The Donation

By Myles Edwin Lee

The Donation is a medical thriller that dramatizes the shortage of organs available for transplantation. It asks what if organ donation became a choice as a means of means of execution for prisoners on death row? How would it affect the donor pool? Would prisoners realize one last chance for redemption, to give something back to society? And what about the physicians who find themselves cast in the role of executioners as they convert executions into surgical procedures, against the guidelines of the American Medical Association and their own Hippocratic oath that urges them to do no harm?

A surgeon's role is to bring order out of chaos. The chaos begins when a celebrity patient, Joseph Spencer, discovers he needs a heart transplant. While in the pre-operative holding area, Spencer sees his donor in an adjacent bed. Not only does he see him, he recognizes him. His sedation makes it impossible for him to protest what for him is an unimaginable horror, and he loses consciousness, unable to abort the procedure, even though to do so could cost him his life. Spencer survives the procedure but becomes suicidal.

The transplant surgeon, Ross Fairing, discovers that he and his team have been unwitting co-conspirators in the death of the donor who had no business on an operating table, let alone be in a hospital. He confronts his own consternation that a courageous and innovative operation has created an ethical conundrum that could destroy his transplant program and his career.

And how does a shocking revelation at the end of the book, a revelation that turns a tragedy driven by one man's grief, into an affirmation of life, release Spencer from his suicidal torments, and return him to the world of the living?

Morality and medicine collide with the criminal justice system in The Donation, a medical thriller that illuminates the organ donor shortage, one of the most pressing issues in medicine today

• Language: English
• Publisher: iUniverse
• Release date: Mar 5, 2008
• ISBN: 9780595908172

Myles Edwin Lee

Myles Edwin Lee is a board-certified cardiothoracic surgeon who has practiced in Los Angeles, California, for thirty-two years. He has authored numerous scientific abstracts, articles, and book chapters in his field, including a textbook of complications in cardiac surgery. This is his first novel.

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ENDORSEMENTS

"An immensely satisfying medical thriller with a poignant epilogue. Myles Edwin Lee, M.D. steps out of his scrubs as a cardiothoracic surgeon and into the rarified air of intelligent, informed, gifted writers with this, his first novel–The Donation. While other writers have frequently used the wonder and glamour and innately fascinating field of medicine as the topic of their novels, few have succeeded as well as Dr. Lee. This is not only a well–crafted thriller and mystery. It is also a story that by the book’s end raises some questions about life and death in our penal system that will challenge every reader fortunate enough to discover this book.

As Lee so aptly uses Kierkegaard’s philosophy to pace this story–‘Life is lived forward, but understood backward.’–this is a complexly woven tale about cardiac transplants, about the surgeons who perform them, and about the patients who are both donors and recipients, and about the intricacies of hospital politics and operating room dramas all related in the most understandable manner imaginable. Judge Joseph Spencer raised his gavel to condemn to death a man who assassinated a governor, and in that trying moment the judge suffered a cardiac malfunction that would make him an eventual candidate for transplantation when all other modes of treatment had failed. The judge’s surgeon is one Ross Fairing, a man of great skill and wisdom in the operating room, but also a man at odds with the politics of the hospital in which he operates. Working with a cardiac scientist, Fairing finds a way to use patients once thought not to be donor candidates because of an intrinsic electrical malfunction (Wolff Parkinson White Syndrome), and this triumph adds to his esteem as a superior surgeon. That esteem is abruptly threatened when he becomes involved in the heart transplant for Judge Spencer, the problem being one of enormous magnitude in the resource of the donor heart: the salvaged judge is enraged with the source of his new heart, a rage that opens the intricate secrets of a multifaceted mystery. How a potential public scandal is averted by Dr. Fairing’s superb detective work brings closure to this problem, providing the satisfactory end to the story. But it is in the epilogue that the big issues/concepts are addressed–questions about life and death and law that will set every reader to thinking.

