The Face Transplant

by R Arundel

  “It wasn’t meant to, but if you’re impressed, that’s great.”

  “The problem is other countries are doing this type of research. They’re probably spying on you guys as well. I know you’re going to say you’re far ahead, but this stuff is so secret. Do you really know that?”

  “I was thinking the same thing. And when I saw that canister, I knew it was obviously a face harvested from someone. The canister looked like it was from one of the Transplant Working Group centers, but who knows?”

  “Maybe he paid someone in the military to set this up?”

  “You’re talking big money.”

  “To get that kind of plan together, big, big money.”

  “If I hadn’t severed that vessel and killed the guy, the plan would have worked perfectly.”

  “Don’t feel guilty. You were under stress. We all were. That was not easy surgery.”

  “I still hate to lose a patient. Even a criminal.”

  “The guy forced you to do this in the middle of the night.”

  “You’re right. We all make mistakes, even the best surgeons.”

  Sarah sits up and laughs. “So you’re the best now, are you?”

  “You know what I mean.”

  Sarah laughs. “I was looking forward to a long sleepless night. You’ve made it a bit of fun, Matthew. If we weren’t in such a bad mess, I would almost forgive you.”

  “All is forgiven?”

  “I said almost.”

  “Almost is not too shabby.”

  “We’re not sure what is going to happen. Whoever planned this might want to make sure we have no way of talking about it. This could be very, very bad. But I understand you really can’t be held responsible.”

  “I’ll take that as all is forgiven.”

  “Good night.”

  “See you tomorrow.”

  Matthew looks at the light blinking on his phone. He suddenly remembers his mom. Matthew listens to the voice mail.

  “Good evening, Matthew, it’s your mom, I was expecting you. Guess you got busy with work. Or maybe you’re busy finding someone to give me that grandchild I want. Love you, call me.”

  He looks at his watch, it is four a.m. He will call his mom later today.

  Chapter Four

  Sarah is busy in the operating room alone. She is preparing her anesthetic machine. Today’s list of surgical patients is short and she should be home early. The cases look routine; they should go to sleep with no problem. The modern anesthetic machine is now really at the level of a state-of-the-art fighter jet in terms of computerization and complexity. The modern anesthetic machine did everything. It recorded the blood pressure, heart rate, patient’s oxygenation. It suggested when the vapors used to put a patient to sleep needed to be increased and then did it. It realized when the vapors were too low and the patient was awake while under anesthetic. A terror for the patient. With the new machines, this was eliminated.

  The machine really was a super computer. It shared many of the components of the modern surgical robots. This machine could almost think. A computer with the power of these new anesthetic machines just ten years ago would have needed to be housed in a small warehouse. Today it came in a package the size of a washing machine. The anesthetist watches and lets the machine do its thing. In fact, some researchers have begun trials where the anesthetist is not even in the room for the surgery. They monitor the machine remotely and are available if some emergency occurs. One day humans will not be needed for any aspect of surgery. Robots will put the patient to sleep. Another robot will do the cutting.

  Sarah looks out the window of the operating room and sees that Matthew has arrived. Sarah approaches Matthew as he washes his hands in preparation for surgery. Matthew notes how the slight curls of pure white hair peak through the sides of Dr. Larsson’s operating room cap. Somehow Sarah’s pale skin seems to have color when placed against that hair.

  Sarah says, “I was thinking about last night.”

  “I just couldn’t sleep. I’m sorry if I bored you.”

  “I wasn’t going to sleep.”

  “I got a couple hours.”

  “I was thinking about what I did in the parking lot. I had no right to strike you. I’m sorry.

  “We were all frazzled.”

  Sarah says, “There’s a lot going on in my life. I thought I had it under control. Now this happens. I’m not making excuses. I should not have slapped you.”

  “No worries. I just got off the phone with Dr. Coulson.”

  “What did he have to say?”

