My research would never have progressed without the Bush administration (I may be the only scientist in North America who could say that). Hurricane Katrina killed thousands in a very short span of time. It might have been a humanitarian crisis, but for an entrepreneurial researcher (with a boat), it was, we’ll call it, an opportunity.
But perhaps I’m getting ahead of myself. My fascination came in early childhood. My mother died from breast cancer, an entire body lost for a single defect, the kingdom lost for a nail. My father was not a kind man; the thought of a life alone with him seemed more than I could bear. I was alone with her when she passed; by the time my father arrived home from the hospital, I was nearly done sawing through her skull (no small feat, without a proper bone saw). He beat me mercilessly, but it wasn’t the first time for that. Or the last. He was also the man who changed our family name the day he arrived from Germany to Frankbenburger; I changed mine back the day after I graduated from Johns Hopkins.
Most of the materials I gathered came from the Jenson family. I don’t know them, personally, but from their home, and the fact that they stayed through the storm indicate they were poor. The family died of a combination of drowning-related causes. There are three basic ways to die from drowning: during the initial submersion, pulmonary edema from water trapped in the lower airway passages obstructing red blood cell oxygenation (sometimes called the secondary or parking lot drowning, because it happens potentially hours later, in the parking lot as you leave), complications of emesis during resuscitation (it’s a fair bet that most patients vomit after nearly drowning, and vomitus in the lungs can lead to drowning, infection, or if it is highly acidic enough, destruction of the lung tissue).
Tragic though the fate of the Jensons was, their manners of expiration meant that, medically speaking, I’d arrived mere moments after their death. Their organs were pristine. I loaded their corpses onto my boat, and took them to my laboratory.
The human pancreas is the fussiest; within 4 to 6 hours the organ will become nonviable if not removed. I chose the youngest Jenson, who I named Jenny; she was perhaps twenty, pretty, if slightly overweight, but the youth of the organ was key. Next was the heart, but while carving out Jenny’s pancreas, I noticed her lungs were black already- a heavy smoker for a girl so young. I decided to risk taking the heart from Janny, likely Jenny’s mother, or aunt, slightly larger, but not obese, along with the lungs and several of the major arterial pathways (en-bloc, as it’s medically known). The liver has the longest expected lifespan, so that I removed last from Jenny, along with the spleen, stomach and kidneys en bloc. Preserving organ system integrity has been shown to increase organ life span, as well as ease the reintegration of organs into the patient. I preserved them in Histidine-Tryptophan-Ketogluterate (HTK), which had only recently surpassed the more viscous UW lactobionate, and add the delta opioid ligand DADLE- which causes organs to go into a suspended animation not unlike hibernation.
I readily admit, time being of the essence, that when it came to tissues, muscles, bones, tendons and skin, I did not apply the same surgically gentile techniques. Having a family of bodies to choose from, I hacked them to separable, preservable pieces, often doing the majority of the work with a cleaver. It was inarticulate, to be sure, but while tissue is easy enough to obtain, I knew that whole organ systems were a rarity indeed.
At which point I collapsed. I had been alert for nearly forty hours at that point. I slept only an hour and a half. I had not time to spare; even with HTK and DADLE, I was perilously close to ruining one or more organ systems, and I was keenly aware how unique this opportunity was. Truth be told, my experiment hinged on the participation of one man. He was homeless, and dying a slow death from Alzheimer’s. He no longer recalled who he was. To honor the family’s memory, I decided to call him Jenson.
I took a low dose of dextroamphetamine ands started the implantation process. The combination of the HTK and DADLE meant that most of the organ systems would last at least forty hours; however, most single-organ transplant surgeries can take around four, mutliorgan transplantation can take up to 8, so I was forced to improvise. I placed Jenson’s brain on extracorporeal membrane oxygenation, and gave him IV heparin and a cocktail of immunosuppressants. The heart I laid gently inside the chest cavity, without sewing it into the chest wall. I took similar shortcuts throughout the systems, trusting that the paralytics and Jenson’s immobility would keep him from damaging his new organs, focusing instead on restoring connections between organ systems and the blood stream.
At 37 hours, I finished my task. I spent a half an hour rechecking every major artery and vein. I removed him from bypass, and shocked the heart. For a moment, neither of us breathed. Then his heart convulsed, and Jenson gasped.
I harvested bone marrow from the hips of all five Jensons, and injected these into the new Jenson’s blood stream; with a little luck, the chemo had cleared enough of a path for the marrow to gain a foothold. I slept fitfully, and woke after three hours more. I sewed the various organs in place using biodegradable sutures. Jenson was nearly braindead, but his vitals remained strong. He continued on a steady regimen of anticoagulants and immunosuppressants. Over the next several days I began reconstructing Jenson. I started with the legs. Jenny’s legs were not strong enough, and Janny had a slight disparity with leg lengths. Far stronger, both in musculature and in bone density, were her husband Jonny’s legs. I also used Jonny’s arms, shoulders, and hips, but with these I took my time, letting days melt into weeks and months. Jenson’s body was mending slowly. Each new surgery placed additional burden on his already overburdened frame.
The face I’d chosen early. The organs were largely feminine, because of their perceived health, and the added fact that women still tend to live on the average longer lives. The musculoskeletal system, however, was largely masculine, owing to its perceived superior health. The gender of the face was largely cosmetic, however, it had potential psychological implications, and given that the majority of Jenson’s exterior physiology was male, so too became his face, and his genitalia.