... This is no airport novel, but instead a work of artistic as well as scientific merit; readers who thrive on thrillers will be as satisfied as readers who seek out elegant and informative, philosophically softened stories. For a first novel (or for any novel) this is exceptional. Myles Edwin Lee, M.D. has found a new and most promising career! Highly recommended." Grady Harp, Los Angeles

"A lot of doctors try to write novels and most don’t do it very well. A fraction, like Robin Cook, have great commercial success as writers. Others like William Carlos Williams and Walker Perry find literary fame. With The Donation, Dr. Lee joins the ranks of physicians who can really write. He tells a compelling tale in a hard, muscular prose style, evident from the start: ‘He could have turned in the report to his superior at California’s Health and Welfare Agency, but it lay strewn at his feet like the guts of an innocent bystander splattered by a shotgun blast over the pock–marked asphalt of an inner city street.’... a fine and entertaining novel of mystery, suspense, and morality." Writer’s Digest

Executing death row inmates by lethal injection and electrocution has sparked heated debate for decades. Is it possible there is an alternative solution that would eliminate the controversy of this issue? This fascinating novel by Myles Edwin Lee, a board–certified cardiothoracic surgeon, dives into the very heart of both these issues and adds a controversial possible solution, death by organ donation, which could spark debate for years to come. Recommended for adult readers who enjoy drama, suspense, and controversial moral and ethical issues facing the criminal justice system and the medical field. This novel includes a glossary of medical terms, which is helpful to the reader in understanding terms that may be unfamiliar; this is a nice bonus to readers. This is author Myles Edwin Lee’s first novel. He has authored numerous scientific articles and book chapters in this field including a textbook of complications in cardiac surgery. Tonya Thui–Theis, Midwest Book Review.

Lee knows this territory like the inside of a chest cavity ... Kirkus Discoveries

Eloquent and suspenseful, this fast–paced novel is hard to put down. The intriguing plot takes the reader on a journey into rarely witnessed ethical issues in the medical and judicial worlds. The author writes a compelling scenario with a series of momentous, fateful events that conclude with a surprising resolution. Insightful and thrilling. This is a must–read. Marthe Gravel, R.D., LDN., Sudbury Massachusetts

... an exciting, can’t–put–down page–turner with behind–the–scenes glimpses into the labyrinth of hospital politics. Ronald L Katz, M.D., former Professor and Chairman, Anesthesiology UCLA School of Medicine and USC School of Medicine; former Chief of Staff UCLA. Los Angeles, California

Reads like a screenplay... insightful... thrilling... challenging. I highly recommend this ... book to everyone. Il Kim, M.D., Boston, Massachusetts

"An auspicious debut as a novelist!! The ... character delineations are deft (‘A whale of a man, he swung his arms in exaggerated arcs as he walked, as if he were wading through glue.) and the narrative, brisk (‘The window framed a view of the plaza level three floors below, replete with plants and artwork, euphemistic deceits that veiled the true mission of the hospital and the sometimes gory machinations it had to use to accomplish its goals. The hospital was really a pus–spattered, death–strewn battlefield saturated with anguish. The decorations attempted to conceal the details of its business and present an antiseptic sanctuary for the sick and weary travelers who paused for repairs, from time to time, during their journey through life.’) Not only an engrossing tale but a serious meditation on a major ethical dilemma in modern medicine." Cameron Messenger, Ph.D., Arlington, Virginia

What a read! ... Compelling ... poetic ... thought–provoking. Kenneth Roger Sherman, Fort Lauderdale, Florida

PREVIOUS PUBLICATION

NEAR MISSES IN CARDIAC SURGERY

(1992; Reissued in 2009)

(Surgical textbook in disguise)

PERFORMED WORK

PATER PATRIAE

A Washington Portrait

(Text for an Orchestral Work by Victoria Bond

Performed at Mount Vernon, 2007)

THE DONATION

Copyright © 2008 by Myles Edwin Lee

All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the publisher except in the case of brief quotations embodied in critical articles and reviews.

iUniverse books may be ordered through booksellers or by contacting:

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Because of the dynamic nature of the Internet, any Web addresses or links contained in this book may have changed since publication and may no longer be valid.

ISBN: 978–0–595–46519–4 (pbk)

ISBN: 978–0–595–70379–1 (cloth)

ISBN: 978–0–595–90817–2 (ebk)

Printed in the United States of America

First Edition. Second Issue

iUniverse rev. date: 10/27/09

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

The author thanks George Borchardt, Inc. Literary Agency, 136 East 57th Street, New York, NY 10022 for permission to reproduce a quotation from the following:

Letters to a Young Doctor by Richard Selzer. Copyright 1987, 2001 by Richard Selzer.

To those courageous people around the world who have either donated organs or

enjoyed a renewal of life as transplant recipients.

