 
Medical Sci-Fi

Short Stories

By

Charles Kaluza

Smashwords Edition

Copyright 2011 Charles Kaluza

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The Other Side

The automated patient monitoring system detected a change in the physiologic status of the patient. The oxygen levels were dropping and the carbon dioxide levels rising in the patient's blood. This was associated with a drop in the heart rate and blood pressure. Alarms were sounded and the automatic resuscitation equipment became active. Small robotic levers began positioning the body as a capsule descended from above. The body was soon sealed, from the neck down, inside the capsule where pressure changes began to force air into the lungs. A small piston began chest compressions to produce simulated cardiac function. This unit was a high-tech version of the "Iron Lung" devices which were used during the polio epidemics 190 years prior. By the time humans arrived on the scene resuscitation was proceeding well. Sometimes death ruled over technology and sometimes death was delayed by technology.

***

Jim was continuing his vigil at the bedside of his lifelong friend. From morning till evening he sat quietly in his wheelchair next to Henry's bed. He had not practiced medicine for almost 60 years but recognized the signs of impending death. Technology had changed medicine beyond his wildest dreams but death remained an absolute. Henry's breathing had become erratic with quiet periods interrupted by gasping sessions. It would not be long now. He spoke silently to Henry, "Damn it Henry, it was your idea to prolong our lives and now you are getting ready to leave me. I don't want to be alone. It's not fair that you are dying before me."

They were the two oldest humans living, a direct result of an unauthorized experiment they had performed 90 years prior. Harry had first presented his idea for controlling aging by using a vaccine to protect the cellular mitochondria around a campfire during one of their many fishing trips. Tony, the third member of the "Three Musketeers Fishing Club" had objected saying, "We all have to die of something."

Henry had only partially disagreed admitting that if we lived long enough we would all die of cancer because of the cumulative genetic damage that we sustained through living. The three of them had collaborated on the research project which progressed to the point of human trials. A change in the political situation made the project politically incorrect. Prolonging life would increase the population problems exponentially. Henry was worried about the political change and had hidden a small amount of his vaccine in his home. After well-organized terrorists destroyed the research lab, this vaccine was all that remained of their 10 years of work. In an unusual act of rebellion they decided to test the vaccine on themselves. It was 20 years before the effects became noticeable. They were aging much slower than their colleagues. Now Henry, at 147 years of age, was the oldest human on earth. The hospital was working hard to keep him alive but Jim knew it was hopeless. The cancer had spread too aggressively.

Despite Jim's efforts his eyelids closed momentarily. When he opened them he saw Tony standing by the bedside. He said, "What are you doing here? You died 50 some years ago in the tractor accident on your farm. What are you, some kind of ghost."

Tony replied, "I am what's left of all my experiences and interactions after the death of my body. I have come back to take Henry to the other side."

"What other side?"

"The other side of life."

"What do you mean, the other side of life, either you are alive or you're not."

Tony smiled and said, "For almost my entire life I argued with you about the existence of life after death and now after being dead for 53 years I am still arguing with you. Does not my presence here indicate life after death?"

"This isn't logical. If you're dead you're dead."

"It may not be logical, but it is what it is. I've come to take Henry to the other side."

"If it existed, what would the other side be like?"

"I'm not allowed to discuss it."

"Why not?"

"That's just the way it is."

"Well at least tell me if there is pain on the other side."

"Why?"

"Doubling my life span seemed like a good idea at the time. How did I know I was going to come down with rheumatoid arthritis and spend an additional 50 or 60 years with constant pain living in this wheelchair. Out living my wife and my children has been hard and now Henry is dying. I will be even more alone now. At least if I knew there would be no pain on the other side it would help."

"There is no pain on the other side."

"One other thing, is there fishing on the other side?"

Tony broke into a large smile and replied, "You continue as the sum of your experiences and your interactions with everyone you have met. If those experiences included fishing trips then they are always part of you."

"Why can't you just answer the question instead of giving me your metaphysical answers?"

"You always ask questions that require metaphysical answers but you refuse to accept them. It is the best answer I can give you."

Jim was about to rebut Tony's reply when he realized that Henry was standing next to Tony. He glanced at the bed and saw Henry there too, still struggling to breathe.

Tony said, "It is time for us to go. Henry's body will not know he has left for a few minutes."

Henry added, "Jim, I have felt you by my side during the past several days and it provided me with comfort. I thank you for all of the support you have given me. Enjoy life."

"Why can't you guys stay for awhile and we can BS like the old days."

Tony replied, " Jim, we must go."

"But if you leave I will be alone. Everyone else has died."

"You're never truly alone, but you have always refused to accept this."

"Will you come back for me?"

"When it is your time, I will be back for you."

"Till then."

They were gone.

Jim's great-granddaughter had come into the room and asked, "Grandpa, who were you talking to?"

"Just my old friends."

"But I didn't see anybody else."

"No, I don't suppose you did. Why don't you help me move back away from the bed because it is going to get very busy in here."

"Grandpa, I'm sorry your friend is dying."

"Henry was a good friend."

"Grandpa, are you afraid of dying?"

"No dear, not anymore."

Just then the alarms began to sound and the automatic resuscitation equipment became active.

The End.

JOSEPH'S NEW BODY

Henry was eating breakfast with his family and was not aware of his distracted state until his wife asked, "What is bothering you this morning?"

Henry replied, "I have my monthly review meeting with Joseph this morning. He changed the meeting schedule to allow for a full hour instead of the usual 15 minutes. I have been wondering why the change?"

She responded, "You will know soon enough. For now our children are more important."

Henry brought himself back to the present and helped his wife get the children ready for school. The drive to work allowed him more time to think about the upcoming meeting. Joseph was a stickler for punctuality and he had never before extended the monthly review past the normal 15 minutes. His mind wandered back to his first meeting with Joseph six years prior. He had just started looking for a job, when his program director told him about the opportunity at the "International Transplant Institute." They were looking for a director of transplant services. Joseph had called his program director and asked specifically about Henry and his availability. Apparently Henry's small research project regarding the potential of spinal cord transplantation had intrigued Joseph.

Henry had been flown in a private jet to the interview setting. The lush corporate setting was in marked contrast to the small, crippled figure sitting in a wheelchair across from him. It took Henry several minutes to realize that the mind contained in that crippled body was extremely astute and in complete control of the situation. The institute was relatively new, but the goal was to establish a world class transplantation center. As a private foundation, which was richly endowed by Joseph himself, they had the means of instituting a protocol of "Bereavement Settlement." It was amazing how much more willing families were to donate the viable organs of their deceased loved ones when a substantial bereavement payment was made. This had allowed the institute to quickly become a major source of organs for the medical community worldwide.

The increased funding which became available from recipients who made "charitable contributions" to the institute, allowed the institute to develop a major research facility and now a specialized hospital for transplantation surgery. Joseph was seeking a surgeon with a research emphasis on brain and spinal cord transplantation. His small research project had interested Joseph and resulted in the interview. The interview ranged over a large variety of topics, including ethics and morality. Joseph knew that many in the medical community objected to his "Bereavement Settlement" policy. Henry was able to honestly say that the overall benefit to humanity from increased organ availability made the concept a necessary evil. Joseph was apparently satisfied with this limited approval and offered him the position. The past six years had been a professional paradise. He had not only been allowed but strongly encouraged to continue his research on the spinal cord. In addition they had succeeded in developing a world-class transplantation program at their center. His work, which had previously been ignored by his colleagues, was starting to attract legitimate scientific interest. By transplanting the spinal cord with the head, all of the neural connections were made with peripheral nerves, which had a much better chance of healing. Spinal cord regeneration was still way beyond their present ability, but peripheral nerves re-grew fairly well. By taking advantage of this improved re-growth, Henry had successfully transplanted a head from one dog to the body of another dog. As the nerves re-grew, the dog regained its ability to walk. His research was done with no known usable objective; it was research simply for the sake of science.

As Henry parked his car and walked into the institute, he felt a sense of pride. He was a major part of the success of the institute, and took ownership in a small way of the institute itself. He took the elevator to the top floor and entered the office of the director. Mary was as cheerful and polite as always. She said Joseph would be ready in a few minutes and offered him coffee. He accepted the coffee and asked if she knew why the meeting time had been extended. Mary shrugged her shoulders and said, "I am sure Joseph has his reasons."

At exactly 9:00 A.M. the intercom on Mary's desk came to life and asked her to send Henry in. They smiled at each other and Mary said, "Joseph is ready for you now, right on time as usual."

Henry gave her the thumbs up sign as he opened the door and entered Joseph's office. Joseph welcomed him in with a wave and said, "Henry, it is good to see you as always. Come and help me move into my wheelchair so we can visit at the coffee table."

Joseph was all but hidden behind his desk, which was covered with more computer stuff than Henry had ever seen in one place before. He helped Joseph move his frail distorted body from the custom rocking chair at his desk to the power wheelchair. He knew academically that rheumatoid arthritis could result in severe deformities. Seeing Joseph's horribly deformed body made the academic knowledge seem trivial in comparison to the reality of the disease. They moved back to the coffee table and Henry poured them both a cup of tea. It was all the Joseph could do to manage a cup with his mangled hands. Joseph asked about Henry's wife and children. Joseph always wanted to know everything about his kids and was always sending them small gifts. After a few more minutes of visiting, Joseph asked him about his ongoing research. Henry told him about the effectiveness of the nerve growth stimulant they were using. They discussed the new endoscopic equipment which allowed a less traumatic dissection of the spinal cord.

Joseph asked him specifically about the new vascular anastomosis clips they had developed. These miniature, tissue compatible, plugs acted like "quick connect" hose connections which allowed for endoscopic repair of the small blood vessels that nourish the spinal cord. Henry's biggest challenge in the surgery had been maintaining the vascular viability of the spinal cord for transplantation. The cord is nourished by small penetrating blood vessels which had to be carefully preserved and reconnected for the transplant to work. The new clips improved the success of lower cord rejuvenation significantly. Henry summarized his work by saying, "We have improved significantly with more than 90 percent success of the upper body nerve re-growth. The new vascular clips have improved our lower body and cord success to 50 percent. The problem of vascular compromise of the small penetrating vessels remains paramount."

Joseph asked, "Do you think the problem is technological or biological?"

Henry responded, "I think we have a pretty good handle on the biological issues. The technical difficulty of working within the confines of the spinal column is the major hurdle. We have not been able to speed the rate of healing and are limited to 1 mm per day of nerve re-growth. A head transplant would be more feasible if we could solve the issue of spinal cord regeneration. I do not see this happening in our lifetimes. A combined transplant of both the head and the spinal cord is our best option at this time."

Joseph sat and sipped his tea. When he spoke again, the topic was his own health. He said, "My kidneys are failing and I will need to start dialysis soon. It seems that every new medicine that we try to control my arthritis ends up destroying something else."

Henry's response was automatic, "You should just have a kidney transplant."

Joseph smiled and said, "My liver is severely damaged also."

With a little more reserve Henry said, "A liver transplant too."

"I also have a progressive myocardiopathy and pulmonary fibrosis from the medication. I have lost most of the feeling in my hands and feet from the peripheral neuropathy caused by the rheumatoid arthritis. I live with a constant burning sensation in addition to my joint pain."

All Henry could say was, "Shit, you need a new body."

Joseph agreed saying, "Our work for the past 10 years, here at the institute, has been in preparation of this. I knew that my body would fail, so I dedicated my efforts to making a transplant possible. I would like to be the first human to benefit from your research."

Henry objected saying, "We are not ready for human trials."

Joseph nodded in agreement but responded, "Henry, we may not be ready for human trials but I am dying. This body is so destroyed, despite the best medical efforts my money can buy, I live in constant pain. My weight has dropped to 93 pounds even with all of the metal implants I have. I can no longer even go to the bathroom by myself, and have not been able to walk for several years. I am ready."

Henry countered, "It would be unethical to perform the surgery because of the inherent dangers." He added, "Besides, I would hate to lose you."

