Chapter 10
Death Watch
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    The images of Charlotte over all the years of their marriage plague Howard's mind.  He remembers the first time he saw her and how her striking good looks significantly clashed with her rather child-like innocence.  He can see her in her wedding dress and the loving sparkle in her eyes the first time she held her children.  But most of all, there is the horrible image of the last moments of her life, a time when she had at last found a purpose denied by a marriage gone wrong, when she was cut down in an instant at the Techside Crusade site.  At this very moment, he is staring at his medical notes but he sees nothing but  her St. Jude's Badge and the Cross Of The Restoration being placed around her neck as her body rested in her open coffin.  His own voice is repeating over and over in his mind, "Oh that I could only go back and change it all."  That is the fate of many - often, it takes some tragic event to force the mind into a maturity that then so easily recognizes so many failings, all too late.
    His research at Henderson Hospital is the only thing that has spared him the course followed by so many who reach such a belated recognition of themselves.  He hasn't been consumed by some indulgence, hoping that will blunt feelings of guilt that dim the mind, obscure purpose and ultimately destroy any hope in a person's life.  His mind has been purged of the resent he felt towards his profession, and the endless work he has put into his research has at the very least convinced him he was sincere all that time he maintained he wanted to contribute something that would free the sick from the pain management system and give them some hope of regaining a portion of their lives.
    And now, it is complete; and if his proposed treatment methods fail, he will at least have the consolation of knowing he has done his very best.  His final report and recommendations for the test phase of the research were submitted to Doctor Henderson several days ago; and for the first time since he saw the Cross Of The Restoration being placed around Charlotte's neck, his conscience has allowed a measure of peace to his troubled mind.

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    Shelton Henderson stares out his office window.  His hand is under his chin and his eyes fixed on the cars as they pass on the street.  But he doesn't see them.  He doesn't see the pleasant sky, the tree branches gently tossing in the slight wind or the visitors walking into the hospital.  He only sees the grimaced pain on the face of the patient in room 34.  Slowly, he turns to his desk and looks at Howard's report before picking it up and beginning to read.

Initial Report On Neoplasm And Proto-Oncogene Mutation 
Through Induced Reverse Metastasis And Alteration Of DNA Tissue Content

   Genes are the basic structure of inheritance and consist of long, coiled molecules known as deoxybonueleic acid (dna).  Genes trigger the production of protein within the body, and in cancer, the genes fail resulting in abnormal communication with the receptors on the surface of the cells.  The normal growth factor is inhibited, and binding to the receptors of adjacent cells is impaired resulting in a proto-oncogene mutation producing an oncogene that instructs the adjacent cells to fall into an unrestricted division not controlled by telomeres which normally would damage the dna and kill the cell after 40 divisions.  The cancer cells escape this process by producing a telomerase protein which renders the cells immortal and capable of never-ending divisions.
    The body has an inborn healing process and in the initial stages of oncogene, will produce a p53 tumor suppressing gene that will prevent the dna damage until the cell is repaired.  If this repair process fails, apoptosis is prevented, and the unrestricted cell division continues.  Cancer can survive without the extracelluar matrix which is the the fibrous network to which cells adhere.  The tumor mass is not dependant on this network and forms its own angiogenesis to supply itself.  Malignancy results when metastases develops and the mass breaks through blood vessels to enter the lymphatic system.
    Recognizing these basic facts, treatment and cure must follow a carefully-monitored 3-step process.
        1-The extent of the tumor and resultant impairment of organs should be evaluated and the appropriate surgical procedure chosen to remove as much of the malignancy as possible.  In all instances, chemo-therapy and radiation are not recommended.  Such extensive treatment processes tend to weaken the body and further restrict its normal ability to sustain itself with proper nutrition and hydration. Prolonged periods of weakness resulting from such procedures often ushers the patient into severe depression, further restricting the natural healing process and in extreme situations, can find the  patient wishing for death rather than enduring what seems hopelessness and constant pain and weakness.
    2-During the initial surgery, depending on the organ involved, the essential amino acids should be combined with other amino acids and existing tumor suppressing agents to produce the formulas in Annex A.  The resultant compounds are subdivided into groups viewed as the best combination of the essential amino acids and others for the organ or organs involved in the malignancy.  These formulas shall be called Inhibitons and provide the chemical basis on which the body can produce a uracil base RNA to strengthened the p53 gene and suppress further unrestricted cell division through a feedback inhibition of high protein molecules and reinforce the normal telomeres process.  The undamaged portions of the organ or organs should receive an injection of one of the substances in Annex B and shall be called Enhanceitons.  These amino acid compounds through greater protein synthesis should build the tissue around the line of incision where the tumor was removed into a barrier wall through highly sensitive cell receptors that can correctly receive growth factor transmissions and restore the normal dna replication. 
