Jigsaw Puzzle
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When the jet plane seemed to lose power on its left side
during take off, the pilot initially did nothing. The old joke
was that with growing automation, soon air crews would consist
of a pilot and a dog. The pilot's only job would be to feed the
dog. The dog's job would be to bite the pilot's hand if he tried
to touch the controls.
The pilot monitored the plane's controls as they moved to
compensate. Pilots these days were more like generals who made
the high level decisions and gave orders, they no longer had to
carry out every little action themselves no matter how mundane.
The computers did it faster anyway. The pilot watched as the
plane veered left out of the flight corridor, despite the
controls moving as he would have moved them. He reached out and
instructed the plane to abort takeoff. It notified the control
tower computer. Looking at the flight path, looping back was not
an option, there were no other landing areas in range, so he
instructed it to accept a controlled flight into unpopulated
terrain. He dumped the left fuel tanks to try to keep the plane
level. He did a few other things. The crash could have been
worse. He didn't survive.
Linda got the call on the way home from the airport, after
dropping Gerrold off. Airport emergency services told her which
hospital Gerrold would be taken to after the crash, and said she
should be there for admitting him when he arrived.
She hoped he would be okay. She feared the worst.
Next of kin for a few other passengers were there, and a few
more arrived before the ambulances. Paramedics brought
stretchers in on the other side of the hallway, which was walled
off with glass windows. She watched as the first few came in and
were met by doctors who looked at the bodies on the stretchers,
and body parts on other stretchers, all of which were wrapped in
leaking, plastic bags filled with red liquid. The doctors made
notes on handheld pads, and sent the bodies on their way. As
each one arrived, a nurse called out the name of someone waiting
on this side of the glass, like mail call for people expecting a
package.
"Mrs. Young," came the call as two more stretchers came in.
Linda couldn't look away from the body missing the entire right
side of its chest and right shoulder on one stretcher, and four
or five large red bags on the other. Tubes ran from the bags to
pumps and equipment underneath, the body also had something else
on a frame above it. "Linda Young!" the voice repeated.
"Yes!" she answered, turning. She moved to the desk and sat
down shakily, handing over the insurance card and answering some
meaningless questions. "Is he going to be all right?" she asked
when she could say something herself.
The nurse looked at the monitor in front of her. "We don't
know yet," she replied. "If you'll wait, there will be a doctor
to answer your questions after they finish triage. There's a
waiting room over there," she motioned down the hall. "We'll
page you when we're ready."
The waiting room was comfortable and relaxing, but it didn't
help. Linda couldn't get the images out of her mind - all those
bagged parts looking like badly butchered organs on the
stretchers. The fear that it was Gerrold she'd seen with a large
part of him missing, lying there without all the energy and the
constant laughter she'd said goodbye to at the airport...
"Mrs. Young?"
The doctor entered the waiting room again. He'd already
talked to a few of the people waiting with her. Most of those
had since gone home.
"How is he?" she asked, as he ushered her out into a more
private room.
"He's in surgery now. We think he'll make it, but he'll
probably be in surgery for at least three days, and in recovery
for at least four months afterwards. He's suffered some brain
injury, and we think we can repair it, but he won't remember
much of anything from the past twelve months, maybe more. He
still has his heart and two thirds of a lung, which means he
won't need long-term life support during recovery, which is
definitely good news. And best of all, there's no spinal
damage."
"I want to see him," Linda said.
"I don't think that's a good idea," the doctor replied.
"Watching surgery of this type can be extremely disconcerting,
especially of someone you're close to. It's best to wait until
he's in recovery-"
"No, I want to see him!" she interrupted, the edges of
hysteria creeping into her voice despite her best efforts to
sound calm. "I want to know what's happening to him, I- if I
can't be with him I need to see him at least. I have a legal
right to watch his treatment!"
"All right Mrs. Young, I'm not trying to prevent you. It's
just not usually a very good idea. But I'll tell the nurse,
she'll set up a viewing room for you and come to get you."
The viewing room was dark, and actually had four cubicles
with chairs and a set of viewing screens. Three of them were
empty, one of them was occupied but a curtain prevented her from
seeing who was inside. Another was empty, but the screens were
on.
Inside that cubicle there was also a cot, a small table,
some shelves, and a few other amenities.
"Did the doctor try to talk you out of it?" the nurse asked.
"Yes," Linda replied simply.
