“So, bottom line, what are the chances?”
Emilio Barrola, the neurosurgeon, peered over his wire-framed glasses. The question had come from the observation gallery, at the tail end of a surgical briefing. Ordinarily he would have ignored it, but these people, the Colonel Hendersons of this world, were paying for this procedure, so he owed them a reply. His mentor, Wolfe, would have known exactly what to say, but at the moment Wolfe was nowhere to be found in the operating theater. Wolfe was in his own private green room, entering an alpha state so profound that legend had it a contingent of Buddhist monks had once been dispatched by the Dalai Lama himself to observe its effects. The monks had come away scratching their heads. The story was apocryphal, of course, but the trance was real and, as far as Wolfe was concerned, absolutely crucial to peak performance. So Barrola, for a while at least, was on his own. “The chances? One in a thousand, perhaps. Perhaps one in a million. It is foolish-” He retracted the word hastily. “Rather I should say difficult, to put a number on it. One has to think in terms of expectation-the probability times the reward. Failure costs us nothing except what you gentlemen have so generously allotted to this experiment.” That was good, he thought, he wished Wolfe had been here to hear it. “Whereas, success,” he added, pointing in the direction of the subject in a papal gesture, “brings us all incalculable benefits. To put it another way- Behind Barrola, standing next to the operating table trying not to let this blather get to her, Beatrice Jance gripped her husband’s hand. Pomposity had always had this effect on each of them. Whether they were exposed to it in a lecture hall, a committee meeting, a party or a movie theater, they always reached silently for each other, holding tight until the embarrassing moment had passed. It was just one of their many rituals of marital telepathy that had evolved over the years, unknown to anyone but themselves, and impervious to circumstance. Peter, desperately weak, couldn’t squeeze back. But that didn’t prevent Beatrice from holding on to his hand as she gazed up at the OR lights. Get on with it, she thought-we have nothing to lose but our souls. Then she heard the commotion of an arriving gurney, and though her view of the other man was blocked by a wall of surgical sheeting, she knew he was there, not five feet away. Hearing the muffled scurry of the man being shifted to the table and positioned, she clutched Peter’s limp hand all the harder, and forced herself to look. “Can you see him?” Peter asked, his voice barely audible. She looked back at Peter’s face, the eyes incredibly intense. “Does he look like me?”
She was trying to keep her face from twitching. “Peter, it is you.
A terrifying image flashed into her mind-a painting she had once seen of a huge man, a misshapen giant, clutching a much smaller helpless human figure in his fist, about to cram it into his mouth. Goya, she remembered. One of his works. What was it called? Oh, yes. Saturn Devouring His Son. She heard herself take a sharp breath, as a team of nurses approached the table. They were waiting for her to let go of her husband’s hand. She knelt and kissed him unashamedly, then walked away. Peter’s mouth opened, but whether to speak or cry out it was impossible to say. The draping of the body began immediately. Within seconds Peter had vanished from view under a sea of green surgical cloth. The nurses moved quickly, and in a matter of minutes, only his head and upper legs remained exposed. Barrola gave the signal and the anesthesiologist inserted a tube down Peter’s windpipe. Through this, he administered an exquisitely delicate cocktail of barbiturates that sent Peter into a profound sleep-in fact the same low-grade coma Hans Brinkman had been plunged into ten hours before. The barbiturates radically lowered Peter’s cerebral 02 uptake, and thus his requirement of blood. After twenty minutes of adjusting and readjusting various gas mixtures, the anesthesiologist turned both Peter and Hans over to their respective cardiac teams. Swiftly, two incisions were made in each man, one into the large femoral artery just beneath the surface on the inside of each man’s thigh, another into the femoral vein. Into these openings large-bore catheters were inserted and sealed. With both Peter and Hans the next step was the same: the blood was pumped from the artery into the huge masses of tubing, chromed pump cylinders and coolant chambers that comprised one of two multimillion-dollar artificial heart machines. Just as powerfully, it was pumped back into each man’s veins. In effect, their hearts had been bypassed and rendered superfluous. At this point, the observers in the gallery-those who had listened attentively to Barrola’s briefing-edged forward in their seats. Something different, something new, was about to be added to the process. The pump technicians spun dials and flipped switches, the machines hummed and thumped, and the core temperature of each man began to drop dramatically, along with the temperature of the operating room. Personnel not working the artificial hearts took the opportunity to slip into sterile down vests, their breath becoming visible as the brains of the two men on the tables reached hypothermic arrest. This procedure, as Barrola had just explained, had been perfected both in civilian and government operating theaters and was key to the success of heart bypass operations and transplantation. But it was extraordinarily tricky. Now they were at the critical juncture. With the body temperatures of each men at 23 degrees Centigrade, 7 degrees below normal, Barrola ordered that each man be injected with a strong solution of potassium chloride. Their hearts stopped as if a switch had been thrown. The flat line alarm split the air suddenly, and droned on, unbearably, until someone thought to turn it off. Barrola took a deep breath.