Might there not be a charity in sin, to save this brother's life?

–William Shakespeare

CONTENTS

ACKNOWLEDGMENTS

PROLOGUE

CHAPTER 1

CHAPTER 2

CHAPTER 3

CHAPTER 4

CHAPTER 5

CHAPTER 6

CHAPTER 7

CHAPTER 8

CHAPTER 9

CHAPTER 10

CHAPTER 11

CHAPTER 12

CHAPTER 13

CHAPTER 14

CHAPTER 15

CHAPTER 16

CHAPTER 17

CHAPTER 18

CHAPTER 19

CHAPTER 20

CHAPTER 21

CHAPTER 22

CHAPTER 23

CHAPTER 24

CHAPTER 25

CHAPTER 26

CHAPTER 27

CHAPTER 28

CHAPTER 29

CHAPTER 30

CHAPTER 31

CHAPTER 32

CHAPTER 33

CHAPTER 34

CHAPTER 35

CHAPTER 36

CHAPTER 37

CHAPTER 38

CHAPTER 39

CHAPTER 40

CHAPTER 41

ACKNOWLEDGMENTS

I wish to thank my wife, Elizabeth, and my cousin, Lance Lee, for their incisive and insightful criticism of this work in its formative stages, and Robert Rees for his friendship and support during its maturation. I assume responsibility for any errors of omission or commission that may appear in the text.

PROLOGUE

The kitchen table was littered with half–empty glasses that contained a variety of discarded liquids. Those with high sugar levels had become like the petri dishes bacteriologists used to grow microbes in a laboratory; fungal colonies floated on their surfaces. The shriveled carcass of a half–eaten hot dog lay glued to the surface of a chipped plastic dish. Terry Chalmers, seneschal of this filth, sat alone before the table, fondling the butt of a .38 Smith & Wesson revolver.

Under the table lay fragments of a report on gang culture Chalmers had written. He could have turned in the report to his superior at California’s Health and Welfare Agency, but it lay strewn at his feet like the guts of an innocent bystander splattered by a shotgun blast over the pockmarked asphalt of an inner city street. The discarded food and drink, and the paper fragments, were threnodies to the tragedy of a wasted life.

For Chalmers, a bearded bear of a man tethered to the past, the issue had always been escape–release from a life of discordant rhythms that had been punctuated by false starts, failure, and rejection. His existence had been poisoned by the desertion of his father and the early death of his mother, besotted by alcohol, ravaged by drugs, and haunted by solitude. The recent loss of his job as a gang liaison operative at the Health and Welfare Agency as a result of Governor Simon Pearson’s dumb–ass budget cuts–through no fault of his own for once–had been the final blow. Chalmers didn’t give a damn anymore.

Chalmers carried the image of a red–haired Vargas girl on the back of his right hand, her legs formed by his second and third fingers, tattooed during desolate days of military hardship duty in Korea where he had been a grunt in the motor pool. He had spent as much time repairing motor vehicles as he had preventing the locals from stealing inventory from the parts depot for sale on the black market. He hated the country, hadn’t wanted to be there in the first place, didn’t speak the language, didn’t like the food–sure, he’d sampled his share of the women, but they were always the camp followers who cared nothing about him except for his access to the PX or maybe a ticket to the States. So he had thrown them all away like used Kleenex. Except for the one on his hand. She was forever.

The Vargas girl pandered to his fantasies. She never asked questions and never required anything in return for her favors. Now she wrapped her legs around Chalmers’s .38. He reached into a box in front of him and extracted six Teflon–coated hollow points that he loaded, one after the other, with icy deliberation into each chamber. He spun the cylinder, snapped it shut, and shoved the weapon under his belt. It was time to act.

Chalmers stood up from the table. His chair toppled backward and struck a counter piled with dishes that crashed into the sink behind him, but he paid no heed to the clatter. He paced back and forth like a fighter in the locker room before a championship bout, thumping his fists together, anxious for that first sweat–sprayed exchange of punches in the ring.

He stopped pacing at the door and took a deep breath. The decision hadn’t been easy, but he was ready now. Chalmers opened the door, entered the corridor, and pulled the door closed behind him. Without a backward glance, he clomped down the stairs and went outside. He stood in the cool Los Angeles night, oblivious to the bustle of the Latino shops and vendors that enlivened a dark evening on downtown Broadway. Then, like a lone ship plying an uncharted sea, he thrust through the blackness toward the television studio where Governor Pearson was to defend his positions for a statewide audience on the last night of his re–election campaign.

