by Michael Blumlein
At seven a.m. on Thursday morning, Mr. Reagan was wheeled through the swinging doors and down the corridor to operating room six. He was lying flat on the gurney, and his gaze was fixed on the ceiling; he had the glassy stare of a man in shock. I was concerned that he had been given analgesia, but the attendant assured me that he had not. As we were talking, Mr. Reagan turned his eyes to me: the pupils were wide, dark as olives, and I recognized the dilatation of pain and fear. I felt sympathy, but more, I was relieved that he had not inadvertently been narcotized, for it would have delayed the operation for days.
I had yet to scrub and placed my hand on his shoulder to acknowledge his courage. His skin was coarse beneath the thin sheet that covered him, as the pili erecti tried in vain to warm the chill we had induced. He shivered, which was natural, though eventually it would stop—it must—if we were to proceed with the surgery. I removed my hand and bent to examine the plastic bag that hung like a showy organ from the side of the gurney. There was nearly a liter of pale urine, which assured me that his kidneys were functioning well.
I turned away, and, entering the scrub room, once more conceptualized our plan. There were three teams, one for each pair of extremities and a third for torso and viscera. I headed the latter, which was proper, for the major responsibility for this project was mine. We had chosen to avoid analgesia, the analeptic properties of excruciating pain being well known. There are several well-drawn studies that conclusively demonstrate the superior survival of tissues thus exposed, and I have cited these in a number of my own monographs. In addition, chlorinated hydrocarbons, which still form the bulk of our anesthetics, are tissue-toxic in extremely small quantities. Though these agents clear rapidly in the normal course of post-operative recovery, tissue propagation is too sensitive a phenomenon for us to have risked their use. The patient was offered, routinely, the choice of an Eastern mode of anesthesia, but he demurred. Mr. Reagan has an obdurate faith in things American.
I set the timer above the sink and commenced to scrub. Through the window I watched as the staff went about the final preparations. Two large tables stood along one wall, and on top of them sat the numerous trays of instruments we would use during the operation. Since this was the largest one of its kind any of us at the center had participated in, I had been generous in my estimation of what would be needed. It is always best in such situations to err on the side of caution, and I had ordered duplicates of each pack to be prepared and placed accessibly. Already an enormous quantity of instruments lay unpacked on the tables, divided into general areas of proximity. Thus, urologic was placed beside rectal and lower intestinal, and hepatic, splenic, and gastric were grouped together. Thoracic was separate, and orthopedic and vascular were divided into two groups for those teams assigned to the extremities. There were three sets of general instruments—hemostats, forceps, scissors, and the like—and these were on smaller trays that stood close to the operating table. Perched above them, and sorting the instruments chronologically, were the scrub nurses, hooded, masked, and gloved. Behind, and throughout the operating room circulated other, non-sterile personnel, the nurses and technicians who functioned as the extended arm of the team.
For the dozenth time I scrubbed my cuticles and the space between fingernail and fingertip, then scoured both sides of my forearms to the elbow. The sheet had been removed from Mr. Reagan, and his ventral surface—from neck to foot—was covered by the yellow suds of antiseptic. His pubic parts, chest, and axilla, had been shaved earlier, although he had no great plethora of hair to begin with. The artificial light striking his body at that moment recalled to me the jaundiced hue I have seen at times on certain dysfunctional gall bladders, and I looked at my own hands. They seemed brighter, and I rinsed them several times, then backed into the surgical suite.
A nurse approached with a towel, whose corner I grabbed, proceeding to dry methodically each finger. She returned with a glove, spreading the entrance wide as one might the mouth of a fish in order to peer down its throat. I thrust my fingers and thumb into it, and she snapped it upon my forearm. She repeated the exchange with the other, and I thanked her, then stood back and waited for the final preparations.
The soap had been removed from his skin, and now Mr. Reagan was being draped with various sized linens. Two of these were used to fashion a vertical barrier at the mid-point of his neck; behind this, with his head, sat the two anesthesiologists. Since no anesthetic was to be used, their responsibility lay in monitoring his respiratory and cardiovascular status. He would be intubated, and they would make periodic measurements of the carbon dioxide and oxygen content of his blood.