    3-Post-operative procedures should include long needle injections of Enhanceitons to the area of surgery and close monitor of blood samples to confirm the proper levels of the protein compounds are being ingested.  Recommended levels appear in Annex C.  A programmed exercise schedule to increase blood circulation and respiratory activity should improve the delivery and retention of the Enhanceitons in the area of surgical involvement.

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     The study of Cell Biology and Protein Synthesis never quite found its way into Shelton's mind during medical school and were not powerful enough to displace his determination to screw as many of the female students as possible.  Like most fixations, determination is fueled by success, and this reached the apex when one of the female professors developed a fixation on him.  Only then did he determine that, properly administered through original techniques, an older woman's sex drive is much stronger and with that, the urge to chase after every cute little ass was superceded by a higher level of sexual fulfillment with only one person.
    After graduation and years in a declining medical system, his interests turned to surgery but that only led to mounting discontent with the limitations constantly imposed by medical insurance and its administrators who seemed to have all been taken in by the idea of progressive statistics.  Ultimately, this resulted in a means to increase insurance surpluses, release additional funds for investment and increase profits.  It all worked very well until the economy and stock market began to fall.  Now, there is little profit and instead of employing a cadre of investment councilors, the insurance companies are using lawyers to restrict and rewrite eligibility standards.
    Very quickly, he becomes bored in trying to follow the calculations on protein synthesis and tissue formation.  He pages Howard and resumes his stare out the window - first recalling that amorous professor but his thoughts quickly turn to all the stages of his career that led him to The Restoration.  Regrettably, it was resent towards the system more than determination that caused him to commit his family's extensive financial holdings and open Henderson Hospital.
    When Howard takes a chair in front of Shelton's desk, he has the same feeling as when he first presented an essay assignment to his 5th grade teacher.  When Shelton picks up the report and begins to nod his head, Howard says, "There's no need to request a grant.  It wouldn't find its way past the secretary's desk of the pain managers.  Such an approach is passé in today's world of genetic engineering and stem-cell research."
    A very stern expression comes over Shelton as he says, "A grant never entered my mind.  I gave up on those bastards at the Georgia Research Institute years ago.  They've got more accountants on the staff than doctors.  Someone with the mind of a doctor and heart of a stock broker isn't going to do us or anyone any good."  He pauses a moment and seems to wrestle with conflicting thoughts before saying, "I started to call your work theoretical but it's hardly that.  It deals with scientific fact established years ago but has been abandoned due to the cost of treating what has come to be known as candidates for pain management.  Obviously, you're at a point the science must be applied.  How do you propose to do that?"
    "Animal testing is the logical next step in any...."
    Shelton holds up his hand and begins waving it from side to side.  "That could take months and months and get us back into the rut of either requesting a grant based on cages full of rats or trying to enlist the sanctions of the Food and Drug Administration.  They've all got a closed mind on conventional treatment and don't want to hear anything except prevention methods and pain management.  He picks up a medical magazine on his desk and in one motion hurls it into the trash can some 20 feet across the room.  "There's an article in there called Economics of Prevention and Pain Management tracing the hospital costs of attempting to administer advanced cancer cases.  The statistics of 1000 cases studied showed the average life span of a severely involved patient from diagnosis to death is 16 months and the average cost is $450000.  A comparison of 1000 similar cases relegated into pain management placed the average cost at $45000 and life span of 8 months - that including only sending a LPN to the patients home everyday to clean up his urine and shit and give some kind of drug that keeps him sedated most of the time.  With the profession contaminated with that sort of "treatment," we're going to have to push all the bull shit aside and move rather boldly on our own."
    Very guardedly, Howard asks, "Surely you don't mean human testing."
    Shelton becomes very intolerant and pointedly says, "Go down to room 34.  Tell that patient whatever you did when you were over there at that useless hospital filling out forms and not doing a damn thing to help anyone.  Then, come back in here and we'll discuss doing something to help someone rather than prolonging his suffering."  With one sweep of his hand, it rakes all the papers back into Howard's folder and hands it back to him.
    Howard has been consumed in his research and has made few visits to the hospital floors where most of the patients are now cast-outs from the medical system, viewed as untreatable, placed on pain-killers and left to die.  In most cases, the system as well as the patients hope for death which has replaced all other options as the only feasible outcome.
