Shoofly Pie & Chop Shop (63 page)

“Have they listened?”

Paulos shrugged. “I watch the henhouse from outside the fence. I have no physical presence at PharmaGen. I serve as an advisor; how they implement my suggestions is up to them.”

“What about the other guy? Who’s the second member of the panel?”

Paulos folded his arms across his chest. “Now there’s an interesting bird,” he said. “His name is Julian Zohar. He’s the executive director of COPE—the Center for Organ Procurement and Education here in Pittsburgh.”

“Organ procurement?”

“You know, for transplants—hearts, lungs, livers, that sort of thing. The United States is divided into fifty-nine regions by the federal government. Each region has its own not-for-profit organ procurement office. Their job is to make the connection between potential donors and patients awaiting transplants. If you run your car into a bridge abutment, and if you’ve got a little red heart on your driver’s license, then they call Zohar. Zohar checks the waiting list, takes the first guy on the list who matches your blood type, and zingo—you left your heart in Pittsburgh. Zohar runs our regional procurement office. It covers western PA and West Virginia, too, I think.”

“So why Zohar? Why not another Episcopal priest?”

“You’d have to ask Truett that one. Maybe for variety—different ethical perspectives.”

“Are your perspectives different?”

“Like night and day.”

“How so?”

Paulos got up now, stretched, and walked around to the front of
his desk. “Ethics is not just about right and wrong,” he said. “It’s about how you get to right and wrong. As an Episcopalian, as a Christian, I believe in the need for a grounded ethic—an ethical system that has its roots in unchanging values of right and wrong. I believe those values are found in the nature of God himself.”

“And Zohar?”

“Like I said—a strange bird. Zohar did a doctorate in bioethics when the field was first emerging. He was very smart, very passionate, and very persuasive. He’s an internationally respected bioethicist—or I should say, he was.”

“What happened?”

“Transplant people are very concerned about definitions of death—they can’t save a life until somebody else loses his, and the sooner he does, the better the odds of an effective transplant. The definition of death we use in America is a view known as whole-brain death: death is not pronounced until there is irreversible cessation of all functions of the brain and brain stem.

“But all the functions that make us really alive—personality, consciousness, memory, reasoning—they all involve the cerebrum, the so-called higher brain. If you lose all consciousness and personality, are you really alive? And if not, why should we wait around for all the lower-brain functions to cease as well? That was Zohar’s position. He began to champion this view, known as higher-brain death.”

“And that got him into trouble?”

“Not really—lots of people hold that view. He was just a little ahead of the curve on that one. It was what happened next that sank his boat. Zohar began to push an ethical view of organ procurement known as
routine salvaging,
a view that grants the state the right to harvest needed organs after death without the individual’s permission.”

“Wow.”

“I agree. But think about it: when you set your garbage out on the curb, it’s no longer your property. Anyone who wants to go through it can do so. Your rights over your garbage end at your property line. The routine salvaging view makes the same case for the human body: when you die, what’s left over is garbage, and you give up your rights over it at death.

“You can see why a transplant person would love this view. His
biggest headache is that he has to ask permission, and almost half the time he gets turned down. Wouldn’t it be easier if he didn’t have to ask?

“Zohar threw everything he had into this fight, but it was a nowin situation. In the Western world we place too high a value on the rights of the individual. We believe we have the right to control our own bodies, and that those rights continue even after death. To the Western mind, ideas like routine salvaging call up images of Dr. Mengele and Nazi medical experiments. When Zohar argued for a new definition of death, he was able to blend in with the crowd. But when he began to really push for routine salvaging—not just as an ethicist, but as a transplant officer—people recognized him for what he was: a pure utilitarian. The harder he pushed, the harder everybody else pushed back, until he finally gave up in disgust and just disappeared.”

“Disappeared?”

“Dropped out of the ethical arena. Withdrew from panels and ceased publication. It’s too bad, really. I used to read some of his stuff—very insightful. I lost track of Zohar completely until he suddenly turned up on PharmaGen’s advisory board.”

“Did that surprise you?”

Paulos shrugged. “I guess you can’t expect burnout to last a lifetime. I was glad to see him again, actually—at least at first.”

“The Christian meets the utilitarian,” Nick said. “How has that worked out?”

“It hasn’t exactly been a marriage made in heaven. Zohar is a big fan of PharmaGen—why wouldn’t he be? PharmaGen is a utilitarian’s dream:
the greatest good for the greatest number of people.
I don’t get a lot of warm fuzzies from Zohar when I remind him about the rights of each individual, made in the image of God.”

“You have concerns about where Zohar is taking the company?”

“I have concerns about a utilitarian approach to ethics. ‘The greatest good for the greatest number of people’—what exactly does that mean? What is good, Dr. Polchak, and whose good are we talking about? I fear an ethical system that isn’t tied down.”

“Tied down?”

Paulos held up three fingers. “Three cowboys ride into town.
The first cowboy ties his horse to the second horse, the second ties his horse to the third, and all three horses run off together. Why? Because none of the horses was tied to the hitching post. That’s the problem with an ungrounded ethic, Dr. Polchak—no hitching post. Things have a way of running off without you.”

“And who are these cowboys?”

“I suppose they change in every generation. In our day and age? I’d vote for information, technology, and efficiency—but that’s just my opinion. There are a lot of new frontiers—and there are plenty of cowboys out there.”

Nick slowly rose from his chair and extended his hand again. “Thanks for your time,” he said. “Lots to think about.”

“You might want to follow up with Dr. Zohar. You know—talk to the cowboy in person.”

“I just might do that.”

“So tell me—have you decided to participate in the population study?”