I gave them a nod, and they inserted the intracath, through which we would drip a standard, paralytic dose of succinylcholine. We had briefly considered doing without the drug, for its effect, albeit minimal, would still be noticeable on the ablated tissues. Finally, though, we had chosen to use it, reasoning—and experience proved us correct—that we could not rely on the paralysis of pain to immobilize the patient for the duration of the surgery. If there had been a lull, during which time he had chosen to move, hours of careful work might have been destroyed. Prudence dictated a conservative approach.
After initiating the paralytic, Dr. Guevara, the senior anesthesiologist, promptly inserted the endotracheal tube. It passed easily for there was little, if any, muscular resistance. The respirator was turned on and artificial ventilation begun. I told Mr. Reagan, who would be conscious throughout, that we were about to begin.
I stepped to the table and surveyed the body. The chest was exposed, as were the two legs, above which Drs. Ng and Cochise were poised to begin.
“Scalpel,” I said, and the tool was slapped into my palm. I transferred it to my other hand. “Forceps.”
I bent over the body, mentally drawing a line from the sternal notch to the symphysis pubis. We had studied our approaches for hours, for the incisions were unique and had been used but rarely before. A procedure of this scale required precision in every detail in order that we preserve the maximal amount of viable tissue. I lifted the scalpel and with a firm and steady hand made the first cut.
He had been cooled in part to cause constriction of the small dermal vessels, thus reducing the quantity of blood lost to ooze. We were not, of course, able to use the electric scalpel to cut or coagulate, nor could we tie bleeding vessels, for both would inflict damage to tissue. Within reason, we had chosen planes incision that avoided major dermal vasculature, and as I retraced my first cut, pressing harder to separate the more stubborn fascial layers, I was reassured by the paucity of blood that was appearing at the margins of the wound. I exchanged my delicate tissue forceps for a larger pair, everting the stratum of skin, fat, and muscle, and continuing my incision until I reached the costochondral junction in the chest and the linea alba in the belly. I made two lateral incisions, one from the pubis, along the inguinal ligament, ending near the anterior superior iliac spine, and the other from the sternal notch, along the inferior border of the clavicle to the anterior edge of the axilla. There was more blood appearing now, and for a moment I aided Dr. Biko in packing the wound. Much of our success at controlling the bleeding depended, however, upon the speed at which I carried out the next stage, and with this in mind, I left him to mop the red fluid and turned to the thorax.
Pectus hypertrophicus occurs perhaps in one in a thousand; Billings, in a recent study of a dozen such cases, links the condition to a congenital aberration of the short arm of chromosome thirteen, and he postulates a correlation between the hypertrophied sternum, a marked preponderance of glabrous skin, and a mild associative cortical defect. He has studied these cases; I have not. Indeed, Mr. Reagan’s sternum was only the second in all my experience that would not yield to the Lebsche knife. I asked for the bone snips, and with the help of Dr. Biko was finally able to split the structure. My forehead dripped from the effort, and a circulating nurse dabbed it with a towel.
I applied the wide-armed retractor, and as I ratcheted it apart, I felt a wince of resistance. I asked Dr. Guevara to increase the infusion of muscle relaxant, for we were entering a most crucial part of the operation.
“His pupils are fixed and dilated,” he announced.
I could see his heart, and it was beating normally. “His gases?” I asked.
“O2 85, CO2 38, pH 7.37.”
“Good,” I said. “It’s just agony then. Not death.” Dr. Guevara nodded above the barrier that separated us, and as he bent to whisper words of encouragement to Mr. Reagan, I looked into the chest. There I paused, as I always seem to do at the sight of that glistening organ. It throbbed and rolled, sensuously, I thought, majestically, and I renewed my vows to treat it kindly. With the tissue forceps I lifted the pericardium and with the curved scissors punctured it. It peeled off smoothly, reminding me fleetingly of the delicate skin that encloses the tip of the male child’s penis.
