him. He tended to err on the side of optimism, proceeding with a
resuscitation that could have more tragic consequences if it succeeded
than if it failed.
The other four members of the team understood his weakness, too.
They watched him expectantly.
If the operating room had been tomb--still before, it was now as silent
as the vacuum of any lonely place between the stars where God, if He
existed, passed judgment on His helpless creations.
Jonas was acutely aware of the precious seconds ticking past.
The patient had been in the operating room less than two minutes. But
two minutes could make all the difference.
On the table, Harrison was as dead as any man had ever been. His skin
was an unhealthy shade of gray, lips and fingernails and toenails a
cyanotic blue, lips slightly parted in an eternal exhalation. His flesh
was utterly devoid of the tension of life.
However, aside from the two-inch-long shallow gash on the right side of
his forehead, an abrasion on his left jaw, and abrasions on the palms of
his hands, he was apparently uninjured. He had been in excellent
physical condition for a man of thirty-eight, carrying no more than five
extra pounds, with straight bones and well-defined musculature.
No matter what might have happened to his brain cells, he looked like a
perfect candidate for resuscitation.
A decade ago, a physician in Jonas's position would have been guided by
the Five-Minute Limit, which then had been acknowledged as the maximum
length of time the human brain could go without blood-borne oxygen and
suffer no diminution of mental faculties. During the past decade,
however, as resuscitation medicine had become an exciting new field, the
Five-Minute Limit had been exceeded so often that it was eventually
disregarded. With new drugs that acted as free-radical scavengers,
machines that could cool and heat blood, massive doses of epinephrine,
and other tools, doctors could step well past the Five-Minute Limit and
snatch some patients back from deeper regions of death. And
hypothermia-extreme cooling of the brain which blocked the swift and
ruinous chemical changes in cells following death old extend the length
of time a patient might lie dead yet be successfully revived. Twenty
minutes was common. Thirty was not hopeless. Cases of triumphant
resuscitation at forty and fifty minutes were on record. In 1988, a
two-year-old girl in Utah, plucked from an icy river, was brought back
to life without any apparent brain damage after being dead at least
sixty-six minutes, and only last year a twenty-year-old woman in
Pennsylvania had been revived with all faculties intact seventy minutes
after death.
The other four members of the team were still staring at Jonas.
Death, he told himself, is just another pathological state.
Most pathological states could be reversed with treatment.
Dead was one thing. But cold and dead was another.
To Gina, he said, "How long's he been dead?"
Part of Gina's job was to serve as liaison, by radio, with the on-site
paramedics and make a record of the information most vital to the
resuscitation team at this moment of decision. She looked at her
watch-a Rolex on an incongruous pink leather band to match her sock-and
did not even have to pause to calculate: "Sixty minutes, but they're
only guessing how long he was dead in the water before they found him.
Could be longer."
"Or shorter," Jonas said.
While Jonas made his decision, Helga rounded the table to Gina's side
and, together, they began to study the flesh on the cadaver's left arm,
searching for the major vein, just in case Jonas decided to resuscitate.
Locating blood vessels in the slack flesh of a corpse was not always
easy, since applying a rubber tourniquet would not increase systemic
pressure.
There was no pressure in the system.
"Okay, I'm going to call it," Jonas said.
He looked around at Ken, Kari, Helga, and Gnia, giving them one last
chance to challenge him. Then he checked his own Timer wristwatch and
said, "It's nine-twelve P.M Monday night, March fourth. The patient,
Hatchford Benjamin Harrison, is dead ... but retrievable."
To their credit, whatever their doubts might have been, no one on the
team hesitated once the call had been made. They had the right-and the
duty-to advise Jonas as he was making the decision, but once it was
made, they put all of their knowledge, skill, and training to work to
insure that the "retrievable" part of his call proved correct.
Dear God, Jonas thought, I hope I've done the right thing.
Already Gina had inserted an exsanguination needle into the vein that
she and Helga had located. Together they switched on and adjusted the
bypass machine, which would draw the blood out of Harrison's body and
gradually warm it to one hundred degrees. Once warmed, the blood would
be pumped back into the still-blue patient through another tube feeding
a needle inserted in a thigh vein.
With the process begun, more urgent work awaited than time to do it.