    He walks into the chart room and notices all the nurses are in the traditional white uniforms, with white shoes, white stockings and pointed caps with their Restoration rank pinned on their collars - quite different from the modernized attire now worn by hospital staff, making them look more like street whores than medical patricians.   He removes Harold Brownly's folder, looks at his medications and asks the nurse why he isn't receiving Sedateomoxifaine and is somewhat surprised when she says the pain-killer has a very short effectiveness for advanced cancer cases and after only a brief period, only produces depression.  He recalls that the original manufacturer of Sedateomoxifaine had introduced the drug as a miracle pain killer developed especially for patients in pain management.  The company's stock rose 100% almost overnight but in what seemed a pre-planned maneuver, it quickly was bought out by a larger pharmaceutical awarding windfall profits to insiders and day traders.
    There is a number of x-rays, and as he begins viewing them, he is shocked that surgery is even being considered.  There is a non-operative tumor across the bottom of the spleen extending to the lower surface of the stomach where there is penetration into the gastric folds extending to the pancreatic duct.  There is a lesser-developed tumor at the pyloric opening extending into the ascending colon down to the hepatic flexure with substantial tissue deterioration all along the mucosa and submucosa of the ascending colon.  He places his hand under his chin and begins to shake his head, again wondering why Henderson even asked him to see the patient who seems more unlikely to survive the week rather than identify as a candidate for extensive surgery.  The automatic thought process from years as a conventional surgeon momentarily expels any diagnosis other than terminal but he is no longer a conventional surgeon and begins to think in terms of tissue reconstruction through amino acid compounds, reverse metastasis and DNA enhancement.
    He begins walking towards room 34 with his hand still under his chin and staring at the the freshly buffed floor but stops just outside the room, trying to think what he should tell a patient who only has a matter of days to live.  As he enters the room, there is the customary IVs and monitors but the patient is delirious, slipping in and out of consciousness at frequent intervals.  Howard scans the monitors and notes low heart rate, low blood pressure and poor oxygen blood content as well as hands and arms severely bruised from multiple IV injections.  The patient turns his head to the side, and when he sees Howard, his eyes snap open and begin a fixed stare straight into Howard's face.  The patient's hand firmly grasps Howard's wrist with a strength that defies his critical condition.  There is dissent and pain in his voice as he quite clearly says, "Kill me, you son of a bitch.  Why are you making me suffer like this?"  His grip gradually weakens, his hand falls back to his side and he begins mumbling.  Tears begin running down his cheeks before he again loses consciousness, his sole remaining benefit from coma-inducing drugs.
    Howard is back in the hall.  His hand is still under his chin, and he is still staring at the floor.  A cold chill seeps through his body as he thinks of his mother and what her life must now be like, confined to that house that has so many unhappy memories as her life slowly ebbs away.  All the way back to Henderson's office, he can barely hold back his own tears.  His mind is dazed as he again faces Henderson who asks, "What do you think?"
    Before venturing any diagnosis, Howard asks, "How did he come to be admitted?  What did his primary care doctor think you could do?"
    Again, Henderson's head tilts to one side and hints displeasure with someone who doesn't seem to understand the extent to which pain management has overtaken any treatment efforts before he says, "He doesn't have a primary doctor.  The Restoration  patrol found him on the street outside Westside Hospital.  The Emergency Room had turned him away after only a brief look into the computer system that showed his Medicaid benefits had expired, which I suppose they thought sounded better than telling him Medicaid is sufficiently bankrupt to severely restrict any consideration of extending benefits.   They told him the pain management ward was full and he would need to go back to his private doctor; but when he had a private doctor, he wouldn't admit patients to a hospital due to all the qualifying paperwork for those who couldn't afford to pay and always told them to go to the Emergency Room."  Henderson leans forward, places his elbows on his desk and in something of an amused expression and tone, again asks, "What do you think we should do?"
    Howard responds, "He needs to die."
    Shelton leans back and folds his arms.  "I don't mean that."
    Howard's extensive past surgical experience has left his with quite an ego, and he doesn't like being down-dressed like a 1st year medical student.  He snaps, "Surely, you don't intend to operate."
