Coming of Age: Volume 1: Eternal Life Page 5

  “We’re having some trouble with speech here.”

  Wells gave up and glared at him.

  “You’ve had a cerebral accident—a stroke,” the voice said.

  Now that her vision was recovering from the glare of the light, she could make out a young, dark face. It was much younger than Antigone herself, and not so dark as Sully Mkubwa, but still with dark skin, dark eyes framed by gold-rimmed spectacles, curly dark hair, and very white teeth. Indian or Pakistani, or from somewhere up country from there. Half of him was in sharp, clear focus. The other half was a soft blur.

  “Whoo?” she hooted carefully at him, “Youu?”

  “I’m sorry, I’m sure some of this may be confusing for you.” The man tilted his head to one side. “I’m your doctor, Prabhjot Bajwa. I’m on the neurosurgery staff here. You’re in the San Francisco Medical Center. Do you remember when they brought you in?”

  Suddenly, Wells did remember. Two children wearing green plastic gloves had taken her in the back of a tiny fire truck, or perhaps it was an ambulance, to a place that was too cold, filled with glass and metal that moved too fast. She remembered bare hallways rushing past, bars of light strobing overhead, wide doors swinging open and then closing, and lots of cold air flowing around her. People did things to her body, then lifted her into a white machine with a narrow tunnel that made annoying, beeping, buzzing, ringing noises. That was like listening to a telephone somebody had left off the hook—except she could not reach it to put the receiver back, because the noises came from behind a curve of smooth, white plastic that pressed down right above her face. The noises went on until she wanted to scream. Her eyes went wide with the memory of it.

  “Noy … ses …” was the best she could manage.

  “Yes, we had you in the MRI for a brain scan,” the dark-skinned man said. “That must have been unpleasant. You had experienced an intracerebral hemorrhage—which means you had some bleeding into your brain. Then we took you into surgery to stop the bleeding. But that’s all fixed now. You’re going to get better.”

  Antigone Wells, who had spent a lifetime of studying people, watching their eyes, reading their reactions—so that she could know the truth of their words—now worked her mouth and tongue to say as carefully as she could: “Lie … yarrh!”

  * * *

  Over the days that followed, Wells suffered the attentions of others from among the hospital staff. Another doctor examined her without as much conversation—or confidence—as Dr. Bajwa. A rotating team of nurses and orderlies pushed needles into her intravenous drip tube, rearranged the electrodes attached to her chest and side for heartbeat and to the shaven patches on her skull for brainwaves, fed her oatmeal and tapioca from a bowl because her right arm wasn’t working and neither was most of her tongue, changed the bottle attached to her catheter, and put a bedpan under her infrequent bowel movements. And two therapists came by to poke at her.

  One, the man, alternately stroked and jabbed her limbs and the soles of her feet with blunt and pointed objects and asked, “Feel that?” Then he asked Wells to move various parts of her body and made noncommittal sounds as she flopped around on the bed. But he seemed satisfied as he went away.

  The other therapist, a woman, didn’t touch her but asked her questions and showed her pictures. Some of the questions Wells was supposed to listen to and answer with just a nod or shake of her head. Others required spoken answers, and the woman listened intently to interpret the warbling sounds Wells made. Then she showed cards with simple line drawings of common things—a cat, a football, a bird, a house—and asked Wells to name them if she could. Finally, she showed cards with lines that met in odd ways: twists and angles, curves and branchings. Wells studied them hard. She knew what these things were, of course, but she could not … actually … remember … what they … meant.

  She looked to the side, to the table next to the bed, and reached with her good left hand for the wide plastic tube that was standing on its cap. The nurses had used this tube to squirt out and rub yellow, smelly liquid into Wells’s wrists and hands, ankles and feet. Across the widest part of the tube were some of these same twisting, branching lines. She knew these shapes were terribly important, but she could not name them. She used her thumb to tap the images on the widest part of the tube.