Harrison's vital signs, currently nonexistent, had to be monitored for
the first indications of response to therapy. The treatment already
provided by the paramedics needed to be reviewed to determine if a
previously administered dose of epinephrina heart-stimulating
hormone-was so large as to rule out giving more of it to Harrison at
this time. Meanwhile Jonas pulled up a wheeled cart of medications,
prepared by Helga before the body had arrived, and began to calculate
the variety and quantity of ingredients for a chemical cocktail of
free-radical scavengers designed to retard tissue damage.
"Sixty-one minutes," Gina said, updating them on the estimated length of
time that the patient had been dead. "Wow! That's a long time talking
to the angels. Getting this one back isn't going to be a weenie roast,
boys and girls."
"Forty-eight degrees," Helga reported solemnly, noting the cadaver's
body temperature as it slowly rose toward the temperature of the room
around it.
Death is just an ordinary pathological state, Jonas reminded himself.
Pathological states can usually be reversed.
With her incongruously slender, long-fingered hands, Helga folded a
cotton surgical towel over the patient's genitals, and Jonas recognized
that she was not merely making a concession to modesty but was
performing an act of kindness that expressed an important new attitude
toward Harrison. A dead man had no interest in modesty. A dead man did
not require kindness- Helga's consideration was a way of saying that she
believed this man would once more be one of the living, welcomed back to
the brotherhood and sisterhood of humanity, and that he should be
treated henceforth with tenderness and compassion and not just as an
interesting and challenging prospect for reanimation.
2
The weeds and grass were as high as his knees, lush from an unusually
rainy winter. A cool breeze whispered through the meadow.
Occasionall
y bats and night birds passed overhead or swooped low off to
one side, briefly drawn to him as if they recognized a fellow predator
but immediately repelled when they sensed the terrible difference
between him and them.
He stood defiantly, gazing up at the stars shining between the steadily
thickening clouds that moved eastward across the late-winter sky- He
believed that the universe was a kingdom of death, where life was so
rare as to be freakish, a place filled with countless barren planets, a
testament not to the creative powers of God but to the sterility of His
imagination and the triumph of the forces of darkness aligned against
Him. Of the two realities that coexisted in this universe-life and
death-life was the smaller and less consequential. As a citizen in the
land of the living, your existence was limited to years, months, weeks,
days, hours. But as a citizen in the kingdom of the dead, you were
immortal.
He lived in the borderland.
He hated the world of the living, into which he had been born. He
loathed the pretense to meaning and manners and morals and virtue that
the living embraced. The hypocrisy of human interaction, wherein
selflessness was publicly championed and selfishness privately pursued,
both amused and disgusted him. Every act of kindness seemed, to him, to
be performed only with an eye to the payback that might one day be
extracted from the recipient.
His greatest scorn and sometimes fury-as reserved for those who spoke of
love and made claims to feeling such a thing. Love, he knew, was like
all the other high-minded virtues that family, teachers, and priests
blathered about. It didn't exist. It was a sham, a way to control
others, a con.
He cherished, instead, the darkness and strange anti-life of the world
of the dead in which he belonged but to which he could not yet return.
His rightful place was with the damned. He felt at home among those who
despised love, who knew that the pursuit of pleasure was the sole
purpose of existence. Self was primary. There were no such things as
"wrong" and sin.
The longer he stared at the stars between the clouds, the brighter they
appeared, until each pinpoint of light in the void seemed to prick his
eyes.
Tears of discomfort blurred his vision, and he lowered his gaze to the
earth at his feet. Even at night, the land of the living was too bright
for the likes of him. He didn't need light to see. His vision had
adapted to the perfect blackness of death, to the catacombs of Hell.
Light was not merely superfluous to eyes like his; it was a nuisance
and, at times, an abomination.
Ignoring the heavens, he walked out of the field, returning to the
cracked pavement. His footsteps echoed hollowly through this place that
had once been filled with the voices and laughter of multitudes.
If he had wanted, he could have moved with the silence of a stalking
cat.
The clouds parted and the lunar lamp beamed down, making him wince.
On all sides, the decaying structures of his hideaway cast stark and
jagged shadows in moonlight that would have seemed wan to anyone else
but that, to him, shimmered on the pavement as if it were luminous
paint.