Joseph smiled and said gently, "I greatly appreciate your concerns, but I am dying. Without your surgery I will die within a year or two, with your help I may live. The chance to live, makes the risk worthwhile."

Henry said, "We should wait until we can perfect the vascular connectors."

Joseph shook his head no and said, "The only thing left functional is my mind. If I go the route of dialysis and multiple organ transplants, I will almost certainly lose some of what I have left. My slow death is accelerating and I am willing to gamble on a chance to live."

Henry finally objected, "I'm afraid to lose someone I consider a friend because of my surgical limitations."

"I have no argument other than to say that you are the best. I trust you and your work. I ask that you do not condemn me because of your own fears. It is my life to risk and I just ask that you do your best. President Grant died a horrible death because his physicians were afraid to operate on him to remove his throat cancer. The surgery was being performed with success, but there was some danger of dying from surgical blood loss. Their fear of losing the former 'President of the United States' during surgery cost him his only chance for life. Please do not allow your fear to cost me my chance to live."

"Can I think on it?"

"Absolutely."

Joseph then brought up another sensitive issue. He said, "Henry, you and I have disagreed about the institute's 'Preferred Recipient Status'. The endowment that has resulted from this program has allowed us to greatly expand our 'Bereavement Settlement' program and allowed a dramatic increase in research funding. Is there any way of making you more comfortable with this program?"

Henry replied, "Preferential treatment seems unethical. I must admit the institute's program has resulted in a dramatic increase in organ donations. In a perfect world a'>Bereavement Settlement' program would not be required. Everyone should be willing to act as a donor and organs should be used according to need. The ideal was not working and the institute's program has been a fantastic success. The realist in me says the end justifies the means."

Joseph accepted this position. He quietly said, "I will be putting my name at the top of our recipient list. I was hoping that you would be willing to accept this ethical dilemma. I know utilizing my position is not fair. This organization was built to meet my own needs in addition to benefiting society in general."

Henry said, "I would not deny you the right for preferential treatment considering all that you have done. I know that the institute's policies are not perfect, but they're practical."

Henry began thinking about all the requirements a donor would have to meet and was lost in his mental review for several moments. When he returned to the present Joseph smiled and said, "You have been thinking. Are you ready to share your thoughts?"

Henry replied, "I was thinking about the specific requirements that a donor would have to meet. The fatal injury would have to be limited to head trauma and the donor would have to be kept physiologically alive for the transplant to be successful. The tissue match needs to be good and the donor in good general health. A young but mature body would be required to prevent any growth of the spinal column which would damage your spinal cord. Size would also be a critical concern because the spinal cords need to be of equal length. We may need to use a female donor to match your spinal cord length. "

Joseph nodded in agreement. He said, "I need a healthy body and at this point I do not care what sex it is."

Henry's response was a simple, "Why not?"

Joseph said, "I have missed most of the experiences people associate with living. My disease and treatment have left me not only sterile but essentially asexual. I may never be able to experience the high of climbing a mountain, so I will settle for whatever life experiences I can get. My goal is to live my life to the fullest. I am making the choice to seek life and want to experience as much of life as I can no matter which gender I end up as." Joseph was some what embarrassed by his declaration and started to apologize.

Henry interrupted, "You need not apologize. I forget the freedom of movement and activity I enjoy. Whenever I am with you, I become more thankful for the health I have. I have not yet agreed to proceed, but I will honor your wishes if we do."

The meeting ended with some general discussion and Henry's pledge to let Joseph know in two days. Henry left the office and noticed that it was exactly 10 A.M.. He smiled at Mary and said, "Right on time." Mary waved to him as he departed the office. The rest of the day passed in a fog. His attention kept returning to Joseph's request. He spent the time driving home arguing with himself about the ethics of performing the surgery. The commotion of his young children managed to keep him centered in the present for a while. After the household had settled down, he shared Joseph's request with his wife.

She responded in her very straightforward fashion, "Joseph's request is very reasonable and you should help him if you can." She was not at all bothered by his gender neutrality. She said, "Men place way too much importance on their sex. Living as a women, would be better than dying as a man."

Henry had trouble sleeping because of a recurrent nightmare. He kept visualizing the surgery which was complicated by massive bleeding. The dissected head of Joseph was telling him, "Henry, you need to control the bleeding." When he awoke in the morning, he felt exhausted from working all night. It was not until he walked into the operating room that he returned fully to the present. The concentration of surgery allowed his mind to hide from the decision he had to make. The evening hours were again filled with his personal debate about Joseph's request. He knew that his colleagues would consider the procedure unethical mostly because of the surgical risk. Professional jealousy would be a component of their disapproval. He was bothered less by this than the nightmare. He was not sure how he would live with himself if the surgery failed.

It was his wife's astute reasoning that allowed him to sleep more soundly. She said, "Is it more important to help someone in pain or to worry about what your colleagues will think?"

He countered, "I took a vow to first do no harm."

She replied, "It would seem that allowing someone to die in pain and loneliness because of your fears would be worse than losing the patient in surgery."

Henry knew that his wife was right. He could think of many academic arguments, but knew in the end it was a choice between Joseph's potential for life and his fear of failure. He decided to try.

He sleep was better. He called Joseph first thing in the morning. He tried to summarize the ethical dilemma, but had trouble making the arguments seem significant. Once he had made the decision it was much more obvious how the dilemma was based on his own fears of failure. He finally said, "I will try."

Joseph's response was a simple, "Thank you."

Henry started to discuss the issues of obtaining an appropriate donor. Joseph interrupted him saying, "We have an organ procurement department. They can handle this task. I will make sure my affairs are in order. You need to concentrate on making sure the surgical details are looked after." Henry was glad someone else had the job of securing the donor.

The director of procurement was not surprised when Joseph called. Joseph's calls usually meant that a high-profile patient required a specific tissue match organ. It was his job to find the organ that was needed. He had established a network of contacts in most of the trauma centers. His ability to offer families a significant "Bereavement Settlement" had made his task relatively easy. This request was more complicated. The donor had to be a very small adult between the ages of 18 and 35. The genetic analysis had to be free of significant abnormalities. The general health had to be excellent without any spinal injuries or arthritis. The tissue match characteristics were not too difficult. He was authorized to offer their highest level of "Bereavement Settlement."

She was a junior at a small western college. It was a beautiful spring day and the offer for a ride on the motorcycle was too good to pass up. She was young and free and did not need to wear a helmet. It was an exhilarating ride until the truck pulled out in front of them. She did not have time for fear. The motorcycle struck the side of the truck at a high speed. Her future was ended, and with it the family's dream of a daughter moving out of poverty. Her massive head injuries insured her death. The strength of her youth kept her alive for transport to the hospital. The physiological life of her body was maintained with a respirator, but there was no hope for her. It was a parent's worst nightmare. The family, in shock, was not able to consider donating their daughter's organs for transplant. They wanted their tragedy ended. They could not afford much of a funeral. They would do their best.

When the director of organ procurement received a call regarding the patient status, he mobilized his team. The local agent requested an opportunity to meet with the family. She very sincerely offered her condolences and shared the concerns of parenthood. She then discussed the possibility of a "Bereavement Settlement" with them. She assured them that only the needed organs would be used, and the remainder of the body would be returned for burial or cremation. When the family realized this person was sincerely offering to help, not only with the funeral, but also by providing $100,000 as a "Bereavement Settlement," they reconsidered. They did not want to "sell" their daughter's body, but the money would allow them to send their other children to college. They agreed, and asked only that their daughter's remains be cremated, and returned to them for a funeral. The agent was able to assure them that the cremated remains would be available in 48 hours for the funeral. They were satisfied and arrangements were made. Joseph's well-organized staff expedited the transfer of the donor body on full life support to their transplant center.

Henry received a call at 5:00 A.M., notifying him that the donor would be arriving in three hours. He was happy that the call had come in the early morning. He had slept without worrying about the surgery. His wife did not usually hear the telephone at night; she was tuned to the sounds of her children. This early morning call did awaken her and she asked, "Do you have to go in?"

Henry replied, "I will have to leave earlier this morning. Joseph's donor body is on the way."

"I'll make you breakfast, while you get ready. We need to do everything possible to ensure success for Joseph." Henry enjoyed the breakfast with his wife. The absence of their children gave them time to talk about the risk Joseph was taking. Henry still had his doubts, but his wife insisted that Joseph deserved the chance. Her reinforcement always boosted his confidence. His drive to the center was strictly on autopilot, as he reviewed the surgical protocol in his mind. He had learned from his college football coach that visualizing successful completion of a task was the most important step toward accomplishing a goal. He had carried this lesson forward in his professional life with good results.

The donor body arrived just ahead of him. He went directly to the intake room for his personal examination of the donor. He knew that the procurement team had already completed all of the genetic and blood testing. His examination was meant mostly to satisfy his own requirements for health status and size suitability. He ignored the grizzly evidence of head trauma and concentrated on measuring the length of the spinal column to make sure that it was compatible with Joseph's spinal cord. The donor was an athletic appearing small female without obvious deformities or surgical scars. He reviewed the MRI scans. The radiologist had measured spinal cord length and documented an acceptable match. Henry could see no reason not to proceed.

Henry called Joseph's office and was a little surprised when Mary answered the phone. He said, "You are up early this morning."

"As are you, Doctor. It is an exciting day."

"May I speak to Joseph please?"

Mary replied, "He has been expecting your call. I will put you through."

Joseph answered the phone almost immediately and said, "Good morning Henry, I hope that you had a good rest. I assume everything is 'a go' for today."

Henry replied, "I am satisfied with the donor and the anatomical fit. It is a female body. I need to make sure that you really want to go ahead with this. Ethically I must review the procedure, risk and possible alternatives with you."

Henry, I appreciate your concern and I do not care about the gender as long as all other parameters are acceptable. I think that I understand the procedure and risk as well as anyone. I see no viable alternatives. I am ready to proceed. Are you ready?"

Henry said, "I do not suppose it is possible to ever be fully prepared for something like this. I have reviewed the procedure hundreds of times in my mind. I see no way to be more prepared until we have developed improved technology for performing the vascular connections. I am ready to assume the responsibility for your surgery. I am still scared of failure, but I will do my best."

"All anyone can ask is that you do your best. It is my decision to proceed, and I do not want you to bear any guilt if the surgery is not successful. I have run out of time. It is best that we proceed now."

"My wife asked me to tell you that she is keeping you in her prayers and agrees with your decision. If prayers do work, we can use the help. I will notify the OR crew to proceed. I would expect that they will be ready for you in about two hours."

Joseph simply replied, "Thank you."

Henry entered the operating room before scrubbing, just to make sure everything was ready. They had the finest surgical crew in the country. His assistant surgeon and the surgical fellows were very capable. They had pushed the technology of vascular and nerve connections way beyond any other center. Just being in the operating room bolstered Henry's confidence. He asked, "Is everything ready?"

The anesthesiologist had already changed the life support system of the donor over to his operating room equipment. He said, "She is stable and I am ready." The chief nurse gave him a thumbs up sign. His assistant surgeon nodded in the affirmative.

Henry said, "Finish prepping her and I will get scrubbed."

Henry spent 10 minutes scrubbing his hands. He used the time to visualize the entire procedure in his mind one more time. He entered the OR with his hands held high in front of him with the water dripping off his elbows. The surgical nurse draped a sterile towel over his hands and he proceeded to carefully dry them from the fingers to the elbows. She then held out his gown and he slipped his arms through the sleeves. The circulating nurse tied his gown in the back as he pushed first his right hand and then his left hand into the surgical gloves. The nurse held the outer gown tie as he rotated in a circle. He tied a simple knot to secure his sterile cocoon and he was ready. They had already draped the donor with adherent plastic sheets that formed a continuous seal around her. He stepped up to the table and before starting said a silent prayer, "For Joseph's sake, let this go well." Out loud he said, "Operating on dead people who are still alive is more than a little strange, but it is the task before us. You are the best surgical team in the world. With your help maybe we can give Joseph his new body."