    Shelton's mood immediately becomes more stern and analytical.  "How long do you think he will live?  Can you imagine what his life is like now?  When we took the oath of doctors, we both pledged to do no harm.  What do you think is the lesser harm - attempting radical surgery which might well kill him or be bound up in some senseless concept of preserving life at any cost with no concern for the patient's suffering or even what the patient wants for himself.  That's a fucking cop-out.  Forget about your supposed ethics.  Think of the patient and only consider his condition.  Howard Brownly can't ingest food and is IV-dependant.  He's becoming progressively weaker by the day, and his organs will soon begin to shut down.  Then, he'll enter into a coma and who can say how long he will live. If he dies on the operating table, will we have committed some grave unethical act or will we have relieved suffering and granted peace to a man who can now only hope for death.  All these damn do-gooders who do nothing but read scripture and tell everyone how sinful they are keep preaching how wonderful Heaven is but they all claim removing someone from hopeless pain through euthanasia and permitting him to enter Heaven is a condemning sin.  We need to leave that to the priesthood and direct our attention to the best medical approach after asking what we would want for ourselves, if we were in that man's condition."
    All the while Shelton is speaking, Howard's thoughts are of his mother.  Many times in the past, he has visualized her death and didn't know if he was wishing her dead only to remove his worry or truly wanted what was best for her.  It all left him with a terrible feeling of guilt in the prospect he was placing his own feelings above those of his mother with little concern for what she wanted.
    Shelton sees he has triggered something that has placed Howard into an obvious thought process.  Rather than exploring that, he pointedly says, "Harold Brownly doesn't have time for us to fuck around with a bunch of laboratory rats or hire some lawyer to push your work through the FDA.  Surgery is scheduled for 10.00 am tomorrow.  You will assist and administer what you feel are the correct Inhibitons and Enhanceitons.  Prepare a post-operative treatment regimen.  We're going about this exactly as you suggested in your report."

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    In all the surgeries Howard has done in the past, he always visited the patients in their rooms before they were transported to the ORs.  On this morning, he left that to Shelton, partly because he is the lead surgeon and partly because of the strange feeling of apprehension that he is entering into experimental medicine which isn't what he always visualized when his research was completed.  Now that The Restoration has given him the chance he always wanted, there is also a troubling doubt if he ever hoped to have such a chance or if he just set goals he knew he could never accomplish simply to justify himself in his own mind.  People often fabricate all sorts of self-endearing goals, take many steps to insure they are well known and then, are unwilling to exert enough effort towards accomplishment.  Now, it is fear of failure that is overpowering and not any effort towards self-evaluation. 
    The full surgical staff is in the scrub room, and a greater degree of fear and doubt tears through his body as he sees Vernon Watson, president of the American Medical Bureau, conversing with Shelton.  Watson walks to Howard's side, extends his hand and says, "I read with interest your report, and I must say it is an intriguing combination of outdated methods and revolutionary ideas.  We'll follow the progress closely.  Of course you realize, even if such procedures are a crowning success, implementing them through the system will be a consuming process.  The pain managers and insurance companies will oppose it from the outset."
    Howard nods and Watson remains standing in front of him for a moment, looking directly into his eyes.
    As the surgical staff completes preparation, Shelton calls everyone together to the center of the room and quietly says, "St. Jude Thaddeus, may we turn away from our own selfishness and not be obsessed with goals that only serve our egos and what we want for ourselves.  May we have the will and determination to best employ the skills we were fortunate enough to acquire and let it be for the benefit of others to free them from the suffering they endure.  Pray our own sins not be punished in failure in what we are about to do.  In you intercession, convey the pain in this man's eyes and the thoughts that must possess his mind in the helplessness he surely does not deserve.  May we then be the messengers of mercy and through that, better fulfill our places in this life, whatever we might find them to be.  Surely, this is what Christ intended."
    He faces the staff with a brief smile before walking from the room and leading everyone into the long hallway  towards the OR.  The instruments on the cart behind the procession make a rattling sound as it rolls along and reminds Howard of his childhood and how the thunder would rattle the windows in his family's house.  He can see his mother as she was then and wonders how she feels and what she is thinking about at this very moment.  Surely, it must be of those times she was happy but all that was taken from her long ago.  He silently says, "God bless my mother. Keep her until I can help her, but if it be her time to depart this life, then grant her a peaceful death."
    The anesthesiologist briefly confers with Shelton just before Shelton walks to the operating table and, with a tear in his eye, looks at the man's withered face.  For a moment, he carefully studies the x-ray images on the adjacent wall before making a few marks on the patient's abdomen.  A look of total purpose flows over his face as he begins the initial incision parallel to the upper large intestine and perpendicular to the center of the stomach.  He folds back the layers of the skin to expose the full involvement of the tumors and for a full 5 minutes probes along the course of the malignancy.  Carefully, he separates the organs with a retractor and begins a tedious removal along the lower wall of the spleen beginning at the anterior margin and progressing towards the splenic artery, being especially careful not to involve the omentum.  Then, there is a slight incision into the lower wall of the stomach towards the pancreatic duct, followed by another lengthy probe across the full width of the stomach before beginning a series of short incisions into the tumor along its course through the gastric folds of the stomach.
