“John! Can you hear me?” Dr. Nawaz called. He had leaned over while holding up the edge of the sterile drapes hanging down over Ashley’s face. Most of the stereotaxic frame anchored to Ashley’s skull as well as Ashley himself was covered by drapes, exposing only a portion of the right side of the senator’s forehead. There, Dr. Nawaz had made a small skin incision, now held open with a clamped skin retractor.
After exposing the bare bone, Dr. Nawaz had used a special power drill to make a small, eleven-sixteenth-inch-diameter craniotomy hole to expose the grayish-white fascial coverings of the brain. Directly aligned with the hole and firmly attached to one of the arches of the stereotaxic frame was the implantation needle. With the help of the X rays, the correct angles had been determined, and already the needle had been inserted through the brain’s coverings, into the outer part of the brain itself. At this point, it was only necessary to advance the needle to the exact, predetermined depth to reach the targeted substantia nigra.
“Dr. Newhouse, perhaps you could nudge the patient for me,” Dr. Nawaz said in his melodious, Pakistani-English accent. “At this point, I would prefer the patient to be awake.”
“Of course,” Dr. Newhouse said, getting to his feet and putting aside a magazine he was reading. He reached under the drapes and gave Ashley’s shoulder a shake.
Ashley’s heavily lidded eyes struggled open.
“Can you hear me now, John?” Dr. Nawaz asked again. “We need your help.”
“Of course I can hear you,” Ashley said, his voice thick with sleep.
“I want you to tell me if you have any sensations whatsoever over the next few minutes. Can you do that?”
“What do you mean ‘sensations’?”
“Like images, thoughts, sounds, odors, or sense of movement: anything at all you notice.”
“I’m very sleepy.”
“I appreciate that, but try to stay awake for just these few minutes. As I said, we need your help.”
“I’ll try.”
“That’s all we can ask,” Dr. Nawaz said. He lowered the drape, obscuring Ashley’s face. He turned and gave a thumbs-up to the group standing outside the window in the hall. Then, after flexing his latex-gloved fingers, he used the micromanipulator wheel on the guide holding the implantation needle. Slowly, millimeter by millimeter, he advanced the blunt implantation needle into the depths of Ashley’s brain. When the needle was halfway in, he again lifted the edge of the drape. He was pleased to see Ashley’s eyes still open, although barely. “Are you doing okay?” he asked the senator.
“Lovely,” Ashley said, with a trace of Southern accent. “As happy as a pig in a poke.”
“You are doing fine,” Dr. Nawaz said. “It won’t be much longer.”
“Take your time. The important thing is that it is done right.”
“There’s never a question about that,” Dr. Nawaz responded. He smiled beneath his surgical mask as he lowered the drape and returned to advancing the needle. He was impressed with Ashley’s courage and good humor. A few minutes later and with a final twist of the micromanipulator, he stopped at the exact measured depth. After a final check of Ashley’s status, he told Marjorie to ask Dr. Lowell to come into the room. Meanwhile, he readied the syringe that was to deliver the treatment cells.
“Everything going okay?” Daniel asked. He had donned a facemask as he entered. With his hands clasped behind his back, he bent over to look into the craniotomy hole with its imbedded needle.
“Very well,” Dr. Nawaz said. “But there is a problem I admit slipped my mind in the earlier fracas. At this stage, it is customary to take another corroborating X ray to be one hundred percent certain of the needle tip’s location. However, without X ray here in the OR, that is not possible. With the craniotomy open and the needle inserted, the patient cannot be safely moved.”
“Are you asking for my opinion whether to proceed?”
“Precisely. Ultimately, he is your patient. In this rather unique situation, I am, as you Americans say, only a hired gun.”
“How confident are you of your needle’s position?”
“Very confident. In all my experience with the stereotaxic frame, I have never not been where I targeted. There is also another reassuring factor in this case. We are adding cells, not doing ablative surgery, which is what I am usually doing with this procedure and which would cause far more problems if the needle were to be slightly off.”
“It is hard to argue with a one hundred percent record. I’m confident we’re in good hands. Let’s do it!”