Henry held out his hand for the scalpel. The OR nurse placed it in his palm ready for use just as she had done a thousand times before. They worked well together and Henry almost never had to ask for anything. He simply held out his hand and she placed the proper instrument in it. This teamwork not only speeded up the surgery, but it also allowed Henry to keep his attention focused on the operation. Everyone had their own duties and it was the smooth integration of their efforts that made this surgery team special. They chatted about a variety of things and the jokes flowed freely. During critical points in the procedure the crew automatically assumed the appropriate serious mode and only the quiet sounds of the respirator could be heard over the sounds of the classical music playing in the background.

Henry made the horizontal neck incision which was extended into a flattened "W" on each side of the neck. The skin flaps were elevated and the muscle insertion points identified. The neck muscles were divided, preserving the attachment points for the transplantation. The vagus and phrenic nerves were identified and anastomotic clips were placed. These clips held a special computer chip which would be monitored and identify the matching nerve clip. These clips also contained the nerve regrowth stimulating compounds. The major vessels of the neck were freed from the surrounding tissue. The vascular clips were placed and the vessels divided. The donor's head was now deprived of all blood, and life was maintained in the body only by mechanical support, and the intrinsic capability of the organs to continue functioning. The large brachial plexus nerves extending into the arms were identified and the appropriate nerve clips applied. The thyroid gland was freed from the underlying trachea and left attached to the body. The larynx was cut free of the trachea below the cricoid cartilage. The breathing tube was reinserted into the open trachea. The esophagus was cut inferior to the trachea to help prevent scarring.

Henry stretched as they used an x-ray to document the C7-T1 vertebral junction. The spinal column was divided at this level. The spinal cord was amputated. The posterior dissection of the muscles proceeded quickly and the final skin incision was made as an inverted "V" to help reduce scarring. Seeing the human head cut free from the body made even this highly trained crew shudder. Henry tried to ease the tension by saying, "Remember, she was already dead." They passed the donor's head off the table. It was sent to the funeral home for cremation and return to the family for their funeral service.

Henry began the delicate task of freeing the spinal cord from the backbone. He inserted a special endoscope and carefully identified each thoracic nerve. The nerve was clipped as it exited the spinal cord with the coded nerve clips. Working in this confined space was a challenge they had only partially overcome with instruments they had developed. The spinal cord was nourished with multiple perforating vessels which had to be carefully freed from their attachments and secured with the vascular clips. The dissection continued inferiorly to the large lumbar and sacral nerve plexus. They used a nerve stimulator to identify specific branches of the plexus, before placing the clips and cutting them. The coded nerve clips were again used. With gentle traction Henry was now able to remove the entire cord. He inspected the sheath which had contained the cord and was encouraged to see he had managed the removal of the cord without damaging the sheath. The donor was now ready.

Henry turned his attention to Joseph. They had divided the large operating room into two sections for this procedure. Joseph had already undergone his anesthesia, and was prepped and draped for surgery. They had difficulty inserting the endotracheal tube because of his severe deformities. The anesthesiologist had to use a flexible endoscope to pass the tube through Joseph's nose and into his trachea. An infusion of alcohol was used to prevent gelling of Joseph's blood. The alcohol concentration in Joseph's blood was increased to 0.3 percent. The anesthetic agents had to be reduced to compensate for this high-level of intoxication. The next step in preparation was a significant cooling of Joseph. This severe hypothermia added to the anesthesiologist's problems. They used high levels of anti-inflammatory drugs to further protect Joseph's brain. It was time for Henry to begin.

Henry looked down at this small crippled figure in front of him and thought, "I sure hope I am up to the task you have assigned me." He looked up at the anesthesiologist and asked, "Ready?" Hearing a positive response, he placed his hand palm up and the surgical nurse placed the scalpel in his hand. He now duplicated the neck incisions in an inverse fashion that he had made on the donor. He divided the muscles of the neck at their insertion points. He cut through the trachea and esophagus, taking great care to identify and preserve the nerves to the larynx. The phrenic nerve to the diaphragm was identified on each side. The nerve clips were applied for anastomosis and pacing to allow Joseph to breathe fairly naturally until nerve regeneration occurred. The brachial plexus branches were now visible and he applied the coded nerve clips before dividing the nerves. The anterior spine was now visible and he identified the first two thoracic vertebra. Using an air powered drill with water cooling he began removing the vertebra. The bone was soft and very weak from the steroids and other medicines Joseph had taken. He was able to drill away most of the bone in a few moments, and gained access to the spinal cord. After he had freed the spinal cord sheath from the bone anteriorly, Henry made a small incision for his surgical endoscopes. He was able to identify the thoracic nerves, and applied the nerve clips distal to the ganglions. Henry made sure that he left as much nerve attached to the cord as possible to facilitate rejoining them with the donor's nerves. The vascular perforators were treated with the vascular clips as they had been with the donor. Henry was swearing under his breath because of the arthritic narrowing and curvature of the spine frustrated his surgery. He was having trouble with the dissection of the lower lumbar and sacral nerve plexus. A different approach was needed.

He decided to open Joseph's abdominal cavity and approach the lower cord directly. The additional surgery slowed his progress, but he had no choice. His animal work had shown that the cord would survive for only 90 minutes, despite the cooling, once the perforating vessels had been clamped. Only the lowest perforating vessel remained and 35 minutes and already passed. If this one remaining vessel was not adequate to feed the spinal cord, the surgery would probably fail. Henry wasted no time in opening the lower abdomen and exposing the "Y" split in the aorta. He cut through the skin and abdominal muscles with one stroke of the scalpel. The intestines were simply placed in a retractor bag and held to the side. The fascial attachments were divided without regard to fixing them. His goal was to save the nerves. Everything else was worthless. He worked on the lower lumbar vertebra which were now visible. The bone drill quickly cut through the vertebral bodies exposing the spinal cord sheath. A small opening was again made which allowed the scopes and instruments to be inserted much more easily. The nerve stimulator was again used to identify specific branches and the corresponding nerve clips used. Henry now clipped the last remaining vascular supply to the spinal cord. The spinal cord was now free, and with luck, would tolerate the time required to reconnect the vascular supply.

Henry almost mechanically completed the dissection of the neck muscles and attachments posteriorly. He divided the bony ligaments which connected the C7 vertebra with the T1 vertebra. The only thing left connecting Joseph's head and body were the vessels. The two surgical tables were now placed head to head. The right carotid artery on Joseph was cut and a bypass tube inserted which had already been placed in the donor's right carotid artery. The clamp was removed and part of the blood feeding Joseph's brain was now coming from the donor. The right jugular vein was then connected in a similar fashion, allowing a return and mixing of the blood. The right vertebral artery was now connected. The right sided vessels were functioning, with the bypass tubes connecting Joseph's brain with the donor's body. The left sided vessels were then connected, using the same technique. Joseph's brain was now dependent solely on his new body for nourishment.

Henry began the delicate task of actually pulling the spinal cord out of the sheath. By using the inferior access he was able to use his endoscopes to help mobilize the cord as the body was slowly pulled away from its head. The head and cord were rotated 180 degrees, and Henry began inserting the cord into the spinal sheath of the donor. Passing the cord was like trying to push wet spaghetti noodles through a straw. He used saline irrigation to help float the new cord into position. The coded clips were used to connect the inferior nerves. As the clips were brought together, a sound signal was generated from the monitoring device, indicating whether it was a compatible clip or not. The inferior vascular perforating vessels were then approximated using the vascular clips. This produced some bleeding from the central portion of the cord, which was a mixed blessing. Bleeding proved that the vascular connections were working. It also complicated the surgery by obscuring Henry's vision. When the critical central perforating vessels were reconnected Henry stopped working and stretched. The nurse placed a straw under his mask allowing him to drink a glass of orange juice without contaminated his sterile status.

Joseph's thoracic nerves were then connected using the coded clips. When Henry was able to begin working on the brachial plexus nerves he relaxed. It seemed almost easy working in the open. The vertebral bodies were stabilized with rigid titanium plates. The plates attached with special screws. The healthy donor vertebra required Henry to drill holes and tap the holes for the threaded screws. Joseph's vertebra did not have enough strength for traditional screws. A coarse screw which looked like a simple wood screw was required. The esophagus was reconnected, then the trachea. The phrenic nerves were connected. A sensor was placed on Joseph's nerves and a stimulator was placed on the donor nerves to allow him to breathe in a normal fashion until nerve re-growth took place. The vessels were now connected directly and the bypass tubes removed. As Henry and his team began repairing the muscle attachments, the alcohol infusion was decreased slightly and the cooling moderated. It had seemed strange to Henry to be working on such cold tissues. Closing of the skin and subcutaneous tissue was performed in a mechanical fashion because everyone was tired. The drains were connected and dressings applied. Henry removed his gown and gloves. The anesthesiologist directed the crew in the move from the operating table to the bed. They used the sheets and a small transfer roller to move Joseph into the bed. Great care was used to prevent any bending of the neck during this move.

The operating room supervisor said, "The name Joseph no longer fits. I think we should use the name Jo." Everyone agreed. Jo was taken to the intensive care unit. Deep sedation and alcohol perfusion continued as the body slowly warmed.

Henry went to the surgical lounge and sat drinking a cup of coffee and eating chocolate cookies. He knew that he would get a pounding headache from the combination, he needed the sugar and stimulation. Six hours had passed almost instantly. His intense concentration had produced a "Runners High" and now he had to pay the price for the adrenaline rush. He let the surgical fellow complete the paperwork. Henry left to finish his coffee in the ICU. Jo was now connected to all of the monitoring equipment. The brain waves remained slow. The strength of Jo's young body was evident with the stable blood pressure and pulse. Henry hoped this strength would be enough for healing to occur. There was not really anything for him to do, so he just watched and kibitzed with the nurses. Jo was stable and Henry had done his best. He knew this, but leaving and returning to the pile of paperwork in his office just did not seem right. He finally remembered that he had promised to call his wife. Suppertime at his house was punctual at 6 P.M.. She ran a tight ship. It was almost seven o'clock.

When his wife answered the phone, he started to apologize for not calling sooner. She interrupted him by saying, "Henry, for God's sake, I know you have been busy. How did the surgery go?"

Henry replied, "The resection of Joseph's cord was difficult because of his deformities. The transplant went well otherwise. Jo seems to be stable."

"Who is Jo?"

Henry explained, "The donor was a young woman. It seemed natural to start using the name Jo."

She replied, "This should make for an interesting outcome. Will you be coming home tonight?"

"I should be home by 10 o'clock if everything stays stable. If not, I will call you. Give the kids a hug for me." Henry tried to do some paperwork, to no avail. He realized he was hungry and the Advil he had taken after surgery, was wearing off. He decided to head home and stopped for a hamburger on the way. He had no sooner walked in the door at home, when his beeper began summoning him. It was a simple question about the drains. It was enough of a scare to again raise his adrenaline level. He tried to relax by reading with minimal success. Henry's sleep was interrupted by many dreams one of which caused him to awaken in a sweat. His previous nightmare of Joseph's head telling him to control the bleeding was replaced by one where it asked him, "Are you sure you connected the nerves in the right order?" He got up and called the hospital to check on Jo. Everything was stable. His last few hours of sleep were less stressful. His kids knew that he had worked late, but his promise of discretion prevented him from sharing his accomplishment.

The next few days Henry almost lived in the ICU. He would make it home in time to share supper with his family, only to return in the evening for one final check on Jo. Whenever he awakened from his recurring dream, he would call and check on the status of Jo. By the fifth day, the alcohol and barbiturate levels had been dropped to the point that Jo regained consciousness. Awareness was intermittent, but the brain wave pattern showed a significant improvement. Henry tried to explain her condition, and she seemed to respond. He began to feel real hope. On the 7th day, Jo was weaned from the ventilator. When the breathing tube was removed, she had significant coughing and some bleeding from her nose. When these things settled down, she tried to talk. The phrenic nerve stimulators allowed her to breathe, but she had to learn to control her breath for speaking. Her speech had a staccato pattern, limited to only a few words per breath.