Chalmers’s breathing became rapid and heavy as he approached the studio. Because of the governor’s presence, press vans with extended antennae, an ambulance, and extra police patrolled the main entrance, so he passed by on the opposite side of the street, continued two blocks beyond, crossed the street, and doubled back along the alley that ran behind the studio. Beads of sweat glistened on his forehead as he neared the service entrance. It was unguarded. That made it easier. He slipped inside, undetected, and crabbed along a hallway that led to an elevator and the stairway next to it. He crept up the stairs to the second floor, his hand on the grip of his pistol. Peering into the hallway from the stairwell and finding no one in sight, he crossed the hall and opened a door that led to the semi–lit backstage area behind the blue curtains that formed the backdrop for the set of the governor’s interview.

The opening of the door caused a gentle flutter of the curtains, but no one seemed to have noticed. Chalmers followed the sound of the governor’s voice, picking his way over the network of cables that criss–crossed the concrete floor, toward a small gap he had noticed between two of the curtains. He crept closer to the opening, close enough to distinguish his quarry through it and to confirm a clear shot at the governor’s back, not twenty feet from where he stood. Eyes glued to his target, Chalmers extracted the Smith & Wesson from his belt, planted his feet in a wide stance, and extended both arms. The Vargas girl, doing his bidding one more time, squeezed her legs together in a climactic, explosive rapture.

* * * *

Governor Simon Pearson, a vibrant fifty–nine year old chief executive with blindingly white teeth he could flash on cue, digested moderator Richard Barlow’s prickly question about health care reform. He scanned the three hundred faces in the studio audience for clues to the mood of the electorate. He knew the tone and content of his response could affect the outcome of his re-election campaign because of the budget restraints he had pushed through the state Legislature. They had been hurtful to those who had lost their jobs and benefits in the wake of the cuts, and hurtful to him politically, coming as they had in an election year, but it had been necessary to avoid raising taxes, an act which would have inflamed the entire electorate.

Look, Richard. There’s a finite pool of dollars society can allocate to health care. The issue is how we spend those dollars. The governor leaned forward in his seat and wagged a finger at Barlow. The problem with health care delivery relates directly to the disintegration of the family. This, more than any other thing, has led to the profusion of social ills that have overwhelmed the resources of our medical establishment. The infrastructure can’t handle it all. We’re swamped. The governor ticked them off on his fingers. I’m talking drugs, guns, gangs, illegal immigrants, teen pregnancies, insufficient preventive care–I could go on and on.

Barlow studied his notes, spread his hands on his desk, and looked up at Pearson. Well, let’s take guns, Governor, and you know they’re not just a gang–related problem–take Columbine where two disturbed kids killed thirteen students and wounded twenty–five others.

Precisely my point, Richard. Now, look. As a nation, we spend somewhere between five to ten billion–that’s billion with a ‘b’–for the treatment of gun–shot and stab wounds in our emergency rooms. A collective gasp escaped from the audience. Our emergency rooms were never intended to be battalion aid stations serving inner city warfare, he proclaimed, but they are, and it’s bankrupting the system.

The crowd burst into applause. The governor turned his head to nod at the camera with the flashing red light. Like politicians everywhere, he gilded official pronouncements, however dire or horrific, with packaged nods, winks, waves, and grins. No matter how disconnected from the gravity of the remarks or how disingenuous the practice, he used this technique to project that folksy I’m–on–your–side type of image that cloaked blind ambition and the lust for power in the guise of accessibility and genuine concern for the common welfare. The voters fell for it every time.

So what’s the solution?

Well, we can’t reclaim all the handguns out there, but we can restrict the sale of ammunition to only authorized government outlets–no more ammo in gun shops or gun shows, okay? Now, then, we tax the hell out of the sale of this ammunition and maybe–just maybe–we might curtail its availability and render a portion of the guns out there useless. The audience reacted with more applause. Pearson smiled through a sip of water. The blue curtain fluttered behind the governor.

