At the moment, though, it was the scrub-clad nurse tugging at my sleepy sleeve. “He’s awake, and he’d like to see you both.” She smiled.
Miranda and I struggled to our feet. The nurse took us up an elevator and down a hall to an ICU room, which bristled with monitors. Through the large panel of glass that faced the nurses’ station, I saw Carmen sitting beside the head of the bed, stroking her husband’s cheek.
Eddie opened his eyes and smiled groggily when we came into the room. “My friends,” he murmured. “My good, good friends.” Then his eyes closed again.
His arms were fastened into an elaborate traction harness above the bed. Protruding from the ends of the arms were a pair of white oval bundles, roughly the size and shape of handmade loaves of bread. Five fingertips protruded from the end of each loaf. The swaddled hands looked awkward and out of place, strangely foreign, because just twenty-four hours before there had been nothing there. Nothing but emptiness and loss.
The hands — like the surgery’s outcome, and like Eddie’s future, and like all our hopes for it — hung in the air, suspended. And just for a moment, those bright white bundles of suspense and hope were transformed. In my mind they shone like a pair of binary stars at the center of the universe, and they were the most beautiful things I had ever seen, or ever would.
AUTHOR’S NOTE: FACT AND FICTION
“This book is a work of fiction,” reads the disclaimer in the front of this novel. “Any resemblance to actual events or persons, living or dead, is entirely coincidental.”
That very disclaimer itself is part fiction: Although many characters and most plot threads in The Bone Thief are woven entirely out of thin air, this book has many bases in scientific and biomedical fact. Within this subject area, truth rivals or surpasses fiction in ways that are mostly inspiring but occasionally horrifying.
The thriving trade in bodies and body parts — including illegal black-market sales of corpses and tissues — was recently the subject of a riveting nonfiction book, Body Brokers, by Annie Cheney. Published in 2006, Cheney’s book documents — among other things — shocking postmortem “chop shops” (our term, not hers) operated by a California funeral-home owner and a Texas medical-school staff member. Body Brokers also describes multiple instances of bodies and body parts being sent to laboratories and even luxury hotels (including, Cheney reports, “forty-two heads and necks to the Marriott Marquis” in New York City’s Times Square) for medical trainings. Cheney’s book also documents the tragic case of a young man who died suddenly from toxic shock after receiving an improperly sterilized bone graft — one contaminated with Clostridium sordellii bacteria.
Crime fiction focuses, by definition, on the seamier side of life. The happier truth is that organ transplants and tissue grafts allow remarkable feats of medical repair and restoration. And as stem-cell technology advances — offering the potential to grow rejection-proof tissues and organs with the patient’s own DNA and tissue type — the possibilities become almost miraculous. Indeed, near miracles are already being wrought: The surgery in Spain that was described by our character Glen Faust — in which a cadaver trachea was used as a scaffold to create a new windpipe from the recipient’s own stem cells — is unvarnished fact. The one significant bit of artistic license we’ve taken with biomedical fact is the notion that by combining CT scans with advanced composite materials it’s possible to synthesize bones that are virtually exact copies of their originals. That’s not possible — not yet anyhow. But never say never.
A few footnotes about hands: Artificial hands are now very sophisticated and lifelike in their workings, as a glance at the i-LIMB Hand — with its individually controlled fingers — makes clear (www.touchbionics.com/i-LIMB). Soon bionic prostheses will become even more advanced, thanks to millions of dollars’ worth of R&D sponsored by the Pentagon’s Defense Advanced Research Projects Agency (DARPA). DARPA’s Revolutionizing Prosthetics Program — motivated by the military’s commitment to restoring function to soldiers whose arms or hands have been lost to trauma — is led by two premiere R&D laboratories: DEKA Research and Development (the birthplace of the portable insulin pump and the Segway scooter) and the Johns Hopkins University Applied Physics Laboratory (whose numerous other projects include interplanetary satellites and bomb-disposal robots). Within the next few years, Revolutionizing Prosthetics aims to create bionic arms that are virtually identical to natural limbs in performance and durability. For more information on this program, see www.darpa.mil/Docs/prosthetics_f_s3_200807180945042.pdf.
Hand surgery, too, has undergone remarkable advances. Toe-to-thumb transplantation, briefly discussed as a way to restore function to Dr. Garcia’s right hand, is a well-established and highly successful way to replace a missing thumb, as Asheville, North Carolina, hand surgeon Bruce Minkin — a former student of Dr. Bill Bass — explained to us in detail over dinner and via many subsequent e-mails. After a teenage patient lost his thumb and two fingers to an explosion, Dr. Minkin grafted one of the boy’s toes onto his mangled hand, creating a thumb that looks and functions almost like the original.
Total hand transplantation is, for now, an inspiring but experimental and very rare procedure. Worldwide, only about forty hand transplants have ever been performed; in the United States, just half a dozen patients have received transplanted hands — and only one has received a bilateral (double) transplant. Those numbers will rise, and the procedure will become more common, if Dr. Linda Cendales has her way. Dr. Cendales — the inspiration for the Emory surgeon we call Dr. Alvarez — is the only surgeon in the United States who has been formally trained in both hand surgery and transplant surgery.
Dr. Cendales helped perform two of the earliest U.S. transplants, including the 1999 transplant that — after more than a decade — remains the world’s most enduringly successful hand transplant. Dr. Cendales is not just a gifted surgeon, she’s also a pioneering researcher. She completed two research fellowships at the National Institutes for Health, focusing on ways to keep patients’ immune systems from rejecting transplants. Now, through a joint appointment at Emory University School of Medicine and the Atlanta VA Medical Center, Dr. Cendales is building a visionary new hand-transplant program, one that combines surgical expertise with immunological research. During the research for this book, Dr. Cendales graciously invited Jon Jefferson into her operating room to observe hand surgery. Using a curved needle and strong sutures, she carefully stitched together a severed tendon in a man’s hand, and then — peering through a microscope to guide an even more delicate part of the procedure — she snipped and spliced the ends of a damaged nerve together again. After the repairs were done, but before the hand was stitched shut, she flexed and straightened the sleeping patient’s index finger repeatedly, nodding with satisfaction as the reattached tendon slid smoothly within the remarkable cable-and-pulley mechanism of the human hand.
As the first edition of this book goes to press, Dr. Cendales is evaluating transplant candidates — and preparing to test a powerful new antirejection drug that she hopes will revolutionize transplant medicine and bring hope and hands to more real-life patients like our fictional Eddie Garcia.