  “Hhhhgg?” Wells husked, forcing the words out. “Hh … what? Sss-same?”

  “Yes! Exactly!” the woman therapist said. “That’s writing. Those are words.”

  “Urrds!” Wells agreed. But she still did not know what they meant.

  4. … And Then You Live

  After two weeks, John Praxis was able to contemplate the tubes entering his abdomen without feeling squeamish and wanting to gag with thinking about what was going on inside his chest. And when he didn’t actually look down at the gently pulsing curves where they slid under the incisions in his skin, he could forget the whole degrading experience. Except that he was still trapped in bed, flat on his back. The only good thing was that the doctors now trusted him enough to remove the restraints on his wrists and ankles. They even let him get out of bed, under supervision, and stretch the mechanical heart’s air hoses to their maximum length to use the bathroom. That was the highlight of his day.

  He looked across to the visitor’s chair where Adele sat. She was leafing through a magazine without really reading it. The pages flipped by faster and faster. With her legs crossed at the knee, Adele’s free foot was bobbing up and down, and it, too, was moving faster and faster. Some minutes ago, maybe half an hour, it had kept pace with the click and whirr of the machine under the bed. But now her fidgeting was accelerating.

  Dear Adele. … She had stuck by him for forty-three years of the hardest life a woman could face: following him from one jobsite to the next, usually in those out-of-the-way places in undeveloped countries where a major dam or aluminum smelter complex was under construction. She had coped admirably with strange languages, strange foods bought in rural markets, sullen and inadequate domestic help, and sometimes primitive sanitation and medical conditions. Through it all, she had borne and raised three children, watched over them in sickness, taken a hand in their education, and then sent them off to boarding schools in Europe or the States when the time was right. And she never said a word against that life.

  But the strains were there and the scars remained. Praxis could smell one of them now, whenever she came to visit. By ten in the morning Adele would have taken her first and maybe even her second drink of the day. And after an hour by his bedside, when she had exhausted the possibilities of small talk and magazines, as her fidgeting became more and more pronounced, he knew she was itching for a chance to get up, go outside, light up a cigarette, and take a nip from the flask of bourbon she kept in her purse.

  He couldn’t blame her for these vices. They had once been his, although he had curbed them some years ago on doctor’s orders. Adele had never seen the point of such abstinence for herself, nor had she made a personal commitment to it, and he certainly didn’t want to nag. After all, she’d done her job with an uncomplaining will and a straight back. She could indulge herself now, when it didn’t matter.

  However, the irony wasn’t lost on him. He was the one who had made the healthy decisions and changed his life. And he was the one whose heart had died, while Adele continued to soldier on, resolutely drinking and smoking, tough as an old pair of work gloves, virtually immortal. But this was not the time for him to mention the unfairness of life.

  Praxis looked down at the tubes again. The best he could manage was the lament from a dimly remembered situation comedy in the golden age of broadcast television. He uttered it softly now: “What a revoltin’ development this is!”

  “Dear?” Adele asked, looking up. “Do you need something?”

  “Nothing. I’m just commenting on human mortality.”

  “I know … and when you’ve done everything right,” she said, echoing his thoughts. “You watch your weight. You take your vitamins. You pla
y golf. And you’re still the man I married—a strong and vital man.”

  Who has to wait for another man to die so he can get a new heart, Praxis thought, although he refrained from saying it. Almost three more months of this waiting, on average, they had said. He could already feel his muscles growing slack from inactivity, his weight starting to creep up—even on the prescribed diet they fed him—and his joints tightening up. Three days ago he had developed his first bedsore. And if the waiting didn’t kill him, the boredom certainly would.

  “You look tired, dear,” he said. “Do you want to step outside? Stretch your legs?”

  “You don’t mind? I mean, I want to keep you company. …”

  “You go now. I’m really doing all right.”

  She dropped the magazine, gathered up her purse, and was gone before he could change his mind.

