Of Flesh and Blood

Of Flesh and Blood

BY DANIEL KALLA

FROM TOM DOHERTY ASSOCIATES

Blood Lies

Cold Plague

Of Flesh and Blood

Pandemic

Rage Therapy

Resistance

DANIEL KALLA

This is a work of fiction. All of the characters, organizations, and events portrayed in this novel are either products of the author’s imagination or are used fictitiously.

OF FLESH AND BLOOD

Copyright © 2010 by Daniel Kalla

All rights reserved.

A Forge Book
Published by Tom Doherty Associates, LLC
175 Fifth Avenue
New York, NY 10010

www.tor-forge.com

Forge
^®
is a registered trademark of Tom Doherty Associates, LLC.

ISBN 978-0-7653-2141-1

First Edition: April 2010

Printed in the United States of America

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For my girls: Cheryl, Chelsea, and Ashley

Stripped down to its studs, this is a story of family. And I am forever grateful for the love and encouragement I receive from mine.

I wouldn’t be in print without the support of the friends and colleagues who read the early drafts and provide pivotal feedback. I’m especially indebted to the wonderful Kit Schindell, a freelance editor (somervillebook [email protected]) whose insights, suggestions, and advice are essential to my work. I would also like to acknowledge Nancy Stairs for her razor-sharp critique and feedback. And thanks to Dal Schindell for so carefully proofing my pages.

I am so grateful to my agent, Henry Morrison, who inspired this novel by suggesting that I spread my wings and tackle the genre of the epic “industry” saga that, to use his words, “has lain fallow for too long.” I would also like to thank my foreign rights agent, Danny Baror. And I am fortunate to work with a terrific marketing consultant, Kristin Andress.

I am lucky to have found a home in New York with Tor/Forge, a publisher with true heart and soul. And my editor, Natalia Aponte, epitomizes the “triple threat” of the publishing world: friend, collaborator, and advocate.

Of Flesh and Blood

Where the hell is my heart?
Erin McGrath wondered as she burst through the swinging door and into the operating room.

Inside OR 22, the usual controlled chaos reigned. The staff buzzed with activity. The anesthesiologist, a taciturn South African named Peter Proust, hovered beside a bank of high-tech monitors as he mixed the cocktail of drugs required to achieve the delicate balance between putting the patient to sleep and keeping her brain and other organs viable during the three-hour transplant surgery.

Wearing green hospital scrubs, but not yet gowned, Erin strode up to the stretcher beside the operating table. Her patient, Kristen Hill, lay still on the gurney. Kristen’s pale face was covered with a bulky breathing mask to optimize the oxygen delivered to her fluid-logged lungs. On the right side of her neck, several intravenous lines converged at the plastic hub connecting to a central line that tunneled through the skin and into her jugular vein.

Erin felt a deep affinity for the young woman who, like her, was a mother of fraternal twins. Life had dealt Kristen one blow after another. Abandoned by her husband when her twins were only toddlers, forced to support the family on a minimum-wage income, and now incapacitated by a failing heart, somehow the twenty-six-year-old remained perpetually hopeful. Underneath the clear plastic mask, Kristen wore the same accepting expression as usual. But despite the oxygen, her lips were bluer than ever. She appeared to deteriorate by the minute.

Where’s the damn chopper with my heart?
Erin thought again as she reached the bedside.

Kristen’s own heart was shot. The once-powerful pump had turned into a mass of engorged useless tissue after a virus had suddenly attacked it. The
illness had begun innocuously enough, as little more than the same cold that had hit her children. But the virus unexpectedly turned on Kristen’s heart, causing myocarditis. Within days, it had destroyed the muscle that constituted the cardiac wall. Despite the maximal medication and all other interventions Erin had tried, Kristen’s shattered heart couldn’t keep up with the circulatory demands of her body.

Erin rubbed her patient’s elbow. “How are you holding up, Kristen?”

“Okay.” She mustered a grin through her mask. “Dr. McGrath, I thought I’d be asleep by now.”

“Not much longer,” Erin said, hoping she was speaking the truth.

The call from the national organ donor registry had woken Erin at five
A.M
. from a very light sleep. The day before, because of Kristen’s drastic deterioration, the heart surgeon had put out a plea through the transplant network for any viable heart within a thousand-mile radius of the Alfredson Medical Center. That evening, on a rainy highway outside of Billings, Montana, a twenty-two-year-old biker hit an oil slick and lost control of his motorcycle. Slamming into the guardrail, the biker was thrown thirty feet and smashed headfirst into the mountainside. His helmet was no match for the wall of rock. Brain-dead at the hospital, he turned out to be a close enough tissue match to Kristen Hill for organ donation. By seven
A.M
., the transplant team had harvested the biker’s heart, finding it in healthy condition and miraculously unscathed from the accident.

As soon as Erin heard the news, she had ordered Kristen transferred into the operating room to prep for the imminent transplant. Everything looked promising. And then a sudden storm blew in from the east and grounded the Alfredson’s transport helicopter.

Erin viewed her patient with an apologetic smile. “Kristen, the heart is still not here.”

Panting heavily, Kristen nodded. “It’ll get here soon, huh?”

