Cutting Season

Fallon

I leaned all 126 pounds of myself onto the edge of the scalpel, and despite a near decade of cutting, I remained mesmerized by the unyielding resistance of the epidermis. Moving through mental checklists, ensuring the life under my care has not croaked unexpectedly, as they often do. I loved that about the human body. Perfectly predictable one minute, then chaotically lawless the next.

I gently tapped on the fleshy organ and waited. Patience was a virtue that evaded many surgeons. Time was the one thing no one could buy for the operating room. Slowly, a triumphant smile emerged behind my surgical mask as the liver pinked up. With a brief glance at the clock, I thought maybe I’d even squeeze in a manicure.

This Tuesday was shaping up!

The silent triumph was eclipsed by the trembling body opposite me. The cowering figure wore the same surgical gear over the exposed body cavity, just as I did. Unlike myself, she was sweating profusely through her light blue scrubs, fighting for consciousness.

The intern had a very common revulsion to blood. Albeit less common for a surgeon. I'd already had her fetch me two coffees, a spirulina juice, and to check on my post ops, twice to minimize her time in here.

Sure, she couldn’t stand the smell of blood. But really, shouldn’t we be more concerned about the ones who love it? They seem like the first bunch who would in fact do some harm.

And where she failed in the operating room, she more than made up in medical theory. And of course, the on-call room.

“Have any plans tonight Dr. Karch?” I asked. It was only a matter of time before she fainted like a Victorian child. Her seafoam-colored eyes slipped along the longitudinal fissure, eyeing the perfectly healthy new liver I'd just spent the better part of two hours inserting into my patient who swore he had his last single-malt whiskey.

“I’m on call tonight. I’m happy to finish your charts,” she offered between labored breaths.

“What would I do without you?” I winked with far too much charm in my words. I heard it, she heard it. The scrub nurses heard it. Even the anesthesiologist who had been asleep for the last forty minutes heard it between snoozes.

This is what happens when you spend your formative years with cadavers and the dead. You forget what is entirely unacceptable with the living, Fallon.

“Probably save an extra life or two without my passing out everywhere,” Ava stared into the linoleum.

“And where would be the fun in that?” My gaze fell back on the unruly blonde curl that was smeared against her sweating forehead. I wondered what it would feel like to loop my fingers through her hair and tuck a lock behind her ear. Would she squeal? Then I looked down at my hands, covered in blood weaving sutures together. She would definitely vomit.

I didn't have the chance to ask, as my inner monologue of HR provoking thoughts was interrupted by loud beeping from the cardioverter defibrillator.

“Ah damn, his heart is crapping out.” I glared at the Holter monitor.

“He’s tachycardic. Push adenosine,” Clayton screamed with unnecessary loudness. I hadn’t even noticed he was there until he started to panic. He always struck me as the wrong side of a half-decent surgeon. All reckless mania, without any of the bold genius of a maverick.

"Thank you, Clayton, for joining the party," I murmured as I moved my hands methodically through the body cavity looking for a bleed. There was a small gush under my left thumb which I quickly plugged. I looked across at Clayton who was charging paddles.

What a ridiculous man you are. The future of medicine lies in his inept hands and my near unconscious intern. What would my father think if he was standing on the other side of this table? Probably that I killed the man on the table before I even cut him open.

“Dr. Karch, course of action here please?” I asked her calmly, trying to invoke a teaching moment before my patient went towards the light.

“With a wide-QRS-complex tachycardia, the first step is to determine if the arrhythmia is a ventricular tachycardia or is conducted with aberrancy. This general antiarrhythmic is used mainly as a diagnostic agent to identify the origin of an underlying narrow-QRS-complex tachycardia. It briefly depresses the atrioventricular (AV) node and sinus node activity—”

“Did not ask for the medical applications of a commonly used drug here.” I cut in. “I am asking you for your recommended course of action. Would you proceed as Clayton recommend? Would you use paddles to try to restart his heart?”

“No, I would not.” she murmured quietly. I tried to stifle my smile under my mask. A man might’ve been dying on my table, but I had a point to make.

“Speak up, Dr. Karch,” I instructed massaging the liver. This teaching crap was costing too much time. “Quickly, your recommended course of action.”

“Calcium.”

“Push .5 of calcium.” I watched as the monitor slowed to more regular beats. “Dr. Karch. You just saved this man’s life. Clayton, please put the paddles down.” I pulled my attention away from the inner workings of the interns and brought it back to where it should have been. With my patient who was doing his absolute best to die on my table and humiliate me in front of Clayton.

The rest of the procedure continued without demanding too much focus. We closed up and sent him off to inevitably find his way to the nearest dive bar by the end of the month, with the sole intent of drinking his way back onto my table.