  “He wasn’t involved at all. A contact told him about this Italian transplant surgeon. The details were sketchy.”

  “Did you tell him about last night?”

  “No. We don’t want anyone else involved. The less who know the better.”

  Sarah says, “I was thinking about this all night; we are in some kind of trouble.”

  “Maybe. Maybe not.” Matthew’s hands are red from scrubbing so hard under the sink. “If this was a well-planned transplant of an organized crime type who wants to escape detection, he is dead. He’s been expertly disposed of. Whoever was helping him wants this to go away.”

  “I thought about that, but with what you’ve told me about TWG, I just don’t see this as some criminal wanting to change identity.”

  Matthew says, “Transplant Working Group may be involved, but whoever did this will want to keep it quiet. The guy who died could have paid a lot of money to arrange this. Whoever arranged this may want to make it look like it worked and the patient left our operating room and disappeared. The perfect job.”

  The circulating nurse calls them inside to begin the case. As Matthew passes she asks casually, “Did you have a good night? You were on call.”

  Matthew had forgotten that he was on call for emergencies last night. They rarely called him in, except for the most severe facial trauma. Residents and fellows handled almost everything.

  “You wouldn’t believe me if I told you.”

  Matthew gets down to the muscle and finds the nerves. His resident today seems uninterested. His senior colleague, Spencer Lambert, is also assisting him. They occasionally operate together on difficult cases.

  A phone rings, and Sarah picks up the operating room phone.

  Dr. Liam Rasulov is on the other end of the line. “Hello.”

  Sarah says, “Hello?”

  “This is Liam. Who am I speaking with?”

  “Hi, Liam, it’s Sarah. You sound funny. Where are you?”

  “I’m in my plane. I’m flying back to New York.”

  “You seem to be in the air quite a bit.”

  “Any chance I get. I told you I’d take you up anytime.”

  “Thanks for the offer. I’ve just been so busy settling in to New York.”

  “You’re with Matthew and Spencer today?”

  “Yes.”

  “The boys treating you well?”

  “They’re behaving.”

  “Good.”

  “They’re almost finished.”

  “Tell Matthew I want to see him in my office in about an hour.”

  Liam presses a button on his head set; he is now connected to air traffic control. Liam looks out at the New York skyline. “This is Liam Rasulov preparing to land.”

  The air traffic controller has known Liam for many years. Liam is notorious for his many flights into and out of the airport at all hours. The controllers never have a problem with him; he likes to fly and takes great pride in doing it professionally.

  Air controller, “Hi, Liam. Clear to land.”

  Liam is anxious to get back to the office; the recent news will make for a busy day.

  ***

  “Dr. MacAulay, that was Dr. Rasulov. He wants to see you in his office. He said he will be there in about an hour.”

  Spencer says, “I didn’t see him at the university meeting this morning. Where’s Liam calling from?”

  Sarah says, “His plane, Dr. Lambert.”


  Spencer says, “It’s great that he’s got all that time and money to fly. Some of us have to look after patients—do the real work.”

  Matthew steps in. “He’s allowed to have a hobby.”

  Spencer says, “His residents do all his work.”

  Matthew remains silent.

  Spencer says, “Let the resident close the case. I want to see that flap you did.”

  “No problem, I was going to get your opinion on that case.”

  Matthew rips off his gloves. Spencer takes off his surgical cap, revealing his thinning gray-brown hair.

  Matthew and Spencer go directly into Ryan’s room. Ryan Smith is a big man. His feet stick out over the bed, especially with the bandages. He is also very wide. Ryan has put on some weight since his injury. The wounds to his legs and back are healing slowly.

  “Good afternoon, Doc MacAulay.” Ryan’s booming voice fills the room.

  “Hi, Ryan, I brought a colleague of mine, Dr. Spencer Lambert, to get his opinion.” “Nice to meet you, Dr. Lambert.”

  Spencer rips the surgical dressing off Ryan’s face.