"He's right, you know. It's not a good idea. I've seen what
it does to relationships. Most of them don't survive."
"But I have to see him," Linda insisted, "I have to know."
"You'll see too much. You been married long?"
"Three months."
"He won't remember."
"That doesn't matter, he loves me. He'll love me. He'll
remember that."
"Yes," the nurse agreed. "If you want him to."
The images came up, and she learned how to select different
views, to select audio, and get various captions, sometimes
helpful, mostly technical.
He was in a bright operating room with copper machinery, and
people in white smocks, head coverings, and surgical masks who
were moving between them. Most of the work was too delicate to
do by hand, so tiny machine arms and claws were grabbing and
moving parts, manipulating small instruments, injecting or
cutting things. Emergency surgeons from eighteen cities were
assigned to Gerrold alone, hundreds of others were handling the
other victims of the plane crash.
His body - all of it, disconnected parts included - were out
of the bags, but partially or completely immersed in basins
filled with clear or pinkish fluid. All had tubes connected by
now, which went up to holders above the machines, gathering in
bundles which were thickest near his body. On another operating
table was his right arm, and an irregular lump of tissue that
used to be his shoulder and part of his chest, and more tubes.
The fluid contained an artificial blood, looking like thin,
diluted milk, with oxygen and nutrients and enough potent
antibiotics for a small city. It flowed through the tubes and
into his arteries while the extent of tissue death so far from
cell damage, lack of circulation and blood loss from the
injuries was determined. Most of it leaked out, but was drained,
filtered, reoxygenated, and pumped back in. What came out was
pinkish.
At the same time the ragged physical injuries were being
cleaned. A set of small arms were working their way around just
inside the chest wall. They grabbed ragged scraps of floating
tissue with one claw and held it in front of a camera for
examination. Muscle tissue. Part of the diaphragm. The other arm
sliced off the most mangled part of it, and the first arm tucked
it into a vacuum intake between them which opened and sucked it
up. There were other scraps floating in the vacuum tube, nudging
forward when the new one was added, like a bizarre traffic jam.
The machine went on to examine another scrap of tissue, tugging
on it, then another.
A larger, different set of arms was up where the shoulder
used to be, examining the bones. It carefully sliced through
muscles and tendons extracting bone chips embedded within them,
which were also vacuumed up, suspended in the tube. Others were
untangling the scraps attached to his detached arm, sorting
those which were still more or less tissue from what was
shredded or damaged beyond use. A twisted metal strip was being
cut out. There were bits of white shattered plastic around it.
The heart was stopped, but throbbed from the fluid pumped
through it from tubes every few seconds. The ragged edges of the
remaining lung floated like sea anemones in the currents of a
coral reef, and it pulsed too.
Gerrold's head had been split open, without being cleaned up
yet. It was wrapped in a clear bag, separate from the fluid
surrounding the rest of the body, but inflated with liquid to
about twice the size of a normal head. It contained much higher
concentrations of oxygen, special hormones, and a very careful
balance of various proteins, ions, and neurotransmitters, plus
drugs to keep him sedated. Tubes, wires, and robotic arms with
video and lights entered through the bag opening, which was tied
tightly around his neck. The frame holding the robotic arms was
clamped to a peg drilled into the base of his skull.
His face seemed to be intact except for flesh torn from the
right side, but the scalp floated loosely around the bone
segments which were cut precisely and held open with thin stays
like toothpicks. The brain itself had been sliced into four
parts. Most of the left half, plus two smaller parts deeper
within had been separated, and the inside faces were completely
covered with thin wires, which spread out from pea-sized nodes
which in turn were connected to others, and finally to a
slightly larger node, on the end of a wire which led out of the
bag. There was a flurry of activity around the remaining part of
the brain as tiny devices inserted thin, hair-like wires deep
into the brain, paused, then removed them and tried again at
different points. There were five of them.
The wires seemed to map out an irregular feature on that
part of the brain, the shape of which kept changing as the tiny
devices repositioned the wires. Finally they seemed to be
satisfied with something, and began slicing around the shape,
between wires. They made a shallow cut, then used small arms to
spread the groove open and began probing within it again. This
went more quickly, and they again made another fine cut, leaving
the inserted wires in place.
One of the doctors she talked to later explained that the
most important part of keeping the brain alive was not just
keeping the cells physically alive, but keeping the electrical
activity consistent so that the neurons don't change the
existing connections which define the personality, memories,
skills, beliefs. Left on their own, without thoughts keeping the
memories or habits or personality traits stimulated, the cells
would atrophy and the connections would die quickly from disuse.
