Informed Consent

D
edicated
to the talented members of the Thomas E. Starzl Transplantation Institute's Liver Transplantation Program at the University of Pittsburgh Medical Center.

D
r. Greta Allstrom
kept her hands in her lap to hide their trembling and tried to work up enough saliva in her dry mouth to answer the question Dexter Corgan had just asked. The three interchangeable, dark-suited, intense men seated around the table waited.

Corgan repeated the question. “How much do you need?”

She wet her lips. “To ramp up production and go to market within the next eighteen months?”

He bobbed his head in a curt nod. The motion drew attention to the prominent ridge in his brow. In the shadowy light of the basement bar, he resembled a Neanderthal man even more than he had in the light of day.

“Um, I’m a scientist, so the business end isn’t my forte. Maybe forty million?” She had no earthly idea. But surely forty million dollars would produce a fleet of medical nano-robots.

The trio of suits laughed.

“That’s pocket change, doctor. Think big,” the one in the middle said.

“Eighty?” she croaked. It was a sum of money she couldn’t even imagine. And she sensed it would come with unbreakable strings.

The middle one, who must have been the senior guy despite the fact that, like the others, he appeared to be in his late twenties, at most, spoke again. “Eighty is fine.” He flicked his eyes toward Corgan. “Mr. Corgan didn’t happen to explain the terms and conditions, did he?”

She shook her head no. Dexter Corgan had explained absolutely nothing. He’d raced up to her at a conference after she’d presented her paper on ‘Theoretical Implications of Anti-Dementia Drug Delivery Through Nano-Robotic Means,’ and pumped her hand with wild enthusiasm. He acted as if he were a fan gushing over a celebrity and not a venture capital consultant talking to a genetic researcher. Literally within thirty minutes, she’d found herself in this cramped underground Boston bar sitting next to Corgan and across the sticky surface of the scarred and scuffed wood table from three nameless would-be investors.

Just then Corgan stood. “I’m just the matchmaker,” he told Greta. “These gentlemen retained me as a talent scout, you might say, and asked me to attend the conference, evaluate the presentations, and bring them the most promising idea.” He paused and flashed her a smile. “And I have. Assuming you all reach an agreement, they’ll pay me a finder’s fee. But from this point forward, the negotiations are between you and them.” He shook the proffered hands around the table, winked at Greta, and then hurried up the stairs and out of the bar.

It was as if he didn’t want to hear what came next.

The middle guy pinned his eyes on hers. “We’re a group of serious private investors, doctor, committed to helping cutting-edge ideas circumvent the federal funding morass and escape the constraints of the glacial pace of university research. We have the means and the will to help you make your innovation a reality.”

She waited.

“Sounds too good to be true, doesn’t it?” the man seated to his left said.

She turned her gaze to him and noticed that, unlike the others, his eyes were green. “It does.”

“Right. Well, there are
some
hoops.” He gave her a toothy smile. “One, the investment will be private, which means you don’t report it to your Institutional Review Board Director.”

“I can’t … that’s not permitted,” she protested.

“We know how to structure the deal so that it will work. That’s
our
expertise. You focus on the science and let us handle the business,” the middle guy said. “You’ll tell your director that an investment group is going to fund the nano-robotics stage outside of the university structure. The university will license us the drug at that point.”

“What if they don’t want to?”

He laughed. “They will. We’ve done this before. We offer a very generous licensing fee. More money than your program receives from grants and donations in a year. And if the trials are successful, the university will continue to reap enormous royalties without taking the risks of development. Trust me, that’s not a problem.”

“But what about the current research? I have reporting requirements—”

“We’ll partition it off. As far as the Department of Health and Human Services and the FDA are concerned, it’ll be two separate studies—the drug study, which they’ll oversee—and a privately funded robotics study. That’s not your concern. You continue under the rules and regulations already in place for the drug study. We’ll worry about the rest.”

The guy on the left interjected. “Two, before we leave here, we’ll agree on a timetable. Think carefully about how much time you need because there will be no extensions given.”

“What if—?”

“None.” His green eyes hardened into emerald marbles.

She swallowed and nodded, not trusting herself to speak.

“Three, if the project doesn’t make it to market, we’ll be looking to you to make us whole.”

“I don’t have eighty million dollars.”

“Of course you don’t. That’s why you’ll make sure the drug gets to market.” He smiled.

She ignored the goosebumps that sprouted on her forearms. “But you wouldn’t be able to collect. My guarantee would be worthless.”