In heart transplants, the usual procedure was to pump blood to every part of the body except the heart. This much had been accomplished countless times in ORs around the civilized world. But Frederick Wolfe had taken the procedure in a whole new direction, and Barrola had been his eager, if now slightly nervous, protege. The hearts of Hans and Peter had been stopped as a first step only. Once a sufficiently low brain temperature was achieved, the blood was entirely drained from both bodies. There was a name for it, and Alex Davies, watching from the front row of the gallery, supplied it to Colonel Oscar Henderson, who, from the look of alarm on his wide, weathered face, was slowly losing his hopes of seeing a star on his epaulets any time soon. “It’s called desanguination,” said Alex grimly. “What the hell’s that?” Henderson demanded under his breath. “It’s what vampires do in the movies,” Alex said. “Or coroners do in morgues,” he went on, seeing Henderson blanch. He gave a faint smile and Henderson didn’t ask another question. The shunt back into the bodies was shut down, and within ten minutes the lifeblood of both men was in the machines and nowhere else. Without blood in their bodies, no oxygen was reaching any cell in either brain, or any other organ for that matter. There was a technical term for this condition as well, and Alex Davies, watching with rapt attention, mouthed it for the benefit of the surrounding brass. It was called death.
There was no trick, really, to bringing patients back from this state. Wolfe had done it many times before and, in fact, this technique too was used in leading medical centers throughout the Western world. But what was about to follow was not. What was next was simply unthinkable, and there was only one neurosurgeon in the world with the technical wherewithal, the absolute sanction and the unfettered hubris to pull it off. Barrola personally made the call to Frederick Wolfe. His mentor generally took fifteen minutes to emerge from his deep alpha state, even for operations vastly more simple than the one he was about to perform-just enough time for the final prep. The heads of both Peter and Hans had been shaved clean. With Barrola working on Hans and his best assistant working on Peter, lines were drawn around the circumference of each head, beginning at the occiput, running around the temporal surfaces-just above the ears on Hans, just below on Peter. On both, the line passed across the face, transecting the orbit of the eyes deadcenter and continuing across the bridge of the nose. Mirror lines met from the other side. Then, employing state-of-the-art laser cutting tools, Barrola and his assistant made the cutaneous cuts. Since the bodies were essentially drained, there was only the barest trace of blood. The work went quickly. For Barrola, the most delicate and rewarding cut was around the eyes, and it was no accident that he, who counted among his many skills plastic surgery, had been assigned to work on Hans. This was the host body, and it was vital that it function perfectly afterward, including the tear ducts, which he delicately skirted now. The eyes themselves didn’t matter. Eyes were anatomically nothing more than extensions of the brain, and the brain of Hans Brinkman was now irrelevant. Barrola completed his cuts and stepped away. Nurses would do the busywork of peeling back the scalp to expose the bone beneath. He moved to Peter, supervising the final step of this preparation, fitting twin titanium disks over the dying scientist’s eyes. It was critical that no accident of saw or splinter of bone compromise their structure. Peter’s eyes and brain were what mattered here. The moment Barrola finished, the gallery fell silent. Frederick Wolfe was entering the operating room. He was walking tall, as though the Zen state had added inches to his long-boned frame. Gone were the looks of adoration he had usually bestowed on Beatrice, the irascible disdain with which he intimidated the military, the nonchalant imperiousness with which he treated his grandson, Alex. Nearly all traces of maliciousness or mischief had been stripped away by meditation and the unique urgency of this moment. He was in total control, of himself and of this operating theater. Assistants slapped up X rays, while others started the CD player that would play, at full volume, his favorite recording of Richard Strauss’s Vier letzte Lieder throughout the rest of this night. The melancholy masterpiece, completed just months before the composer’s death, never failed to fill Wolfe’s heart with a deliciously painful poignancy, especially when Jessye Norman sang it. Military men squirmed, and Beatrice wished she could squeeze Peter’s hand, but Wolfe himself was blissfully and properly indifferent to their opinions. This was his time, his place, his operation. For now-and, if there was any justice in the universe, from now on-he was indisputably the most important scientist in the world. He turned away from the X rays. He had memorized them the night before and there were no changes. “Let’s not waste time,” he said.