  * * *

  During Praxis’s third week in the hospital, the doctors on his team—this one with a nametag that read “Peterson”—were still coming in every morning to listen to his chest with a stethoscope.

  “Why do you do that, I wonder?” Praxis said. “If you want to know how my heart’s doing, lean over and read the dials on that machine.”

  Dr. Peterson stared at him for a long moment, clearly weighing some decision. “It’s not your heart I’m concerned about,” he said finally, “but your lungs.”

  “Is something wrong with them, too?”

  “No—that is, not that we can tell. But elderly people who have been only moderately active for most of their lives, and who suddenly become bedridden, are at greater risk for pneumonia and other respiratory diseases. So we’re keeping an eye on things. How do you feel otherwise?”

  “Lousy … but if you’ll unhook me, I’ll happily get up and dance.”

  The doctor stared at him again. “That’s one of your jokes.”

  “I’ve got nothing to do around here but make jokes.”

  “I see we’ve given you bathroom privileges.”

  “And I’m damned glad to have them.”

  “We should have started you on an exercise program by now,” Peterson said. “I’ll order a portable pump, one that rides along on a cart, and assign an orderly to accompany you.”

  “Where am I going—out to the golf course?” Praxis asked facetiously.

  “No, down to the basketball court, so you can practice your jump shot.”

  “What!”

  “That’s a joke,” Peterson said with the smallest of grins. “You can start by walking up and down the corridor. If you survive that and manage to build up your stamina, we’ll see about more intense activity and some physical therapy.”

  Praxis sighed. “How much longer until they find a heart?”

  “It might be any day now,” Peterson said.

  “Or it might still be months.”

  “Yes, that, too.”

  * * *

  In his fourth week of purgatory, with only two months remaining on his sentence, John Praxis had worked himself up to walking the corridors for twenty minutes at a time, three times a day, and believed himself stronger for it. But he still felt shaky each time the orderly, Marcelo, helped him back into bed. Whether all of this was helping to fight off pneumonia—if two rounds of golf every week for the past ten years hadn’t worked—was still open to debate.

  It was a surprise then, when his medical team of Jamison and Peterson, plus two men he didn’t recognize, came into his room, brought extra chairs, and sat down facing him with sober, worried looks. They reminded him of clients who had signed a fixed cost contract, changed their minds about some major specification, and didn’t know how much the change order was going to cost them. In such cases, the news was generally bad.

  “First, let me say,” Dr. Jamison began, “that we are continuing the search for a suitable transplant candidate for you.”

  “But you must understand,” Dr. Peterson went on, “that the waiting list is long—”

  “—and the situation is made more difficult, in your case, because the donor heart must match you in both histocompatibility and blood type—”

  “—blood type being more important, because we can compensate for most antigen incompatibilities—”

  “—and you have fairly rare blood, type B-negative—”

  “—meaning you receive from only O and B groups—”

  “—and negative Rh factor, which is even more limiting—”

  “—for O, it occurs in about seven percent of the population—”

  “—and for B … well, occurrence is less than two percent.”

  “In other words,” Praxis summed up, “I’m screwed.”

  “Let’s say the match will be difficult and take longer.”

  Praxis pointed to the machinery under the bed. “And what’s the warranty on this thing?”

  “People waiting for transplants have lived for hundreds of days with totally artificial hearts,” Peterson said.

  “But today we want to present you with an alternative,” Jamison concluded.

  He introduced the two strangers in the room as doctors Anderson and Adamson, colleagues from the Stanford Medical Center who specialized in the new field of cellular regeneration.

  “It’s all about taking stem cells from your own body,” Anderson explained. “We isolate them from skin and nerve tissues, muscle and connective tissues. We culture the stem cells in vitro and induce them to grow new organs to specification.”

  “With such an organ,” Adamson put it, “there’s no need for the waiting, searching, and tissue typing, because the implanted material originated in your own body and has all the right antigen signatures.”