“Would you?”

Paulos grinned. “You’re asking the watchdog if the henhouse is safe. All I can tell you is, I haven’t seen a fox so far.”

Nick returned the smile. “What if the fox is already inside?”

Riley pulled off the oven mitt and opened the door to her apartment. There stood Nick Polchak, his head buried in an open book.

“What do you know about organ transplantation?” he said without looking up.

“Nice to see you too,” Riley said, heading back for the kitchen. “Do you want to come in, or are you going to finish the book first?”

Nick stepped slowly inside, leaving the door wide open behind him. He drifted toward the sofa like a sleepwalker and sat down, his eyes still glued to the pages.

“Water or wine?” Riley called from the kitchen.

“With what?”

“Food.”

“Wine.”

“I talked to Leo,” she said. “I had him check the spyware reports from Lassiter’s computer—”

“And there was nothing out of the ordinary,” Nick cut in. “A few innocuous e-mails, visits to the usual Web sites … nothing we haven’t seen already. I talked to Leo too—he said you called him twice today and three times yesterday. Give it some time, Riley. Have a little patience.”

She poked her head around the corner and glared at him. “I spent the Fourth of July treading water in a Donna Karan because you couldn’t wait to meet Tucker Truett. Are you going to stand there and lecture
me
on patience?”

Nick thought it was a good time to change the subject. “I saw Paulos today.”

“And?”

“A very interesting guy.”

“I should have come with you,” Riley grumbled.

“We talked about this—you need to be at the office. You can’t start disappearing all of a sudden. What would Lassiter say?”

“A senior pathologist is only on rotation eight days a month,” Riley said, “but a fellow is on five days a week and every other weekend. How am I ever supposed to get away? When do I get to go with you?”

“You never take me out anymore … All I do is work.
Didn’t I just take you out on the Fourth of July?”

An oven mitt sailed through the kitchen doorway.

“What did you find out from Paulos?”

“I’m not sure yet. Did you ever hear of a guy named Julian Zohar?”

“I don’t think so.”

“He’s the executive director of your local organ procurement organization.”

“COPE? I’ve never met Zohar, but we work with COPE all the time.”

“Really? Why is that?”

“There are about sixteen thousand deaths per year in Allegheny County, but we only do autopsies on about twelve hundred of them. Drug-related deaths, homicides, suicides, deaths in prisons or nursing homes—those are the ones that fall under the coroner’s jurisdiction. Some of those people are potential organ donors—but our office has to view the body and sign off on it before COPE can claim the organs. You like garlic on your bread?”

“Sure.”

Riley glanced at him as she set the plate down on the table. “You’re not planning on kissing me again?” She paused. “Or putting your arm around my shoulder?”

Nick looked up from the book. Riley had already turned away and was headed back to the kitchen.

“Do you know how to tell male and female blowflies apart?” he called after her.

“What a fun evening this is going to be.”

“It’s their eyes. A male’s eyes are very close together, almost touching. But a female’s eyes are always spread wide apart.”

Riley poked her head around the corner. “I’m waiting.”

Nick shrugged. “I think females see more than males do.”

“You needed a PhD to figure that out? Most males of all species are clueless.”

Just then, a coal gray cat jumped onto the sofa and padded its way up onto Nick’s lap, stretching and settling itself comfortably across his legs. Nick arched stiffly back and frowned down at the intruder. Riley returned from the kitchen, setting two glasses and a deep burgundy bottle on the table. She glanced at Nick’s frozen posture, and at her cat contentedly stretched across his lap.

“Problem?”

“Your mammal is sitting on me.”

“Nick, it’s called a cat.”

“Why do people keep mammals? What fun can you have with a mammal?”

“You keep poisonous spiders.”

Nick looked up at her. “My point exactly.”

Riley shook her head. “C’mon, time for dinner.”

Nick looked down at the slumbering feline, its legs tucked invisibly under its overfed body. It seemed almost lifeless to Nick, except for the radiant warmth and the rumbling sound that came from somewhere deep inside. Nick frowned again; it looked like one big, amorphous, fur-covered blob.

“How do I pick it up?”

“How do you pick up an insect?”

“I use a sweep net, and then I drop it in a killing jar.”

“That’s a little hard on a cat,” Riley said, scooping it off Nick’s lap with one hand and dropping it onto the nearby recliner.

They sat together at the tiny dinette. Nick propped the book open against a stack of napkins, weighting down the curling signatures with the salt and pepper shakers.

“Tell me about organ transplantation,” Nick said. “How does the system work?”

“I thought a forensic entomologist would know all this.”

“Why? My species regenerates its own organs.”

“Your species also gets stepped on a lot.”

“That is a downside,” he said. “This is good chicken. It needs salt.”

Riley gestured to the salt shaker holding down the verso side of Nick’s book.

Nick used it liberally, then extended it to Riley.

She shook her head. “I don’t use salt.”

Nick nodded slowly. “Tell me how the transplant system works,” he said.

“Well, let’s say you have a serious liver problem—”

“Let’s say it’s a kidney problem.”

Riley paused. “OK, you have a
kidney
problem. So you go to a specialist, and he verifies that you need a transplant. Your medical information is entered into a database, and you’re put on the national waiting list.”

“Who runs that waiting list?”

“There’s an organization called UNOS—the United Network for Organ Sharing, down in Richmond. They have the federal contract to administer the waiting list.”

“Does that list include everyone who needs a transplant of any kind? All over the U.S.?”

“That’s the whole idea. The list was created as a result of the National Organ Transplant Act of 1984. The goal was to ensure a fair and efficient system of organ allocation.”

“How do you know all this?” Nick asked.