and she felt guilty for even being able to form such a thought.

  A knock at the door startled her back to the here and now. Her heart pounded in her chest. “Yes?” she said weakly, fearing the worst but hoping for the best.

  Glen came in, still wearing his scrubs. His face mask dangled onto his chest; his surgical cap still covered his head. His eyes had the hollow look of utter exhaustion. He looked so bad, she wondered how difficult the procedure had been.

  “Jeremy’s in the recovery room now. He’s just beginning to come out of the anesthetic. I’d like you to wait with him there, so I can get the Subject squared away. I’ve no one to assist, you know.”

  “Sure.” Jeremy had told her what happened with Tim and why he had resigned. The idea of Glen having to perform the procedure singlehandedly had weighed on them all in the interim. “How is he?”

  Glen spoke quickly, as if he needed to get everything said before he collapsed from exhaustion. “So far, so good. I’d have preferred to have completed the procedure faster and had him under for a shorter time. To speed things up, I had to make a larger incision to make access easier. I’m afraid he will have a bit more healing to do because of it, but it was a tradeoff I needed to make.”

  “I understand.”

  Glen led her down the hall to the recovery room and motioned her in. “If anything seems amiss, don’t hesitate to press the call button. I have a portable receiver—it’ll buzz me wherever I happen to be.” He turned and left.

  She went to Jeremy’s bedside, took a seat on the rolling stool that had been left there, and examined him closely in the cold hospital room light. His color wasn’t as good as it had been after the prior procedures, but he had gone into this one in a much more weakened state.

  His eyes began to flutter open. He looked dazed as he tried to focus on his surroundings.

  “I’m here.” She reached out and took his hand. “Don’t try to talk. The surgery is over. You’re in Recovery now.”

  He blinked and gave a slight nod.

  Glen removed the breathing tube from the Subject’s throat, then wheeled his gurney from the surgical suite back to his enclosure. He struggled to singlehandedly transfer him onto the bed-shelf without having him fall to the floor. He had to push and shove and rearrange the Subject’s inert body a number of times to get him properly positioned.

  He pulled down the front of the hospital gown to reveal the area just below the collarbone. Then he connected a long section of IV tubing to a full bottle of parenteral nutrition that hung from a rack above the Subject, and let it flow for a moment to get the air bubbles out of the tube before connecting it to the needle. Quickly, before the Subject could come out of the anesthetic, he swabbed the area with antiseptic, then inserted the large gauge needle. He adjusted the flow, then applied tape to secure the needle where it entered the Subject. Then he raised the hospital gown back up to cover the site.

  Glen sat down on the bed next to the Subject to rest his tired back and legs while he waited for him to regain at least minimal consciousness. He didn’t like energy drinks and artificial stimulants, but this called for a can or two of the stuff. He’d go get some from the break room as soon as he made sure the Subject was stable enough to leave alone.

  After a short while, he could see the Subject’s eyes start to shift beneath the lids. Then they opened and stared back at him with a questioning look. He groaned softly and closed his eyes again.

  Glen checked his pulse and found it satisfactory. He’d be good enough unattended for a while. Wearily, he rose, locked the enclosure behind him, and headed for the break room.

  He opened his eyes. Slowly, his surroundings swam into focus. He couldn’t seem to concentrate. Something was wrong. He tried to move, but his breath caught when a searing pain shot through his midsection. He felt so tired, so broken, but didn’t have the mental language to comprehend it more fully.

  As the pain became increasingly intense, his vision began to clear. He was back in the place he lived, the only place he’d ever known.

  But there was something new.

  There was something hanging above him. A bottle of whitish fluid, hanging from a gleaming metal rack several feet up. He wondered what it was. Then he noticed that a tube ran from it toward him. He followed it with his eyes, and could just move his head enough to se
e that it attached to him high on his chest.

  He reached one hand up and gingerly felt the area. There was something there that didn’t belong, and it hurt him. He removed his hand and tried to understand what had happened to him.

  He couldn’t remember anything since some time after he ate his food last night. Nothing at all until now. He moved his head and looked around his enclosure. Nothing had changed, except for that bottle hanging high above him—and the pain.

  His chest hurt where that thing attached, and his abdomen burned with a consuming pain. He reached his hand to where it hurt and touched carefully. There was some sort of padding there.

  He closed his eyes and tried to go back to the sleeping place he’d come from, before the pain came.

  Glen had taken the energy drinks back to his office to consume. He didn’t want to run into any of the other staff doctors in the break room and have to explain what he had been doing that had exhausted him so.

  Despite downing both drinks in rapid succession, he had been so tired that he’d dozed for little while with his head on his desk. He awoke abruptly and panicked when he realized he had been out for about half an hour. He tried to convince himself he would surely have awakened had Amanda pressed the call button. The buzz of his receiver unit could wake him out of the soundest sleep.

  Nonetheless, he decided he’d better go check on Jeremy. He rubbed his eyes, smoothed his hair a little so he wouldn’t look like he’d just been asleep, and went to the recovery room.

  He opened the door and peered inside. Amanda sat next to the bed, holding Jeremy’s hand. Thankfully, it appeared she had managed to stay awake to keep an eye on things. “How’s he doing?” He whispered to her as he approached to avoid disturbing Jeremy.