The Face Transplant

by R Arundel

  Matthew and Kofi enter a warehouse. From the outside it looks like a deserted factory. The paint is peeling from the concrete walls. The windows are covered with an inch of dirt. They enter the pitch black building. The grimy windows are blacked out. Matthew can sense that they are in a very large room. Suddenly, the lights come on. Matthew is stunned at what he sees.

  Matthew knows exactly what he is looking at, but even then, he cannot believe it. It is as if he has gone to some futuristic new world. His mouth opens, and his eyes widen. Standing in front of him are two fourteen-foot-high columns made of white lacquer. In the center between the two columns, which are four feet wide, is a surgical chair. There are three brushed aluminum steps to get to the chair. It is positioned with a perfect view of the operating table. On each wide arm of the chair are two joysticks. A large video monitor is five feet above the front of this chair. It is on a hydraulic arm which can be raised and lowered into place when operating. This is done by voice commands. Matthew marvels at the design. It looks like a Swedish design studio has created this robot. It is beautiful, a real work of art.

  This robotic surgical suite is like nothing he could have imagined. Occasionally, they have international design competitions featuring ergonomics in the modern surgical suite. This looks like it was taken from one of those designs and implemented flawlessly. This is a true masterpiece of medical design and engineering. Matthew realizes he was holding his breath up until this moment. He then looks to the left and sees the operating room table and the three articulating probes positioned. He is looking at the next generation robotics facility for facial transplantation.

  Matthew moves to get a closer look.

  “Good afternoon, Matthew.”

  The voice is that of a young woman. It is calm, confident, and reassuring.

  Without skipping a beat, Matthew says, “Hi, what should I call you?”

  “I am Alice.”

  “Hi, Alice.”

  Kofi says, “I did all the computer programming. Alice has some facial recognition and voice commands.”

  “So this is what Tom was doing,” says Matthew.

  “He began to have some concerns about the military funding. That’s all he would tell me.”

  “That’s when he started to build this?”

  “He would do all his real facial transplant work here. The university was a decoy.”

  “What was he afraid of?” asks Matthew.

  “Tom was killed, man.”

  “I thought as much.”

  “I was there.”

  “What?” says Matthew.

  “That’s right. I was right there.”

  Kofi points to the area behind Alice. The area is hidden from view by the column of the robot. Matthew walks behind to see the hidden room. Then he comes around and stands looking at Kofi.

  Kofi says, “T came to me that afternoon. I have been doing the transplants or first assists here with him for a while. He said we were going to do something different. I would stay hidden, and if I heard him say, ‘I really need to think this through,’ that was my signal to come out. If not, I was to stay hidden no matter what I heard.”

  “And you agreed to this?” says Matthew.

  “It gets better—he hands me a gun. T says, if I have to come out, I’ll need it.” Kofi takes a deep breath and then continues, “I was in position and T comes in. I had a bad angle, but I saw one guy. He was mean-looking. You could see he was angry at the world, hair trigger. He was short, squat. He had the palest gray eyes.”

  “I’ve met those pale gray eyes.”

  “He looked frightening,” says Kofi.

  “Continue.”

  “I couldn’t see any more. They either did a transplant or took the face off someone. I heard them take a titanium canister. After the procedure, I heard the voices raised. I could hear T was not happy. I heard the voices getting louder and then T said ‘I really need to . . .’ He just paused. I was ready to come out. I knew there was trouble. Then he said ‘I really need to just get out of here.’ He was telling me to stay put. After they left I went out. The place was clean, no trace they were even there. When I went to Alice, they had taken her hard drive and swapped it out with a blank.” Kofi walks over to the large column and pulls open a panel. There are many different colors of wires. The circuits blink. “To know this module and have it ready to swap out . . . These guys were very well-prepared. I knew that when T did not show up. . .”

  Kofi’s voice becomes heavy with emotion, his eyes teary.

  “T was a good man.” Kofi snaps the panel closed. “I think he knew they were going to kill him. He didn’t call me because he knew we would both be dead.”

  “How many people were there?” says Matthew.

  “I only saw the short mean guy, but I heard T and four other men. One was the boss. He didn’t talk much, and he had a hat on, a fedora.”

  “Tom had progressed further than any of the other two centers. Why keep it secret?”

  “I am not sure. I told him we needed to at least share our Steriazol with the others.”

  “He had advanced the Steriazol?” says Matthew.

  Kofi commands, “Alice, demonstrate transplant.”

  “With pleasure. Full trans?” says Alice.

  “Let’s show him the works, full facial transplant.”

  With that, the beautiful piece of architecture whirred into life. The robot produced a 3-D hologram of a face to be transplanted. For the next sixty minutes, Matthew watched as Alice demonstrated her capabilities. For the final closure, the robotic arm carefully poured the Steriazol on the suture lines and recipient bed. Matthew thought what he saw next was time-lapsed photography.

  Kofi, anticipating his thought, says, “This is real time. This is a hologram of a real patient. This is what we can do.”

  Within minutes of pouring the Steriazol, the wounds seemed to heal as if by magic. The incisions disappeared and the blood, nerve, and veins were joined. Perfect healing. The patient got off the table and walked out of the operating room. The hologram was lifelike.

