The Curious Case of the Missing Head
Page 21
‘How come?’
‘Because of the bodies. Some say the bodies have been obtained without consent in Africa. He’s got a clinic in Malta specialising in transplants and has been accused of trafficking in body parts.’
‘How awful,’ said Teodora, her interest aroused.
‘It is. Apparently, he was investigated some years ago by a UN war crimes tribunal.’
‘What about?’
‘Some organ-harvesting racket.’
‘Where?’ asked Teodora, barely able to speak.
‘I think Jack said Kosovo, during the war. Watch out!’
Babu! thought Teodora, her head spinning. She almost lost control of the car and nearly hit a truck travelling next to her.
‘What are you doing?’ shouted Izabel.
‘Sorry,’ said Teodora, taking deep breaths to calm herself. ‘I think we need a break.’ She slowed down, changed lanes and took the next exit.
‘Do you believe in destiny?’ said Teodora.
Izabel looked at Teodora, surprised. ‘Why do you ask?’
‘Because I’ve just seen it at work.’
27
Professor Fabry’s surgery, Malta: 23 June
Fabry slipped the phone into his pocket, sat back and looked pensively down to the harbour below. He could just see the Caritas tied up at the wharf. This is it, he thought. We’ll do it today. The first in vivo cephalosomatic anastomosis ever carried out. The day he had been dreaming about for years had arrived. Everything was lining up perfectly. The last missing piece had just fallen into place. The phone call from the hospital he had just received had seen to that. A fisherman had been rescued from a sinking boat during the night. According to the doctor in emergency, the man was in a coma and on life support with severe, irreparable brain damage, and unlikely to see out the day. His family was by his side and discussions were in progress to turn off the life support. The man, in his early thirties and with a young family, was an organ donor.
Fabry had an arrangement in place with the doctors at the hospital regarding organ donors. He would offer generous payments to relatives and give assurances that the donated organs of the loved one would make a huge difference to someone in great need. Charming and persuasive, Fabry was always believable and usually got what he wanted.
A useless brain and an otherwise strong and healthy body, thought Fabry as he watched the Caritas. And down there was a useless, dying body with an extraordinary, healthy brain and a million-dollar price tag. Perfect; exactly what we need. All he had to do was bring the two together. And Fabry believed he knew exactly how that could be done. He rang his assistant and told her to meet him at the hospital to examine the dying patient. He wanted to make absolutely sure the body was suitable and compatible before making arrangements for the historic operation later that day.
Two hours later, Fabry met his team in his office. The dying patient at the hospital had turned out to be a perfect match, and fifty-thousand euros had eased the family’s pain of losing the breadwinner. The wife had agreed to have the life support turned off and her husband’s body donated. Fabry made arrangements to have the patient immediately transferred to his clinic. The life support would be turned off there when the time was just right. As a generous patron of the hospital, Fabry had no difficulty in making sure the hospital cooperated with this somewhat unusual arrangement, and they didn’t ask any questions.
Fabry had two experienced operating teams at the clinic that specialised in transplants. He decided to use both teams for this operation because he knew it could last up to eighteen hours, involve several specialists, and most likely stray into uncharted territory. Fabry had often discussed the possibility of an in vivo head transplantation with his teams. In fact, some members of the team had already experimented with him on live humans, trying to perfect various aspects of the revolutionary procedure while they were working with him on the Caritas in Africa. On two occasions, some limited motor function had been achieved after an in vivo head transplantation. What had eventually killed the patients was rejection and other associated complications. But recent advances in immunology and especially stem-cell research had come a long way since then to overcome this problem.
One month earlier, Fabry had conducted a full-scale cephalosomatic anastomosis (CSA) rehearsal on two recently deceased cadavers, including neck-surgery, orthopaedic surgery, vascular surgery, gastronomical surgery and, of course, neurosurgery, in preparation for a live human CSA.
‘My friends, I believe we will make history today,’ said Fabry and paused to look at each of his team member’s expectant faces. ‘We have a patient on the Caritas right now with a perfectly healthy brain, but a severely injured body that is about to shut down. And then as you’ve heard, we have just received a dying patient in a coma who has a fatally damaged brain after almost drowning, but an otherwise strong, healthy body. The body has been donated with full family consent and the life support is about to be turned off, by us. This is exactly what we’ve been talking about and waiting for. This is the perfect scenario and I believe we must take advantage of it, right now. We are ready to do what has never been done before, but time is of the essence. You all know why. We will carry out the first in vivo CSA – today!’
Fabry turned around and pointed to the X-ray on the illuminated glass board behind his desk. It was the same X-ray of Stolzfus’s head, neck and shoulders he had shown to Alessandro and Rodrigo two days before.
‘The CSA will be conducted in the standard neurosurgical sitting position. We will sever the patient’s head at the base here,’ Fabry drew a line with his finger across the base of the neck, ‘and then attach it to the new, healthy donor body we’ve just received. In short, we will carry out an in vivo head transplantation.’
At first there was silence in the room as Fabry’s surprise announcement was beginning to sink in. While the team members were all familiar with the various steps involved in the revolutionary procedure, it had never been carried out on a live patient before.