“Very.” The chopper was in flight and expected to arrive at any moment, but Erin knew that wasn’t the problem. “The donor organ has been outside the body—or ‘on ice’—for almost four hours now.”

“That’s too long?”

Erin squeezed Kristen’s hand. “Generally, we accept five hours as the upper limit of cold ischemia, the time a nonbeating heart can be outside of a body and still usable in transplant.”

“So you still have an hour,” Kristen encouraged.

“But it will take longer than that to open your chest and implant the new heart.”

The first flicker of despair crept into Kristen’s features. “What happens after five hours?”

Erin frowned. “It gets dicey. The donor heart can become irreversibly damaged from lack of blood and oxygen. It often doesn’t pump well after transplant. Sometimes, we can’t even get it restarted once we’ve implanted it.”

Kristen’s face tensed with resolve. “Dr. McGrath, you don’t know when another heart will become available, do you?”

Erin shook her head grimly. “No.”

“Look at me.” Kristen sputtered a moist cough, as if for effect. “We both know I can’t wait much longer.”

Erin nodded.

“I am willing to take my chances on this heart. Today. Right now.”

Erin leaned closer. “Kristen, you do understand that once we begin, there’s no turning back? If the new heart doesn’t take . . .”

Kristen swallowed. “I understand, Dr. McGrath. I still want you to try.”

Erin let go of her patient’s hand. “Okay, Kristen. As long as the heart arrives in the next fifteen minutes, we’ll go for it.”

Erin looked over and saw that the anesthesiologist was eyeing her dubiously. “Fifteen minutes, Peter,” she said. “Not a second more.”

With a minimal shrug of his shoulders, Proust turned back to the syringes and vials laid out in front of him.

Erin looked over at the charge nurse. “Joanne, let’s get Kristen on the table and prepped for surgery.”

The heavyset nurse turned and nodded to another nurse. Together, they headed for Kristen’s stretcher. The wall phone behind Proust rang shrilly. The anesthesiologist grabbed it. “OR twenty-two,” he said in his terse Afrikaner inflection. He hung the phone up without saying another word into the receiver. “It’s here,” he announced matter-of-factly.

Erin turned back to her patient. “Kristen, this is the point of no return, you understand?”

Her lips broke into a brave smile. “I just want to see Katie and Alex through grade school. That’s all.”

“Fair enough.” Erin swallowed, thinking of her own twins, who were in their last year of grade school. “I’m going to go scrub now.”

Even before reaching the swinging door, Erin felt the first twinges in her belly.
No!
She wanted to scream.
Not now, of all times
.

Erin stood at the metallic sink outside the OR, scrubbing her hands as she struggled to hold back the surging anxiety.
It’s not real, Erin, it’s not real
. . ., she repeated over and over in her head. But the mantra didn’t deter the sense of suffocation from growing, as though a pair of strong hands was squeezing her throat. Her fingers began to tingle with needles and pins—a telltale sign of hyperventilation.

The first panic attack had struck out of the blue three months earlier. Late one night, Erin was wheeling her garbage can down her driveway when she was overcome by a horrible sensation, as though someone had suddenly tightened a bag over her head. She wanted to run, but she couldn’t breathe well enough to move. So she stood beside the garbage can, gripping its handle and trembling like a leaf. Though vaguely aware that she was suffering a panic attack, Erin still expected to die at any moment. Nauseous from anxiety and the smell of decaying fruit and vegetables, she spent ten of the most distressing minutes of her life frozen in the driveway before she was able to pull herself together enough to even go inside.

Since the first panic attack, Erin had experienced six or seven more. None of them came with any warning. She had not told anyone about the attacks, not even her husband. Instead, she had started herself on an antidepressant that was supposed to suppress the episodes. It hadn’t. And today, for the first time, she was experiencing what she had dreaded most: a panic attack at work.

Fingers shaking under the warm soapy suds, Erin fought to slow her breathing and focus her racing thoughts. Thanks to the storm in Montana, too much time had already been lost. Every second she wasted at the sink trying to calm herself would lessen the chance of the donor heart working. She considered calling a colleague in to take over the operation, but the only other cardiac surgeons in the building were already scrubbed into surgery. By the time one of them could respond, the donor heart would be as useless as ice cream that had been left out of the freezer too long.

Erin turned off the tap with her knee. Her chest thudding, she studied her fingers and noticed that the shake had lessened to a subtle tremor. The needles-and-pins sensation had dissipated, too. She took a few controlled
breaths and then, holding her sterile hands in the air, backed through the swinging door and into the operating room.

Erin was relieved that her mask shielded her face from the others, but she avoided all eye contact, not wanting them to see the remnants of panic in her eyes.

“She’s under,” Proust said with his typical economy of words.

Erin glanced over to see Kristen Hill unconscious on the table with an endotracheal breathing tube poking between her lips and connecting to a respirator. One of the surgical assistants had already sterilized and draped her chest, exposing a ten-by-ten-inch surgical field centered on the sternum, or breastbone. Kristen looked peaceful, which helped calm Erin slightly, but she still started at the sudden noisy whir of the bone saw when her assistant tested its blade.