As if all the things it had learned weren't important enough to
keep any more, the neurons would withdraw their dendrites to
conserve resources. Even a comatose brain has enough activity
and metabolism that it doesn't lose too many connections, but a
brain that's electrically dead will lose those connections
within days.
Newer and short term memories are stored as chemical
concentrations, which eventually pull neural connections to
them. Those would be the first to disperse, and most of them had
by now, but the electrical stimulations were meant to retain as
many of them as possible as well.
Severe brain trauma needs to isolate the most damaged parts
and basically rebuild or reconstruct them before the brain can
recover normal function, otherwise the brain can't support the
minimum activity for consciousness. Any electrical neural
activity in the healthy part quickly dies when it reaches the
damaged part, and for large damage that can cause the activity
of the whole brain to stop - the person remains brain dead. Each
cut resulted in permanent damage, so had to be carefully mapped
out to avoid crossing important centres, if they could be
avoided.
A sophisticated and powerful computer program senses and
models the electrical activity in the different brain sections,
and learns patterns of electrode stimulations needed to keep the
activity going as long as possible, repeating it every time the
activity stops. In addition, when brain sections are separated,
the computer passes the signals between them as if they were
still attached. It continues doing this until eventually they
are physically reattached and the brain becomes whole again.
"The computer doesn't actually model his brain or recreate
any thought process at all," the doctor continued. "It doesn't
resemble human thought at all, it's much more similar to an
epileptic seizure. It's purpose is to simply trigger brain
activity which should settle down into normal activity when the
damaged part is repaired, in the same way that a cardiac
stimulator is meant to trigger the heart into resuming a normal
cardiac rhythm after it's been stopped for heart surgery, or a
defibrilator interrupts a chaotic heart spasm to make it beat
steadily again."
The minuscule arms completed removing the piece of brain now
covered in wires, and moved on to another section. Tiny blood
supply tubes had been grafted on to the brain piece as well.
This was a damaged piece, and it was moved a bit further from
the others.
Linda wasn't hungry and couldn't eat. She grew tired and
napped on the cubicle's cot. She alternated between dead sleep
and dreams of robots carving up bloodless human bodies.
Gerrold's brain was still being worked on, but his chest had
been split open, with the entire front half of the remaining rib
cage open like the hood of a car. The ribs were ripples under
the muscle and sinews and fatty globs attached to the inside, a
few of which floated free, the others which had been bundled and
tied up neatly.
About 5 million stem cells of various types had been
filtered out from his blood, as well as various scraps of
removed tissue that had been liquefied, and then filtered as
well. A surprisingly small number for the amount of cells
processed, but those which were in short supply were being
cloned now. Non-stem cells were also collected for use in
reconstruction.
The arm looked like it was attached to something resembling
a chest now. A sort of scaffolding had been erected to replace
the shattered bones, and the scraps of tissues had been arranged
on it in a more orderly fashion, roughly matching the huge gap
in his body. A section of frilly tissue like his other lung was
now visible waving gently on the inside.
In another part of the room, a number of machines looked
like they were repeatedly scraping white blocks which had
cross-sections of different bones of some sort drawn on each of
them. Information on another screen told Linda that it was
actually building the shapes up layer by layer, the white
substance being a soluble filler powder that was added in layers
thinner than paper, and the bone being a combination of
collagen, bone stem cells, cells for blood vessels, marrow,
growth factor hormones, vitamins and nutrients sprayed on like
ink from a printer, gluing the filler together in very precise
shapes, including tiny channels for blood vessels, cartilage,
tendons, and so on - everything to start the bone growing and
eventually replacing the filler. When finished, the unglued
filler would remain powder and fall away, or be washed out.
The complete regrowth process would still take months. The
bones would be fragile, but metal braces were being constructed
elsewhere and would be shipped to the hospital when completed,
and would wrap the larger bones to support them while they
solidified, so they could be implanted immediately.
Enough liver had been found to reassemble it. A few other
liver parts found in the chest cavity were genetically checked,
and returned to another patient in a nearby hospital. Another
machine had already formed several precise pieces of tissue
which were being assembled to close the gaping hole in the
stomach. They had been composed of stomach cells, liquefied from
tissue snipped from it earlier and separated into layers, mixed
with stem cells, and growth and nutrient factors. They were
being attached with what looked like glue, which an information
screen said was another mixture of stem cells and liquefied
stomach tissue, along with actual soluble glue.