‘Don’t look so surprised. I know we can do it. We have all the necessary consents in place, so you don’t have to be concerned about that. If something does go wrong, there will be no repercussions.’
Fabry had a strict privacy policy in force at his clinic that ensured patient–donor anonymity and confidentiality at all times. The identity of the parties involved was never disclosed. ‘We will split into two teams,’ continued Fabry. ‘One team will work on the donor body and keep it functioning after the head has been removed, the other will work with me to sever the head from the damaged body, which we will discard. As you know, this is the most critical part of the entire procedure. The cut has to be as precise as possible to ensure that the spinal cord can be reattached. I will use the latest diamond blade for this. Fusing the spinal cord of the head to that of the new body is the real challenge here; uncharted waters, I’m afraid, but definitely possible. Of course, we have to reconnect the head to blood vessels, the oesophagus and airways. With me so far?’
‘Sure, but what happens after we’ve severed the head?’ asked Fabry’s assistant, a young doctor from Ghana.
‘We know we can keep the unconscious, severed head alive by keeping it below fifty degrees Fahrenheit to avoid brain damage,’ continued Fabry, warming to his favourite subject. ‘Of course, the head will have to be hooked up to two pumps to provide continuous blood flow and oxygen while we get the donor body ready, and the head can be attached. However, we do know the brain can survive intact under deep hypothermia for up to an hour without blood supply. That should be sufficient time for us to complete all the vascular anastomoses and thus restore blood supply.’
Fabry paused. ‘One other critically important issue I would like to mention right now,’ he continued, ‘is this: we have to make absolutely sure that we transfer the head with the larynx and the recurrent laryngeal nerves intact to preserve phonation. We must be able to communicate with the patient once he’s been reawakened.’
‘And
then?’ asked one of the other doctors.
‘We then use an adhesive – polyethylene glycol – to connect the head with the spinal cord of the donor body, supported by an eleven-hole titanium plate held in place by vertebral screws. After that, the patient will be fitted with a cervicothoracic orthosis brace before we induce a coma for a month or so to allow blood vessels and nerve networks to regenerate. This is a complex, multi-specialty procedure. I firmly believe that present in this very room right now, we have all the necessary interdisciplinary expertise and experience required to succeed. And one more thing ... we will film the entire procedure to ensure we have a detailed record of everything. Time is obviously of the essence here. We better get started. This is a team effort. Any questions?’
It took several hours to prepare the operating theatre for the groundbreaking procedure. Surgery commenced at three pm and lasted just under eighteen hours.
Fabry was on a high. The patient was alive and had come through the complex surgery with his brain intact. In the end, everything had worked out better than expected. Professor Stolzfus had kept his old head and his memory, and had received a new, healthy body that had saved his life.
An old head on young shoulders, thought Fabry, smiling. He took off his surgical gown and went from team member to team member, congratulating each one personally. They had encountered several tense, nail-biting moments during the epic CSA, with the threat of failure and the shadow of instant death never too far away, but somehow ingenious solutions had been found, often in unexpected ways, to overcome each of the problems.
Exhausted but elated, Fabry went up to the roof terrace on top of the building. He wanted to be alone to savour the moment of personal triumph he had longed for so desperately, and for so long. I knew it could be done, he thought, drinking in the cool, refreshing air, which felt particularly invigorating after eighteen stressful hours in the operating theatre.
Now, everything he had done in the past, all the questionable practices, those early, dark horror years in Albania, the trafficking in body parts in league with the Mafia and the many reckless, experimental surgical procedures carried out on the Caritas without consent or regard for the patients’ rights or wellbeing, seemed perfectly justified. Pioneers had to take risks, Fabry told himself. Guilt had been washed away by success, and conscience devoured by blind ambition and ego in the name of science and glory.
Never one to dwell in the past or be troubled by moral considerations, Fabry looked across to Fort Saint Elmo that divided Marsamxett Harbour from the Grand Harbour, and contemplated the future. There could be a Nobel Prize in this, he thought, letting the morning sun caress his face. A couple of hours’ sleep in the office and then off to the airport to meet a legendary rock star with buckets of money. Life was good.
Little did Fabry know that at the very pinnacle of success, dark forces were gathering all around him, and the terrible day of reckoning was coming closer with relentless certainty.
28
Visit to the Caritas, Grand Harbour, Malta: 24 June
Pegasus landed at three-thirty pm sharp at Malta International Airport as scheduled, and taxied to the designated bay reserved for private jets. Lola, who was flying the plane, had arranged a brief stop at Venice Marco Polo Airport to pick up Jack and Tristan on the way.
Fabry watched the sleek aircraft make a sharp turn and come to a sudden stop. Moments later, the door opened and Isis appeared at the top of the stairs. Looking like a glamorous movie star in a striking Valentino creation, she adjusted her dark glasses and Chanel headscarf and looked around. Aware that she was being watched by the officials waiting at the bottom of the stairs to check passports, she began to walk slowly down the stairs, one step at a time, careful not get her insanely high heels caught in the steel grooves.