But here’s the key provision of the program. The governor leaned forward and peered into the camera. Today, I promise all my fellow Californians that the taxes we raise from ammunition sales in the legal outlets will reimburse the health care system for all the free care it gives for the treatment of these unfortunate, but unnecessary cases. More applause. We may even have enough money to prevent closure of our trauma centers and outpatient clinics that serve our disadvantaged citizens. Pearson leaned back in his chair and basked in the whistles and uninhibited cheers that came from the crowd. If their reaction was indicative of the statewide response he expected on this issue, the election was a lock.

"Three questions, if I may, Governor. First, do you really think the ammunition tax can generate enough money to pay for all the mayhem caused by these knife and gun clubs? Second, won’t such a regulation infringe on the second amendment to the Constitution? And third, even though you’re not talking prohibition, wouldn’t this plan simply encourage a black market for ammunition?"

That’s a three–fer, Pearson scolded, but let me tackle it for you point by point. The governor clasped his hands in front of him and flashed another grin for the camera. He was still smiling when the bullet tore through the curtain and plowed into his back. The slug shredded the governor’s lung and exploded through the front of his chest. Pearson lurched forward after the impact, his arms spread as if in supplication to his electorate. His forehead thudded on the desk and his chair rolled backwards, causing him to slip off and fall toward the floor. As he fell, his trademark teeth caught the edge of the desk, snapping his head backwards. He crumpled onto the floor, awash in a sea of warm blood.

Shrieks of terror erupted from the horrified spectators. Some hunkered down in their seats. Others crawled on their bellies up the aisles toward the exits, only to be trampled by others running in full panic from the stage.

Barlow, wild–eyed with fear, leapt from the stage. Shut it down, people! That shot came from behind the curtains! He cowered on the studio floor, waiting for the next gunshot. Where the hell is security? Get the paramedics in here.

One of the governor’s aides vaulted onto the stage where Pearson’s body convulsed with reflexive efforts to breathe. He ripped open Pearson’s blood–soaked shirt, launching the buttons on crazed trajectories into the air. His giant fist smacked the governor’s chest to start the heart. Another aide wiped the blood that gurgled from Pearson’s mouth and gave him mouth–to–mouth breaths. The two men quickly established a rhythmic sequence of breaths and chest compressions, hoping the paramedics would arrive in time to get him to a hospital before it was too late, but it didn’t look good.

The police, guns drawn, rushed the curtain. Others dashed to cover the service entrance at the back of the building. They ran down the corridor Chalmers had used, up the stairs, and approached the backstage door. Two officers flanked the door, guns drawn, while a third kicked it open, fanning his gun right and left. Seeing no one other than Chalmers in the area, he scaled a ladder that led to the catwalk above the stage behind the curtains. Below him, Chalmers stood there, motionless, as if in a cataleptic trance, arms extended, the smoking .38 still clutched in his hands.

Chalmers never saw the officer leap from the catwalk. The impact pasted him to the concrete floor. The officer buried a knee in Chalmers’s back, handcuffed his wrists behind him, and yanked his head up by the hair. You have the right to remain silent, you son of a bitch. Anything you say may be used against you in a court of law. Then he lowered his voice. It’s murder one if the governor dies, you bastard. If he dies, you die.

* * * *

All rise! cried the bailiff. Taking his cue like an actor in the wings awaiting his grand entrance, Judge Joseph Spencer, tall and broad–shouldered with thick gray hair and an urbane manner he had cultivated early in his career at law school, strode into the courtroom to preside over the sentencing phase of Terry Chalmers’s trial. He settled into a high–backed black leather chair on a dais several feet above the floor in front of the great seal of the state of California, flanked by the flags of both California and the United States of America. He rolled the chair up to the desk in the same motion. He ignored the courtroom and shuffled some papers before him with detached authority.

Be seated!

Spencer looked up from his paperwork, as though he had noticed for the first time he was not alone in the courtroom. He scanned his surroundings like an eighteenth–century general, telescope in hand, might have reconnoitered the field of battle from a hilltop. Arrayed below him were the combatants (the attorneys for the prosecution and the defense and their respective staffers), the court reporter, the audience, armed guards, and the defendant. With a cursory glance at Chalmers, Spencer intoned the litany that defined appropriate behavior in his courtroom.

I wish to remind all present that this court will not tolerate outbursts of any kind during these proceedings. Any disruption will result in immediate ejection from the courtroom and possible detention for contempt of court. Spencer spoke dispassionately in