Channels had been created for nerves to grow into, and
seeded with nerve cells and hormones to direct growth, but they
would not be allowed to grow for until recovery started. Nerves
had to grow from the central nervous system - when fed growth
factors, each nerve cell would grow along the channel the meet
up with others. About 90% would die out, the remaining ones had
a chance of reproducing most of the functionality needed.
Linda watched as the tissue-making machines finished
different scraps like fabric cut for clothing, which were then
taken and glued into place on a ragged mannequin, forming a
human being rather than a costume.
She viewed other parts of his body that weren't being worked
on. The left arm had already been sliced open, and the bone
fragments rearranged back into their original shape, and tied
back together with glue and biodegradable filament, a relatively
simple operation that normally would have been done with local
anaesthetic in about twenty minutes. The difference is the skin
and muscles would have been sutured closed normally, but with
the available tissue cells, it was glued like everything else
seemed to be.
His legs were undamaged, and his hips. Strangely, his penis
seemed inappropriately plumped, waving slightly in the fluid.
His skin was ghastly pale, completely devoid of real blood by
now.
All the damaged areas of the brain had been isolated - they
had been split into smaller and smaller chunks until the damaged
sections were just tiny bits attached by wires. Now the really
delicate work had begun, as the brain experts used the computers
to try to figure out how to rewire the individual neural cells
to minimize the interference with the healthy brain tissue.
A few thousand rare neural and glial stem cells had been
found and extracted from the brain tissue, and were being
incubated in jars of growth hormone, nutrients, and extra
oxygen. A few hundred had already been siphoned off and were
being used for the first parts, injected into damaged brain
sections, and subjected to electrical stimulation and bathed in
proteins and neurotransmitters which made them extremely
responsive to that stimulation.
The repaired pieces wouldn't be reconstructed as they were
before the damage, the process was intended to make them appear
essentially transparent to the healthy brain tissue, so they
wouldn't interfere in the regular functioning. At the same time,
the cells would be alive and functioning properly, capable of
learning and developing as needed to re-learn skills or hold new
memories, unlike the victims of strokes in the past who would
have lost use of those sections completely, only able to
re-learn skills using other parts of their brains to compensate.
It was fortunate that the damage was fairly small. Larger
amounts of brain damage often left entire sections of brain
unfunctional as a newborn's, and even when repaired, they lacked
enough functionality to recover the old abilities.
Reconstructed brain tissue couldn't be turned out on the
machines, it needed to be hand-assembled, sometimes only a few
cells at a time, because each tiny bit had to function correctly
and with tolerances of a dozen micrometres.
Linda woke up in the chair, head laying on her arms, on the
desk in front of the monitors. She was now painfully hungry, and
went to get some food that she carried back to the cubical to
eat.
The ribs in the chest area had been closed again. The lung
had been closed up with no new tissue added, only a few blood
vessels had been relocated to attach to the heart.
He would be able to breath with the left lung, while the
other, which needed to be entirely reconstructed, grew the cells
to replace the filler material and allowed them to mature enough
to function. If both lungs had needed reconstruction, a machine
would have had to oxygenate his blood for the whole time, and he
would have needed to be kept sedated and in a coma for most of
it.
She replayed the video from the closing process on one
monitor while she watched the rest of the operation on the
others.
In the second chunk of body the scaffolding had been
replaced by ribs and other bones, still quite delicate but with
shiny metal lines reinforcing their lengths. In the replay, she
watched the shapeless flesh wrapped around the ribs, dabbed with
glue, and sewn together like the fabrication of some sort of
tent. It began to look again like part of a body, but with a
hideously mottled appearance where normal flesh met damaged
flesh, which met the patches that had been constructed and
attached in place, tissue which was a strange mixture of
recovered adult cells, and tissue he hadn't had making up his
body since he was a foetus. Most of the skin and much of the
muscle on the arm was fabricated replacement.