‘Welcome to Malta,’ said Fabry, extending his hand. ‘Is this your first visit?’
‘No. I’ve been here before,’ said Isis, giving Fabry her best smile. ‘We shot a promotion video here at Fort Saint Elmo a few years ago for my album, Siege. We used the Siege of Malta as our theme. I love history, you see, and I incorporate historical themes into my music and my performances. The video was very popular.’
‘If you are interested in history, you’ve certainly come to the right place,’ Fabry continued breezily. ‘There’s probably more history on these islands than any other place in the Mediterranean I can think of. You must allow me to show you around, if you have time,’ he prattled on.
‘I would like that very much, thank you, but first we should visit the Caritas. After all, that’s the reason we are here ...’
‘Of course. Everything is ready. We’ll go there straight away. The whole of the Caritas is at your disposal. I’m sure you’ll be impressed.’
‘I have heard a lot about the Caritas and the wonderful work you do. That’s why I wanted to see it for myself. But first, allow me to introduce you to my friends ...’ Isis pointed to Jack and Tristan standing behind her.
‘What did I tell you?’ whispered Jack, squeezing Tristan’s arm. ‘She’s got him wrapped around her little finger already. All we have to do is tag along and watch.’
Tristan nodded and stepped forward to shake Fabry’s hand. As he looked briefly into Fabry’s eyes, a strange feeling came over him, like he was looking into a murky, bottomless pool full of dark promises, drawing him in. A well of accusing souls, thought Tristan, recognising the unsettling feeling he had experienced before, usually in situations of acute danger. The feeling became stronger as he touched Fabry’s cold hand. This man has killed, many times. We have to be careful! On this occasion, Tristan, who could hear the whisper of angels and glimpse eternity, glimpsed only misery and horrible death.
Fabry took his visitors straight to the Caritas to meet the captain and the medical team. Everyone had been fully briefed, knew the drill and was ready to impress the famous visitor. It was all about loosening the purse strings. Used to such occasions, the medical team knew exactly what to do and say. After all, the Caritas was run by a charity and depended on donations to keep it afloat, literally, and Fabry was an experienced fundraiser who knew exactly which levers to pull.
As soon as they stepped on board, Tristan was momentarily overwhelmed by signals and impressions assaulting his finely honed senses from all sides, like a tide of pain screaming for attention.
Jack noticed that Tristan appeared to be uncomfortable and in a daze. ‘What’s wrong?’ he asked, reaching for Tristan’s arm to steady him.
‘This place. I’ve never felt anything quite like this before,’ replied Tristan, shaking his head.
‘What do you mean?’
‘Difficult to put into words.’
‘Try.’
‘Pain. And evil.’
‘Sounds promising.’
‘You don’t seem to understand. Horrible things have happened here. And there’s something else ...’
‘What?’
‘Danger.’
‘Great. Just what we need.’
‘We have three fully equipped operating theatres on board,’ said one of the doctors showing them around, ‘and a ward of fifty beds—’
‘We have heard a lot about your famous travelling exhibition – Our Bodies,’ interrupted Jack, changing the subject. ‘Can you tell us something about that?’
‘We use that exhibition to raise money for our charity, which as you know runs this ship,’ said Fabry, stepping in. He clearly didn’t like the question and appeared keen to move on.
‘I’m absolutely fascinated by the concept,’ said Isis, picking up the thread. ‘As I understand it, you are using real human bodies ...’
‘Yes, we are.’
‘And you prepare them right here, on this ship,’ said Jack, watching Fabry carefully, ‘using a unique, revolutionary procedure? I think it’s called vivification?’
Fabry looked at Jack, instantly on guard. How does he know all this? he wondered. ‘Where did you hear that, if I may ask?’ he said casually.
‘I certainly do,’ said Fabry, smiling. ‘And what would you consider a substantial donation?’ he added casually.
‘A million pounds, say, over three years?’ said Isis, baiting the hook.
Fabry looked impressed. Donations like this didn’t come along too often, and the cash-strapped charity could certainly do with the money. He realised that to secure the donation, he had to somehow impress his visitors and give them confidence in the charity’s work.
‘May I speak frankly?’ said Jack, realising the right moment had arrived to introduce the subject of real interest.
‘Of course,’ replied Fabry.
‘The exceptional work the Caritas is doing in third-world countries is well known and needs no further explanation. We have no problem with that. What does cause us some concern, are the rumours ...’
‘What kind of rumours?’ interjected Fabry, frowning.
‘Rumours about the bodies that are being used in the exhibition and for anatomical teaching purposes. As you no doubt know, allegations are circulating that many of the bodies have been obtained without consent, or worse. Before Isis can put her name to a donation, we have to be satisfied, you know ...’
‘I completely understand,’ Fabry cut in again. ‘I can assure you, all of the bodies we use have been donated with full, informed consent.’ Fabry paused, collecting his thoughts. He realised that more was needed to put this controversial matter to rest and get Isis over the line, and the best way do to that would be by providing a convincing, current example, or better still, a demonstration.