Her first words were, "Henry, thank you. I have...no pain."

Henry explained, "You are of course paralyzed and without sensation below your neck. We will have to wait and see how effective the nerve re-growth is."

Jo replied, "You do not... understand. For the first... time... I do not hurt."

Henry was amazed at Jo's rapid recovery. Almost all of his previous patients were older individuals. Operating on a young healthy body with its tremendous healing capacity was a new experience. Rehabilitation was begun almost immediately with electrical stimulation of the muscles to preserve them. Jo quickly progressed to using her computer with voice commands. She required 24-hour nursing care, but was assuming control of her life.

Word gradually leaked out about the surgery. The Institute was bombarded with requests for information. The public relations Dept. shielded Henry and Jo from this publicity. It was only after Jo began to interact using video-conferences that the identity of the transplant recipient was made public. She refused all interviews.

Jo had her hands full trying to learn what it meant to be a woman. Henry watched the transformation, and used his wife's advice to help. The private nurses did their best to help, but it was a struggle. Everything was a little different. Even her eyeglasses had to be changed to fit the new image. Henry suggested that Jo allow a dermatologist to use a laser to speed the regression of her beard. The facial hair was just beginning to change because of the change in hormonal stimulation. Henry found it hard to interact with Jo as a woman when she had a beard shadow. Jo agreed to the change and put up with the discomfort.

Soon, Jo was navigating in a motorized wheelchair she controlled with subtle head motions and voice commands. Henry was discussing her progress, and asked Jo if there were any other problems.

Jo responded, "I had a major problem this morning. I noticed a blood spot on the floor when I moved my wheelchair. I thought I was hemorrhaging. I called my nurse and she told me I was having a menstrual period. She plugged me up with a tampon. Knowing about menstruation and experiencing it are two different things."

Henry asked, "Did you notice any of the premenstrual symptoms?"

"I had been feeling irritable. I suppose my paralysis prevented me from enjoying the physical signs. I wanted to experience life. This just happens to be part of life that I had not planned on experiencing."

Henry was trying not to laugh without much success. He said, "We can fix this if it is too much of a bother."

Jo responded, "I'll put up with the hassle for now."

The weeks wore onto months and rehab efforts continued. When nerve testing revealed a return of function in the upper arm muscles, Jo had a party. It may have been the smallest party Henry ever attended. Despite Jo's improving health she remained reclusive. The party consisted of her secretary Mary, the private nurses, the rehab team and Henry. The highlight of the party was when Jo raised a toast using a glass taped to her hand. Her shoulder and arm muscles were strong enough to raise the glass, but she needed help to actually drink from it. A cheer arose spontaneously from the small crowd! Progress was much more rapid for the next several months as more nerves re-grew. Some of the connections failed, and Jo had some areas of numbness and other areas with a constant tingling sensation.

Henry awoke early with anticipation of the one year anniversary evaluation of Jo's surgery. His meeting with Jo was scheduled at 9:00 A.M. as customary. He enjoyed breakfast with his family before leaving for work. He arrived at Jo's office a few minutes before nine. Mary greeted him with a friendly hello and offered him coffee. She said, "Jo will be with you in a few minutes."

Henry smiled and accepted the coffee asking, "As punctual as ever?"

"We will see."

At 9:00 A.M. a voice over the intercom asked Mary to send Henry in. Henry smiled and gave Mary the thumbs up sign. He entered the office which now had a more feminine flare. The jumble of computer paraphernalia had been replaced by a single sleek computer monitor and fresh flowers. Henry had become accustomed to seeing Jo as a middle-aged woman with a young body. Her dress was a conservative business suite in a dark blue. This worked well with the slight graying of her hair which was nicely styled. Her greeting was genuinely pleasant and she asked specifically about his wife and their children. Henry updated her on the family. Jo asked about Henry's ongoing research and he summarized the status for her. It was then Henry's turn to ask questions. They had already decided that the one year anniversary would be the final assessment. Henry wanted to know the status of the nerve function.

Jo said, "I have enough arm and leg strength to walk with a walker. I have only fair sensation in my feet but pretty good sensation in my hands. The fine motor function is less than ideal and I am very clumsy. Most importantly though, there has been no return of the rheumatoid arthritis."

Henry said, "This has been a very dramatic treatment option for rheumatoid arthritis. I would prefer to think that we are now able to prevent the horrible complications you incurred. You should expect to get some further improvement in your fine motor skills. Your result is not perfect, but I am happy that you are doing this well."

Jo said, "I am now more mobile then I was before the surgery. The horrible fatigue that I suffered from is gone. Instead of being constantly cold, I am always warm. It is a joy not to be living in constant pain. Adapting to my status as a woman is an ongoing struggle."

"Despite watching you adapt, I cannot even imagine the changes that are required."

Jo replied, "I was the one who said that any suitable donor was acceptable. I had no idea how different it would be to be a female. The menstrual thing is just a very small part of the change. My mood swings have been hardest to adapt to. As Joseph, I ate very little. Now with this young body I need to eat all of the time, and I crave chocolate which I never even liked before."

As the meeting was ending Jo said, "One other thing, I'm pregnant."

Henry was very surprised and said, "I didn't think you were getting out."

Jo replied, "Artificial insemination."

"Why so soon?"

"I have a young body, but my pituitary gland is middle aged. The fertility doctors thought I was already starting to enter menopause. It was now or never."

Henry asked quietly, "Who is the father?"

Jo said, "I am. I made a deposit in a sperm bank before I started my first round of chemotherapy."

The End

Sacred Womanhood

James existed in a state of mental fog, awaiting his appeal. Time had lost its meaning after he was found guilty of a Class Three sex crime. He figured the old-timer was right and his food was laced with marijuana to keep him passive, but he was hungry. At times he would skip a meal just so he could think better. Facing the reality of the situation was not nearly as comfortable as remembering the wonderful times he had with Lori, before they were captured. They had stolen a wonderful six months, and despite his pending punishment it seemed worthwhile. He wanted to talk to her and hold her again, but all contact was forbidden after the guilty verdict was handed down. His image of her standing with tears streaming down her face as the judge read the verdict remained clear. She was obviously pregnant and he figured it was his child she carried, a child he would never be allowed to see.

The night he had been arrested, James had laid on the small bed in the darkened cabin with Lori nestled on his shoulder; her soft, regular breathing added to his sense of calmness. The settlement was primitive but they had been accepted without questions. The work in the settlement fields had been challenging, and he knew Lori had struggled with it, but even she had developed much-improved muscle tone. At the end of the day they had always found a little free time to spend together and enjoy the togetherness they had so desired. Lori had insisted they take the chance and live the promise they had made to each other to enjoy each moment together. As he had drifted off to sleep that night, he heard a pounding. The pounding on the door seemed to be part of a dream and he hadn't responded to it initially. Lori had awakened immediately and her urgent pleas to wake up made him respond. He called out, "What'd you want?"

"We are from the Reproductive Ministry, please open the door."

James said, "Shit, it's the sex police!"

Lori clung to his arm, "What are we going to do?"

Her question was answered as the door crashed to the floor. The blinding light from the floodlights prevented them from seeing the intruders. His hand shading his eyes as best he could, James stood up slowly. Facing the light, he lowered his hand and stared straight ahead, saying "What do you want?"

"Are you James Hildebrandt?"

"What if I am?"

"You are under arrest for the abduction of a member of the Sacred Womanhood."

Lori rose beside him, "James didn't abduct anybody, it was my idea to run away!"

The policeman motioned for his partner to lower the floodlight. James could now see the police were dressed in full riot gear, and knew there was no chance of resistance. Stepping forward, his black boots resounding on the plywood floor, the policeman ignored Lori's interruption, saying, "James Hildebrandt, as a citizen of Eros you have the right to obtain legal representation. You've been charged with violating Section 23 of the Reproductive Security Act, which establishes the rules of contact with those women identified as fertile and therefore automatic members of the Sacred Womanhood. As per this statute you'll be held without bail until your trial. Anything you say until your trial is subject to monitoring and could be used against you. Do you understand the charges?" James nodded his head in the affirmative, afraid his voice would quaver if he spoke.

"Say it!"

"Yes, I do."

The policeman's partner waved his hand, and two women appeared who began dressing Lori in the robe of the Sacred Womanhood despite her tears and protestations. He stood helplessly under the glare of the lights, altering his gaze from Lori to the police rifles, and back again. The women wrapped her in a perfumed cotton robe designed to cling to her feminine curves and accentuate her fertility. They had no sooner whisked his love from him when the policeman ordered him to get dressed, handcuffing his wrists roughly behind his back. Dragging him out to the transporter, they shoved him into the back seat and departed immediately for the city. James sat in the darkened seat in shock. His new life with Lori had ended so quickly, and now the dread began to set in regarding the consequences of their decision to ignore the rules.

James thought of the many late-night discussions he had with Lori before they decided to run away. They had fallen in love and planned on getting married. When it was determined that Lori was fertile, everything changed because then she became a member of the SW. Few enough girls survived infancy because of the estrogen-induced tumors, and only half of those that survived were fertile. The world depended upon these few fertile women for the future; unfortunately, James had chosen to fall in love with one of them. Lori was not willing to chance having James picked by the marriage lottery to be her husband, and he wasn't willing to chance losing her. They made the decision together to flee to one of the settlements where they would be able to live anonymously together. It had been a wonderful six months, but now the consequences weighed him down.

* * *

He stoically received the results of his appeal decision, which upheld the conviction. The next morning he was escorted to the prison operating room and an IV was started in his arm. The medication produced a slight burning in his arm as the injection worked its way through his system, forcing him to relax. When he awoke he felt no different until he rolled over and felt the dressing on his groin. He carefully reached below the covers and felt the dressing. The area was tender, but mostly there was nothing.

For the next several weeks, life continued in a fog, with his only periods of really clear thinking following his abstinence from a meal. Before his parole hearing, his thinking remained clear despite eating. The old-timer, who had befriended him, had said they would stop his medication for the hearing. It seemed an odd choice that he had to make now. He could serve the rest of his twenty-year sentence, stupefied by the very food he was eating, or he could accept the alternative. The old-timer was straightforward and told him to take the alternative and get out while he was young. It was going to shrink up and not be usable anyway, he explained. James wasn't sure that he could make the transition.

The parole board was more humane than the primary sentencing judge. They had a doctor present who explained in general terms how James would be transformed if he chose the alternative. His attorney explained the legal ramifications, but he was not really listening. They were offering him freedom as a woman or imprisonment as a castrated sex offender. There were too few women in the world anymore, and men needed companions and mates; society didn't need criminals.

James spent the next week arguing with himself. He had already noted some swelling of his breast and tenderness of his nipples, which the old-timer told him was because of the marijuana. He didn't like the change in his self-image and tried to imagine what he would look like with real breasts. When it was time to announce his decision at the second parole hearing, he was almost surprised when he heard himself say, "I will accept the sex transformation."

From that point forward his life changed. He was moved to in an apartment within the prison. A small support group of similar individuals met daily to discuss the transformations they were undergoing. The group was led by women who had already undergone the gender transformation. They gently nurtured the group, to help them accept their new status. This sexual re-education was designed to help them mold their identities into a new role and self image. The hormonal therapy accelerated the changes in James; his beard became softer and his breasts continued to swell. His clothing was now sexually neutral and his hair was allowed to grow.

His first transformation surgery was so minor, he didn't even realize he had taken the first big step. The doctors had cultured special nerve cells from his blood stem cells and treated them with special female hormones. The existing cells in the small vomeronasal organs in the front of his nose were destroyed and the new cells injected. He did not notice any change in his sense of smell, but the doctors kept testing him with different vials. The vials contained vague smells and he noted their level of pleasantness. Apparently something was changing because his score improved significantly over several weeks. The physicians had explained that the vomeronasal organ detected sexual pheromones. His change in perception of the pheromones was controlled by the most primitive part of his brain and he was not conscious of any change. He now just enjoyed sensing different pheromones; his brain was now more receptive to things female.