  Ryan sucks in a breath. “Whoa, it’s a little sensitive.”

  Spencer continues prodding the wound. “Sorry.”

  Matthew looks at Ryan’s facial wound over Dr. Lambert’s shoulder. “No pus.”

  Dr. Lambert says, “Not yet.”

  Dr. Lambert moves to the side so Matthew can see.

  Matthew carefully examines the wound. “This may hurt a bit. I’ll say sorry in advance.”

  Dr. Lambert says, “Not that great really.”

  Matthew wanted to respond to Spencer’s comment, but it would not be a good move. Dr. Lambert was his senior colleague; he was on the hospital board that determines whether the facial transplant program proceeds.

  Matthew asks, “Did my resident check the flap this morning?”

  Ryan says, “Of course, you were the one missing.”

  “Sorry I didn’t stop by this morning. I had a long night.”

  Ryan Smith’s military uniform is freshly pressed and hung with great care. His private room has a large closet. . It will never be worn again. The uniform stands in memory of better days. Days when Ryan had comrades, when he could battle. Now he is a bedridden wreck with a mangled face. An invalid monster—that’s how he thought of himself these days.

  Matthew moves to the foot of the bed with Dr. Lambert. He notices the slight stoop in Spencer’s shoulders. “I’m going to ask my senior colleague for advice. Don’t worry if you hear some talk that’s medical. I’m going to tell you the game plan as soon as we make it.”

  “No problem.” Ryan picks up a magazine and begins reading.

  Dr. Lambert says, “When you take off the dressing, it’s a much bigger loss than I thought; his nose is completely gone.”

  Matthew says, “I rotated some tissue from his forehead to make a new nose and repair skin lost in the middle of his face.”

  “It’s a little dusky.”

  “I agree. What should I do?”

  Dr. Lambert answers, “Just wait and see what happens.”

  Matthew agrees. That is going to be his plan. Spencer has good clinical judgment, even if he sometimes lacks beside manner.

  Matthew goes to the head of bed. Spencer leaves without acknowledging the patient or saying good-bye.

  Matthew says, “Ryan, I think this flap was a good idea. The forehead flap is a workhorse. As I told you before, we took some skin from your forehead and turned it to fix the areas of your nose and cheeks that were damaged.”

  Ryan says, “I know. It’s a flap that’s been used for thousands of years, very reliable, first used in India.”

  “Correct, I see you do listen to what I say, and remember it too. I thought you were just a pretty face.”

  “Very funny, Doc MacAulay.”

  “I try. When we told you we were going to do this, I said there could be some problems. You remember my concern with the tissue and the blood supply due to all the damage to the surrounding skin. I was hopeful but not confident that this would take.”

  “I just want to be able to go to the mall and not have everyone look at me.”

  “That’s our objective, but I am not sure this flap is going to get us there.”

  “Then what?” asks Ryan.

  “Well, first we are going to follow this flap closely. We’re going to start giving you medicines intravenously to help the flap live, but even with that it’s touch and go.”

  “What happens if the flap dies?”

  “We have other options, but let’s just see how this goes. If we need to do something else, we will, don’t worry. How’s the physio going?”

  “Great. My movement is improving.” Ryan flexes and extends his leg.

  “Looking good,” says Matthew.

  “My resident will be by later. If there are any concerns, he’ll contact me,” says Matthew. Matthew closes the door. Spencer is waiting for him outside.

  Dr. Lambert says, “You keep a close eye on this. We want our department flap survival rate to be above 98 percent. I am publishing a paper soon.”

  Matthew says, “I’ll be checking every six hours.”

  “No, every three hours. Around the clock.”

  “Not a problem.”

  Dr. Lambert asks, “How’s he holding up? He seems chipper.”

  “Nurses say he seems upbeat.”

  Chapter Five

  Matthew walks into Liam’s office. It is a large square space. A little-used squash racket lies beside the wooden desk. Liam has a large computer monitor on his desk. Beside the desk is a picture of Liam and his wife with their twin daughters, smiling on vacation.

