The Face Transplant Read online

  The Face Transplant

  R. Arundel

  To my family for their enduring support, encouragement and nurturing.

  Text copyright © 2015 R Arundel

  All rights reserved.

  ISBN: 978-0-9919799-1-2

  Table of Contents

  Chapter One

  Chapter Two

  Chapter Three

  Chapter Four

  Chapter Five

  Chapter Six

  Chapter Seven

  Chapter Eight

  Chapter Nine

  Chapter Ten

  Chapter Eleven

  Chapter Twelve

  Chapter Thirteen

  Chapter Fourteen

  Chapter Fifteen

  Chapter Sixteen

  Chapter Seventeen

  Chapter Eighteen

  Chapter Nineteen

  Chapter Twenty

  Chapter Twenty-One

  Chapter Twenty-Two

  Chapter Twenty-Three

  Chapter Twenty-Four

  Chapter Twenty-Five

  Chapter Twenty-Six

  Chapter Twenty-Seven

  Chapter Twenty-Eight

  Chapter Twenty-Nine

  Chapter Thirty

  Chapter Thirty-One

  Chapter Thirty-Two

  Chapter Thirty-Three

  Chapter Thirty-Four

  Chapter Thirty-Five

  Chapter Thirty-Six

  Chapter Thirty-Seven

  Chapter Thirty-Eight

  Chapter Thirty-Nine

  Chapter Forty

  Chapter Forty-One

  Chapter Forty-Two

  Chapter Forty-Three

  Chapter Forty-Four

  Chapter Forty-Five

  Chapter Forty-Six

  Chapter Forty-Seven

  Chapter Forty-Eight

  Chapter Forty-Nine

  Chapter Fifty

  Chapter Fifty-One

  Chapter One

  Guaarrr. It sounds like water draining from a very large bathtub, through a very large hole. I just killed myself. I just killed the patient. Dr. Matthew MacAulay looks down on the operating room table at the gaunt, graying man. Matthew quickly scans the operating theater. Out of the corner of his eye, he can see the short wide man in the observation area.

  I just killed myself, Sarah, and Amanda.

  They have been hijacked into performing a face transplant. The patient is unknown. Mr. Glock, the short wide man, hovers in the far end of the operating room. He made it clear that if the patient did not survive, the three of them would be following him in short order. The 9 mm Glock with a silencer on the end gave credence to his profanity-laced words of warning.

  Matthew looks across the operating room table at Amanda Soto, forty-two, an American of Spanish ancestry. She has been his scrub nurse, assisting him in the operating room for the last three years. Divorced, one child.

  It will take a few more seconds for the monitors to tell everybody what Matthew already knows. Amanda already knows. She is right across the table. She saw him use the robotic arm to dissect the vessel and mistakenly cut the large artery in the neck. An operating room nurse of Amanda’s experience has seen it all. When Matthew looks into her eyes, they flash ever so quickly an acknowledgement that it is all over. Instead of any words, she quietly unclamps the suction. Now a dull hiss fills the air. To the casual observer, or the short wide man holding a 9 mm Glock pistol in his fat stubby hands, nothing really has changed. Amanda, anesthetist Dr. Sarah Larsson, and Dr. Matthew MacAulay act as if all is going well.

  Matthew can not help but glance over to the man with the 9 mm Glock. In his mind he names him Mr. Glock. Adrenaline surges through Matthew’s body and time slows. The short wide man, Mr. Glock, has gray eyes. Pale, gray eyes. Very pale, almost tired. Matthew remembers reading somewhere that people with gray eyes have the best visual acuity. They make the best marksmen, the best assassins. He wonders if this was true.

  Guaarrr. Matthew tries to make eye contact with Amanda. He wonders whether or not she has ever heard this sound before. Probably not, he muses to himself with a wry smile. Amanda is bright; she hands him the instruments in the exact order needed. She is very observant. Not infrequently she puts the instrument in his hand that he needs, not the one he asks for.

  Maybe she does know what that sound means. She could have heard it before. Matthew remembers his days as a trainee surgeon, a resident, at St. Mary’s Medical Center in Chicago. Myles B. Neuwirth was the Professor of Surgery and his teacher.

