The Janus Legacy

by Lisa von Biela

  Tim rested his hand on the knob of the door to the Subject’s room. It had become harder and harder for him to go inside to perform the needed maintenance and deliver a fresh bottle of IV nutrition. Every time, the Subject’s face seemed more hollow and more devoid of life and energy. Tim had started to see it in his dreams at night—that is, when he was even able to sleep.

  He took a deep breath and entered. The Subject lay on that thin mattress, just as always. Today he seemed to be just staring aimlessly at the ceiling. He didn’t seem to even notice Tim’s entrance. Maybe he just didn’t care anymore.

  Tim approached the enclosure for a closer look. The Subject languidly turned toward him and regarded him with glassy eyes.

  The White Coat had returned, the only one that came any more. He couldn’t remember seeing the other White Coat since that time they pushed him down and he went to sleep, only to wake up in pain. He didn’t like the other one very much. In fact, he didn’t like either one of them after what they did to him to make him hurt, but this one seemed a little different from the other one. He still came by, and he hadn’t hurt him any more since then. That was something anyway.

  The White Coat was looking at him strangely. He didn’t know what to think of that. Just looking at him strangely and standing there.

  He looked up at the bottle that hung above him. It was nearly full. Usually the White Coat didn’t come until the bottle was nearly empty. Something strange was going on.

  The White Coat started to open the door to the enclosure. The Subject shrank back toward the wall. He feared he had come to take him to the strange room again. The room that always brought more pain.

  Tim felt a pang of guilt as the Subject drew back against the wall when he entered the enclosure. There was a time when the Subject did not fear him. Of course, that was when he brought the Subject food that was halfway palatable, and had never hurt him in any way. Now he had taken him through two painful surgical procedures and put him in the piteous state he was in now. The Subject had every right to be afraid.

  “It’s all right. I won’t hurt you anymore.” Tim felt odd speaking to the Subject. No one had ever really tried to converse with him or bothered to teach him rudimentary English. He wondered if the Subject had picked anything up just from overhearing him talking with Glen on prior visits. He hoped he could at least sense that he wanted to help him.

  He stepped all the way inside the enclosure and shut the door behind him. He crouched down, doing everything possible to avoid being threatening or intimidating. “It’s all right.” He carefully reached for one of the Subject’s hands and gently stroked it to try to soothe him.

  The Subject at first recoiled and pressed himself even more tightly against the wall. Then he looked at Tim very intently and relaxed a little. He allowed Tim to take his hand, and he continued to stare back at him as Tim tried to soothe him.

  “I’m so sorry. I should never have done what I did. I am so sorry.” Tears slid down Tim’s face as he continued to hold the Subject’s hand.

  He reached out and gently touched the tear. Many nights, as he lay alone in pain in the dark, such things had come from his eyes and run down his face. He wiped them away as he wiped them away from the White Coat’s face now.

  Maybe the White Coat can understand.

  He gazed along the length of the tube leading from him to the bottle above him. He thought of all the pain, of how it hurt to move anymore. One tear, then another, then a stream of them, began to flow down his face. He turned to the White Coat, hoping he could make him understand.

  Tim observed the Subject’s movements and tears, and then it hit him like a blow to the gut. The Subject was trying to communicate with him. Tim had imagined the Subject must be miserable, but now he knew it. The Subject’s facial expression, the way he looked at the IV setup, then at Tim, with tears in his eyes. That was his way of communicating just how miserable he was.

  Tim reached out and gently wiped the Subject’s tears away with one hand. It was time for the pain to stop.

  He released the Subject’s hand and stood. He reached into the pocket of his lab coat with a trembling hand and took out the syringe he had prepared. He maintained eye contact with the Subject and muttered soothing words as best he could as he grasped the tubing in his left hand. He popped the cap off the needle and inserted it into a port in the tubing, then hesitated.

  The Subject continued to gaze up at him with wide, trusting eyes brimming with unshed tears. He looked relaxed now, not fearful.

