“She’s an emergency appendectomy. Apparently a hot one, too. And she’s a medical student. You’d think she would have had enough sense to be seen sooner.”
Another voice, deeper than the first. “I understand she had called in sick this morning to the dean’s office, so obviously she knew something was wrong. Maybe she was worried about being pregnant.”
“Maybe you’re right. But she tested negative.”
Susan’s mouth tried to form words but no sounds issued from her larynx. She found that her head could move from side to side. The drug was beginning to wear off. Then the movement stopped. Susan recognized the area. She was in the scrub room. By turning her head to the right she could see the scrub sink. A surgeon was scrubbing.
“You want one or two assistants, sir?” said one of the voices behind Susan.
The man at the scrub sink turned. He was wearing a hood and a mask. But Susan recognized him. It was Stark.
“One’s enough for a simple appy. I’ll have it out in twenty minutes.”
“No, no,” cried Susan, voicelessly. Only a bit of air hissed between her lips. Then she began to move toward the operating room. She could see the door open. She saw the number over it. Room No. 8.
The drug was wearing off. Susan could lift her head and her left arm. She saw the huge operating room lights. The glare dazzled her. She knew she had to get up . . . to run.
Strong arms gripped her waist, her ankles and head. She felt hands thrust under her, and she was lifted effortlessly onto the operating table. Susan lifted her left hand to grasp at anything. She grabbed an arm.
“Please . . . don’t . . . I am . . .” The words came slowly, almost inaudibly from Susan’s throat. She was trying to sit up despite the weight of her head.
A strong arm was laid across her forehead. Her head was pressed back.
“Don’t worry, everything will be all right. Just take some deep breaths.”
“No, no,” said Susan, her voice gaining slightly in power.
But an anesthesia mask dropped over her face. She felt a sudden pain in her right arm . . . an I.V. The liquid started into her vein. No. No. She tried to shake her head from side to side but strong arms held her. She looked up and saw a masked face. The eyes looked into hers. She saw an I.V. bottle with bubbles dancing up through the fluid. She saw someone thrust a syringe into the I.V. line. The Pentothal!
“Everything will be all right. Just relax. Take a deep breath. Everything will be all right. Just relax. Take a deep breath. . . .”
The atmosphere in room 8 at 12:36 A.M. that February 27 was extremely tense. The junior resident had found himself all thumbs during the case, even dropping clamps and fumbling ties. Stark’s presence and reputation had been too much for the fledgling surgeon, especially after the initial rapport had evaporated.
The anesthesiologist’s handwriting was even more erratic than usual as he put the finishing touches on his anesthesia record. He wanted the case to be over. The patient’s sudden cardiac irregularities in the middle of the case had totally unnerved him. But even worse had been the sudden closure of the non-return valve on the wall oxygen line. In his eight years as an anesthesiologist, it was the first time that piped-in oxygen had actually failed. He had made the transition to the green emergency cylinders smoothly, and he was fairly confident there had been no change in the amount of oxygen he had been delivering. But the experience had been frightening; he knew he could have lost the patient.
“How much longer?” the anesthesiologist asked over the ether screen, putting his pen down.
Stark’s eyes were wildly dancing from the clock to the door, then back to the operative field. He had taken over tying the skin sutures from the bumbling resident.
“Five minutes, tops,” said Stark as he ran a knot down with his deft fingers. Stark too was nervous. That was obvious to the resident, who thought he himself must be the cause. But Stark was nervous because he knew that something was not right.
The oxygen non-return valve should not have failed. That meant that the oxygen pressure had fallen to zero in the main line. Of the operating team, only Stark knew that the patient’s cardiac irregularities meant that she had received carbon monoxide with the mainline oxygen. But when that oxygen source failed, he couldn’t be sure whether Susan had received enough of the deadly gas for his purposes.
And then there had been the muffled shouts which had caused the circulating nurses to check the corridor. But Stark knew that the noises came from above, from the ceiling space.
But that wasn’t all. As Stark was making the next to last skin suture, his eyes caught a surge of movement in the corridor through the window of the OR door. The corridor seemed to be filled with people, and at 12:35 A.M. that was inappropriate, to say the least.
Stark placed the last skin suture and dropped the needle holder onto the instrument tray. As he picked up the ends to tie the knot, the OR door swung open, and Stark saw at least four people advance into the room. Mark Bellows was among them.
The sudden visitors wore surgical gowns, and Stark’s pulse began to race as he realized that most of them had thrown their gowns over blue uniforms. A deadly silence hung in the OR. But as Stark straightened up from the operating table, he knew now that something was wrong. Something was very wrong.
Author’s Note
This novel was conceived as an entertainment, but it is not science fiction. Its implications are scary because they are possible, perhaps even probable. Consider a classified advertisement that appeared in the San Gabriel (Calif.) Tribune, May 9, 1968, col. 4:
NEED A TRANSPLANT?