What can I say? I just have the kind of magic touch all the boys come running back to.

“That was a good save in there,” I muttered, as I lather clinical smelling soap into my hands. I could still feel the familiar metallic liquid oozing through the cracks of my fingers as if the gloves had never even been there.

“You did all the saving. I made one recommendation,” Ava whispered looking at the tips of her shoes. I gently placed my pointer finger under her chin to bring her eyes to mine.

“Dr. Karch—”

“You’re kidding me with that doctor shit, right?”

“Ava,” I sigh, “I know I’ve I blurred every line imaginable. But can’t we at least pretend I have a little decency left?” She slowly removed her surgical mask to reveal a shy smile. “If we would have gone with Clayton's plan, we would have killed him. But we went with yours. You saved that man’s life today.”

She studied my face cautiously for a moment, then slipped her arm around my waist pulling me towards her. I liked these brief moments when she was bold and demanding of me.

“He was in no real danger,” her lips were dangerously close to my earlobe.

“Did you see his decaying liver? He was on death’s door before I sliced him open.” She winced at the thought of violent activity, but I reached for the defiant curl that had been distracting me all morning. I looped my finger through the soft hair. “Ava, I know I ask you this a lot. And a lot of people ask you this a lot—” Before she could answer I decided I didn’t want her to lie to my face again.

“Could you do me a favor?” I pivoted. “Can you check in on our patient this afternoon? I have to run out this evening.”

“Yes, of course,” she beamed. “I’ll handle the rest of your post-ops, so you have some time before your presentation for the board.”

“Completely forgot about that. That’s today? Stupidly, I thought I had time for a manicure,” I murmur, provoking a quizzical glance. My nails were almost never done. Spending the majority of their unpainted lives in surgical gloves.

“Dinner with your sister?” Ava guessed, chalking up my mercurial mood to the impending family night. I grimaced. “Well, you should get going!” She instructed.

The conference theatre had all the theatrics of an opera house. But instead of Italian ballads, the people who graced this stage were awkward doctors, and fast-talking pharma reps promising longevity, health, and steadily increasing profits.

Today, I was going to have to outperform them as the cyclist on the high rope, balancing between the soaring towers of monetary gains and modern medicine. The Chief of Surgery gave me a curt nod, glad to see I had indeed turned up. With one glance he sternly affirmed this was neither the time nor place for anything other than bewitching tales of medical triumphs. I understood if we didn’t convince the suits that the organs that came to us ethically sourced saved lives.

Halcyon Medical Institute would be done. My job would be done. And we would probably be on our way to a few consecutive life sentences.

Deep breath, Fallon.

This was to be light work compared to the mental obstacle course that was my sister. Because between whatever melodrama my family was inflicting on the other socialites, this presentation could save lives. This would just be another typical Tuesday for me.

Wyatt

I couldn’t quite remember when I’d first started to hate Tuesdays. I didn’t like how it seemed to just be sandwiched into the week. Nor did I enjoy the predictability of the day. I certainly didn’t enjoy the Tuesday that I walked into my bedroom to find my brothers’ innermost thoughts and brain matter splattered across my racecar printed bed set. I guess I just didn’t like how predictable they always were.

Until they weren’t.

So, when another unapologetic Tuesday unceremoniously took my wife and daughter from me, I should not have been all that surprised.

It was damn foolish of me to let them get into a car on a Tuesday. It might have sparred me the mental image of finding the long dancer’s legs my wife twirled upon, mangled around the dash of our family’s sedan.

On crueler Tuesdays, I am woken up to the visceral sound of the jaws of life screaming out in resistance, while my daughter’s wide eyes bore into me.

A Wednesday would never ask so much of me.

The peace in my decision washed through my veins as I felt the faint tug of muscles that hadn’t been used in too long.

There was peace in a resolution.

Swinging my legs to the floor, where my mattress met with the uneven planks of wood, I picked up the tethers of my fraying wallet and shoved it into the shallow pockets of the jeans I had slept in for the past week.

There was no need to rush. The things in the world that were coming for you, would find you. No matter what.

Threading the through the movement of people littering the pavement felt like an assault to my senses. Finally standing in front of frosted glass doors, I was suddenly met with the cool air as I pushed through the doors.

“Good morning,” a cheery middle-aged woman declared unemotionally surrounded by a sea of white decorum. “Welcome to Donum. How can I be of service to you today?”

Without forcing the thought, I wondered momentarily if this would be the last face I would ever see.

A face pulled taut by two over ample cheeks, a left leaning nose, and coffee smeared pink lipstick. Would this be the face to welcome me into oblivion?

I had wanted to picture my wife. Her soft brown eyes, that followed me into my dreams and now my nightmares. I wanted to see the ones I couldn’t escape from and longed to drown in, one last time.