    The anesthesiologist becomes increasingly nervous at the radical invasive procedure, and his eyes are fixed on the monitors, only at brief intervals observing Henderson's innovative procedure as a very structured process begins to remove the cancerous masses with careful probes along all organs following each step.  There is another lengthy pause before Henderson's attention turns to the mucosa and submucosa of the ascending colon, only noting tissue deterioration and no evidence of tumor invasion. 
    Calling for a new series of instruments from the staff who seems petrified by a procedure far more radical than anything they have even witnessed, he begins an extensive suturing process using a combination of tissue from the omentum and some reconstructive mesh.  This is followed by another lengthy pause and many probes to check for internal bleeding.  He nods, turns to Howard and says, "Since this is the first time anything like this has been done, please inform the guests as you proceed."  He steps aside, and all eyes are fixed on Howard as he wonders just who the guests other than Vernon Watson are.
    Howard remembers his first lead surgery and has the identical feeling he did some 25 years ago as he assembles various syringes and says in a deliberative voice, "After tumor removal, the initial step is to obstruct further oncogene process by strengthening the p53 gene and re-establish normal pronto-oncogene progression.  Inhibiton 4 contains a composite of amino acids, Cofinafermadine and Restrandetheon that will assist the body in producing a uracil-base RNA to develop the p53 gene and confine further unrestricted cell division through a feed-back inhibition of high protein molecules and reinforce the normal telomeres process."  He judiciously follows Shelton's incision and reconstructive lines with several syringe injections into the areas where the tumor angiogenesis had formed and where the metastases had broken through the blood vessels into the lymphatic system.
    As he begins a second series of injections, he says, "We now need to build the tissue surrounding the tumor sites with Enhanceiton 2 to enable a greater protein synthesis around the lines of the incisions and form barrier walls of highly sensitive cell receptors that can correctly receive the modified growth factor transmissions and restore normal DNA replication.  This is done through injecting high concentrates of the essential 8 amino acids to assist the body in producing the other 14.  The high injection of the essentials directly into the tumor site will draw the tissue building protein directly to the tissue surrounding the removal site, strengthen the p53 gene and restore normal cell meiosis." 
    During his portion of the surgery, which consumes some 30 minutes, his attention alternates between the monitors and watching the patient's organs throb with each beat of the heart.  Mixed in with it all, he reconstructs the stages of his research that have extended over a period of years, often broken by limitations of the system and his own discouragement in always being turned away from hopes of cure and directed towards pain management.
    When his work is completed, he pauses, only then fully realizing the masterful art of surgery he has just witnessed extending far beyond anything he has ever done or even thought possible.  Shelton closes, and again contrary to normal surgery protocol, the full staff accompanies the patient to the recovery room where they all carefully observe the arrangement of the leads for the numerous monitors.
    Vernon Watson walks to Shelton's side, extends his hand and quietly says, "Brilliant.  I hope the legal system doesn't destroy it all."
    Shelton is quite obviously very tired as he places his hand on Howard's shoulder and says, "Let's go back to my office for a moment."  There is something of a troubled expression on his face as he sits in his chair and says, "This is a start.  I hadn't intended to mention the legal system but regardless of the outcome, we can expect many challenges from many sources.  The system will oppose any effort to return to conventional treatment methods or anything that will upset the profit motive that has ruled for quite sometime."  He picks up a folder and hands Howard a sizable collection of pages as he says, "Regardless, if we have any confidence at all in our supposed convictions, we must proceed.  This is the surgery schedule for the next 2 weeks.  Review it carefully and prepare your formulas.  I should mention all the patients are, what should we say, terminal."  For quite a few moments, he is consumed in deep thought and says nothing.
    Walking back to his office, Howard looks into each room as he passes.  Some of the patients are sitting in front of the windows, aimlessly staring out but seem not to have their attention focused on any one thing.  It is just vacant stares, declaring hopelessness and perhaps only a will to die and be taken away from it all.  Others are in their beds and appear only semi-conscious.   He wonders if they even have the presence of mind to hope for help or now can only wish for death.  He sits down at his desk and a deliberative stare comes over him - the same as he just saw on Henderson's face.  He isn't sure if he should fear or eagerly await what the future might hold. 
    Just then, his telephone rings.  It's Franklin but his voice doesn't have his usual course, blue collar tone.  He only mumbles, "Howard....Ma....Mama's dead."