In rapid succession I ligated the inferior vena cava and cross-clamped the descending aorta, just distal to the bronchial arteries. We had decided not to use our bypass system, thus obviating cannulations that would have required lengthy and meticulous suturing. We had opted instead for a complete de-vascularization distal to the thoracic cavity, reasoning that since all the organs and other structures were to be removed anyway, there was no sense in preserving circulation below the heart. I signaled to my colleagues waiting at the lower extremities to begin their dissections.
I isolated the right subclavian artery and vein, ligated them, and did the same on the left. I anastomosed the internal thoracic artery to the ventral surface of the aortic arch, thus providing arterial flow to the chest wall, which we planned to preserve more or less intact. I returned to the descending aorta, choosing 3.0 Ethilon to assure occlusion of the lumen, and oversewed twice. I released the clamp slowly: there was no leakage, and I breathed a sigh of satisfaction. We had completed a crucial stage, isolating the thoracic and cephalic circulation from that of the rest of the body, and the patient’s condition remained stable. What was left was the harvesting of his parts.
I would like to insert here a word on our behalf, aimed not just at the surgical team but at the full technical and administrative apparatus. We had early on agreed that we must approach the dissection assiduously, meaning that in every case we would apply a greater, rather than a lesser, degree of scrupulousness. At the time of the operation, no use—other than in transplantation—had been found for many of the organs we were to resect. Such parts as colon, spleen, and vasculature had not then, nor have they yet, struck utilitarian chords in our imaginations. Surely, they will in the future, and with this as our philosophy, we determined to discard not even the most seemingly insignificant part. What could not immediately be utilized would be preserved in our banks, waiting for a bright idea to send it to the regeneration tanks.
It was for this reason, and this reason alone, that the operation lasted as long as it did. I would be lying if I claimed that Mr. Reagan was not in constant and excruciating pain. Who would not be to have his skin fileted, his chest cracked, his limbs meticulously dissected and dismembered? In retrospect, I should have carried out a high transection of the spinal cord, thus interrupting most of the nerve fibers to his brain, but I did not think of it beforehand and during the operation was too occupied with other concerns. That he did survive is a testimony to his strength, though I still remember his post-operative shrieks and protestations. We had, of course, already detached his upper limbs, and therefore we ourselves had to dab the streams of tears that flew from his eyes. At that point, there being no further danger of tissue damage, I did order an analgesic.
After I had successfully completed the de-vascularization procedure, thus removing the risk of life-threatening hemorrhage from our fields, I returned to the outer layer of thorax and abdomen. With an Adson forceps I gently retracted the thin sheet of dermis and began to undermine with the scalpel. It was painstaking, but after much time I finally had the entire area freed. It hung limp, drooping like a dewlap, and as I began the final axillary cut that would release it completely, I asked Ms. Narciso, my scrub nurse, to call the technician. He came just as I finished, and I handed him the skin.
I confess that I have less than a full understanding of the technology of organ variation and regeneration. I am a surgeon, not a technologist, and devote the major part of my energies toward refinement and perfection of operative skills. We do, however, live in an age of great scientific achievement, and the iconoclasm of many of my younger colleagues has forced me to cast my gaze more broadly afield. Thus it is that I am not a complete stranger to inductive mitotics and controlled oncogenesis, and I will attempt to convey the fundamentals.
Upon receiving the tissue, the technician transports it to the appropriate room wherein lie the thermo-magnetic protein baths. These are organ specific, distinguished by temperature, pH, magnetic field, and substrate, and designed to suppress cellular activity; specifically, they prolong dormancy at the G1 stage of mitosis. The magnetic field is altered then, such that each cell will arrange itself ninety degrees to it. A concentrated solution of isotonic nucleic and amino acids is then pumped into the tank, and the bath mechanically agitated to diffuse the solute. Several hours are allowed to pass, and the magnetic field is again shifted, attempting to align it with the nucleic loci that govern the latter stages of mitosis. If this is successful, and success is immediately apparent for failure induces rapid and massive necrosis, the organ system will begin to reproduce. This is a macroscopic phenomenon, obvious to the naked eye. I have been present at this critical moment, and it is a simple, yet wondrous, thing to behold.