“Right you are!” Dr. Nawaz said. He picked up the syringe, now loaded with the predetermined aliquot of treatment cells. After removing the trocar from the lumen of the imbedded implantation needle, he attached the syringe. “Dr. Newhouse, I’m ready to begin the implantation.”
“Thank you,” Dr. Newhouse said. He liked to be informed at critical stages of a procedure, and he quickly rechecked the vital signs. When he was done and had taken the stethoscope from his ears, he motioned for Dr. Nawaz to go ahead.
After raising the drape and having Dr. Newhouse give Ashley another nudge to wake him, Dr. Nawaz repeated the same instructions he’d given Ashley before inserting the needle. Only then did he start the implantation, utilizing another manual mechanical-assist device to depress the syringe’s plunger in a slow, even fashion.
Daniel felt a chill of excitement as he watched the implantation proceed. As the cloned dopamine-producing neurons augmented with genes from the blood on the Shroud of Turin were being slowly deposited in Ashley’s brain, he was confident medical history was in the making. In one fell swoop, the promise of stem cells, therapeutic cloning, and HTSR was being realized to cure a major human degenerative disease for the first time. With a sense of mounting exhilaration, he turned and flashed Stephanie a victory sign with his index and middle fingers. Self-consciously, Stephanie returned the gesture, with hardly the same alacrity. Daniel assumed it was because she was uncomfortable having to stand alongside Paul Saunders and Spencer Wingate and make small talk.
Midway through the implantation, Dr. Nawaz stopped as he’d done during the needle insertion. When he lifted the edge of the drape, he discovered that Ashley had fallen back asleep.
“Do you want me to wake him?” Dr. Newhouse questioned.
“Please,” Dr. Nawaz responded. “And maybe you could try to keep him awake for the next few minutes.”
Ashley’s eyes struggled open in response to being jostled. Dr. Newhouse’s hand was gripping his shoulder.
“Are you okay, Mr. Smith?” Dr. Nawaz asked.
“Delightful,” Ashley mumbled. “Are we finished?”
“Almost! Just a moment longer!” Dr. Nawaz said. After letting go of the drape, he looked at Dr. Newhouse. “Is everything stable?”
“Rock solid.”
Dr. Nawaz went back to depressing the syringe’s plunger. He continued at the same slow, controlled rate. At the moment he was about to give the mechanical-assist device the final twist, which would have delivered the last bit of treatment cells, Ashley mumbled something unintelligible beneath the drapes. Dr. Nawaz stopped, glanced at Dr. Newhouse, and asked if he’d understood what Ashley had said.
“I couldn’t hear it either,” Dr. Newhouse admitted.
“Is everything still stable?”
“There’s been no change,” Dr. Newhouse said. He put the earpieces of the stethoscope back in his ears to recheck the blood pressure. Meanwhile, Dr. Nawaz raised the edge of the drape and peered in at Ashley. The appearance of his face, which was visible only to the level of his eyebrows because of the frame, had changed rather dramatically. Curiously, the corners of his mouth were drawn up, and his nose was wrinkled in an expression that suggested disgust. This was even more surprising, because earlier his face had been demonstrably blank, a symptom of his disease.
“Is there something bothering you?” Dr. Nawaz asked.
“What is that awful stink?” Ashley questioned. He still sounded
drunk, with his words running together.
“You tell us!” Dr. Nawaz said, with the stirrings of concern. “What does it smell like?”
“Pig shit, if I had to guess. What the hell are you people doing?”
An intuition of potential disaster spread through Dr. Nawaz like a faint, unpleasant electric current leaving a weak feeling in his stomach that only experienced surgeons know. He glanced at Daniel for consolation, but Daniel merely shrugged. With limited personal surgical experience, Daniel was only confused. “Pig manure? What’s that about?” he asked.
“Since there are no pigs in here, I’m afraid he’s having an olfactory hallucination,” Dr. Nawaz said, as if angry.
“Is that a problem?”
“Let’s put it this way,” Dr. Nawaz snapped. “It worries me. We can all hope it’s nothing, but I recommend we forego the last bit of implantation cells. Do you agree? We’ve given well over ninety percent.”