  Dr. Neuwirth said, “Matt, both you and I know you are well on your way to being a very rare commodity, a true surgeon, not a political animal that climbs the greasy pole.”

  To this day Matthew remembers his sophisticated British accent as he spoke. The trainees joked it was an affectation since he left the United Kingdom over forty years ago.

  Dr. Neuwirth continued, “Maintain your passion to be the best, and keep your humanity. There is nothing more I can teach you. Go forth and prosper.”

  Matthew said, “Thanks for the kind comments.”

  A long pause ensued and Professor Neuwirth seemed to consider something before he made up his mind to speak.

  Dr. Neuwirth said, “There is only one more thing I can teach you.”

  The entire operating room staff was silent. The medical students took out their pens to record the impending words of wisdom from the professor.

  “There are only three types of bleeding that are important when performing surgery. One: bleeding you can’t see. Two: bleeding that you can hear. Three . . .”

  Silence filled the operating room theater as nurses, anesthetists, medical students, and visiting surgeons strained to hear.

  With a sense of the dramatic, Myles lowered his voice. “Three . . .” Then he roared, “Your own!”

  With the final comment, the operating room burst into applause and laughed; it was vintage Myles. He had a flair for the dramatic. The Professor pulled off his gloves with a flourish.

  “Matthew, close up the wound.”

  The professor passed Matthew and whispered, “Unfortunately as you go through life, young man, you will learn: the heart bleeds the worst.”

  ***

  Guaarrr. Matthew is back to the present. All these thoughts and recollections shot through his mind in a fraction of a second. Time has slowed, must be the adrenaline. He is back in the here and now. Matthew cut the major vessel in the neck. The impossible had occurred. Blood flows at a ridiculously fast rate out of the patient’s body. It is leaving at such a rate that Matthew hears the bleeding. The sound is distinct, once heard never forgotten. In sixty seconds at the outside, this man would be dead.

  It’s funny how all these things run through Matthew’s head in less than half a second. It seems to him he has been daydreaming for a long time. The feeling of slowing time is due to the surge of adrenaline. It is a wonderful natural drug. He can now think more clearly and react instantly. Surprisingly, for the position he is in, he feels good. No, he feels great.

  Who is this man on the table? Why does he want this transplant? Who is the man with the 9 mm Glock? Mr. Glock holds a shiny titanium container. There is no doubt in Matthew’s mind that this contains the face to be transplanted. The container is only available in three centers in the United States: Houston, Palo Alto, and his center in New York. It definitely is not from his center. He always checks the faces to be transplanted; he is sure all the containers are accounted for. No worries.

  The suction roars to life and Amanda begins to suction blood. Matthew needs to see. Blood flows like bright red water pouring out of a faucet. Out of the corner of his eye, Matthew can see Mr. Glock moving toward the operating room table. Matthew works to stop the ble
eding; he notes Dr. Sarah Larsson did a remarkable thing. With two quick finger strokes, Sarah silenced the alarms. Brilliant. Our supervisor with the 9 mm Glock will not hear a thing. Sarah does not appear flustered. She does not make any move to increase the intravenous fluids or call for blood for an emergency transfusion. She just calmly switches off the alarms. She already knows they have a problem; the alarms aren’t going to help her. They will only tell Mr. Glock they have a problem. Sarah continues like all is routine. Of course she doesn’t call for blood. They are in the experimental wing of the university facial transplant facility in the middle of the night. Who would hear her?

  Mr. Glock looks like a caricature of a thug. Short, muscular, but overweight. His face is like a square block. A wide short nose. Chopped black hair. Intimidating. The thing Matthew noticed first were his pale gray eyes. A watery gray from a washed out palette.

  Amanda tries to keep the banter up. It is working; Mr. Glock has not detected anything is wrong yet.

  Amanda asked, “Have you seen the play The Spiral Staircase?”

  Matthew said, “Not yet, but I have tickets for next week.”

  Amanda said, “It was pretty good.”

  Sarah added, “I saw it a couple of weeks ago. I really liked it too.”