I did not declare the body a success until the final scar had healed, over the spine. By this point, Jenson was clinically brain dead. Had he not been suffering from Alzheimers, and had he been able to hold on longer, I might have, from a sense of loyalty, allowed his brain to reside in my homunculus. Or were Einstein’s brain a possibility, perhaps I would have chosen him, instead. What I found instead was David Andress, a man in his thirties, who had been robbed of a distinguished track and field career by myotonic dystrophy; his case was so severe he had spent the last four years in a wheelchair, struggling to breath. And he was dying, of a lung infection that wouldn’t have kept him off the field in his youth.
Were I a better man, perhaps I would have spoken to David, and sought his permission. But I feared his reaction, and worse, that he could expose my work at this sensitive state. David had been given a week by his doctors. His sister was staying with him. I stole quietly into his home, dosed the both of them with ketamine, and removed him back to my lab.
I began by typing David’s HLAs; there were three in common with Jenson- the bare minimum for success, and a far cry from a perfect match. But I’d been prepared for this eventuality. I started Jenson on immunosuppressants. Had I the equipment, I would have taken the extra step of radiation. I extracted more than two quarts of bone marrow via needle from David’s iliac crest (in the rear hip bone), and injected these into Jenson’s blood.
I waited. Jenson displayed no signed of graft-versus-host. I planned to type him again, to see if the graft had taken hold, but David began to struggle breathing. The human brain uses 25% of the oxygen taken in by the body; in less than five minutes, certain brain cells begin to die without oxygenation. I obviously had no room for error. I placed Jenson on an ECMO, not to bypass his heart, but to augment it. Then I clamped David’s internal carotid artery. I connected the artery to the ECMO, in effect combining both bodies into a single circuit. I proceeded by severing the external carotid artery, and the common carotid artery. The eyes presented a particular challenge; due to the volatility of ocular tissue, and its relationship to the central nervous system, Jenson had kept his original eyes; and now, David’s brain had to be transplanted with his.
I placed the bodies side-by side, and exposed the spine. Reattachment of the spinal cord is still not medically possible, so the spinal cord had to come with the brain. David’s was sliced free, and oriented so that it lay beside Jenson’s, and I began the painstaking work of remapping his nervous system. At hour eighteen of the surgery, I nearly dropped my scalpel; I took a large dose of dextroamphetamine, and continued. I’m uncertain how long the entire process took. I slept in fifteen minute increments every eight hours, and increased my dextro dosage 10% with every dose. When the surgery was complete, I passed out. I believe I slept for several days.
I awoke to the sounds of labored breathing. David was conscious. With every breath he’d whisper, “ouch,” as he exhaled.
I increased his morphine drip. After a day and a half, he’d regained enough strength to look around the room, and in doing so, he found me. “Kill me, please,” he asked through his new lips. I asked, “What would you give to be able to run again?” His eyes didn’t change, but the timbre of his voice did. “What would I have to give?”
His rehabilitation was torture. Even for a man hardly able to move his arms before, it was frustration. But David found reasons to remain optimistic. “My arm. It moved more than yesterday. And yesterday it moved more than the day before.” Truth be told, I hadn’t thought the difference worth measuring; but the difference it made in him was palpable.
Beyond the physical rehabilitation, there was neuronal rehabilitation; many of his nerves were mapped differently than the body he now inhabited. It took him an entire week to learn how to move his left hand without setting his eye to blinking furiously.
Of course, he would never fully recover functionality. Scarred nerve tissue does not transmit signals well; this is in fact a portion of why I chose David. A slow physiological response was relatively comparable to a weakened one. Stem cells proved useful in a few places where reattachment failed, and no function was available at all. In a few years’ time, experiments with the exceptional healing abilities of MRL mice could perhaps address this more fully, but neither David nor I could have waited.
It was the fall of 2006 when David asked me what he would have to give. It’s taken the time since for him to heal himself. At the beginning of this year, he stood for the first time without aid. He took great pride in the fact he can now do more push-ups than I, though he seems suspicious I let him win (I didn’t).
He’d been pestering me to go outside. It had been so long since he’d felt the sun or a breeze, smelled fresh air, or seen a pretty girl. I saw through him instantly. “You want to run.” He smiled. “You said I could.” I tried to dissuade him. His body was barely recovered from its ordeals. He said he’d like to go outside as a gift, for his birthday. I assumed, of course, he meant the day I’d given him a new body, which would have given him several more months to heal. “That was my rebirthday. I was born at the end of October.” I relented.
I’d grown fond of David. He had shown himself a man of intelligence and passion, and our forced proximity had given way to a very true friendship. But when he emerged into the day I saw him anew. His face was as bright as the sky; he tore off his shirt, without care for the autumnal chill in the air. We walked for a long while, and he smiled and yelled, “Hello” to anyone nearby. Then he glanced at me, a mischievous smile creeping over his face, and he ran.
I chased him several blocks before I stopped to catch my breath. He kept running, several more block down to Main Street, then ran back towards me. He stopped a block away, stumbling. I ran to him, as he sat down on the edge of the street. “My heart feels funny,” he said, without removing the smile from his face, “but I ran.”
He fell back. I tried resuscitation; in fact, I didn’t stop until a burly paramedic woman tore me away. “He’s gone,” she said.
“Again,” I told her, without expecting her to understand.