Different organs regenerate, multiply, in distinctive fashion. In the case of the skin, genesis occurs quite like the polymerization of synthetic fibers, such as nylon and its congeners. The testes grow in a more sequential manner, analogous perhaps to the clustering of grapes along the vine. Muscles seem to laminate, forming thicker and thicker sheets until, if not separated, they collapse upon themselves. Bone propagates as tubules; ligaments as lianoid strands of great length. All distinct, yet all variations on a theme.
In the case of our own patient, the outcome, I am pleased to report, was bounteous; this was especially gratifying in light of our guarded prognostications. I was not alone in the skepticism with which I approached the operation, for the tissues and regenerative capacity of an old man are not those of a youngster. During the surgery, when I noticed the friability and general degree of degeneration of his organs, my thoughts were inclined rather pessimistically. I remember wondering, as Dr. Cochise severed the humeral head from the glenoid fossa, inadvertently crushing a quantity of porotic and fragile bone, if our scrupulous planning had not been a waste of effort, that the fruits of our labor would not be commensurate with our toil. Even now, with the benefit of hindsight, I remain astonished at our degree of success. As much as it is a credit to the work of our surgical team, it is, perhaps moreso, a tribute to the resilience and fundamental vitality of the human body.
After releasing the dermal layer as described, I proceeded to detach the muscles. The adipose tissue, so slippery and difficult to manipulate, would be removed chemically, thus saving valuable time. As I have mentioned, the risk of hemorrhage—and its threat to Mr. Reagan’s life—had been eliminated, but because of the resultant interruption of circulation we were faced with the real possibility of massive tissue necrosis. For this reason we were required to move most expeditiously.
With sweeping but well-guided strokes of the scalpel, I transected the ligamentous origins of pectoralis major and minor, and serratus anterior. I located their points of insertion on the scapula and humerus and severed them as well, indicating to Ms. Narciso that we would need the technician responsible for the muscles. She replied that he had already been summoned by Dr. Ng, and I took that moment to peer in his vicinity.
He and Dr. Cochise had been working rapidly, already having completed the spiraling circumferential incisions from groin to toe, thus allowing, in a fashion similar to the peeling of an orange, the removal in toto of the dermal sheath of the leg. The anterior femoral and pelvic musculature had been exposed, and I could see the sartorius and at least two of the quadriceps heads dangling. This was good work and I nodded appreciatively, then turned my attention to the abdominal wall.
In terms of time the abdominal muscles presented less of a problem than the thoracic ones, for there were no ribs to contend with. In addition, as long as I was careful not to puncture the viscera, I could enter the peritoneum almost recklessly. I took my scalpel and thrust it upon the xiphoid process, near what laymen call the solar plexus, and started the long and penetrating incision down the linea alba, past the umbilicus, to the symphysis pubis. With one hand I lifted the margin of the wound, and with the other delicately sliced the peritoneal membrane. I reflected all the abdominal muscles, the rectus and transversus abdominis, the obliquus internus and externus, and detached them from their bony insertions. Grasping the peritoneum with a long-toothed forceps and peeling it back, I placed two large towel clips in the overlying muscle mass, and then, as an iceman would pick up a block of ice, lifted it above the table, passing it into the hands of the waiting technician. Another was there for the thoracic musculature, and once these were cleared from the table, I turned to the abdominal contents themselves.
Let me interject a note as to the status of our patient at that time. As deeply as I become involved in the techniques and mechanics of any surgery, I am always, with another part of my mind, aware of the human being who lies at the mercy of the knife. At this juncture in our operation I noticed, by the flaccidity in the muscles on the other half of the abdomen, that the patient was perhaps too deeply relaxed. Always there is a tension in the muscles, and this must be mollified sufficiently to allow the surgeon to operate without undo resistance, but not so much that it endangers the life of the patient. In this case I noted little, if any, resistance, and I asked Dr. Guevara to reduce slightly the rate of infusion of the relaxant. This affected all the muscles, including, of course, the diaphragm and those of the larynx, and Mr. Reagan took the opportunity to attempt to vocalize. Being intubated, he was in no position to do so, yet somehow managed to produce a keening sound that unnerved us all. His face, as reported by Dr. Guevara, became constricted in a horrible rictus, and his eyes seemed to convulse in their sockets. Clearly, he was in excruciating pain, and my heart flew to him as to a valiant soldier.