  Matthew works furiously to stop the bleeding. He is winning; the blood flow is slowing. The sucking sound lessens. He notes Amanda has moved her body ever so slightly to block any view Mr. Glock has of the suction canister. Even with the blood slowing, the canister will fill soon. Mr. Glock will realize things are not going as planned if the canister overflows and blood pours onto the floor. Matthew reminds himself, Don’t worry about that now. Concentrate on the task at hand. Stop the bleeding.

  “Everything okay?”

  Mr. Glock’s voice sends a bolt through Matthew. Sarah flinches ever so slightly. Maybe Matthew has misjudged Mr. Glock; maybe they aren’t as slick in covering the bleeding.

  “We got into a little bleeding. It’s normal for a face transplant, no worries,” Matthew replies.

  Mr. Glock said, “When the incisions are closed and the recipient site prepared, I have some Steriazol to put on them.”

  Steriazol? The night turns surreal. Matthew is bewildered. A street thug just told him about the most secret compound in the Transplant Working Group’s facial transplant program. It is being developed in Houston, Palo Alto, and New York. Only a few other highly specialized international facial transplant centers are working on this compound. No one is publishing data on this yet. They are all hoping to make a substantial breakthrough in the compound and then publish a blockbuster result in a prestigious journal. Steriazol is made to heal the thick incisions in face transplants. At the moment it still leaves a lot to be desired. The incisions are disfiguring and prominent.

  “Don’t worry, we have some and I will use it at the end,” says Matthew.

  “No, call me when you’re ready. I want you to use mine,” Mr. Glock takes his cell phone out of his jacket and punches in some numbers. One large hand remains firmly on the Glock. One more clamp and they will be home free. The vessel is deep and hard to see despite Amanda’s suctioning. If Matthew can get this clamp on, they will live. The metal clamp is titanium, the best quality; unfortunately he has a bad angle. Matthew puts the clamp on the vessel. The sucking sound stops. His racing heart slows. Matthew now is aware of the sweat on his forehead. His surgical cap is wet; it now has a tie-dyed appearance.

  Matthew looks into Amanda’s brown eyes. Amanda’s pupils are dilated. They have won. They will at least get out of this alive. The patient will live. Mr. Glock will not have to carry out his profanity-laced threat. Matthew quickly looks at Sarah; she peers over the drapes, looking at the wound. The twitching on the left side of her face relaxes.

  Guaarrr. Matthew looks down at the neck. The clamp is at the bottom of the wound, and the vessel is open, like a large fish mouth. Open and frowning at him. There is no more to do. The patient is dead.

  He looks up at Amanda and sees the panic in her eyes. The heart rate monitor continues a steady beep, beep, beep. The heart pumps two more dry beats and then stops. Even with the alarms off, Mr. Glock will know what happened. The patient is turning white, stark white. There is no blood in the body. The mystery patient is dead. Dr. Matthew MacAulay, Dr. Sarah Larsson, and Nurse Amanda Soto will soon follow.

  Matthew and Amanda wait to hear the last beep. The adrenaline is wearing off. He and Amanda look exhausted. Amanda’s shoulders are rounded, and he can feel himself slouching. Keep your back straight. Think of a line of string going right through your back and out the top of your head. His mom, Caroline, has good advice.

  He begins to experience the events in real time. No more extra clarity of mind and focus that the adrenaline had given him. They wait for the last beep, and then as if by a miracle the heart rate picks up. A regular rhythm of seventy beats per minute. Matthew knows that the sound from the anesthetic machine is normal sinus rhythm. He doesn’t need to look at the monitors. He peeks at the monitor showing oxygen saturation, 100 percent. That is better than before they started the operation. He closes and then opens his eyes. The patient is alive and fine; the heart is beating. He must have misjudged things due to the extreme stress. The clamp did stay on; in his hyperactive state, he misjudged it. Or was it the other way round? Is this all a very silly dream? In the time it takes to opens his eyes, he understands. He has a few minutes, but he must act fast.