  Matthew says, “Every time I see that photo it makes me smile.”

  Liam picks up the photo. “Me too. We took it while we vacationed in the Caribbean. Jamaica.”

  “I remember. You guys went to a high school track meet.”

  “Not just any track meet. This was the yearly event. All the great runners on the island of great runners come out. It was a blast. I loved watching those young kids run.”

  Matthew says, “Everyone loves competition.”

  “I tell you I had to beg the girls to go, but when they got to the track, they loved it. We all loved it. It was the highlight of our vacation.”

  “A lot of Olympic champions come out of that small island.”

  Liam says, “Yes, they do. I’m such a hopeless athlete, I don’t know why I enjoy track so much.” He puts the photo down.

  Matthew points to the photo beside it. “New pic.”

  “Just shot that last week.”

  “That’s you and the university president.”

  “We were at a graduation ceremony.”

  “And it gets the prime real estate, right beside your family. When is he stepping down?”

  “I didn’t ask him, but I heard any day.”

  “Rumor is you’re the next university president.”

  Liam says, “I won’t lie—I want the job. He asked me to pose with him. That’s got to mean something.”

  Matthew looks at Liam’s smooth narrow face. “You have my vote.”

  “You don’t have a vote. You’re not on university council.”

  “Well, you know what I mean.”

  “Now to more sobering business.”

  Matthew squirms in his seat on the old metal chair in front of the desk. The somber look on Liam’s face leaves no doubt he heard about last night and the failed face transplant.

  “How did you hear?” says Matthew.

  “Got a call yesterday.”

  “I’m surprised you heard so quickly. I was coming to tell you the story.”

  “News of a death always travels fast.”

  “Who was he?” says Matthew.

  “Who was he?” Liam is perplexed.

  “I didn’t recognize him.”

  “What are you talking about? Tom died last night.”

  Matthew gasps. “Tom Gr
abowski?”

  “Yes, what did you think I was talking about?”

  “How did he die?”

  “An MI.”

  Matthew stares at nothing.

  “I know it’s a shock.”

  Matthew’s eyes moisten.

  “I know he was like a father to you.”

  Matthew recovers. “He was there for me and mom.”

  “Tom was a good friend to me as well.”

  ”How did you get the news?”

  “I was in Palo Alto visiting his lab. It happened in the night. I flew back to tell you.”

  “Thanks. Does my mom know?”

  “Not yet. I know Caroline was close with Tom. Do you want me to call her?”

  “No, I’ll tell her.”

  “Sure.”

  “This is out of the blue.”

  “These things happen.”

  “I doubt that it was a heart attack.”

  Liam asks, “Why?”

  “I was down in our lab doing a transplant last night.”

  “For who?”

  “A very persuasive man carrying a very large gun.”

  “What are you talking about?”

  “Mike Coulson called me last minute. He said a surgeon from Italy was in New York and wanted to go over some aspects of transplantation for the program he was setting up back home. He requested an anesthesiologist, scrub nurse, and transplant surgeon. He wanted to ask the team some questions.”

  “Why didn’t he ask Mike in Houston?”

  “I asked the same question. Mike said he never saw these guys, but the name the guy mentioned was of a guy in Italy where he had lectured, so Mike wasn’t suspicious.”

  “Sound fishy. Why didn’t he go to Houston?”

  “He was flying into New York. He was leaving after a quick visit because he had emergency cases to do back home.”

  “I guess that makes sense.”

  “So I asked Sarah Larsson and Amanda Soto to join me. When we got to the lab, we were met by a very large gun.”

  After Matthew tells Liam the story, they both sit in silence.

  Matthew asks, “Nothing to say? You’ve always got something to say.”

  “I’m still trying to take it all in.”

  “I was up most of last night, and I still can’t make sense of it.”