“If there is any question, absolutely,” Daniel said. He didn’t care about the last of the treatment cells. The amount he had decided on had been a mere educated guess, based on the mouse experiments. What bothered him was Dr. Nawaz’s reaction. He could tell the man was concerned, but he had no idea why a bad smell would be so worrisome. But the last thing Daniel needed was a complication of any sort, especially not when they were this close to success.
“I’m withdrawing the needle,” Dr. Nawaz said for Dr. Newhouse’s benefit, although there was no inhalation anesthesia to lighten up. With the same amount of care Dr. Nawaz had used for the insertion, he slowly extracted the implantation needle. Once its tip cleared the brain, Dr. Nawaz checked for any sign of bleeding from the site. Thankfully, there was none.
“Needle out!” Dr. Nawaz announced and handed it over to Constance. He took a deep breath and then lifted the edge of the drape to look in at Ashley. He could sense Daniel was looking over his shoulder. Ashley’s expression of revulsion had changed to irritation. His mouth was now set, with his lips pressed together in a thin line. His eyes were open wider and his nares flared.
“Are you all right, Mr. Smith?” Dr. Nawaz asked.
“I want to get the hell out of here,” Ashley snapped.
“Do you still smell that odor?”
“What odor?”
“You complained about a bad smell just a moment ago.”
“I don’t know what the hell you are talking about. All I know is I want out of here!” Suddenly intent on standing up, Ashley strained against the tape holding his torso to the cranked-up operating table and against the tape on his wrists. At the same time, he drew his legs up, bringing his knees to his chest.
“Hold him down!” Dr. Nawaz shouted. He leaned across Ashley’s lap, trying to force Ashley’s legs back down flat with the weight of his body. Dr. Nawaz was still holding up the edge of the drape, watching Ashley’s face turn red with effort.
Daniel dashed to the foot of the operating table and reached in under the drapes to grasp Ashley’s ankles. He tried to pull them down and was surprised at Ashley’s strength of resistance. Dr. Newhouse had released the hold he had on Ashley’s shoulder to grab his wrist, which Ashley had succeeded in freeing from its taped restraint. Marjorie leapt around the table to grab Ashley’s other arm, which was also coming free.
“Mr. Smith, calm down!” Dr. Nawaz shouted. “Everything is okay!”
“Get off me, you freaking animals,” Ashley shouted back. He sounded like the quintessential belligerent drunk, resisting all efforts to be constrained.
Stephanie, Paul, and Spencer came flying into the operating room while struggling to get their facemasks in place. They lent a hand holding Ashley down, giving Marjorie a chance to reinforce the wrist restraints and helping Daniel get Ashley’s legs flat again. With his hands free, Dr. Newhouse rechecked Ashley’s blood pressure. The beeping of the cardiac monitor had increased its tempo considerably. Marjorie briefly left the room to get a pair of leather ankle restraints.
“Everything is okay,” Dr. Nawaz repeated to Ashley once they had him under control. He stared at the man’s defiant, enraged face, which was beet-red from exertion. “You must calm down! We have to close your little incision, and we will be done. Then you can get up. Do you understand?”
“You’re all a bunch of perverts. Get the fuck off me!”
Ashley’s use of such inappropriate and objectionable language in the operating room stunned everyone almost as much as his sudden physical struggling. For a beat, no one moved or said a word.
Dr. Nawaz was the first to recover. Now that he was confident Ashley was restrained, he raised himself from lying across Ashley’s lap. As he did so, everyone noticed Ashley had a full penile erection that tented up the drapes.
“Please let go of my hands and feet!” Ashley said tearfully, as he began to cry. “They are bleeding.”
Everyone’s eyes immediately looked at Ashley’s hands and feet, particularly Daniel, who was still holding Ashley’s ankles as Marjorie struggled to put on the restraints.
“There’s no blood,” Paul said, speaking for the group. “What’s he talking about?”
“John, listen to me!” Dr. Nawaz said. He was still holding up the flap of drape to expose Ashley’s face from the eyebrows down. “Your hands and feet are not bleeding. You are fine. You just have to relax for a few more minutes to allow me to finish.”
“My name is not John,” Ashley said softly. The tears had disappeared as quickly as they had appeared. Although he still sounded inebriated, he seemed suddenly at peace.
“If it is not John, what is it?” Dr. Nawaz asked.