The men exchanged glances. After a moment, the man on the right, who up until then had been completely mute, spoke. “It’s not a financial guarantee. It’s a personal guarantee.”

“I still don’t understand.”

The middle guy sighed. “This is tiresome. Instead of worrying about what happens if you fail, focus on succeeding, so you won’t ever have to find out. But let’s just say our organization will think of some work for you to do until the debt is repaid.”

Visions of working in a meth lab in her underwear or performing cosmetic surgery on fugitives in a dim back alley flashed across her mind. “You know, I never caught your names,” she blurted.

“You don’t need to know our names. Our investment group is the Alpha Fund. That’s all you need to know,” the man on the left told her.

“What’s the actual status of the drug trials?” the one in the middle asked.

“We’re testing the supplement in live patients. So far, it’s slowing their deterioration. It’s very promising as is. But if we could deliver it to the myelin sheath directly, well, I’m convinced it will
stop
the deterioration in its tracks. It could be used as a preventative to avoid it entirely.”

“What needs to happen before you test nano-robot delivery?”

“Well, the creation of the nano-robots, of course.”

Green Eyes waved his hand at that. “We’ll arrange that. What needs to happen with the drug trial?”

“I need to compare the gray matter of a control patient who exhibited no signs of dementia with brain slices from a dementia patient who received the drug and a patient whose dementia was uncontrolled.”

“Just one of each? That’s not very rigorous,” the middle man observed.

“Given their ages and health issues, my research participants die fairly regularly. But many people are squeamish about post-mortem brain autopsies. They don’t like to think about it. So I don’t have a large pool of subjects who will consent. The numbers are limited by necessity but I have a robust computer model that will extrapolate from a small sample size. But obviously, the more samples the better,” she hurried to explain.

“You understand that if we go forward we don’t want to hear that you’re behind schedule because nobody’s died in a while,” he pressed.

She stared at him. “That’s out of my hands, though.”

“Not if you take our money. If you take our money, you need to deliver. End of story.”

Her heart raced and her shaking hands began to positively vibrate in her lap. She
needed
this funding. She
knew
the nano-robotic delivery would work. It would change lives.
She
would improve the quality of end of life for people all over the world. But these men, they scared her.

“What do you say, Dr. Allstrom?”

She couldn’t hear the thumping music from the house band or the laughter of the revelers around her over the sound of her blood whooshing in her ears. She couldn’t hear her own voice and didn’t know if she whispered or shouted when she said, “I need some of my subjects to die.”

“
I
’m so sorry
, Mr. Wynn,” the doctor said, looking up from his chart and meeting Doug Wynn’s hardened gaze with his own sad brown eyes. “You’re running out of time. This last round of chemotherapy wasn’t as successful as we’d hoped it would be. If you don’t get a liver soon there’s very little left that we can do.”

Wynn nodded, set this mouth in a firm line, and looked past the doctor out the window, focusing on the cold, gray landscape.

“The transplant list, then?” he asked, dragging his eyes back to the man.

After several long moments of silence passed, the doctor began to fidget. He cleared his throat and shuffled through the papers on his clipboard. “No, I’m afraid that won’t be an option. Your tumor size is too large. It disqualifies you from receiving a liver from a deceased donor.”

“Just as well,” Wynn said. He had a visceral, negative reaction to the thought of having the organ of a dead stranger placed in his body.

The doctor gave him a nonplussed look. Then he ventured, “Does that mean you’ve made some progress in locating your … son, I believe it was? Your only real option now is a live donor.”

Wynn took his time answering. “No, I haven’t had any luck so far.” It was true as far as it went: having made no effort to find his son, he had, not surprisingly, failed to do so. He steeled himself for the answer and asked the question that mattered most to him. “How much time are we talking, doctor?”

The oncologist blinked behind his glasses and screwed up his face in concentration while he tried to decide whether and how much to sugarcoat his answer.

Wynn waited impassively.

Apparently deciding that he was faced with a patient who wanted to hear it straight, he choked out an answer. “Um, I’d say anywhere between six weeks to four months. But bear in mind that we’d have to transfer your care to a center that performs the surgery, and those arrangements could take some time. So I’d encourage you not to delay.” The doctor delivered the death sentence and stared across the room at Wynn.

Wynn nodded, immediately and with a force he didn’t feel. “Thanks, Doc.”

He carefully eased his swollen, sore feet into the slipper-like work shoes he’d found on the Internet. Then he straightened his shoulders and reached out his right hand. The doctor squeezed it gingerly.

