“Feels like a normal amount of scarring,” Stephen said after running the balls of his fingers back and forth over the tissue a number of times. He then stopped and pointed. “This is where we closed the pericardium with a running suture.” He then straightened up and withdrew his hand. “Do you think this is about the same degree of scarring you saw when you did Carol’s post?”
Jack palpated the tissue between the lungs, imitating Stephen. He’d not done that with Carol until after he’d removed the lungs and the heart, so he couldn’t compare exactly, but it seemed equivalent, and he said so.
“Did you open Carol’s pericardium at this point?” Stephen asked.
“No,” Jack said. “I didn’t do that until I had removed the lungs and the heart en bloc. Do you want me to do the same here or would you like me to open the pericardium now, so you can see the heart in place?”
“I think he should use the same technique as he used with Carol,” Ted said, speaking up for the first time. “That’s the only way he will be able to truly compare the two.”
Stephen agreed. “Go ahead and follow your usual modus operandi.”
Using a pair of dissecting scissors rather than a scalpel, as he thought it safer, Jack proceeded to free up the lungs and the heart. He then lifted the entire mass up out of the thorax. He carried the weighty slab of flesh over to a nearby countertop and plopped it down on a scale.
“Is that heavier than usual?” Stephen asked, looking at the readout.
“Much heavier,” Jack said. He then started to open the pericardium exactly as he had done with Carol, to expose the heart itself. “You can see there is considerable fibrotic scarring, but it is to be expected.”
Both Stephen and Ted crowded in to take a look once the heart was fully exposed.
“My word, it looks entirely normal,” Ted said. “Perfect orientation. I’m impressed even more than I expected to be. It looks like a very happy heart.”
“I agree,” Stephen said. “I don’t mind saying so myself, but it was a perfect job.”
“And a perfect donor heart,” Ted added.
“How does it compare with Carol’s?” Stephen said, turning to Jack. “If you were pressed to say which one you thought had been accepted the best, which one would you say?”
“It would be hard to say,” Jack replied thoughtfully. “I’d say they were equivalent.”
“Let’s see the rest of the anastomoses,” Stephen said. “The aorta looks fine, but there could be a difference with the others.”
Jack pushed back the bloated right lung in an attempt to visualize the great veins called the superior and inferior vena cava. It was difficult because the lung was turgid with fluid.
“Why don’t you go ahead and remove the lungs,” Stephen said. “Just make sure the pulmonary anastomoses are proximal to the heart.”
At first Jack wasn’t sure what Stephen meant, but then he got it. Stephen wanted the connections he’d made when he’d done the transplant to be connected to the heart, not to the freed-up lung. Using the dissecting scissors again rather than the scalpel, Jack separated both lungs from the heart. The connections with the great vessels could all be seen. Jack stepped back to give Stephen and Ted more room. While they looked, Jack weighed each lung.
“They all look terrific to me,” Stephen said. “I hate to blow my own horn, but they are all masterfully done.”
“You’re getting good in your old age,” Ted teased. “But you’re right. They all look terrific, well healed and without the inflammation we agonized about. I don’t see any difference here with what we saw during Carol’s second autopsy. It seems as if our experiment is a draw. What are your thoughts?”
“I have to agree with you,” Stephen said. “How about you, Dr. Stapleton. Do you see any differences between Margaret’s anastomoses and Carol’s?”
“Not at all,” Jack said. “They look comparable to me.”
“So there we have it,” Stephen said. “We didn’t think there was going to be a difference, and there doesn’t seem to be.” He looked over at the institutional clock as if he was planning on leaving.
“I think you should see the inside of the lungs,” Jack said. Without waiting for a response, he got one of the long-bladed knives used in autopsies and made some slices into the lungs’ parenchyma, which under normal conditions were air-filled, light, and spongelike. As he made the cuts, the edema fluid burst forth, almost as if it had been under pressure. It was blood-tinged and mixed with exudate and bits of tissue.
“Whoa,” Ted exclaimed. “That’s rather dramatic. We didn’t see that with Carol’s lungs.”
“That’s because most of the fluid had drained out,” Jack said. “It gives you a better appreciation of what the immune system can do whenit’s turned on to create a cytokine storm. It’s not a mystery why these people died so quickly. This is a nasty virus.”
“Are you still thinking this is caused by a virus?” Stephen asked. “We’re continuing to look into the protein angle, thinking of something like a prion.”
Jack started. The idea of a prion disease never occurred to him. But as soon as he considered it, he rejected it. “Prion disease only strikes neural tissue, not pulmonary tissue,” he said. “No, this must be a virus, but I admit there are some aspects that don’t make sense.”
“And what are they?” Stephen asked patronizingly.