The cultural adaptation classes were designed to help them adapt to society's view of them as women. They practiced simple things like crossing their legs to learn a new muscle memory. Women were expected to be more refined socially and they practiced continually on the small differences. They were not forced to wear feminine clothing but encouraged to forgo their masculine preferences.

After his face recovered from the laser hair-removal treatment, James realized that not shaving wasn't so bad after all. He dreaded the next step, which was a minor surgery to insert the temporary breast augmentation prosthesis. The surgery was minor, but the change in his self-image was significant. He tried to hide his new anatomical prominence, but with the help of his support group he became less self-conscious. The breast implants were gradually expanded, stretching his natural tissue, which made it necessary to wear feminine clothing just for comfort sake. The next step was construction of the permanent breast using vascular tissue grafts from his abdomen. The surgery was much more complex and painful. As the swelling finally subsided and his new image became reality he prepared himself for the next step. His name was changed from James to Jamie. It was only a couple of letters but it signified his new status. Accepting this name was a major concession to his new reality.

Despite the many lectures on how they accomplished the next stage, it remained incomprehensible to Jamie. His last remnant of masculinity was to be surgically transformed into anatomically correct female genitalia. The surgery took several hours and when Jamie awoke, he was a she. The next several months consisted of ongoing training and several minor surgeries. Her Adams Apple was shaved and her voice raised by an operation on her larynx. Plastic surgery to refine her facial features completed the physical transformation.

The next stage of her transformation was learning to appreciate her new sexuality. The surgeons had carefully preserved the nerves during her reconstruction. Learning to appreciate and enjoy sexual stimulation to the point of fulfillment required not only physical retraining, but also a major mental transformation. She was not sure if she would ever fully adapt to her new status, but the counselors kept assuring her that not only would she adapt, but she would learn to thoroughly enjoy her new status

For Jamie, the final step seemed even more stressful than the surgery itself. One of the counselors took her on a shopping trip to the mall. She was so self-conscious that the stress was almost overwhelming. When she complained about the way men looked at her, the counselor smiled and reminded her that she was now a very pretty woman on a world of men. Women were special.

* * *

Jamie saw Lori sitting at the coffee shop where they had agreed to meet and ran toward her in stilettos, crying out, "Lori, it's me Jamie!"

Lori put down her coffee cup, "James is that you?"

"I'm Jamie now."

"My God, James, I can't believe it. You're beautiful. Everyone told me you were, but seeing you again like this is absolutely amazing." Lori paused, unsure of how she should act. This was the man she had loved and who had risked his life out of love for her. Now he stood in front of her, a woman. Tangled thoughts crowded Lori's mind as she tried to determine the best way to break her news to Jamie. "I'm sorry, Jamie, I will have to adjust to your new name. I still see James in your eyes."

Jamie paused, and glanced down to avoid meeting Lori's eyes, she tried to keep the conversation light. "I was so excited when I got the letter notifying me that my parole conditions were changed and that this meeting was set up. I haven't been able to sleep for the past couple of days."

Lori noticed the embarrassment and tried her best to encourage Jamie's confidence. "So what's it like, you know...being a woman?"

"Well, the surgical part of the gender reassignment wasn't so bad, but learning to think and act like a lady has been tough. Not being able to talk to you was the worst part."

"And are you doing OK?"

"Like they told me, women are special. I have a fantastic social life, and my career is going well. How have you been?"

Lori glanced around the café before answering. She wasn't sure whether Jamie knew that she had fathered a child. She looked Jamie up and down, from her stilettos to her swinging A-line skirt, to the low-cut V-neck sweater. Her hair was soft and dark, curling around her ears and framing her face perfectly. Lori recognized her own daughter in that face and continued, "I have four wonderful children and two of them are healthy girls. Sally is eight now, and, Jamie, she's beautiful just like you. The resemblance is stunning."

"I saw you were pregnant during the trial and I hoped the baby was mine. Is she?"

Holding back her tears, Lori responded, "Yes, she's ours."

Jamie looked down again. Rage flooded her body, then guilt, then sadness. She had fathered a child. She had created another life, the product of her love for the woman facing her at the café. She wondered how she would have reacted as a man. "Did your husband accept her?"

"Oh Jamie, I was so scared to go through the marriage lottery, but it worked out. I was grieving for you so much, that all I could do was cry, even in my sleep. Arthur, my husband, was kind and patient. He was a bit jealous during my pregnancy, but loved the baby right off, and has taken wonderful care of us. I didn't want to go on living after we were caught and they separated us, but with Arthur's help I made it. His only condition was that we have more children of our own."

"I spent most of my time, in prison worrying about you. I felt so worthless not being able to even comfort you. I'm glad they found you a good husband."

"Jamie, he is a good man and the best husband I could have hoped for. I mean, except for you, before your change."

Jamie's mind was filled with conflicting emotions. They had made the decision to elope together. Why was Lori granted a perfect life and she had to undergo the sentence alone? "Do you love him?"

"Yeah, the hormonal treatments they gave us worked and we bonded okay. I love him, not the way I loved you, but..." Lori looked up. She saw the pain in Jamie's eyes, recognized the jealousy and the hurt. They locked gazes for a minute, and Jamie finally smiled.

"Good." Lori exhaled with relief. They had connected again.

Jamie said, "But you haven't told me anything about yourself."

"Not much to say, really, I'm a full-time mom." Lori avoided Jamie's eyes this time. She wasn't sure how to approach the real reason that this meeting was scheduled.

"Are you feeling OK? You look a little thin."

Lori shifted in her seat, re-crossing her legs. "I'm not hungry much anymore. Would you like a piece of cake or a coffee or something? Here we are chatting this whole time and you don't have anything to eat or drink."

Jamie ignored the attempt to change the subject. She saw the fear in Lori's eyes and pushed for more information. "No. Why are you not eating? Lori are you ill?"

Lori looked up with amazement. How could this stranger recognize that? Then she remembered, this stranger was her true love. "I have a tumor," she admitted softly.

"Can't they fix it?"

"No, it's one of those damn hormonal cancers. The plague of the Sacred Womanhood never ends."

Jamie's heart sank. The medical care on Eros had been able to treat everything except for the diseases of the Sacred Womanhood. "Shit, this isn't fair. I finally get to see you again and now you're telling me that you are going to die."

"My dad always said that nothing was fair in this world."

"Is this why they changed my parole?"

"The Sacred Womanhood petitioned the court, on my behalf, for the change. I needed to see you again and ask you to do something for me."

"What? Anything!"

"The children need a mother," Lori said, her voice indicating the gravity of her situation.

Jamie was stunned. "Me? But Lori, I don't know anything about being a mother."

"I'll teach you."

"What about your husband?"

"Jamie, you're 27 now, I'm sure you can handle the responsibility. Arthur is going to need you after I'm gone," Lori pleaded, reaching across the table to take hold of Jamie's hands. It was their first physical contact in eight years and a rush surged through Lori's body.

Jamie resisted with fear and uncertainty. The physical contact unnerved her. "But what about my career?"

"Being a mother is the most important of all careers. The children, our child, needs you. Arthur and I will teach you."

Jamie let go of Lori's hands. She shook her head, looking around the café and imagining herself adopting yet another role in society. "I just don't know if I can do it."

Lori watched her, saying resolutely, "James, you have to. It's the best thing for everyone."

The End.

Molly

When she awoke, sunshine was just creeping into her hospital room from the window. The glare transformed the framed picture on the opposite wall into a mirror. Molly recognized her own reflection. But the perspective was wrong, like the distorting mirrors at the carnival. She was much too short. She was a tall woman, yet her feet pushed the sheets up only two-thirds of the way down the bed. Something wasn't right. "If I am paralyzed, my back must have been broken," she thought. Could I have lost that much height from a broken back?" She knew that her reasoning was off. The answer evaded her, and she drifted off to sleep again.

* * *

Two months earlier, Jack and Molly had sat on their sofa watching the evening newscast. Molly's interview with the TV crew was to be the final segment. Her work had become public knowledge with the filing of an FDA application for the use of their genetically engineered organs in humans. The local TV station asked for an interview with Molly regarding her work. She was more than happy to share her excitement about increasing the supply of donor organs using her genetically engineered orangutans as donors. The interviewer seemed friendly enough while she was giving it -- even playing a bit with Molly's oldest donor-orangutan, Miss Lucy. She now sat stunned as the TV newscast replayed the much-edited version. There was no correlation between the interview she had given and the interview she was witnessing on TV. As the interview finished, Jack clicked the TV off, without saying anything. Molly started to cry. "They make it sound like we are slaughtering orangutans for greed. They left out entirely my statement that sacrificing one of our orangutans will allow six humans to live. Why did they do that?"

Jack replied, "I suppose they need to generate controversy. It's much harder to sell good news than it is to sell conflict." He left unsaid the "I told you so" he had coming.

"I should've listened to you and refused the interview. What are we going to do now?" she asked, wiping her tears and trying to stifle her crying.

"What is done, is done."

"But Jack they're making us look like monsters."

"Molly, it would have happened sooner or later. We'll keep moving forward because we know we are right. I need to go to bed and get some sleep. We can deal with tomorrow when it gets here."

Molly usually had no trouble falling asleep, but tonight was different. She tried lying quietly by Jack's side to no avail. She finally got up and moved to the comfort of her study. She resumed working on the chemical structure of the neurotrophic growth factor for spinal cord regeneration. Concentrating on the complex chemical structure and the genetic code which would create it finally cleared her mind of the newscast. It was almost 4:00 A.M. when she slipped back into bed and fell asleep. Jack had been aware of Molly's absence from their bed. When he arose at 6:00 A.M., he knew better than to wake her. He prepared for the day and just before leaving gave her a kiss saying, "You had better sleep in this morning. I'll give you a call later." When Jack arrived at the research facility, a small crowd of protesters had already gathered. They were chanting and carrying placards with statements about animal rights being violated. Jack tried to ignore them as he drove through the security gate. He asked the security guard, "Have you called in reinforcements?"

The security guard said he did not think the protesters would be a problem. Jack disagreed, "Call in all available security personnel and notify the police department of the protest. I want this gate secure for our employees. Molly will be coming in later, and I would prefer if this demonstration could be dispersed by then.

"The protest grew in numbers and in emotion. Jack called Molly and tried to get her to stay home. She insisted on coming to work. Jack said he would send a car to pick her up. When Molly arrived, the several-hundred protesters were turning into an angry mob. The police secured an entry path to the security gate. The driver maneuvered slowly up to the gate. Molly slumped down in the back seat, trying to hide. Unfortunately, her nearly six-foot frame did not hide easily. When the protesters recognized her, their yelling increased in volume and vehemence. They surged forward against the police line toward her car. Molly's fear escalated when the crowd began throwing rocks at her car. By the time she made it through the security gate, it was all she could do to walk into her office. She just nodded to the other employees, afraid to speak, knowing she was close to breaking down and crying. She tried to work. First on her agenda were the forms she had requested to remove Miss Lucy from the donor program, due to a physical problem. But Molly was unable to even sign the papers. She got up and closed the door of her office and sat back at her desk, holding her head in her hands.

Jack finished the morning review and stopped by her office. She was still sitting with her head in her hands. He gently asked, "Are you okay?"

Molly replied without looking up, "Jack, all of these horrible things they're saying, maybe they're true."

Jack began rubbing her shoulders, silently supporting her. Molly let go and began to cry. Jack let her cry. As the sobbing moderated, he said, "Things will work out. We knew some people would object to our work. Some of them are sincere. Others are just looking for something to protest against. They have no trouble eating pork chops from hogs bred for meat production. If they wear leather or eat any meat, they're being hypocrites. Your work on the universal donor has the potential for saving thousands of lives each year. Saving lives is the essence of our effort."