  Matthew claps spontaneously. “Bravo, Bravo.”

  Alice says, “I’m so glad you liked my demonstration, Dr. MacAulay.”

  “Call me Matthew.”

  Matthew has his answer; this is why Tom was killed. Tom had done it. But how could he have been so foolish, so reckless? He had developed the robotic transplant technology and upgraded the Steriazol. Tom had brought in Kofi and his work eclipsed the other groups. Matthew was sure Houston had no idea of this; he sure didn’t. He thought they were ten years away from some modest improvements, nothing like this. What Tom had developed was the perfect facial transplant. No scarring, no downtime. Presumably, this could be done on anyone, anytime. The possibilities were limitless. Tom had done it.

  Kofi says, “I told him we could not keep this secret; it was too big. He finally agreed but said it was complicated. He wanted a little more time. He was going to bring you out to see it. He was going to call you, get your advice.”

  “It makes no sense. He had the breakthrough we were all after. Tom should have made his work available.”

  “He was going to hold a meeting. Just the Transplant Working Group: you, Michael, Liam. He wasn’t sure he should turn it over to the military. He was considering publishing it all online. Make it available to all scientists throughout the world at once. Put the world on a level playing field.”

  “Are you sure your modifications of the Steriazol can do what I just saw consistently?” says Matthew.

  “Guaranteed. Our tests confirm the healing and the ability of all microvessels to seek each other out and heal within minutes. It builds on the work of Dr. Liam Rasulov down at your institution.”

  “This is truly revolutionary. This is disruptive technology.”

  “There are some caveats. It has not been tested in all conditions. We were mainly doing midface and lower face.”

  “How about the more difficult complete facial transplant that yo
u just showed?” says Matthew.

  “We did very few complete trans. That was our next step, to do a few more.”

  “Complete trans would be incredible.”

  “Yes, the complete trans is the ultimate, but carries the ultimate risk.”

  “How so?” says Matthew.

  “We know that the transplanted face must not be subjected to heat more than eighty degrees Fahrenheit for more than thirty minutes. If this occurs the protein bonds break down. The face completely separates from the patient. It will dissolve into a gelatinous mass.”

  “What happens?”

  “We did a nose early on and the patient was from Florida. We got a call his nose had melted off.”

  “Melted off?”

  “In a heat wave. His wife noted he was sweating from the forehead and nose, which was weird, for about thirty minutes. He felt nothing and then it just dissolved.”

  “Could you save it?” says Matthew.

  “No, we had to do some local flaps to reconstruct the nose. We were lucky it was just the nose. If it were the whole face, a complete trans, it would have been a disaster.”

  “Why the sweating?”

  Kofi, “The largest concentration of sweat glands on the face is on the forehead. When the temperature rises, the first sign of impending transplant failure is sweating from the forehead. We are not sure why, but the transplanted part of the face feels no sensation. We were working on that when T passed.”

  “No sensation at all?”

  “No sensation on the transplanted face. They don’t even feel the sweat on the transplanted forehead. When the temperature rises, the complete transplant recipient starts to sweat on the forehead. The sweating increases, and at that point, if the recipient does not cool the face, the breakdown begins. Once the process starts, it is irreversible. Just like the nose, but due to the size of tissue involved in a complete facial transplant, the result is far more serious. The vessels and tissue of the entire face just melt away.”

  “Tell me this has not happened,” says Matthew.

  “Thankfully, no, but we have not had a patient keep a complete trans for more than seven days. We always reverse them.”

  Matthew walks up to Alice and sits in the chair.

  Kofi says, “Authorize Matthew, single use, model head.”

  Alice comes alive. The chair is very comfortable and in no time Matthew is immersed in the operation.

  Kofi says, “Seventy-five minutes, not bad.”

  “That was fun. I could get it down to sixty.”

  “I think you could.”

  “Even right now, that was a full face transplant, no scars in seventy-five minutes!”

  “We’re not bad out here.”

  Matthew says, “Alice is amazing; this is no ordinary robot. The inputs are flawless.”

  Alice says, “Thanks.”

  Matthew says, “The pure fun of cutting and sewing—it reminded me of why I got into this business. Partway through I forget about everything. It was just me and the patient.”

  Kofi says, “We’re surgeons. That’s what it’s all about.”

  Matthew says, “He called me.”

  “Tom called you?”

  “The day he died. He didn’t leave a message. If I had taken the call . . .”

  “Don’t play that game. I wonder should I have done things differently. Should I have even helped him in the first place? I should have stopped this when he handed me the gun. We’re surgeons, man. If I had said we’re not doing this, this is crazy, we need to go to the police, Tom may be alive today.”

  Matthew says, “If he had left a message, given me any idea his life was in danger, I would have been out here. I would have come out here.”

  “He knew you were there for him. He spoke of you all the time. He was proud of the man you had become. Maybe that’s why he did it this way. He didn’t want to involve us. He knew the dangers. I think he protected us to the end.”

  “What Tom has achieved here . . . I mean, it’s just, I don’t know what to say.”