As he shuffled out the door, the man called after him in a strangled voice, “Stop by Marie’s desk and make an appointment for two weeks from now. Let her know if you need any refills on your medication. And Mr. Wynn?”

“Yeah?” Wynn turned slowly and peered at the doctor through narrowed eyes.

“I don’t know your faith, sir. But it’s never too late to pray for a miracle.”

I
t’s never too
late to pray for a miracle.
The phrase reverberated in Wynn’s ears all throughout the long journey back to his home. It rumbled through his brain as the cab driver slowly wended his way through crosstown Portland traffic to the bus depot.

It rattled in time with the wheels on the old bus as he bumped along to the ferry, lulling him into a fitful sleep that dredged up memories he’d rather not relive.

It echoed as he bounced in his seat as the boat churned through the choppy water to the island.

And it repeated rhythmically, like a drumbeat, while he drove his old dirty Jeep out of town and along the poorly maintained roads that wound their way from the highway to his compound.

Doug Wynn was not a man who counted on miracles. He hadn’t survived this long by praying or hoping or waiting. He was a man who made things happen.

He had made his own luck his entire life. Now it looked like he would need to make his own miracle.

He unlocked the door to his home, shrugged out of his heavy parka, and warmed a can of soup to take the chill out of his bones. Then he waited for his nausea to pass, picked up the phone and dialed a number he’d hoped he’d never need to call.

“Yeah?” Stevey Tran answered on the second ring. His high-pitched, nasal voice, so incongruent to his height and bulk, was cautious and suspicious.

Wynn understood. Only a handful of men knew the telephone number he’d just dialed to reach Tran. And none of them would use it for anything less than a disaster. They’d vowed to cut their ties as a matter of survival.

“It’s me. Duc.” His tripped a bit over his birth name.

“What’s wrong?”

“I need to find my son.”

“That’s not a good idea. You can’t get sentimental in your old age. It’s not safe.”

Wynn snorted. “I’m not getting misty-eyed, you fool. I’m dying.”

There was a long pause. When Tran spoke again, his voice was thick with emotion. “I’m sorry.” He coughed. “But even so. Some things should go to the grave with us. Don’t poke your head up.”

“I have liver cancer, Stevey. I need a transplant. And I need it from a living donor. Someone compatible. So I thought …”

“They can do that? Take out someone’s liver and give it to you? Won’t your kid die?”

To his surprise, the answer to that was no. When the oncologist had first mentioned the possibility of a living donor, Wynn had asked the same question. As it turned out, the liver was unique in its ability to regenerate.

“No. They take, I don’t know, half of it. And then the half in me grows to full-size and the one still in him grows back, too. He’d be good as new in a couple months.” And I’d be alive, he added.

Tran squeaked out an appreciative whistle. “Science, man. That’s unreal.”

“Yeah.” Wynn waited.

“But, still. That’s a big ask. You know, for a kid who’s never even met you.”

“I’m his father.” Wynn clenched his fist.

Tran sighed heavily. “It’s risky, Duc.”

Wynn said nothing. It had been decades since he’d seen the man. Stevey Tran, despite his size, was nothing but a bean counter. He’d kept the trains running on time, as the saying went. Wynn had been the muscle. And unless Stevey’s memory had faded, he’d recall that nothing gave Wynn more pleasure than delivering a beating to some slow-to-pay debtor or reluctant shopkeeper. And his joy had extended to meting out discipline within the organization.

“I’ll have to do some digging. It’s been years since he popped up on the radar. Give me some time.”

“Don’t take too long. The doctors say I don’t have much time left.”

“Okay. I’ll be in touch. Take care of yourself. And, Duc—?”

“Yes?”

“No fear, eh?”

“No fear,” Wynn echoed before ending the call.

He pushed up his flannel shirt sleeve and traced the faded tattoo on the inside of his forearm: a small coffin, three candles, and the stylized letters
B.T.K.
No fear
, he thought. He’d been so young that night in the Chinatown tattoo parlor when he imprinted his arm with the bravado that he was so tough he could face death unafraid. He stared for a moment at his sagging, wrinkled flesh and the distorted image on his arm—his rapid weight loss from treatment had left his skin hanging loosely from his frame like a too-large suit.

After a moment, he yawned and pushed himself up from the chair. The too-frequent trips to the mainland for medical appointments were getting harder. He wasn’t willing to sacrifice his solitude for convenience. Not yet, at least.

He turned out the light and began the slow climb up the stairs to his bedroom.

No fear.