Molly responded, "Maybe, if we show them how well we care for the animals, they will stop protesting."

"No, I do not think that is the issue. I think we should go away for a few days and let things settle down. Our PR department is working to counteract the distortions in the interview. Our security team is being beefed up. Things will be okay."

"Where will we go?"

"Let's go to Sun Valley. You can do some shopping and I can get in a little spring skiing."

* * *

Warren was having a tough time. His doctors wanted him to keep taking medicine and he was tired of taking medicine. His only remaining joy in life was sitting with his friend, Al. Al was one of the great apes at the city zoo. Warren would sit outside of his cage for hours talking to Al. Al seemed to enjoy Warren's company and Warren regarded Al as his only friend. When Warren saw the report on Molly's work, on his small black-and-white TV, he became incensed. He vowed to seek revenge for the wrong done to his friends. He methodically began collecting information on Molly. The Internet cafe provided him access to the information he needed. His goal was revenge. By phoning Molly's office and pretending to be a colleague, he discovered she would be in Sun Valley for the next two weeks. The next day he flew to the resort town and began stalking Molly.

Jack sat on the bench soaking up the warmth of the early spring sun while Molly shopped for the special trinket she wanted to buy for her mother. She liked the small tourist shops in the ski village. Watching Molly come out of one small shop only to begin immediately window shopping at the next shop, reminded him of the intensity at which she had pursued her idea of producing a universal donor species. She had overwhelmed him with her technical explanations of how it was possible to genetically engineer another species of primates to act as human organ donors. It was not the science but the business possibilities that had intrigued him. Their collaboration had grown from a business relationship into a wonderful marriage. She had the ideas. He had the ability to bring them to fruition.

Molly was studying something in the window and never saw the car veer off the road. Jack saw the car jump the curb, striking his wife like a giant battering ram. It pinned her against the building before bouncing back. Warren, dressed in an ape suit, jumped out of the car and began yelling, "Death to the killer of my cousins."

Jack ignored him, crossing the courtyard in a few steps, he was at her side as she slumped to the ground. Her eyes were still alive. She was barely able to breathe and fear showed in her face. He cradled her and waited an eternity for the ambulance to arrive. Meanwhile, the police had arrived, and were now pushing Molly's handcuffed attacker, who was still shouting slogans, into a squad car. The paramedics pulled up and moved Molly quickly into the ambulance and began resuscitation efforts as they raced to the hospital. Despite all of his power and money, Jack now felt helpless. He never had a chance to tell her that he loved her before she was rushed to surgery. Jack was left to wait.

The waiting room had the blandness of most hospital waiting rooms. Sterile fluorescent lights distorted the color of the mauve carpeting and chairs. He paced the length and width of the room repeatedly. Jack recalled the day he realized he was in love with Molly. They were sharing lunch and she was trying to slow the mental dynamo of her mind enough for him to follow her thoughts. Her dark hair was, as always, a bit unruly and her face without makeup, sort of plain. But her eyes were so intensely full of life. He was starring into those eyes when she asked him what he thought. He responded, "I think I am in love with you." For once she didn't know what to say.

When the surgeon, a Dr. Lampert, finally came out from surgery, the grimness of his face told the story. He made Jack sit down and in a flat, professional tone said, "We have controlled the major bleeding, but the injuries are massive. I am afraid your wife is dying."

Jack's look of disbelief was quickly replaced by a look of anger, and he asked, "What injuries are so severe you cannot fix them?"

"The crush injury to the chest has produced a severe myocardial injury, and her lungs have so much internal bleeding that breathing is all but impossible. She is already developing renal shutdown, and I had to tie off the hepatic artery to control the bleeding of her ruptured liver. She would require a heart-lung transplant, a liver, and probably a kidney transplant if she were to have any hope of survival."

Jack listened to him, his mind already working on a plan. He told Dr. Lampert, "Prepare Molly for bypass. I will have the organs here in two hours!"

Dr. Lampert objected, "I can place her on bypass, but finding one organ much less all of them in two hours is impossible. I think placing her on bypass will just prolong her suffering." His voice softened as he continued, "It would be better if you could accept the reality of her death."

"You get Molly on bypass and I will have the organs and the transplant surgical team here in two hours," said Jack, taking control.

"We can't let you bring in a surgical team that hasn't been credentialed here, let alone utilize organs of an uncertain origin."

"Doctor, your job is to place her on bypass and keep her alive for the next couple of hours. Have your hospital administrator meet with me about the credentialing and organ source."

Jack did not even wait for an answer, but immediately called his office and started giving orders. He told them to mobilize Harry's transplant team and a donor. They were to arrive in less than two hours and were authorized to procure jet transportation as needed. The coordinator asked him about the nature of the transplant. He responded, "Molly has been hurt and will need a multiple organ transplant. Bring the donor with the best antigen match."

The older hospital administrator arrived and was listening to the end of Jack's conversation. He presented a nice politically correct smile to Jack and offered his sympathies. He then proceeded to tell Jack, "Hospital rules were put in place to protect patients. Rules have to be followed."

"My wife is going to die unless she receives a multiple organ transplant. My company has developed a new species of primates to act as universal donors. I am prepared to make a grant of one million dollars to your institution, to use as you see fit, if you cooperate in this effort. My staff is forwarding the credentialing information to your office for my surgical team. I will take full responsibility for their efforts and will sign a release of liability for your hospital."

The offer of the grant made the administrator pause. He replied, "If the credentialing is in order and my chief of surgery agrees, we may be able to proceed." He continued speaking, but Jack was no longer listening. He was not a surgeon or a scientist but he knew how to get things done. Time crawled by as he waited. When Jack finally heard the sound of an arriving helicopter, he moved to the doorway of the ER entry to watch it land. He could not bring himself to leave the walls of the hospital to meet the surgical team. It was these walls and what they contained that kept his Molly connected to life.

He was relieved to see Harry, the chief of the transplant team, disembark from the helicopter. It was amazing that a man so large could be so agile. He ran from the chopper in the stooped fashion of those who had served during the Vietnam War. Harry saw Jack in the doorway and asked how Molly was doing. Jack just shrugged his shoulders and the tears welled up in his eyes.

Harry said, "I have been on the phone with the surgery crew and Dr. Lampert, and I will look in on her while the rest of the team gets set up." Harry proceeded to the operating room and quickly changed into scrubs. His reputation had preceded him, and they were ready with an oversize gown and gloves for him. He finished donning his surgical attire and approached the operating table, joining Dr. Lampert. The description that Dr. Lampert had given him was pretty accurate. Things had unfortunately continued to go downhill. The traumatic aneurysm of Molly's aorta was much more evident and had produced vascular compromise of the intestinal tract. The crush injury of the chest had shattered her spine and destroyed her organs, making her life dependent upon the bypass machines. Harry finished his inspection and removed his gloves and gown to visit with Jack.

Jack could not tell if the news was going to be good or bad because Harry was thinking and talking to himself as he walked up. He wasted no words and said, "Jack, this is worse than I thought. Molly will not survive an attempt at a multiple organ transplant. We may be able to proceed with the new protocol she had us develop in the lab."

Jack knew that Harry was talking about the series of head transplants they had performed on dogs. The thought of transplanting his wife's head and essence, onto the body of a genetically engineered orangutan made him sit down. He wrestled with the vision of his wife as she was before the attack with the image of how she would be if the surgery worked. He realized this image paled in comparison to living life without Molly. He knew instinctively that Molly would not be opposed. Her love of life mandated trying anything possible. He looked up at Harry and said simply, "Go for it!"

Harry nodded and turned back to the operating room, he began barking orders as he entered the doorway. The donor orangutan had been deeply sedated for transport. She was placed on the operating table by the OR crew. The anesthesiologist was somewhat hesitant to begin working on the orangutan, but when Harry bellowed, "Put it to sleep so we can get going," he injected the intravenous anesthetic agent and placed the endotracheal breathing tube in without difficulty. The nurses began to scrub and shave the orangutan's upper body in preparation for the surgery When the orangutan was fully prepped and draped, Harry stepped up to the table and picked up the scalpel. He incised the anterior chest wall skin just below the collar bone and around below the arms. Harry had a surgeon's touch and made everything he did look easy. The surgical team controlled the bleeding as he proceeded. He quickly dissected the clavicles and the pectoralis muscle group free from the chest wall. Harry was careful to protect the muscle insertion points which would be used in the transplant. He then began exposing the vessels and nerves of the neck. He carefully identified and preserved the major anatomical structures. He cut through the trachea and reinserted the endotracheal tube. After dividing the esophagus and the anterior neck muscles he was to the level of the backbone. He checked his identification of the C7-T1 disk and separated the spinal column at that level. His dissection continued posteriorly freeing the muscle attachments. He then continued the skin incisions and the head and shoulders were free of the body.

The surgical nurse passed the upper torso off without thinking about it, but the receiving nurse had all she could do to handle it. The company technicians took the torso to a back table and began the task of harvesting all usable tissue for further transplant use in other patients.

The donor was ready and Harry now turned his attention to Molly. He looked down at her shattered body and said, "Molly, I hope this is what you want, and I pray that you forgive me for what I am about to do." He picked up the scalpel with his huge hand and with the deftness of an artist incised through her skin. He again carefully freed the clavicle from the underlying rib cage and peeled the chest muscles free. He carefully freed the vena cava and the aortic arch from the surrounding tissue. He placed clamps between the bypass tubes and the heart itself. Molly's body was now dead and the bypass equipment was all that kept her essence alive. Harry worked rapidly, quickly freeing the rest of the tissues. He knew that she was already paralyzed, but cutting through Molly's spinal cord made him pause, he had never before done this on a human. The anesthesiologist started to ask what the problem was, but before he finished the question, Harry returned to work. He slipped the knife between her vertebrae and cut through her spinal cord. He completed his dissection quickly and had Molly's fractured body removed from the table.

The headless orangutan was now placed on the table below Molly's head and upper torso. The surgical team was working with such intensity that they did not react to the sight. Harry inserted a diffusion mesh between the severed ends of the spinal cords.

Dr. Lampert asked, "What is that pad for?"

Harry responded, "Molly has been working on a method of stimulating re-growth of the spinal cord using a diffusion through this mesh. Nobody ever imagined that she would be the first patient to try her new system." They used surgical titanium plates to re-attach Molly's cervical spine to the orangutan's thoracic spine. The pre-vertebral muscles were then repaired. With the two bodies now connected, Harry turned his attention to reconnecting the vascular system. He started with the brachiocephalic artery followed by the superior vena cava. When these major chest vessels were functional, he proceeded to the opposite side and connected the left carotid and subclavian arteries. He had been careful to protect the recurrent laryngeal nerves to preserve speech. He now connected the remaining portions of the vagus nerves together. The trachea and esophagus were closed using an auto-stapler. Harry took a minute to stretch and checked the EEG monitor.

The anesthesiologist noted Harry's attention on the monitor and said, "She has been stable throughout."

Harry just nodded and went back to work. He placed micro nerve stimulators on both phrenic nerves to stimulate the diaphragm for breathing, and carefully sewed them together. The remaining muscle tissues were repaired using the auto staplers.

It had been four hours of intense surgery and Harry needed a break. He excused himself telling his assistant surgeon, "Go ahead with finish fitting of the torso and closing the skin. I want at least six Penrose drains and as many suction drains."

After Harry left the room Dr. Lambert remarked, "I cannot believe how delicate of a surgeon he is considering his size and aggressiveness."

It took a few more hours to finish the surgery and insert all of the drains. The surgical crew was accustomed to seeing morbid things. Seeing Molly attached to the body of the orangutan all but overwhelmed their professionalism. As they transferred her to the intensive-care unit, they were careful to keep her covered so as not to shock other hospital personnel. They placed her in an isolation bed and carefully suspended her arms to prevent straining the new attachments. While the surgical nurse gave her report to the ICU nurses, a student decided to check Molly's heart and lungs. When she peeled the sheet back below the surgical dressing and realized she was looking at the body of an ape, she simply froze before passing out. The surgical nurse saw what was happening, but the student hit the floor before she could reach her. As they were reviving her the surgical nurse said, "This is why they want her in isolation, and we must respect her privacy."

