—It is a myostatin inhibitor, much more efficient than anything else you may have read about. I am confident it will come with some sort of label. They tell me it works wonders on mice. Do not waste precious time pretending. We both know you are as curious as I am to see it work. You will get to use experimental drugs the FDA will not even hear about for another decade.
—You obviously don’t care about my opinion, but I want to make sure you understand. He could live a very productive life with prosthetics if we amputate now.
—He will live an astoundingly productive life after you build him new legs.
—I need to think about this.
—You do not. You made up your mind about twenty seconds ago. You see, Dr. Haas, our jobs are not that different. We analyze the situation, we gather as much data as we can before we take action, and we try to anticipate every possible outcome. I did my job as thoroughly as I hope you will do yours. You gained a tremendous amount of the knowledge we are now asking you to use during two extensive studies funded with corporate money, one on tapered titanium cementless total hip replacement, and the other on tissue response in failed titanium implants. In 2006, two of the patients participating in your hip replacement study rejected their implants, one of them died of complications. Interestingly, there is absolutely no trace of these two patients in any of your grant proposals, or in any of your publications. Somehow, however, their data show up in a tissue-response study they never took part in. You switched the patients from one study to the next, as if nothing ever happened. No harm, no foul, except for a dead patient.
—That woman had a heart condition she didn’t tell me about. I would never have chosen her for this study had she not lied in her application.
—I have no doubt. Putting her in your report would not have saved her. You just made the preliminary results look this much better to the people paying for it.
More to the point, when you immigrated to this country, you also neglected to declare that you were arrested for driving under the influence. I realize it is only a misdemeanor in the United States, but it is a criminal offence where you come from.
You are egotistic enough to believe that the rules do not really apply to you, that these little white lies served a greater good, and that you were actually helping others. It is not uncommon with people of your background.
—My background?
—Raised in precarious conditions by a poor family with traditional values. First one in the family to get a college education. First to rise out of poverty. It sounds cliché, I know, but we have become very proficient at this sort of profiling. One thing is certain: you are a survivor, Dr. Haas. You are definitely not one to throw away your life, your family, and your career for something as petty as principles.
When you leave this room, you will make sure that enough of the remaining living tissue in Mr. Couture’s legs is preserved while you construct his new bones.
—If we do this, and by some miracle it works, I can guarantee he’ll wish he had died on the operating table. He’ll beg for us to end his life. You simply can’t imagine the amount of pain he’ll have to suffer. Every minute of every day will be the worst of his life. Will you be the one to tell him that?
—I would rather not. That is a horrible thing to tell anyone, especially before life-threatening reconstructive surgery. Will he suffer any less if we tell him that he will?
—No. He’ll go through hell no matter what; if he doesn’t die first.
—Then I see no reason to tell. I want him in as good a mental state as humanly possible. I want you to tell him everything will be fine.
—I want the record to show that this procedure is being done against medical advice and that I am participating under duress.
—I am recording this conversation so anything we have said so far is on the recording. You may call this a record, if you wish. If you were referring to the hospital records, then no. This is your idea and yours alone. You are performing this surgery because you firmly believe this is the best solution for your patient and you have every confidence in its success. There will be no reference to this conversation, in any form, whatsoever. Let me be abundantly clear on this. Any mention of my presence, of my very existence, to anyone, will have dire consequences for both you and your loved ones.
—What kind of consequences?
—I have not yet had time to ponder an appropriate response, but I can guarantee that you will never see your children again, even if the operation is successful.
—What if it isn’t?
—Then you will almost certainly lose your medical license.
—No. I won’t say anything. But what if the patient doesn’t survive? What are you threatening me with?
—Why would I threaten you if you do exactly as I ask? I am not evil, Dr. Haas. That said, you will most likely lose your medical license, along with your house, your car, and everything you own. I would expect some jail time. You are about to perform absurdly complex, insanely risky, and completely unnecessary experimental surgery on a stable patient without his knowledge or consent. What do you think will happen if he dies?
Before you go, I also want you to take a look at these designs. You will need to integrate them into your leg structure.
—What are they?
—Knees.
—I’m not a mechanical engineer, but it looks like they…
—Yes, Dr. Haas. They do.
FILE NO. 126
INTERVIEW WITH ALYSSA PAPANTONIOU, PH.D., GENETICIST
Location: Denver Public Library, Civic Center Park, Denver, CO
—It is an interesting accent you have, Ms. Papantoniou. Is that from the Balkans?
—Yes, most of Greece is in the Balkans.
—You must be from a region I have not visited. It is very unique.
—Thank you. I’m curious to know why we’re meeting at the p…public library. I’m sorry. I get nervous when I t…talk to people.
—There is no need to apologize. I did not want us to be disturbed. It is a pleasure to make your acquaintance.
—The pleasure is mine. What did you want to di…discuss?
—It has come to my attention that you disapprove of the direction this project is taking. I would be remiss if I did not take such complaint seriously, especially coming from someone of your intelligence.
—Thank you very much. I didn’t mean to go over your h…head.
—So it was an accident?
—I…
—It does not matter. Now, tell me, what is it that you find so objectionable in the way that Dr. Franklin is leading her team?
—I have all the respect in the world for Dr. Franklin. She is a very good physicist.
—But?
—But she does make mistakes. She’s not as…she’s not as brilliant as you think she is. I often find it necessary to d…double-check her calculations.
—I am certain she appreciates.
—More than anything, Dr. Franklin is too…fragile. She lets her feelings for the members of her team cloud her judgment. She treats Kara and Vincent as if they were her ch…children. Kara is a stubborn, unyielding person, and I feel it is…irresponsible to rely entirely on her good will for this project to move f…forward. I have requested, on several occasions, that she submit to a series of tests to determine why the helmet will only activate for her, and Dr. Franklin has systematically refused.
—Is that statement really accurate? I was told that Ms. Resnik submitted a saliva sample and that you performed an analysis of that sample. In fact, I remember seeing a report in which you conclude that there is nothing out of the ordinary about her genetics.
—I did perform some genetic and biochemical tests and found no chromosomal anomalies, nor any obvious mutation. But there are a lot more tests, mitochondrial analysis. I haven’t even done a full genome sequencing. I could study her brain structure, her eyes might also be the answer.
—Dr. Franklin also performed a retina scan if I am not mistaken.
—I meant that I could study a sample of her eye, not a picture of it.