  “And also no need for a regimen of immune-suppressing medications,” Anderson concluded. “We don’t interfere with the body’s defense system. That’s one of the major benefits of autonomous regeneration.”

  “You’re going to grow me a heart?” Praxis said. “I didn’t know that was possible.”

  “Well, it’s still in the experimental stage,” Jamison said. “Technically, you would be participating in a clinical trial.”

  “The procedure would not be covered by your insurance,” Peterson said. “And while there’s a modest stipend connected with the trials, we figured in your case—”

  “Screw the money?” Praxis suggested cheerfully.

  “Well, something like that,” Peterson said.

  “So, tell me what’s going to happen.”

  “In the early stages,” Anderson said, “we started with a heart donated from a cadaver. We washed it with various enzymes and detergents to remove the previous owner’s cells, leaving just the connective tissues—a set of intracellular proteins called collagens. This is simply the shape and structure of a human heart but totally inert.”

  “I’ll bet,” Praxis said.

  “We would then bathe this ‘empty’ heart in a solution of stem cells, hormones, chemicals to control cell development, and nutritive media. We place it inside a chamber that provides the appropriate conditions for growth—temperature, pressure, oxygen supply, carbon dioxide removal, et cetera. And the cells arrange themselves and grow into new, living tissue of the appropriate type.”

  “We used to think,” Adamson put in, “that it would be difficult to organize the different kinds of stem cells—muscle, artery, nerve—on such a scaffold and train them to grow into productive tissues. But the amazing thing is that the stem cells seem to be self-organizing, sending chemical signals into their immediate environment and calling forth the right kinds of tissue. It’s the same process that occurs in the womb during—”

  Praxis cut him short. “But you’re still going to put a dead man’s heart inside me?”

  “Not exactly,” Anderson said. “We were able to use the cadaverous hearts in experiments with baboons. But there were still issues of contamination—lingering traces of antigens, virus particles, and such. We actually found it easier to map out the heart’s internal structure, model it on a computer, and then
‘print’ it in three dimensions using layers of fresh, uncontaminated collagen that has been grown synthetically. We can also scale the organ’s size for the intended recipient. You will be getting a new heart made from your own cells that are grown on such an armature.”

  “How long?” Praxis asked.

  “About six weeks,” Adamson said. “That’s the organ’s incubation period in a bioreactor.”

  “Come again?”

  “How long it takes to grow a heart in a jar,” Peterson said.

  Praxis didn’t have to think about it. “When do we start?”

  “Don’t you want to hear the downsides?” Jamison asked.

  “All right. What are they?”

  “This is all still experimental—”

  “But will I remain on the UNOS list?”

  “Well, yes. This procedure won’t invalidate—”

  Praxis plowed ahead of him. “So if the new Frankenstein heart flops or something, you can always rush me into surgery, cut it out, and put back this little two-stroke pump while we wait for a suitable human donor. I don’t lose my place in line, and I only waste about a month and a half—time that I would spend lying here anyway.”

  “Well, you must understand,” Peterson said, “there’s a limit to the amount of ‘cutting out’ and ‘putting back’ your body can tolerate.”

  “Yeah, sure,” Praxis replied. “But you wouldn’t have brought these gentlemen here if you didn’t think I was a good candidate. So I presume they brought along the appropriate forms for me to sign.”

  Dr. Anderson reached for his briefcase.

  All the rest was details.

  * * *

  Antigone Wells had lost track of the days—more than four, less than fourteen. But she was almost certainly aware of several visits at odd intervals by the physical and speech therapists, renewed passages through that white tunnel filled with beeping noises, and repeated, one-sided consultations among her doctors just beyond the door of her hospital room. It had become clear, even to Wells herself, that she was getting better—stronger, clearer, more precise, more focused—in some ways but not in others. So Dr. Bajwa’s original assessment was proving to be only halfway a lie.