The agony, I am certain, was not simply corporeal; surely there was a psychological aspect to it, perhaps a psychosis, as he thought upon the systematic dissection and dismemberment of his manifest self. To me, I know it would have been unbearable, and once again I was humbled by his courage and fortitude. And yet there was still so much left to do; neither empathy nor despair were distractions we could afford. Accordingly, I asked Dr. Guevara to increase the infusion rate in order to still Mr. Reagan’s cries, and this achieved, I returned my concentration to the table.
By prearrangement Dr. Biko now moved to the opposite side of the patient and began to duplicate there what I had just finished on mine. The sole modification was that he began on the belly wall and proceeded in a cephalad direction, so that by the time I had extirpated the contents of one half of the abdomen, the other would be exposed and ready. With alacrity I began the evisceration.
It would be tedious to chronicle step by step the various dissections, ligations, and severances; these are detailed in a separate monograph, whose reference can be found in the bibliography. Suffice to say that I identified the organs and proceeded with the resections as we had planned. Once freeing the stomach, I was able to remove the spleen and pancreas without much delay. Because of their combined mass, the liver and gall bladder required more time but eventually came out quite nicely. I reflected the proximal small and large intestines downward in order to lay bare the deeper recesses of the upper abdominal cavity and have access to the kidneys and adrenals. I treated gland and organ as a unit, removing each pair together, transecting the ureters high, near the renal pelvises. The big abdominal vessels, vena cava and aorta, were now exposed, and I had to withstand the urge to include them in my dissection. We had previously agreed that this part of the procedure would be assumed by Dr. Biko, who is as skilled and renowned a vascular surgeon as I am an abdominothoracic one, and though they lay temptingly now within my reach, I resisted the lure and turned to accomplish the extirpation of the alimentary tract.
We did not, as many had urged, remove the cavitous segment of the digestive apparatus as a whole. After consultation with our technical staff, we determined that it would be more practical and successful if we proceeded segmentally. Thus, we divided the tract into three parts: stomach, including the esophageal segment just distal to the diaphragm; small intestine, from pylorus to ileocecal valve; and colon, from cecum to anus. These were dutifully resected and sent to the holding banks, where they await future purpose and need.
As I harvested the internal abdominal musculature, the psoas, iliacus, quadratus lumborum, I let my mind wander for a few moments. We were nearing the end of the operation, and I felt the luxury of certain philosophical meditations. I thought about the people of the world, the hungry, the cold, those without shelter or goods to meet the exigencies of daily life. What are our responsibilities to them, we the educated, the skilled, the possessors? It is said, and I believe, that no man stands above any other. What then can one person do for the many? Listen, I suppose. Change.
I have found in my profession, as I am certain exists in all others, that to not adapt is to become obsolete. I have known many colleagues, who, unwilling or unable to grapple with innovation, have gone the way of the penny. Tenacity, in some an admirable quality, is no substitute for the ability to change, for what in one age might be considered tenacious in another would most certainly be called cowardly. I thought upon our patient, whose fortunes had so altered since the years of my training, and considered further the question of justice. Could an act of great altruism, albeit forced and involuntary, balance a generation of infamy? How does the dedication of one’s own body to the masses weigh upon the scales of sin and repentance?
My brow furrowed, for these questions were far more difficult to me than the operation itself, and had it not been for Ms. Narciso, who spoke up in a timely voice, I might have broken the sterile field by wiping with my own hand the perspiration on my forehead.
“Shall we move to the pelvis, Doctor?” she said, breaking my reverie.
“Yes,” I replied softly, turning momentarily from the table to recover, while a nurse mopped the moist skin of my face.
