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Tuesday, August 18, 2015

Shopping (SF flash fiction, continuation of the Moon-Man series)

Shopping list:
-Human muscle tissue, live
-60 kg Titanium
-7 kg Neodymium
-5L blood, compatible with human tissue type
-Carbon mesh, for seeding tissue to titanium

I crumble the list back into my pocket and grip the pole beside me as the Metro swerves. I must be nervous. Why else would I take out this list again and again when I already have the ingredients memorized...

"You're too good for this," Ken grumbles beside me. "We're engineers, not repo-men."

He's just talking because he's nervous, too. Even at Ken's young age--what is he, just out of college?--he can probably guess that "carbon mesh, for seeding" doesn't just show up one day at your local Walmart. I'll be designing that, and it will challenge, not insult, my intelligence.

That's not the item he's nervous about, though. He brushes his thin knobby fingers through spiky black hair and blows out his breath in a whoof--the Metro rocks again. 

The doors "ding" open. We're the only passengers to step out. Our footsteps echo in the station, and Ken's clumsy appearance ends here--now he's the master of Krav Maga, eyeing the lone security guard as I eye the metro's service tunnel.

But the guard's decided his girlfriend on the phone poses a greater threat than the weathered Latino and the scrawny Asian kid. He doesn't see us disappear under the Do Not Enter sign. We count paces--we're under the hospital now.

"I wish my body double were here, instead of me," Ken mutters.

"He is much better at biostatistics than stealing organs," I say.

Ken cringes. He hunches his shoulders. "Muscle's not an organ." 

He's right, of course. What we're doing sounds worse when you say it aloud. 

Body doubles, he says…something on the list was bothering me, and I think that's it. This list--it's the person-making kind of list. Does our client know about our self-dolls? If anyone discovers the--reference-intended--Ken-doll at the kid's desk, vomiting out mathematical figures, replacing the human original, they'll fire him. If anyone discovers my body double, well--they'll lock me up in another orange jumpsuit. And--

Dira chore, I forgot to send my newest biosphere design to my self-doll. Bad bad bad. Pull out my phone--no signal. Can't even send it my old stuff. Well. They destroyed my work and now want me to feed it to them--insult and injury--so I suppose there's no reason for them to expect the best effort from me. But still. Some effort, they expect.

"Help," Ken says. He's under the manhole below the hospital's sewer system. I get back to back with him and we push up.

"You could've done that yourself," I huff. I'm not old, the air's just heavy, I wheeze.

"By myself? No way, that's unfair." He slips out the little handheld saw and two masks. We'll be through the drainage grate into the empty surgical supply basement, surrounded by sterilizing autoclaves, in ten…no, eleven minutes.

We shower in the locker room of the surgery floor. Ken's a lost med student now, and the kind nurses show him where to find green pajamas. He gets an extra pair for me, and we leave for the ICU.

"May I see the chart for the patient in 118?" he asks. "My attending asked me for a quick physical."

I told him to say that, you know. My back's to him, and I'm grinning, because unfortunately when you play to stereotypes no one questions you. I'm bent over a trash can like a janitor might be, and he's fidgeting, uptight, high-voiced, and perfect, and they let us in to our target.

She's a young girl. Sixteen. Comatose, vegetative, declared brain-dead. Organ donor. Her parents have already signed the organ donation permission form. In minutes the hospital will turn off her ventilator and send her for harvesting. Harvesting is a nasty word, but that's the truth of it. I've read the local and national protocols over and over again to build this act, so as soon as they pull the plug, before her body's cold, before the real organ collection team arrives, Ken and I will wheel her out to harvest the muscle tissue she's donated to science. It's gruesome. But it's how biomedicine works.

And, for our purposes, it's cheaper to steal that biomedical material than to buy it. 

Dira chore--there's a doctor in here, in the shadow of her IV pole, and a nurse, too, and they're standing around just talking. Are they waiting for the real team? No, we need this to happen fast, in and out!

Ken doesn't skip a beat. 

He skips several. He introduces himself with the wrong identity.

"I'm Ken Uesugi, MS3. Dr. Yamamoto's on vacation? He asked me to observe this procedure." 

No! No no, you're Ken Uesugi, organ donation intern, now! Dira

"Yeah, yeah, I think he mentioned he'd send a student over." The doctor waves, and goes back to chatting casually with the nurse. "Well Ken, go ahead."


"Disconnect the patient."

Well, pues, this is happening. I ruffle the plastic of the trash can, avoiding eye contact with Ken. He's not frozen, but he's icy for sure. I can already hear his future grumbling. You told me we'd just wheel her out after they disconnect. That's it--no direct contact, you told me! 

"Hurry up, Ken, the organ donation team's going to be here in a minute."

That's my cue, yes? To introduce myself as the organ donation team? But there were supposed to be two of us. My lips purse. I'm stuck. Not happy.

Neither is Ken. He's staring straight ahead, turning guts to iron, taking a deep breath. So is she--her chest, rising and falling, rising and falling. He grabs the tube. Her ventilator mists as if she's breathing for herself. He sets his jaw. 

"Wait!" A breathless voice coughs behind me, and the mass and fat and sweat of a middle-aged woman barrels into my shoulder, shoving me aside. She rushes to the bed as I recover from my unwanted embrace with the wall. "Not yet, not yet--she's still breathing!"

Ken stands down with a bastante obvious breath of relief. The doctor shows a toothy, robotic smile.

"Mrs. Zamora, that's the ventilator. All evidence says your daughter is dead. We've been over this? Neurological exam, EEG, the time she's been here...you signed off on the organ donation yesterday."

