The Prize

‘I’m with you,’ said Garrett.

Farelli looked at him. ‘For the same reasons?’

‘For none other.’

Öhman had been observing the exchange with awe. He felt Farelli’s hand on his arm.

‘Dr. Öhman,’ said the Italian, ‘go back to the surgery where you belong. Keep an eye on the patient. Do what you can. Dr. Garrett and I wish to consult on this privately. Make no a

Dazed, obedient, Öhman came out of the chair and left the room.

The second that the door closed, Farelli wheeled towards Garrett. ‘I meant every word I said to him.’

‘I know you did,’ said Garrett.

‘I could not tell him everything, but to you I can reveal. I know very well what you have thought of me this past week-that I am an egotist, a promoter, a self-seeker who wishes too much credit for himself. It is not so, but it must appear that way to you, who are so quiet and self-effacing, an honest man of the laboratory. I was raised in Milan, Dr. Garrett. It is a busy and prosperous city, but not if you are poor and outside. My father sold spoiled fruit for what you call pe

Garrett tried to smile his understanding but could not. ‘I have stopped thinking of two people-Farelli and Garrett-and begun thinking of only one-Count Ramstedt. My personal concerns have left me. They’ve been made too small to live on a morning like this.’

‘But now, what is to be done, Dr. Garrett? I told the Swede I want to fight for that one man. It was bravery without arms. I can think of nothing. I depend on you.’

Garrett received Farelli’s dependence upon him without feeling superiority, but with all the comfort that collaboration often produced. He had left the butt of his cigar in an ashtray, and now he retrieved it, and lit it, thinking all the while. His head had never been clearer.

‘One idea keeps recurring,’ said Garrett, as he slowly circled the room. ‘Even though we have learned to neutralize the rejection mechanism with Anti-reactive Substance S, I have had my secret fears about potential steroid dangers-the side effects, that is. And so I always sought to improve it. I have never written this in a paper, but once, for a period, I experimented on dogs with another version of the serum, an anti-histamine I called Anti-reactive Substance AH-and the early experiments were remarkably effective.’

‘Substance AH?’

‘Yes. While it’s been somewhat less reliable than the steroid version in blocking phlogistic response, it has been far superior in other respects-more selective-more effective in holding off the rejection, yet permitting immunity, strong immunity, against infection.’

‘Would it be possible?’ Farelli wondered.

‘I have never tried this mixture on a human being,’ said Garrett. ‘I intended to do more experiments on animal specimens when I returned to-’

‘Dr. Garrett, I would be willing to take the chance here, now,’ said Farelli suddenly. ‘Can it be prepared here?’

‘Easily,’ said Garrett, but his mind was elsewhere. ‘If only we had some insurance,’ he mused.

‘What do you mean?’

‘If there were something else in the event that this failed.’

Farelli pursed his lips thoughtfully. ‘We could try a modified outside pump, a portable pump-’

Garrett shook his head. ‘Too impermanent. I am thinking-you know-possibly-’ He halted, privately weighing something.

‘Possibly what?’

‘Something else is on my mind,’ said Garrett slowly, ‘something more permanent. I hesitated, because it is premature. Still-at a time like this-’

‘Please-what is it, Dr. Garrett?’

‘In this last year since our discovery, I have gone along on an entirely new offshoot, new tangent, of cardiac grafting. I have not published preliminary data, because I have not gone far-there has not been time-but I must openly confess what I have in mind. As you doubtless know, there is one tissue that can survive the rejection mechanism-I refer to living embryonic tissue. It is virtually nonreactive-it doesn’t have any antigenic specificity. I confirmed this, to my satisfaction, with recent tests on rats. I determined to attempt a pancreas transplantation. I started by transferring a mature pancreas from one adult rat to another, and it wouldn’t grow at all, it was rejected. Then I did something else. I typed a rat’s estrogen cycle to find out when the rat was pregnant, and then-listen to this-at an early stage, I took pancreas tissue out of the fœtus-although pancreatic tissue per se was not the object-and grafted this embryonic tissue into another rat, and, Dr. Farelli, it grew healthy and strong. It was not rejected at all. I kept wondering if the same could be undertaken, successfully, with an embryonic heart.’

Farelli was staring at Garrett, his mind bounding ahead, his temples corded with concentration. ‘But why not?’ he asked suddenly. ‘Let us say that a pregnant mother miscarries in the first trimester-’

‘Remember the obstetrician who looked in on Öhman early this morning? He has a miscarriage he is handling, under this roof, in the fourth week of gestation.’

Farelli could hardly contain himself. ‘We take this tiny four-week-old heart tissue and hook it up with an external circulation pump, induce speedy growth-even apply the new growth hormone those men down in-’

‘Wait, Dr. Farelli, you’ve given me a better idea. Why develop this four-week embryonic heart externally? Why not internally? It won’t be rejected. We graft this embryonic heart into Count Ramstedt’s groin-the way kidney transplants have been placed in the neck-a heterotopic graft. We put the embryonic heart in the inguinal area, because the blood vessels there are twice as big as-don’t you see? We hook it into the arteries and veins-we keep Count Ramstedt on Substance AH as well as Anti-reactive Substance S while the embryonic heart grows. Shortly after, as it develops, we-or Öhman, for that matter-begin to waltz it-move it into the abdominal area where it can work on bigger blood vessels.’

Garrett flung his cigar aside, and paced a moment.

‘Yes, Farelli, it is possible,’ he resumed. ‘There would be no discomfort. A woman’s pelvic site accommodates a large mass in pregnancy, enough to hold a full-grown human heart in her twelfth week. A man with a stomach tumor suffers greater displacement. Why not an embryonic heart? Then we keep injecting the new growth hormone. In four or five months, the embryonic heart, unrejected, is full-grown. It is ready for a final transplantation. Now we have everything in our favour. We keep Ramstedt alive with the anti-reactives and booster pumps. If Anti-reactive Substance AH works, we let Ramstedt go on with the calf’s heart Öhman put in this morning, plus the secondary human heart in his abdomen-they do not have to be synchronized in their beat-but, if Substance AH fails, we have this new heart-raised from an embryo-of sufficient size to transplant into the chest. It gives us our insurance-and a definitive experiment that can open an entire new avenue in the field of-’