Harry was sitting with Jack in the waiting room while the team finished their work. He told Jack, "Surgery went as well as we could expect, only time will tell if we were successful."

Jack thanked him saying, "Molly always said you were the best, Harry, and I appreciate your efforts."

They sat together silently. Harry finally interrupted the silence, "You know Jack, Molly's work on the universal donor and spinal cord regeneration are major advances in medicine. To think that a crazy terrorist could so easily take her from us is not right. I sure as hell hope we were in time to save the smartest person I ever worked with."

Jack responded softly, "So do I."

Molly received the anti-rejection drugs and was kept sedated on the ventilator. After 48 hours the sedation was gradually stopped. Jack sat at her bedside trying, for the first time in a long while, to pray. He stroked her gray-speckled hair and waited. Her long, thin face had the look of a stoic pioneer woman. It was the wonderful displays of excitement playing across her face that transformed it into a thing of beauty. Jack could still see this beauty even with the tubes and tape distorting her appearance. His silent watch was accompanied by the rhythmic air sounds of the ventilator. When she finally opened her eyes Jack saw only confusion and fear in them. She seemed to recognize his voice and touch. He tried to explain that she had been injured and had to have surgery. He told her that she would not be able to talk until she was strong enough to have the breathing tube removed. She seemed to calm with his voice but he could not tell if she understood him. She fell asleep again. When Molly awoke a while later she seemed a little stronger and was able to fix her vision on Jack. They tried to communicate by her answering with eye blinks and subtle head movements.

Harry stopped by to check on her. He asked, "Molly, I suppose you would like to get rid of this breathing tube?" There was no doubt in interpreting the look she gave him. Harry laughed his big laugh and said, "Well my dear friend, we'll test the phrenic nerve stimulators today, and if you can maintain your oxygen level the tube can come out tomorrow."

Jack left to get some needed rest. Molly was alone with her thoughts. Her thinking was clearing. She learned to not struggle because the nurses would inject her with medication and she would drift off to sleep. She needed to stay calm so that they would hold the medicine and she could think. She could feel her hands, and when she looked at them she could make them move. Her arms were supported by an apparatus which prevented any significant motion. She did not feel much pain. It was the lack of pain that made her aware that she could not sense the rest of her body. She tried to move her legs and nothing happened. She tried to wiggle her hips. Nothing. She checked her hands again and she could obviously move them. Now Harry's comment about the phrenic nerve stimulators made sense. She was obviously paralyzed from the shoulders down. How did this happen? She was an invalid. The thought made her cry and the anxiety raised her heart rate enough that the nurse came to check on her. She pretended she was asleep. When the nurse left, Molly again tried to analyze her situation. She said to herself, "Well, like the philosopher said, 'I think, therefore I am'. If my arms still work I will be able to control a wheelchair and a computer. I can still work." She felt sorry for Jack. Just when they thought that they were going to spend more time enjoying life, she gets hurt. Jack deserved a healthy wife. She forced herself to leave this depressing line of reasoning and resumed analyzing her situation. She could read part of the label on the IV infusion and recognized one of the anti-tissue rejection drugs. "I must have had a transplant of some sort. I wonder if they used one of our organs? I kinda hope so."

She dozed off. When she awoke, sunshine was creeping into her room from the window. The glare transformed the picture on the opposite wall into a mirror. She recognized her reflection, but the perspective was wrong, like a funhouse mirror. She was a tall woman, yet her feet pushed the sheets up only two-thirds of the way down the bed. "If I am paralyzed, my back must have been broken. Could I have lost that much height from a broken back?" she wondered. She knew her reasoning was off, and the answer evaded her. She slept for awhile.

When Jack arrived, she tried to ask him. She could not formulate the question using their simple code system. Jack could sense her frustration and said, "You'll need to be patient for a little while longer. Harry said that he would be by this morning to remove the endotracheal tube and you will be able to talk then."

Molly relaxed a bit. Waiting for Harry to show up and remove the damn tube irritated her. She wanted to know now. Harry's booming voice preceded his arrival as he kibitzed with the nursing staff. When he walked into her room he completely filled the doorway. He announced, "It looks like the tube can come out,"

Molly actually smiled. He carefully loosened the tape which secured the tube and said, "This will make you cough a little and might hurt some." With that he broke the small pressure reservoir tube and deflated the endotracheal tube. He told her, "Take a deep breath." He slid the tube out. She coughed and tried to breathe. The spasm of her vocal cords made the breathing even harder. The phrenic nerve stimulators were working, but it was not like breathing naturally. After several minutes she had regained enough composure to try talking. Her speech was limited to a few words per breath. She had only limited control of her breathing, which produced a very jerky uncoordinated speech pattern. She got her point across when she said, "I know-- that I am-- paralyzed-- from the-- arms down. I figured-- I had-- an organ transplant-- because Harry-- is here-- and I am-- receiving-- anti-rejection, drugs. How come-- I am-- so short?"

Harry and Jack looked at each other and both tried to talk at the same time. They deferred to each other without either talking. Molly waited with an impatient look.

Jack explained: "The local surgeon said you would need a multiple organ transplant. I called our office and mobilized Harry and his team. They brought a universal donor with them, the one you called Miss Lucy." Jack looked at Harry for help.

Harry continued, "Your body was so destroyed and your life was failing quickly, a multiple organ transplant would never have worked. We made the decision to utilize your new research protocol." He did not know how to continue.

Molly began nodding her head and said, "You combined-- Miss Lucy-- and me. We have-- become the-- first chimeric." Silence ensued for several moments. Molly continued in her broken rhythm, "Harry, I am glad-- you took-- the chance. Jack, I hope-- you can still-- love me-- this way."

Jack stroked the side of her face with the back of his fingers. He replied, "I will take you anyway I can. I was so afraid of losing you that I accepted the risk of surgery. I figured you would accept your new body."

Molly's thinking was still slow. She knew there was something special about Miss Lucy, but she could not remember what it was. She tried listening to Harry explaining about the surgery, but dozed off. When she awoke Harry was gone, but Jack was still there, he appeared to be napping in the chair. She started to think about how her mother would react, she then remembered what was special about Miss Lucy. She awoke Jack saying, "Jack, my love."

"Yes dear?"

"Jack, I remembered what was special about Miss Lucy."

"Hmmm."

"She is -- or rather, we are -- pregnant."

The End.

Harry's New Toy

By

Charles Kaluza, DO

They were no sooner in the air when Harry was told, "Commander, I recommend you try and get some sleep. Here's a sleeping pill to help you. There is a sleeping berth in the aft section for your use."

Harry replied, "I should get some sleep but I don't think I'll need the sleeping pill."

"Sir, the sleeping pill isn't optional. It is essential that you arrive rested with minimal jet lag. My orders are specific regarding the use of the sleeping pill."

"What's in it?"

"Sorry, I don't know."

Harry did as he was told but not without mumbling under his breath about the damn military. His mind was racing and he regretted the extra glasses of wine which still fuddled his thinking. He thought, "This is a hell of a way to ruin my long-delayed honeymoon. Shit, I hope Martha is doing okay. She's probably right about this being connected to that damn virtual surgery project, my "new toy" she called it. I should have never got involved with it, in the first place. Must be an important somebody to have the President activate my status to active duty." His thoughts rambled on with less coherence as the medication took effect.

Harry fell asleep, a deep and dreamless sleep without any concept of time. He became aware of his present reality only when he heard a calm voice repeat, "Commander, it's time to wake-up."

He opened his eyes to the sight of the Lieutenant Commander holding a cup of coffee for him. He asked, "Where are we?"

"We're 30 minutes out from landing. You'll be transferred to the hospital via helicopter."

"But where are we?"

"Commander, your mission doesn't require knowledge of the geographic location."

"How long did I sleep."

"You slept the designated amount."

Harry sat up and gratefully accepted the cup of hot coffee. He asked, "Can you tell me what my mission is?"

"You will be fully briefed when you arrive at the hospital. I do know the equipment you use has already arrived."

Harry put the cup of coffee down and said, "If they're expecting me to perform surgery I'd better skip the coffee."

Harry did not realize it was daytime until he walked out of the jet. The sun was low in the sky but he could not tell if it was morning or evening. He was looking over a military airfield which had the same vast blandness of most military airfields. A jeep was waiting for him and transferred him to a helicopter which took him to the hospital. The helicopter had no windows in the back and he was deprived of any visual clues to his whereabouts. When the helicopter landed, he was escorted immediately into the hospital through an unmarked side entry and down some stairs to the basement. The technician he had worked with at the University research lab met him. Their amicable greeting was short and the technician immediately led him to the quiet room. They repeated the now familiar head shave and Harry was helped into the virtual reality suit. "When is someone going to explain what we're doing?" he asked.

The technician said, "They told me to get you connected as soon as possible. Apparently they'll be briefing you through the virtual reality circuits."

Harry was still grumbling to himself when the shield on the virtual reality helmet closed and the system activated. He felt the tingling sensation of the neuro-sensors on his bare scalp and his sensory fields were flooded with colors, sounds, odors and touch sensations . He followed the setup protocol and moved his extremities through the required motions to calibrate the system. Harry became directly linked to the miniature robot. His every move would be duplicated by the robot and every sensation the robot perceived he would sense.

A caricature of an admiral greeted him as soon as the setup was completed. The admiral welcomed him and apologized for the unusual secrecy and urgency. He explained, "We have a patient with a leaking berry aneurysm of the brainstem. The angiographers cannot reach the site because of the tortuous vessels. The neurosurgical team is prepared to perform a major resection of the skull base in an attempt to reach the site. It is in the nation's best interest that this individual not undergo such a radical surgery. It is our hope that you can reach the site through a small burr hole using the micro-robotics."

Harry remembered enough neuro-anatomy to realize the difficulty of the task. He explained, "I am a laproscopic surgeon not a neurosurgeon. I don't feel qualified to perform this surgery."

The caricature replied, "Commander, this has been reviewed at the highest levels. Your ability with the virtual surgery equipment is established. The neurosurgical team is here to back you up. It is your mission to use the skills you have acquired to save this person's life."

"But, virtual surgery is still a research project. The technology isn't perfected. I've never done anything like this!"

"Nobody has, but you're our best hope."

"Who's the patient and is it even legal for me to perform surgery?"

"The identity is not your concern and the legal issues have been resolved by military council. As an officer in the United States Navy you are being ordered to serve your country in time of emergency. Do you accept your duty?"

"Yes Sir. When do we start?"

"The patient is already in the operating room. The neurosurgery team is preparing to perform the burr hole. You will have 20 minutes to review the anatomy and proposed surgical procedure. Any questions?"

Harry replied, "I'll do my best but I'd better make a trip to the head before we start."

When Harry returned to the virtual reality, he was immediately immersed in a three-dimensional MRI scan. Someone, a radiologist probably, guided him through the neuroanatomy from the temporal lobe down to the brainstem. He recognized the major vessels, and as they descended into the brainstem, a very well defined aneurysm. Harry realized how appropriate the term "berry aneurysm" was because this aneurysm look just like a large berry attached to a branch by a very small stem. A small blush was evident on the side of the aneurysm. He was told, by the faceless voice, that the leakage had decreased only when the patient's blood pressure was dropped significantly with medication.

Harry began to appreciate the difficulty in reaching the site. The vessels were small and twisted which prevented access of the angiography catheters. In order to reach the site directly a major portion of the skull base would have to be resected, resulting in significant surgical morbidity and a fair possibility of a surgical death. Even with the radical surgical procedure access would be marginal. Virtual surgery using micro- robotics did make sense. Having him do the surgery is what didn't. He asked, "Why can't one of the neurosurgeon's use the equipment?"

