Happy Saturday! I am trying something new: a serialized story published online.  It will not be heavily edited, and out of my comfort zone, but should be fun.  Enjoy!

Connecting the tissues is easy: plates and screws hold bones together and stitches tie the muscles, tendons, skin, and even the large arteries and veins until everything has time to meld together of its own accord.  Nature is amazing that way.  The spinal cord is the hardest by far.  It’s fiddly work and you have to have steady hands and much patience. 

First you do the donor, because if you botch that one it isn’t good, but that’s more of an administrative nuisance than anything else and you can always get a new one.  To start you have to severe the neck cleanly, you can’t hesitate and hack at it: it has to be done in one smooth motion so that you’re left with an even plane and the nerves remain as intact as possible.  Now comes the hard part, because you have to figure out how you’re going to make this body work again.  With small tweezers you have to tease apart the strands of nerves sticking out from within the hole going through the vertebrae and attach them one at a time to an alligator clip that sends an electric charge up the fiber.  The nurses have already covered the body with as many sensors as they can fit on whatever surface area that they are given to work with.  When a sensor picks up activity, one of the staff makes a note of the location and the nerve is labeled with a tiny tab.  On to the next.

If you play music in the background you can get into a steady rhythm.  I like something like techno, not that I like that sort of music, but it’s mindless enough and has a steady beat that I can rely on to power through an afternoon of measuring and labeling.  I always liked to think of this part as making spaghetti from scratch because the bundles of nerves are both firm and elastic.  God forbid you pull on them because they will recoil and good luck fishing them back out.  That’s why some surgeons will make the nurses or residents do all the work, but not Nathan.  He’s always good like that, because by the time he’s done stage one he knows exactly where everything is.

When every last bit of nerve tissue it organized the donor is put on ice and the really nerve-racking part (we always say that and everyone in the room laughs at the pun) can begin.  Only the really good anesthesiologists are ever allowed to work on the patients, and at this point the subject must be completely machine operated: the heart’s been bypassed, the lungs aren’t needed anymore because the blood’s running through an oxygenating pump, and the body is completely inert.  Today that’s not too hard to achieve because I have been a quadriplegic for the last three months.  A car accident between an electric sedan and a diesel freight truck that skids down a steep road on a rainy day and crushes you will do that, but I am sedated so I can’t dwell on it at the moment.  It’s not that shocking that I have to go through the surgery, I mean, statistically most patients are recovering from hate crime violence or terrorist attacks, so I guess I was just lucky to have been in a freak accident.

A patient’s head can’t just be lobbed off, because an unlabeled spinal cord is a bit useless.  Typically the neck would be cut leaving the nerves intact and then they would be tested, labeled and sliced one by one.  In my case, the tests are done below the spinal injury and the labels and cuts are made above. 

“Try not to give me a stump neck,” I’d joked with Nathan the night before and he’d laughed amicably, but I could see that he was already in what he called “the zone”; I was just another patient to him even before I entered the operating room. 

It’s always thrilling making the last cut.  Suddenly, your patient is a compact package and there is no excess left, it is just the essentials: the face, which has come to represent so much in our society, and the brain, that thing that sets us all apart one from the others.  The body doesn’t seem so important at that moment, because it’s just a vessel for what really matters and that’s our grey matter (I love my puns, and that won’t change even when my body does).  The body is never treated like bio waste and discarded unceremoniously: it’s put aside and will receive a proper funeral once the patient is in recovery, because it always helps with the healing to get proper closure.

There are three things that we look for in a donor: good health and a high likelihood of lasting a long time; gender (what that will be is always at the discretion of the patient); and neck dimensions.  You wouldn’t believe how hard it is to stick a body and a head together when the cuts don’t line up properly.  It can be done, but it’s not pretty and is uncomfortable to say the least, so when a patient is adamant that they want a specific body we politely but firmly tell them that they will forever have a neck shaped like a mushroom.  It is unusual that patients force the issue.

The matching nerves from the body and head are connected using a tiny drop of binder.  When the spinal cord has been reassembled, the stem cell treatment is applied directly to the nerves and the patient is stitched together.  Only a patch approximately two inches in length is left unattached at the back of the neck so that the healing can be monitored during the next three days.  The body and head remain under anesthesia until the surgeon is satisfied that the nerves have grown back together nicely.  Slowly, the heart is restarted, the lungs are ventilated mechanically until the brain picks up the rhythm and the communication between organs and head is established.  Now the patient is, for lack of a better word, alive again and ready to be woken up.

That’s where the really hard part begins.

(Copyright © A. A. Frascati 2016)

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