  His heart pounding, Tim took a deep breath, then slowly pressed the plunger until the syringe emptied its contents. He broke his gaze from the Subject for a moment as he glanced at the tubing. He could see the clear fluid he just injected form a segment in contrast to the white fluid from the IV bottle. The clear fluid began to make its way down the tubing toward the Subject. When it was mere inches from where the needle entered the Subject’s subclavian artery, Tim set the syringe aside, sat next to the Subject on the bed, and took his hand in his.

  He looked into the Subject’s eyes, and waited.

  The White Coat had done something with the tube, but he didn’t understand what. Now he sat beside him, very close. No one had ever sat that close to him without causing him pain.

  But there was no new pain. And the old pain was fading a little. That felt good. It faded more. That felt better. Soon the pain was gone entirely for the first time in so long. He looked up at the White Coat. His vision started to get fuzzy, and he started to feel like he was floating. It felt good to feel painless and weightless. He started to get tired and sleepy. He yawned, then relaxed. He closed his eyes and smiled.

  Tim waited several minutes, then checked the Subject’s pulse. It was over.

  He gently set the Subject’s hand down at his side, then stood and stopped the flow of the IV. He turned and very gently pulled down the Subject’s hospital gown to reveal the site where the needle fed into the artery. Gently, so gently, he removed the tape holding it in place, and, as carefully as with the most sensitive patient, he slid the needle out and set the IV assembly aside. He pulled the hospital gown back up over the wound.

  Then he sat on the bed next to the Subject, put his face in his hands, and cried as he had the very first time he lost a patient.

  CHAPTER 56

  “You can see from the graph that the wait time for procedures started to trend up in the last six months or so. We already have the capacity to increase the number of organs being cultivated simultaneously, but I think we need to add two or three more surgeons to keep up with the associated implantations.” Glen held in his lap several printed graphs he wanted to discuss. He flipped to the next one as he waited.

  Jeremy traced a finger on his monitor as he reviewed the graph Glen had just discussed. “I see what you mean—” His face suddenly twisted into a grimace as he paled alarmingly. He screamed in pain, clutched his abdomen and nearly fell from his chair.

  Glen jumped up and went over to him. “What’s the matter?”

  “Pain…like a knife…worst ever…” Jeremy gasped. Drops of sweat formed on his pallid forehead.

  Glen reached for Jeremy’s wrist. His pulse was thready and racing. “Let’s get you to the treatment room.” He crouched to get Jeremy’s arm over his shoulder and half-dragged him out of his office as he continued to moan.

  Once inside the room, he helped Jeremy up onto the exam table and loosened his upper shirt buttons. Then he opened the cabinet and grabbed a syringe and a vial of a fast-acting sedative and painkiller. He hurriedly drew a dose into the syringe and injected it into Jeremy’s arm. “There, that should ease the pain pretty quickly. Are you OK to just stay put a minute while I go get Tim?”

  Jeremy drew himself up into a fetal position. “Yeah, I think so,” he said through clenched teeth.

  Glen hit the call button and paged Tim, then took off down the hall to see if he could find him any faster. As bad as Jeremy had been hit with attacks of his Crohn’s, he had never
seen him have such a sudden and excruciating onset. They needed to stabilize him and run tests—and fast.

  As he sprinted down the hall, he saw the door to the Subject’s room open slowly. Tim emerged, looking every bit as pale as Jeremy.

  “What are you doing in there? Didn’t you hear the page?”

  Tim regarded him with red-rimmed eyes. “What? No, I didn’t hear it.”

  “What the fuck is wrong with you?” Glen pushed Tim aside and took a quick look inside the Subject’s enclosure. “What the hell is going on in here?” He strode inside and saw the Subject had been disconnected from the IV and was lying beneath a blanket. He turned to Tim. “What happened?”

  Tim started to open his mouth, but nothing came out.

  Glen grabbed his arm and began to steer him toward the treatment room. “No time right now, Jeremy’s in crisis.”

  They arrived moments later to find Jeremy still lying in the fetal position. He appeared to be in slightly less pain than when Glen had left him.

  “All right, Jeremy, so what happened?” Glen reached for the blood pressure cuff and stethoscope.