  Sarah realized the bleeding could not be stopped and the patient was about to die, so she switched the anesthetic machine to a pre-programmed patient record with normal heart beat, pulse, and vitals. It is the factory demo setting. It sounded like a routine operation for all who were listening or even looking at the monitors. She had bought them some time. Matthew is very grateful.

  Amanda’s daughter is off to the Australian university in the fall for an Environmental Studies program; Amanda is booked off for three weeks starting in September. Maybe Amanda will see her graduate. Sarah had anticipated this death, maybe as soon as she heard the bleeding. Guaarrr. Maybe she understood what it meant to have bleeding so severe you could hear it. Maybe she knew the professor’s Rules of Bleeding. She understood Rule Two. Before he went to sleep, the patient smiled at Dr. Sarah Larsson. She has pure white hair. It is the only thing people mention when they talk about Sarah. Although she is only twenty-eight years old, her hair has lost all color. Some people think she has dyed it this pure white, but it is natural. Her white hair seems to shimmer. She spent her early years pursuing her mother’s dream of becoming a ten-meter diving champion. She rose to Olympic trials level but never quite made it to the Olympics. It was much harder on her mother than Sarah. The experience left her with a slim, toned body. And a relationship with her mother that was always uneasy. Her pure white hair makes her look like a ghost with her pale skin and blue eyes. Her father told her she looked like an angel. He was a good man. Her Swedish ancestry gave her a narrow, refined nose with a delicate upturn at the end. But it is the hair that everyone notices. The eighty-year-old hair on a twenty-eight-year-old woman. Truth be told it is genetic. Many in her family undergo premature loss of hair color. It is really an absence of pigment that causes this stark white appearance, but she doesn’t bother to explain this to people.

  When the patient tonight asked about the hair color, he asked if she was an angel to carry him to the other side. She made her usual remark about losing her hair color by studying too hard in medical school so he could rest assured she knew what she was doing. The patient was quiet for a moment and then said, “If I don’t wake up with my new face, everyone in this room is joining me on the other side.” As he drifted off to sleep, he quietly murmured, “Maybe we’ll all be in a better place.”

  Matthew looks at Sarah and remembers these words. She is not as calm as he thought. Sarah has a tremor in her right hand and the twitch in her face has returned. She is desperately trying to get herself under control. Matthew notices the hand tremor
when she tries to inject drugs into the IV. Matthew must act now.

  “Looks like the worst is past,” says Sarah.

  “He’s doing good now,” says Matthew.

  Sarah says, “We need to finish soon.”

  Amanda is still panicked and cannot play along with the charade. Matthew is afraid Amanda might start crying or try to run. At this range she will not get five feet before Mr. Glock cuts her down; then he will finish them all off. Amanda has to control herself and fight the natural urge to flee if they are to have any hope. Matthew looks directly at Amanda. He wills her to stay calm, hold it together. Small beads of sweat collect on her forehead; sweat dampens the collar of her surgical gown. Amanda’s eyes fill with water. She is not going to be able to hold it together.

  “Yes, we’re almost there,” says Matthew, scanning the room.

  There are no weapons or potential weapons. Anything used correctly can be a weapon, and if all else fails, the human body is the best weapon. Matthew holds an 11 blade scalpel. Amanda picks up the 10 blade scalpel and hands it to Matthew. The 10 blade is the “harpoon.” A big blade rarely used in facial transplant work. The knife edge is razor sharp. Matthew will have to strike Mr. Glock in precisely the correct spot. One clean cut. There could be associates waiting outside the hospital. .Possible, but not a real concern now. Stay focused, one problem at a time. We can worry about later, if and when later ever comes.

  Mr. Glock seems preoccupied on the cell phone. He is giving or getting instructions. He grips the canister containing the face that is to be transplanted between his legs as he talks. The shiny cylindrical canister looks like a small garbage can.

  “Sir, we’re ready for the transplant,” Amanda beckons Mr. Glock to bring the face.

  Matthew recognizes the white bottle and red top. The red top peeks through the pocket of the black leather jacket Mr. Glock wears. This is the Steriazol being worked on in Palo Alto. Matthew notes the limp in Mr. Glock’s gait. He is sure the right foot is shorter than the left, definitely an old hip fracture.