Man will sell any portion of body for financial remuneration to person needing an operation. Write box 1211-630, Covina.
The advertiser did not specify what organ or organs, or even whose body they were to come from.
And there have been other advertisements, many others, in various newspapers across the country. Even specific offers of the hearts from living people!
As gruesome as these ads sound, they should come as no great surprise. There are plenty of precedents for the market economy in medicine. Blood—which may be considered as an organ—is routinely bought and sold. There is a commerce in semen, which, while not an organ, is the product of an organ.
Other organs have been bought and sold. In the 1930’s, a rich Italian man bought a testis from a young Neapolitan and had it transplanted into himself. (He not only wanted the product but he wanted to be a distributor as well.) In the last few years there have been episodes where families have declined to give their own kidneys to dying relatives and have sought out and paid volunteer donors. Such cases have not been common, but they have occurred.
The larger problem, the danger, arises from the simple matter of scarcity. There are thousands of people waiting for kidneys and corneas today. The reason that these two organs are particularly coveted is because they have most frequently been transplanted—successfully. Thanks to dialysis machines, potential kidney recipients (some of them . . . others are left to die because of shortages of dialysis machines, personnel, and funds) can be kept alive, but their lives are far from normal. In many situations they border on the desperate, so much so that kidney dialysis centers have reported a so-called “Holiday Syndrome.” What that means is that when a holiday weekend approaches, the patients’ spirits rise as they anticipate the rush of auto accidents and the victims who may supply the eagerly awaited and desperately needed organs.
The tragedy in this situation is that the solution to the problem is already within our grasp. Medical technology has advanced to the point where approximately seven percent of all cadaver kidneys are suitable for transplant (and the figure is much higher for corneas), if they are taken from the donor body within an hour of death. But instead of being put to this noble use, these organs are regularly delivered to the worms or to the fires of the crematorium because of legal mumbo jumbo whose origins lie in the dark ages of English law. For back in those times corpses came under
the jurisdiction of the ecclesiastical rather than civil law. It seems inconceivable that such a legacy should limit our lives today. But it does.
However, most, if not all, states have now passed the Uniform Anatomical Gift Act. This law has helped to provide cadavers for medical schools (whose supply was already adequate), but it has not helped in rectifying the sad need for useful “live” organs for transplant purposes. An alternate approach, by which all cadaver organs would be immediately available for salvage unless the deceased or the next of kin had made prior refusal, has been proposed. But alas, the wheels of change turn agonizingly slowly, and potential recipients are allowed to die while organs are wasted in the ground. Hard questions remain to be answered: such as an acceptable definition of death, and the legal rights of an individual after death. But such difficulties should not preclude a solution to the egregiously wasteful practice of discarding valuable human resources.
The problem of organ scarcity for transplantation represents only one flagrant example of the failure of society in general and medicine in particular to anticipate the social, legal, and ethical ramifications of a technological innovation. For some inexplicable reason, society waits to the very end before creating appropriate policy to pick up the pieces and make sense out of chaos. And in the instance of transplantation, failure to recognize mounting problems and enact appropriate solutions will certainly open Pandora’s box, with its countless unconscionable possibilities: the Stark et al. of my fiction suggest only possible, execrable aberrations.
For those readers who are interested in delving into the complex problems of organs for transplantation, I recommend two excellent articles which are delightfully illuminating, despite the fact that they appeared in law journals. This is not to cast aspersions on law journals, but rather to emphasize that the lay individual will find these articles very readable: J. Dukeminier, “Supplying Organs for Transplantation,” Michigan Law Review, vol. 68 (April 1970), pp. 811-866; D. Sanders and J. Dukeminier, “Medical Advance and Legal Lag: Hemodialysis and Kidney Transplantation,” UCLA Law Review, vol. 15 (1968), pp. 357-413.
For those who are interested in medical policy and its phlegmatic character, combined with some positive suggestions for future change, I recommend: J. Katz and M. Capron, Catastrophic Diseases: Who Decides What? Russell Sage Foundation, 1975. This is an excellent, thought-provoking book, probably years ahead of its time. Its only drawback is that not enough people in positions of power in medicine will read it.
A final word about women in medicine: I must admit that the research I did on the subject (there is not much available) caused me to alter my opinions. I now have a heightened regard for female physicians and female medical students. I recognize that their training experiences are much more difficult and stressful than those of their male counterparts. Things are getting better in this respect, but at a snail’s pace. The article I found the most illuminating is: M. Notman and C. Nadelson, “Medicine: Career Conflict for Woman,” American Journal of Psychiatry vol. 130 (October 1973), pp. 1123-1126.
ROBIN COOK, M.D.
August 1976
Robin Cook, Coma
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