It was easier to fabricate a new lung than to patch a new
part to an existing lung, so the remaining grey frill had been
cut out and liquefied for cells to make the new one. It would be
immobilized full of fluid for the first few months, allowing
delicate cilia to grow on the inner surface, then slowly
exercised under computer control while alveoli developed, until
it was fit to be used for breathing. Normally the diaphragm
would be cut in half, one under his control to breathe with the
left lung, the other with nerves cut off and controlled by
computer, but in this case, half had been torn apart already,
and it was simply left separate when the muscle was
reconstructed. A minor operation would remove the computer
electrodes, and inject the last few nerve cells and growth
hormones into the nerve passageways to connect up to the main
nerves and spinal cord. The diaphragm didn't need to be rejoined
in most cases.
With the bones and lung in place, technicians used a sling
and lifted the inert arm-shoulder-chest assembly out of its tub,
dribbling onto the floor as it moved, and into the one which the
main body was in. They lowered it and positioned it, assisted by
a few robotic arms. Linda was frankly surprised at how well the
two parts fit together, like the way a car door on an assembly
line fit onto an automobile body. She'd become used to thinking
of them as two different, unrelated things. The artificial blood
supply tubes hooked up to the heart were moved to enter from
below the rib cage.
The smallest devices began work on the inside, attaching the
lung to the trachea, attaching ligaments to the sternum,
arteries and veins to the heart, and so on.
The brain work was still going on. The skin around his head
had still not been tended, and was still ripped and ragged, in
contrast to the rest of his body. Some of the other tissue was
still irregular and floating free, but it was all trimmed and
looked healthy, if an oddly discoloured patchwork.
The process went on for some time. Linda, frankly, got
bored. She looked at his face. It was still mostly his, the
undamaged part, but completely lifeless, slack. Eyes stared out
unblinking through the liquid, bulging outward far more than
they should.
Finally, the brain was carefully placed back together, piece
by piece, and wires were removed. Thousands of tiny plastic pins
were used to very precisely line up the facing surfaces, and
would remain embedded within the brain. Liberal amounts of brain
glue were used.
The carefully severed optic nerves were reattached. A tiny,
microscopic mesh cap had been placed on each end of those nerves
at the cut, separating and labeling hundreds of thousands of
separate nerve strands with separate electrodes so they could be
matched up again by computer. The mesh caps would also remain in
place, embedded in his skull behind his eye sockets.
The same devices could be used to monitor signals from the
eyes, allowing crude, approximate views of what a person saw, if
they were attached to circuits for that purpose, but they
weren't in this case.
The brain was reattached to the blood vessels. It had
remained attached to the spinal cord the whole time. Connecting
tissues were reconnected to hold the brain in place.
Finally the plastic bag around the head was unfastened from
around the neck and pulled away. Robot arms from elsewhere moved
up and started finally restoring the face and scalp, unfastening
the support bolt from the base of the skull, and folding the
bone sections back into place.
The hair was shaved, tissue trimmed, grafts fabricated and
added, neck folded back up and closed.
The eyes remained blank and unlidded, not responding even
instinctively when a stray wisp of hair or snipped off skin
drifted against them.
As his body came together, he looked more dead than he had
since she first started watching the operation.
It took three and a half days. Apart from a small difficulty
with the brain which a specialist in Paris was called in for,
there were no complications.
Leaks were detected and patched, then a pacemaker was
implanted and used to trigger his heart. It would keep
triggering the heart for between a week and two months to keep
it beating steadily, then it wouldn't be needed anymore. The
lungs were inflated, the new one cleared of any remaining powder
first, then refilled with a different liquid. The other was
attached to a respirator producing short, shallow breaths to
avoid straining the healing injuries.
Finally, with heart and left lung working, the heart was
stopped again briefly, the tubes around the heart were removed,
and the heart was restarted again. The chest cavity was closed.
The respirated body was removed from the operating tub and
placed on a gurney, wrapped in warming blankets, to be wheeled
out to the recovery ward. Technicians began cleaning up and
putting equipment away.
Linda watched them work. At a loss, she looked for and
played back a few scenes. Looked for life in those eyes. In the
body. In anything.
Looked for Gerrold.
A lifeless jigsaw puzzle in human shape.
The provisional death certificate indicated he had been
brain dead for 85 hours and 21 minutes. Brain activity had been
monitored before the skull was closed up, and indicated normal,
heavily sedated activity, unassisted by computer. A few hours
later, he would regain consciousness, at least briefly, to
verify that he was alive, and then he would be allowed to sleep
for most of the rest of the month as his disorientation
gradually cleared and he could remain awake for longer and
longer periods.
Linda wouldn't be there when he woke.
The End.
By Tau.