  Kofi says, “We were doing big things.”

  “How were Patricia and Tom doing?”

  Chapter Eight

  “I want to know all the details surrounding Dr. Tom Grabowski’s heart attack.”

  Quentin says, “Mr. President, at this point it appears to be a tragic heart attack. Nothing more.”

  The president looks over to the television. His college team is losing. A perfect season in the balance. He missed the last play and the mute button is on so he can’t hear the play-by-play.

  “I need to tell my Chief of Staff to make sure I get out to a few more games next year.”

  Quentin says, “Our college is going to lose their perfect season.”

  “It’s not over til it’s over.” The President looks at Quentin. “Any intel?”

  “We’ve had our guys pull his medical records; they were able to get into his doctor’s electronic medical records. His cholesterol was up; he was prediabetic, a lot overweight.”

  Carter Middleton picks up the heavy briefing book and leafs through to a page. “Says he smoked?”

  “Dr. Grabowski liked his cigars. I apologize for the briefing book. We couldn’t get it any smaller.”

  “No apology needed. We’re in the West Wing of the White House, the Oval Office. The most famous office in the world. It’s my duty to serve the people. To serve the people, I need all the facts.”

  “Well said. I get no greater pleasure than sitting in this office with you, serving the people of the United States of America. It’s funny how things end up. I never expected to be here.”

  “I never expected to have you here, old friend. The tragic death of your predecessor, George H. Brown, was very stressful. But you jumped in and are doing a great job.”

  “Thanks. I always get a rush out of coming into this office. I don’t know what it is—the beautiful silk carpet with that big presidential seal, the furniture, the history.”

  The president looks out the east doors to the rose garden.

  “It’s the tradition. There’s real power here. You can feel it.”

  Quentin nods.

  The president says, “Nothing suspicious then?”

  “Unidentified witness saw Dr. Grabowski collapse while jogging up Cypress Hill.”

  “Unidentified?”

  “It was called in. We couldn’t trace from where.”

  “When will the body be here?” says the president.

  “It will be flown to George Washington and an autopsy conducted in a few days. We don’t expect any surprises. I know how important this file is to you, so I’ve sent a man to do some on-the-ground investigating. He will report back shortly.”

  “Keep me informed. I don’t have to remind you, Transplant Working Group is a game changer. TWG success puts us right back at the top.”

  “Yes, Mr. President.”

  “In a few years when they perfect the face transplants, we will be able to put any face we want on anyone.”

  “Yes, Mr. President.”

  “We will be the leader in intelligence gathering. We will develop a legion of perfect spies, able to impersonate anyone.”

  “Not quite, we have to take their face first. From the reports I have read, we’re far away from creating transplants that have no telltale signs.”

  “I agree. I’ll have long left office and been forgotten. But that’s the greatness of this office. I will have started a program that will put America back on top, one of the greatest acts of a sitting president. And I don’t even need to get the credit, but history will remember. True service to country.”

  Quentin says, “We’re spending a great deal of money on this research. Some of it could be spent on projects that might have some benefits in the next two years. Face transplants may not generate anything more than research papers for these guys.”

  “That’s not how a president thinks. I know re-election is two years away. You don’t put a man on the moon with that k
ind of thinking. Greatness, that’s what gets a man on the moon.”

  “Yes, Mr. President.”

  “The world will know to never again underestimate the resiliency, hard work, and creativity of the American people. We innovate. We lead.”

  As Quentin Taylor gets up to leave, the president unmutes the television.

  He says, “Stay. Let’s root for our alma matter.”

  ***

  Jason stops his rental car at the top of Cypress Hill. He then walks to the area where Dr. Grabowski collapsed. The hill is small, more mound than hill. The dirt path has been well-worn by runners, cyclists, and backpackers. It is not that steep a grade. But then again, for a man with a weak heart, it may have been just the tipping point to cause a heart attack.

  Jason turns to go back to his car; about forty feet away, he sees a broken branch. He is looking in that direction because it is the exact spot he would have chosen if he were a sniper. The perfect spot to remain hidden but have a clear line of sight to a runner at the top of the hill. He walks over and looks at the branch. His first thought is that whoever was in this area had broken the branch walking by. He looks at the branch again. Then he bends over to smell it. It looks like it has been burned. Now a few days later, it has bent as the burned segment no longer can hold the weight of the leaves. Jason looks at the burn pattern. It is a regular sphere. Not from a rifle or other firearm.

  Jason smiles to himself as he thinks, We have ourselves a case.

  Chapter Nine

  Matthew sees Aly outside of Ryan’s hospital room.

  “Doc MacAulay.”Aly touches his arm and he stops.

  “You’d like to speak to me?”

  “If you don’t mind.”

  “Of course.”

  They move to a hall a little farther away from Ryan’s room.

  Aly asks, “Do you have any idea when he’s getting out?”

  “As I told you both, I really can’t be sure. I’m still trying to save the flap.”

  Aly has her hands tightly clenched in front of her in an awkward manner. “We have some money issues.”

  “How bad?”

  “We’re going to lose the house.”