He took a pair of sunglasses from an inside pocket of his leather jacket
and put them on. That was better.
For a moment he hesitated, not sure what he wanted to do with the rest
of the night. He had two basic choices, really: spend the remaining
predawn hours with the living or with the dead. This time it was even
an easier choice than usual, for in his current mood, he much preferred
the dead.
He stepped out of a moon-shadow that resembled a giant, canted, broken
wheel, and he headed toward the moldering structure where he kept the
dead. His collection.
3
"Sixty-four minutes," Gina said, consulting her Rolex with the pink
leather band. "This one could get messy."
Jonas couldn't believe how fast time was passing, just speeding by,
surely faster than usual, as if there had been some freak acceleration
of the continuum. But it was always the same in situations like this,
when the difference between life and death was measured in minutes and
seconds.
He glanced at the blood, more blue than red, moving through the
clear-plastic exsanguination tube into the purring bypass machine. The
average human body contained five liters of blood. Before the
resuscitation team was done with Harrison, his five liters would have
been repeatedly recycled, heated, and filtered.
Ken Nakamura was at a light board, studying head and chest X rays and
body-sonograms that had been taken in the air ambulance during its
hundred-eighty-mile-per-hour journey from the base of the San
the patient's face, examining his eyes through an ophthalmoscope,
checking for indications of dangerous cranial pressure from a buildup of
fluid on the brain.
With Helga's assistance, Jonas had filled a series of syringes with
large doses of various free-radical neutralizers. Vitamins E and C were
effective scavengers and had the advantage of being natural substances,
but he also intended to administer a lazeroid-tirilazad mesylate-and
phenyl tertiary butyl nitrone.
Free radicals were fast-moving, unstable molecules that ricocheted
through the body, causing chemical reactions that damaged most cells
with which they came into contact. Current theory held that they were
the primary cause of human aging, which explained why natural scavengers
like vitamins E and C boosted the immune system and, in long-term users,
promoted a more youthful appearance and higher energy levels. Free
radicals were a by-product of ordinary metabolic processes and were
always present in the system. But when the body was deprived of
oxygenated blood for an extended period, even with the protection of
hypothermia, huge pools of free radicals were created in excess of
anything the body had to deal with nsrmally. When the heart was started
again, renewed circulation swept those destructive molecules through the
brain, where their impact was devastating.
The vitamin and chemical scavengers would deal with the free radicals
before they could cause any irreversible damage. At least that was the
hope.
Jonas inserted the three syringes in different ports that fed the main
intravenous line in the patient's thigh, but he did not yet inject the
contents.
"Sixty-five minutes," Gina said.
A long time dead, Jonas thought.
It was very near the record for a successful reanimation.
In spite of the cool air, Jonas felt sweat breaking out on his scalp,
under his thinning hair. He always got too involved, emotional. Some
of his colleagues disapproved of his excessive empathy; they believed a
judicious perspective was insured by the maintenance of a professional
distance between the doctor and those he treated. But no patient was
jus
t a patient.
Every one of them was loved and needed by someone. Jonas was acutely
aware that if he failed a patient, he was failing more than one person,
bringing pain and suffering to a wide network of relatives and friends.
Even when he was treating someone like Harrison, of whom Jonas knew
virtually nothing, he began to imagine the lives interlinking with that
of the patient, and he felt responsible to them as much as he would have
if he had known them intimately.
"The guy looks clean," Ken said, turning away from the X rays and
sonograms. "No broken bones. No internal injuries."
"But those sonograms were taken after he was dead," Jonas noted, "so
they don't show functioning organs."
"Right. We'll snap some pictures again when he's reanimated, make sure
nothing's ruptured, but it looks good so far."
Straightening up from her examination of the dead man's eyes, Kari
Dovell said, "There might be concussion to deal with. Hard to say from
what I can see."
"Sixty-six minutes."
"Seconds count here. Be ready, people," Jonas said, although he knew
they were ready.
The cool air couldn't reach his head because of his surgical cap, but
the sweat on his scalp felt icy. Shivers cascaded through him.
Blood, heated to one hundred degrees, began to move through the clear
plastic IV line and into the body through a thigh vein, surging
rhythmically to the artificial pulse of the bypass machine.