Daniel shot a worried glance at Stephanie, who had taken a step back from the OR table after having helped restrain one of Ashley’s hands. On top of Daniel’s bewilderment, he was now concerned that Ashley was about to reveal his true identity in his drugged state. What that would do to the final outcome of the project he had no idea, but it couldn’t be good, not with all the requisite secrecy so far.
“My name is Jesus,” Ashley said softly, as he beatifically closed his eyes.
Most everyone in the room was again dumbfounded and exchanged bemused glances, but not Dr. Nawaz. His response was to ask Dr. Newhouse what he had given the patient as a sedative before the procedure.
“Intravenous diazepam and fentanyl,” Dr. Newhouse answered.
“Do you feel comfortable giving him another dose immediately?”
“Sure,” Dr. Newhouse said. “Do you want me to?”
“Please,” Dr. Nawaz said.
Dr. Newhouse pulled out the drawer on his anesthesia cart, took out a fresh syringe, and tore open the packaging. With practiced hands, he drew up the medication and injected it into the intravenous port on the IV line.
“Forgive them, Father,” Ashley said without opening his eyes, “for they know not what they do.”
“What’s going on here?” Paul asked in a forced whisper. “Does this guy think he’s Jesus Christ being crucified?”
“Is this some kind of weird drug reaction?” Spencer asked.
“I doubt it,” Dr. Nawaz said. “But whatever its cause, it is certainly a seizure!”
“Seizure?” Paul questioned with incredulity. “This is like no seizure I’ve ever seen.”
“It’s called a complex partial seizure,” Dr. Nawaz said. “Better known as a temporal lobe seizure.”
“What caused it, if not the drugs?” Paul asked. “Sticking the needle into his brain?”
“If it had been the needle, I think it would have occurred earlier,” Dr. Nawaz said. “Since it occurred near the end of the implantation, I think we have to assume it was that.” He looked at Dr. Newhouse. “Check to see if he is asleep?”
Dr. Newhouse reached under the drape and gave Ashley’s shoulder a gentle shake. “Any response?” he asked Dr. Nawaz.
Dr. Nawaz shook his head and lowered the drape over Ashley’s face. He sighed beneath his face mask and turned to look at Daniel. He crossed his still sterile and gloved
hands across his gowned chest.
Daniel felt his legs turn rubbery as he looked into the neurosurgeon’s dark, unblinking eyes. Daniel could tell he was troubled, which undermined the composure Daniel had been strenuously maintaining. The fear of a complication, which had been floating in the background of his mind since Ashley’s complaint about a smell, came flooding back with the force of a burst dam.
“I believe you can let go of the patient’s ankles,” Dr. Nawaz said.
Daniel released his grip, which he had been absently maintaining, even after Marjorie had secured the ankle restraints.
“This seizure has me concerned,” Dr. Nawaz said. “Not only do I believe it was not caused by the drugs, the fact that it occurred with the drugs on board suggests it was a particularly violent focal brain disturbance.”
“Why couldn’t it be drug-related?” Daniel asked, with more hope than reason. “Couldn’t it just be like a drug-induced dream? I mean, intravenous diazepam and fentanyl is a potent mix. Combining such a concoction with the suggestively emotive power of the Shroud of Turin is bound to cause wild flights of fancy.”
“What does the Shroud of Turin have to do with this?” Dr. Nawaz asked.
“It has to do with the treatment cells,” Daniel said. “It’s a long story, but prior to the cloning process, a few of the patient’s genes were replaced with genes obtained from the blood on the Shroud of Turin. It was a specific request by the patient, who believes in the shroud’s authenticity. He even said he was hoping for divine intervention.”
“I suppose such ideation could play a role in the patient’s delusion,” Dr. Nawaz said. “But the fact that this was a seizure that occurred with the implantation cannot be denied.”
“But how can you be so sure?” Daniel asked.
“Because of the timing and because of the olfactory hallucination,” Dr. Nawaz said. “The smell he reported was an aura, and a characteristic of a temporal lobe seizure is that it begins with an aura. Other characteristics are hyperreligiosity, profound mood changes, intense libidinal urges, and aggressive behavior, all of which the patient demonstrated in the short time he was awake. It was a classic example.”