“I, uh, have an appointment,” I announced, more loudly than I had spoken in months.

“Excellent! Someone will be out to take you back in a few minutes. A little busy this morning. You know, the holidays.” She shrugs adding a conspiratorial wink as if we were on the same side of that desk.

“Here you go, dear. These are just the standard I dotting, and T crossing forms we need to confirm all the information is correct. As you are not a walk-in, it’s more of a formality than anything. Once you give it a quick once over, you just need to sign on pages three, six, and seven.”

“Thank you,” I mumbled.

“Can I get you anything to drink, dear? We have chamomile tea, water, and champagne.”

“I’m good. Thanks.” She bared inhumanly white teeth, which I think was meant to reassure. But I had been removed from humanity for so long, I couldn’t quite tell.

I glanced down at the first few lines of the forms:

Name

Date of Birth

Address

I hadn’t had a permanent address in a long time. Were my organs deemed less good if I am sleeping rough these days?

Income

Organ Donation Allocation names (please provide their Organ ID Reference Number)

Savings Donation and Amount (USD)

Email

Drug Use

Blood Type

Sexual Partners

GPA (Grade point Average)

Age

References

I only had two sexual partners, and $6.57 to my name.

Final thoughts?

If I had one singularly profound thought, would I be here?

I had a long list of feelings, all predominantly soaked in grief and sadness. On stronger days, there were untenable waves of anger.

Against my will, I learned one of life’s unspoken truths: it’s inherently unfair. The bad guys get away. They get richer and richer, then die in their sleep surrounded by their families.

I was never going to get justice. And justice was all I could have hoped for. Because happiness was simply too much to ever ask for.

In the end, I just wanted the last thing I said to be true. To be honest in a world of so many interlocked lies.

The kind of truth I stopped screaming, because I stopped hoping a long time ago would find the right ears.

So, I wrote the one thing I could.

The only thing I knew was still true.

No matter where it lived, whoever read it, couldn’t be fooled by any more lies.

You started it, now I’m ending it.

James

I know what you’re thinking, organ trading, how crass for a Tuesday? Take out the humanity, and I’m sure you’d have no problem with it. I mean we use porcine skin grafts and bovine heart valves today.

You don’t become the world’s richest man by laying it all on the line at the Blackjack table.

I’d even wager my exuberant wealth that you had some animal by product in the last 48 hours. Did you know that sugar, white refined sugar, was composed of cow bone char?

So, please get off your elitist, humanist high horse.

You’re not better than me. You just didn’t have the wherewithal to profit from it.

Don’t feel bad. I didn’t have the wherewithal to see my killer coming either.

We all have our shortcomings.

I have digressed. As the dead often do. You might be slightly confused by the nature of it all. But really, the business of organ trading is a bit like trading futures for my finance inclined audience. When you trade futures, you essentially enter a contract to buy or sell something, in the future at a predetermined price. So, instead of buying something outright and in full, you only pay for a fraction of the asset.

In this line of business, the asset is an organ.

All Donum is doing is facilitating a contract to buy and sell products at a future time, at a particular price. Freely given, might add.

I know, I know. You have ethical concerns.

That morality limits your ability to see business potential—maybe that’s how you sleep at night. With your morals and holier-than-thou ethics.

Which is all well and good for you.

But where you see ethical constraints, I see potential.

This was an unrealized capability that I was miles ahead of.

At no fault of my predecessors. This was a hard juggling act to get right. Because even if everyone was ethically ambiguous, the conditions required both everything going right and wrong at all the same, unique moments in time.

Society had to be advanced enough to have the science, scared enough of death to want it, and hesitant enough about the applications, to let the private sector own it.

Then you need the egghead doctors. The ones who got those barbarians to get organs off ice, like a fillet piece of steelhead tuna. I don’t mean that disparagingly, I used to be a cutter myself.

But once someone butchered them up, then they needed to have more longevity than surviving in a glorified lunchbox. We needed a normothermic preservation chamber—technology bought us time. Like any successful investment, interest only becomes valuable over long stretches of it.

Four hours is not enough—not when you are trading on value. You might not need a kidney transplant today. But what if you’re hit by a motorist? Or stabbed by a vengeful ex-lover?

It happens.

Wouldn’t you want a readily available kidney? What if it was introduced with your antibodies over time, with your DNA?

That bidding price just shoots up. You need time to make sure you find the right buyer. Someone who can afford to be the right person for an organ.

Once we could preserve the organs, we needed a steady supply.

When it’s all laid out like this you might think, well how perfectly simple. Of course, that’s the ability of any great magician. Turning the impossible into the inevitable.

So, yes there was more blood, and death. That is how the world works. Something I tried to tell my daughter. Something, even in death I am hoping I can still remind her.