  “I don’t know. I was fine one minute, then this incredibly sharp, burning pain went through my abdomen. Just all through it. The drug is helping some, but it’s still pretty bad.” He wiped sweat from his forehead with a shaking arm.

  “Hook up the monitors.” He gave Tim a little shove to get him moving. “I’ll start an IV drip.” He deftly took Jeremy’s blood pressure and shook his head. “Low. I don’t like it.” He removed the cuff and tried to start the IV. It took him multiple attempts to get a vein that would cooperate.

  Several minutes later, Jeremy lay amid a nest of wires and tubes. Glen studied the monitor screens. “Rhythm good, but a bit fast, probably from the pain. I’ll give you a little more of the med.” He quickly administered a second dose through the IV port. Then he slipped an electronic thermometer beneath Jeremy’s tongue. “One hundred two. Tim, draw blood for a CBC. May have some fast-moving infection.” He turned to Jeremy. “OK, I’m going to have to palpate your abdomen. Please try to relax as best you can.” He helped Jeremy uncurl from the fetal position. He began to palpate, then stopped. “He’s absolutely rigid—but it feels like it’s inside, not in the muscle wall. I’ve never felt anything like it.”

  “What’s happening to me?” Jeremy asked in a small, tight voice.

  “I’m not sure. I want to get a look at the labs first. Try to relax.” Glen turned to Tim. “Make sure he’s stable, then come to my office when you have the labs. We need to talk.”

  CHAPTER 57

  Glen looked up from his computer monitor as Tim entered his office. “What do the labs say?”

  “They point to inflammation—and something else.”

  “What?”

  “Tissue death. On a pretty large scale.” Tim rubbed his eyes. “I’m worried about the transplant. I think something may have gone wrong.”

  Glen sat back in his chair and shook his head. “I don’t get it. If there had been a problem with the surgery or the resection of the blood supply, it should have presented long before now. Hell, he was fully healed from the procedure and had been doing perfectly well.”

  Tim sat silent, head bowed, shoulders slumped. He did not make eye contact with Glen. His hands twisted and fidgeted in his lap as if of their own volition.

  Glen let out a frustrated sigh. “I hate to do it, but I don’t think we have a choice. Let’s get him stable and prepped for an exploratory. I’d like to begin with a laparoscopic exam to keep it minimally invasive. If something needs intervention, then we open him up.”

  “Sure. I’ll monitor him for a bit longer. He was stabilizing reasonably well, but was still in a lot of pain despite the meds.” Tim started to get up to leave.

  “Wait a minute. We have something else to talk about, don’t we?”

  Tim became even paler as he sat back down.

  “What happened to the Subject?”

  “He’s dead.”

  “I got that. What happened?”

  Tim stared at his hands in his lap.

  “What happened?”

  Tim raised his head, looked Glen in the eye. “That was no way to live. He was in constant pain and misery.”

  “Well, for someone who was so damned adamant about bringing him out of arrest during the procedure, that’s quite a turnaround.”

  Tim bowed his head again. “I finally grasped just how miserable an existence I sentenced him to by saving his life that day, and I couldn’t live with that anymore.”

  “Frankly, he had no further use for us anyway—unless we were going to try to develop a new intestinal tract within his abdominal cavity. Guess that’s out now, but it would have been interesting to try.” Glen scratched his head as he pondered the implications. “The main problem this raises is that of disposal. Since he never existed in the normal sense, there would be a lot of uncomfortable questions if we disposed of the body as we would a deceased patient.”

  “I hadn’t thought that far ahead. I just couldn’t watch him suffer like that another day.”

  “Well, now we have to deal with the problem, don’t we? I suppose we could store it in the freezer for the time being, maybe disposing of it in parts in medical waste over time.” Glen slapped a hand onto his desk. “I’d hoped to avoid having to face this issue for some time. Let’s just put it in the freezer for now, so we can focus on Jeremy. We’ll think more about disposal later.”

  “What’s the matter with me?” Jeremy glanced anxiously at Glen and Tim.