"Yes yes, but then I found out you didn't do a PET scan!" The mother drags some over-folded papers from her purse--I can see the URL smudged at the bottom of the print-outs. Oh geez. "A neurological exam misses things. Look, this says 'a high percent of people who recover in six months' don't show up alive on anything but a PET scan! So they turn off people who could recover! I want a PET scan."

"Mrs. Zamora, we have a saying: the internet didn't spend four years in medical school." The doctor folds his hands like a teacher talking to a dirty child. "And you already signed the organ donation forms." 

"Yes, yes I know, but after--after I know for sure she's dead." The mother's arm fat quivers as she shoves the paper at the doctor. Her face sags as she realizes he has no intention of taking it.

"I'm afraid you don't understand," he says. "We cannot let the organs die. They rot--they're only viable for a short amount of time. Organ donation is now or never."

"Never, then. I'd rather wait until she's dead--dead, dead for sure."

"You already signed the form."

She's red now. She's breathing as if she might need a ventilator. She's in disbelief, at first, and then bargaining, pleading her promise to pay for the spot in the hospital, and it feels like a flashback to me. Why? I've never been here before. But I'm dizzy. My fingers freeze like space. My chest is hot, as hot as the doctor is cool and calm, and I just want to see him snap, to see him yell at her, but he won't, he won't. He's so good and right and fatherly and it's disgusting. The doctor know best…

"Mrs. Zamora, with all due respect, you're missing the point. There is a boy who needs that kidney tonight. A grandmother who needs those lungs in two hours. Another daughter, just like yours, dying for that heart. Burn victims, who will putrefy as fungal infections eat them alive if they don't get that skin graft right way. Everything's already promised--everything's already done. It's over."

Ah. That's why it's familiar. The old stop being so selfish. The many. The one. Here in the shadow of the doorway they can't see my fingers clench on the trash bag as the negotiation descends into chaos.

"That's fine, but just wait!"
"I just explained to you, we cannot wait."
"That's my daughter!"
"She is not. She is dead."
"Please, just a PET scan, just make sure!"
"Ma'am, you no longer have a legal say. Hello, kid?" Fingers snap. "We don't have all day here."

Now the nurse is pushing the mother towards me; now the doctor repeats his order. The nurse signs at me with her eyes to do something about this woman; there's edge in the doctor's voice.

And Ken looks at me.

He's been staring at the girl's face the whole time. But when he looks up, it's to me. What now, dad? Just like Antonio. 

My son.

"My daughter!"
She's a life-saving elixir to the doctor. She's a mine of knowledge to the engineers. She's living money to me. She's a daughter to this mother.

And to herself?

The doctor unplugs the ventilator. I snatch the trashcan, hoist it, hurl it to Ken. He catches it reflexively. 

"What the--" 

I gesture. Ken dumps the can over the doctor's head and--whoa, hold the enthusiasm there, kid--shoves him into the corner. I grab the nurse, snatch her phone, throw her into the tiny bathroom, yank the door shut--

"If either of you scream, I'll shoot you." The first words I've said to them, and they can't see I don't have a gun. "Ken, cellphone!"

Ken's already pawing the doctor's coat through the trash spillage, and the mother trembles, a step here, a step there--she doesn't seem to know whether to throw herself over her daughter's body or dash out the door.

"It's okay," I say. "We can keep your daughter alive. I don't know about a PET scan, but we can wait the six months you want."

"How? Why--what are you--who--"

"He's the Moon-man," Ken nods. The absolute confidence in his voice calms her like Jesus and the storm waves. He should've been a doctor. "He'll figure something out."

We're both calm now. Calm in the way that a dead man's calm. We've done this now. We're frito--fried, screwed, done for.

So now I find myself wondering if this is what made us so nervous--if we somehow knew that this one-time crime, the one time we steal tissue from a dead person, would suddenly push us down a path of underground behavior. One crime, just for this first client, just until we got enough money for our little engineering firm to take off…did we know it would end in hostage-holding; forcing a doctor to sign a fake order to 'transport a patient' to the general ward; wheeling a ventilator and a bed down into the bowels of the hospital where the general ward is not; stealing an ambulance? No, I tell myself, of course not. We didn't think that far ahead. 

But as these six months pass, 
and pass…
and we hide this woman and her daughter until her daughter either wakes up, or the mother admits defeat…
and each day it becomes odder and odder to think that we kidnapped an organ donor just to make sure a mother could feel right about her daughter's death--just because I'm not over the death of my family--
and I keep thinking I see the girl's eyelids flutter, or her arms move--
and Ken's trying to build a PET scan machine…
and clients come and go…
I crumble and un-crumble the original list that got us here. 

I think I'm going to go shopping.

First story in this series       Previous story in this series         Next story in this series?

This is actually based on a true case we were given in medical ethics. A hospital cut off a vegetative child against the parents wishes, because the parents signed an organ donation sheet for the child, not understanding that the sheet they signed gave the hospital the right to cut off the child before the parents truly believed the child was dead. The study the mother quotes, about using PET scans instead of normal neurological exams, is a real study that can be found via a quick search in pubmed (where doctors get their studies). The study explains that something like 75% of patients declared brain-dead via neurological exam and EEG could have made a recovery, according to PET scanning. I don't remember the numbers, so look up the story, look up the study, be educated, blablabla...I try to have a little real science in these (like H3 mining on the moon), but of course this is fiction, bla bla, relation to real people incidental, etc. Every Tuesday, right here, more fiction. Stay tuned.