The admiral caricature returned and said, "We do not have time to train another surgeon. You are our only choice. If this aneurysm ruptures, the patient will die. If we must resect the skull base, our country will suffer. Commander are you ready to start?"

"Yes, Sir." Harry lost his pre-game jitters, it was time for the kickoff.

The entire virtual reality system activated. Harry found his virtual self inside the patient's head. He recognized the convolutions of the temporal lobe of the brain. He was walking on the stiff tentorial membrane which looked like glistening white burlap. He became aware of a voice directing him to move forward. Harry did as he was told. He could not resist reaching up and touching the soft substance of the brain just above his virtual head. The gray matter was covered with a soft velvety layer of the meninges which contained a lattice of blood vessels. The brain had the consistency of soft bread dough and the surface undulated into a pattern of sulci much like the texture of braided bread. The voice was telling him to angle more to his right. He moved carefully, immersed in the clear cerebral spinal fluid. The pulsations from the heartbeat were strong enough that every beat of the heart seemed to squeeze Harry. In addition another movement, a rocking sensation of the tentorial membrane was present. It was like the gentle swells of a protected ocean bay. Harry was immersed in silence except for the voice which was directing him. The exhilaration of actually being inside somebody's head and exploring their brain was awesome.

The voice said, "You should be able to see the tentorial notch, ahead on your left. I want you to follow it to the right until you come to the posterior cerebral artery."

Harry responded, "There is a rise ahead and then it drops off suddenly. I presume this is the tentorial notch. The space is becoming a little tight. Can you provide some traction?"

"We are already retracting the lobe as much as we dare. Can you make it?"

"It's tight but I can make it." Harry stooped his virtual self to move ahead. He was walking along the edge of a cliff. Up and to his right was the undersurface of the temporal lobe of the brain, which acted as a ceiling. To his left was a vertical tube that descended into an abyss which contained the brain stem and the spinal cord. As he looked up to the left, he saw nerves which appeared the size of telephone poles entering the substance of the brain. He came across a large vessel which looped around the edge of the cliff. The voice identified the vessel as the posterior cerebral artery.

The voice commanded Harry, "Follow the artery as it descends and connects with the basilar artery."

Harry did as he was told, climbing over the edge of the cliff and pulling himself along the artery. It felt as if he were crawling crossing a deep canyon on a log bridge which pulsated with every beat of the heart. His bridge was only a fraction of an inch long but to his virtual self it was a major crossing. He looked down and became dizzy. He concentrated on looking forward. He saw the artery joining others to form a large vessel. The voice identified it as the basilar artery and told him to keep going. He was now climbing down the brainstem and thought, "My God, this is the very essence of life. The brainstem evolved almost a billion years ago and has changed very little. It is the control center of all critical life functions." The surface was still covered with the velvety meningeal membrane but the texture of the sulci were replaced by a flat smooth surface.

He reached another branch of the artery and the voice said, "You are at the superior cerebellar artery. Follow it half way around the brainstem and you will come to the aneurysm." Harry turned and followed the smaller artery. He seemed to be half floating with poor traction and the resistance of pulling the connecting wires and micro-tubes was making forward progress difficult. His built in light illuminated the immediate area, but the region ahead curved and disappeared in darkness. He was sweating profusely from the exertion and excitement. His physical status must have set off an alarm because the voice told him, "Commander, take five."

Harry was happy to comply. He spent his rest just looking at the myriad of structures arising in the brainstem, each of which was essential for life. It was easy from this view point to understand why minor strokes at the level of the brainstem were so catastrophic. His rest period ended quickly and Harry returned to work. The space remained tight and had an obvious curvature. He crawled on his virtual hands and knees, half wedging himself between the artery and the brainstem, pulling the connections along. Harry was concentrating so hard on moving forward that he was startled when the voice announced, "You should have visual on the aneurysm now."

Harry looked up and saw a bright red beach ball attached to the side of the artery where another branch came off. He acknowledged the voice saying, "I have visual. The aneurysm looks very fragile."

Harry approached within touching distance of the aneurysm. It was pulsating with the heart beat and a trickle of blood revealed the small leak on the topside. The neck of the aneurysm was about the size of his virtual hands and the aneurysm itself was at least the width of his shoulders. The voice asked for several views of the aneurysm. Harry maneuvered his virtual self around the aneurysm providing a complete three-dimensional view. Close examination of the leak revealed a stream of blood cells arising from the microscopic opening. They were quickly diluted in the CSF fluid. It resembled a wisp of smoke arising from an old campfire.

His introspection was interrupted by the voice asking, "Commander, can you place a tie around the neck of the aneurysm?"

Harry responded, "I can maneuver a tie around the neck, but I am not sure I can tie a knot that will hold. Can we coat the aneurysm with TissueGlue?"

There was silence for moment before the voice responded, "Your irrigation system will plug if we use the TissueGlue first. We will pass you a special suture tie through the irrigation catheter. It works like the cable ties which slide in only one direction. You must wrap the tie around the neck of the aneurysm and insert the free end in the locking device. As you apply traction to the free end, the suture will tighten. After you have secured the neck of the aneurysm, we will use the TissueGlue."

Harry had used his virtual hands to explore the surface characteristics of his surroundings and to control the surgical instruments. He had never tried to do anything as delicate as placing a suture. The voice asked, "Commander, are you ready?"

"Ready," replied Harry, but his thoughts were much less certain as he tried to visualize using his virtual hands to control the suture.

The voice said, "We will be floating the suture through the irrigation port. Point the irrigation away from the aneurysm. When the end floats free of the irrigation port, you need to make sure that it does not tangle."

Harry dutifully pointed the irrigation port away from the aneurysm and watched the irrigation fluid create swirls in the slightly cloudy CSF fluid. Soon, a small rope began to float out of the irrigation port. Harry carefully directed the port so the rope would not tangle. His virtual image revealed a rope which was about twice the diameter of his thumb. He knew in reality it was a very delicate suture, finer than most sewing thread, but in his miniaturized world it was a thick rope. The connecting end did not float free of the irrigation tip. Harry did not wait for advice and began pulling on the rope trying to free it. It was stuck and his virtual strength was not adequate to dislodge the rope.

The voice advised him, "Continue pulling while we increase the fluid pressure to see if we can dislodge the suture."

Harry pulled for all his virtual self was worth. The sudden release of resistance sent him tumbling backwards off of the artery he has standing on. Only the resistance of the connecting wires prevented him from falling further down the brainstem. He regained his footing still holding onto the suture. He was a little dizzy from the rapid attitude change. The voice asked, "Are you okay?"

Harry responded, "It'll take me a minute to regain my balance. I don't think this simulator suit and chair were designed for such aggressive maneuvers."

It took several minutes before Harry felt comfortable moving about. He climbed back up to the aneurysm. He carefully looped the suture over the aneurysm trying not to touch it directly to prevent a catastrophic rupture. It was proving difficult to keep the suture from floating out of position, while trying to connect the two ends. His virtual hands just did not have the dexterity to control everything at once. After several minutes of frustration he said, "I am going to try creating a lasso effect by inserting the free end into the locking end first. I will then place the loop over the aneurysm."

Harry concentrated hard on inserting the free end into the locking device. He pulled a small amount of the suture through the locking device to create an easily held loop. Using his outstretched arms, he draped the loop over the aneurysm. The noose tightened on the neck of the aneurysm as he began carefully pulling on the free end while holding the locking end in his other hand. The miniature hands lacked a perfect sense of touch and the left hand slipped from the suture. Harry instinctively tighten his arm muscles to control the robot arm motion but not quick enough. The robotic hand brushed against the aneurysm. A minimal touch but it was enough to puncture the fragile membrane. The out rushing blood pushed Harry's virtual self away like a fire hose and it was all he could do to hang on with his right hand. The blood covered his visual sensors and blinded him. He groped with his lift hand blindly until he again grasped the free end of the suture. Harry tightened the noose with all of his virtual might strangling the aneurysm and stopping the flow of blood. His visual sensors were clearing and he stepped back to inspect the aneurysm. It appeared as a limp beachball hanging from a tree limb. The bleeding had stopped but the brain fluid was clouded by the blood.

The voice said, "Commander, that was close. You responded well. We will begin pumping the TissueGlue through your irrigation device. Several light coats should be applied over the entire aneurysm."

Harry pointed his irrigation port away and watched the cleaning solution swirl out of the tip. When the much thicker TissueGlue became evident, he turned the port onto the aneurysm. He painted the entire structure with several coats of the glue. It was like painting a beachball with an airbrush. He stepped back and looked at his work, thinking,"Not to bad, if I say so myself, but it was almost a catastrophe."

The voice said, "Return along the arterial path. Nice job."

Harry was enjoying the adrenaline rush, and would have liked to have explored some more, but did as he was told. He had no sooner climbed over the edge of the cliff, when his virtual reality ended. The visor opened and he was again just Harry, sitting in the simulator chair. The technician helped him remove the suit and Harry realized how much he had been sweating. The suit was drenched.

The technician smiled and said, "Commander, I would suggest a shower was in order. I don't know what you were doing, but you were sure working hard. I was surprised to see the simulator chair going inverted."

Harry responded, "I am not sure I want to ever experience it inverted again. The shower does sound good and maybe a bite to eat."

When Harry got out of the shower and dressed in a set of surgical scrubs, a sandwich, an apple and a glass of water were waiting for him. He was finishing the simple lunch when the Lieutenant Commander who had accompanied him walked in. He told Harry, "I understand your mission went well."

"Thanks. I would like to give my wife a call."

"I'm sorry sir, it's not allowed. The helicopter is waiting to return you to your wife."

It was night when Harry climbed into the helicopter. The air felt very dry and the terrain seemed flat. He could visualize some city lights in the distance but he still could not figure out his location. Harry and the Lieutenant Commander had no sooner transferred to the small jet when he was again advised that some sleep was in order. Harry accepted the sleeping pill knowing that it was not optional. As he lay on the small bed, he thought of Martha sitting alone in the hotel room. He remembered how disappointed she was when he had to cancel their first honeymoon. Harry had worked hard, taking double call, to free up enough time during his residency for a honeymoon. They were just getting ready to leave for their honeymoon, when he the telephone call came, informing him that two of the residents had been injured in an auto accident. His leave was canceled and Martha missed out on her honeymoon. He would do his best when he got back to give her the honeymoon she had deserved for so long. The medication took effect and sleep again overcame him. He was awakened by the calm voice repeating, "Commander, it's time to wake-up."

Harry was still sleepy and asked, "Are we there yet?"

"We will be landing in 30 minutes and I will have you back to your hotel by 9:30 A.M."

Harry gratefully accepted the offered cup of coffee. His breakfast consisted of prepackaged pastries and a child's box of juice. He concentrated on his coffee.

As Harry finished his first cup of coffee, the officer began the short debriefing. He advised Harry, "Your mission will remain classified. You are not authorized to reveal any information regarding your mission. You will receive one week of reserve officer pay for your time on active duty. Any questions?"

"No, none I suppose which can be answered."

Harry was escorted back to his hotel and knocked on their room door saying, "Martha, I'm back."

Martha opened the door and without saying anything reached up and grabbed Harry around the neck giving him a passionate hug. She ignored the naval officer accompanying Harry. They were interrupted by a discrete, "Excuse me sir, I will be leaving you now."

Harry turned and said, "Thanks for your help."

Martha grabbed Harry's hand and pulled him into the room, closing the door behind them. She sat him in the chair and started to turn off the TV. Harry said, "Wait. I want to see this."

The morning news was reporting on the interruption of the mideast peace talks because of Yasser Arafat having undergone surgery to remove a benign lesion behind his left ear. The telecast showed him leaving a hospital with a bandage over his ear. He waved to the cameras as he climbed into his limousine.

When the report was over Harry told Martha, "You can turn it off now."

Martha looked at Harry and asked, "Did you have something to do with his surgery?"

Harry shrugged his shoulders, and said, "I'm not sure."

The End.