  “We’re not entirely sure. Signs point to some sort of infection and inflammation. There appears to be tissue damage as well, but it’s not clear why or how that would happen at this point.” Glen glanced at the monitors. “Tim, what do you think?”

  “Probably as good as we’re going to get.”

  “What are you talking about?” Jeremy tried to sit up, grimaced, and lay back down.

  “We need to see what’s going on in there. I’m planning to use the laparoscope. It’s tiny, and we can get a little camera in there. From there, it all depends what we see. It’s possible we may have to do something more extensive. I just don’t know. Whatever we do, we need to move quickly.”

  Jeremy looked away. “Oh, God. Can someone let Amanda know?”

  “No time right now. We’ll let her know afterwards. Tim, prep him.”

  Glen maneuvered the slim metal tubes and tiny camera inside Jeremy’s abdominal cavity. “Still stable, Tim?”

  “Heart rate is a bit higher than I’d like, but so far, so good.”

  “That’s not a surprise, given the labs. All right, just about in position here.” Glen nearly felt sick when the camera and light revealed the problem. “Oh, dear Christ.”

  “What is it?”

  Stunned, Glen quickly ran the camera over the rest of the abdominal contents to verify what he’d seen, then switched on the external video monitor so Tim could see for himself. “The entire intestinal tract. Look at it—it’s darkening. Looks like total tissue death. Gangrene can’t be far behind. We’re going to have to go in and remove it all.” He slid out the laparoscopic tubes and set them aside. He drew his gown-clad forearm across his forehead. “My God. Adjust the anesthetic while I get ready.”

  “You’re going to remove it all?”

  “No choice. If it stays in it’ll kill him. I suppose it was useful to have the Subject around as long as we did. Jeremy’s going to have to go on the same total parenteral nutrition IV regimen until the second Subject is ready to harvest.” Glen paused as he arranged his instruments. “We’re going to need to use that time to figure out what went wrong here, and how to avoid it next time. It was so strange. I was in Jeremy’s office. He was fine, then this came on so suddenly. Like someone flipped a switch.”

  CHAPTER 58

  Jeremy awoke in a pain-laced haze. His mouth felt like he’d been eating sand; his entire abdomen felt as if it were on fire. He struggled to open his
eyes; his eyelids felt weighed down. He tried to focus, to figure out where he was and why.

  Amanda gazed down at him with a frown of obvious concern. “Hey, hello there.” She did not smile.

  He tried to form words, but his mouth couldn’t properly coordinate. “What—?” Uttering the single word tore at his dry throat.

  She made shushing sounds. “Don’t try to talk right now. You came out of surgery just a little while ago.”

  He tried again to speak, but this time his throat just clicked painfully. He wanted to weep, but knew the pain would be even more unbearable.

  “All right, I’ll tell you, but you’re still pretty drugged up right now. They said you started having severe pain, they ran tests and decided they’d better do an exploratory.” She fought off tears.

  He tried to form a questioning look to prod her for more information.

  She swallowed hard, hesitated, then said in a small, frightened voice, “And they found that the intestinal tissue had all died, and they were worried about infection.”

  Jeremy feared what she would say next; feared that he knew what was coming.

  “Jeremy, they had to remove it. They said they had no choice, that it was already too far advanced.” The tears won out and began to stream down her cheeks.

  The news knifed through the drug haze as the implications made themselves known. He’d seen the Subject firsthand, and so knew what it would mean to be completely dependent on an IV bottle for all his nutrition. He wanted to scream, but only a small croak escaped his lips.

  Amanda paled, then turned and pressed a button. Moments later, Glen, looking drained and worn, entered the room.

  “What’s going on?”

  Amanda told him what she had revealed to Jeremy.

  “I see. Jeremy, I know you’re upset. We had no choice, none at all. We’ll do everything possible for your comfort, but you will need to be on parenteral nutrition for the time being. No solid food. But it’s temporary. I had already initiated cultivation on a new Subject after we spoke a few weeks back. I’ll work with Tim on seeing if we can speed the process up in light of this development. You just need to hang on and be patient for a while. You tolerated the surgery well, and we were lucky we realized what was going on as quickly as we did.”