The bladder, of course, had been decompressed by the catheter that had been passed prior to surgery, and once I pierced the floor of the peritoneum, it lay beneath my blade like a flat and flaccid tire. I severed it quickly, taking care to include the prostate, seminal vesicles, ureters, and membranous urethra in the resection. A technician carried these to an intermediate room, where a surgeon was standing by to separate the structures before they were taken to their respective tanks. What remained was to take the penis, which was relatively simple, and testes, which required more care so as not to disrupt the delicate tunica that surrounded them. This done, I straightened my back for perhaps the first time since we began and assessed our progress.
When one becomes so engrossed in a task, so keyed and focused that huge chunks of time pass unaware, it is a jarring feeling, akin to waking from a vivid and lifelike dream, to return to reality. I have felt this frequently during surgeries, but never as I did this time. Hours had passed, personnel had changed, perhaps even the moon outside had risen, in a span that for me was marked in moments. I looked for Drs. Ng and Cochise and was informed that they had left the surgical suite some time ago. I recalled this only dimly, but when I looked to their work was pleased to find that it had been performed most adequately. All limbs were gone, and the glenoid fossae, where the shoulders had been de-articulated, were sealed as we had discussed. Across from me Dr. Biko was just completing the abdominal vascular work. I nodded to myself, and using an interior approach, detached the muscles of the lumbar spine, then asked for the bone saw.
We transected the spinal cord between the second and third lumbar vertebrae, thus preserving the major portion of attachments of the diaphragm. This, of course, was vital, if, as we had planned, Mr. Reagan was to retain the ability to respire. It is well-known that those who leave surgery still attached to the respirator, which surely would have been the case if we had been sloppy in this last part of the operation, do poorly thereafter, often dying in the immediate post-operative period. In this case especially, such an outcome would have been particularly heinous, for it would have deprived this brave man of the fate and rewards most deservedly his.
I am nearing the conclusion of our report, and it must be obvious that I have failed to include each and every nerve, ligament, muscle, and vessel that we removed. If it seems a critical error, I can only say that it is a purposeful one, intended to improve the readability of this document. Hopefully, I have made it more accessible to the laypeople that exist outside the cloister of our medical world, but those who crave more detailed information I refer to the Archives of Ablative Technique, vol. 113, number 6, pp. 67-104, or, indeed, to any comprehensive atlas of anatomy.
We sealed the chest wall and sub-diaphragmatic area with a synthetic polymer (XRO 137, by Dow) that is thin but surprisingly durable and impervious to bacterial invasion. We did a towel count to make certain that none were inadvertently left inside the patient, though at that point there was little of him that could escape our attention, then Dr. Guevara inserted the jugular catheter that would be used for nourishment and medication. Dr. Biko fashioned a neat little fistula from the right external carotid artery, which, because we had taken the kidneys, would be used for dialysis. These completed, we did a final blood gas and vital sign check, each of which was acceptable, and I stepped back from the table.
“Thank you all very much,” I said, and turned to Mr. Reagan as I peeled back my gloves. He was beginning to recover from the drug-induced paralysis, and his face seemed to recoil from mine as I bent toward him. I have seen this before in surgery, where the strange apparel, the hooded and masked faces, often cause fright in a patient. It is especially common in the immediate post-operative period, when unusual bodily sensations and a frequently marked mental disorientation play such large roles. I was therefore not alarmed to see our patient’s features contort as I drew near.
“It is over,” I said gently, keeping my words simple and clear. “It went well. We will take the tube from your mouth, but don’t try to talk. Your throat will be quite sore for a while, and it will hurt.”
I placed a hand on his cheek, which felt clammy even though the skin was flushed, and Dr. Guevara withdrew the tube. By that time the muscle relaxant had worn off completely, and Mr. Reagan responded superbly by beginning to breathe on his own immediately. Shortly thereafter, he began to shriek.
There are some surgeons I know, and many other physicians, who believe in some arcane manner in the strengthening properties of pain. They assert that it fortifies the organism, steeling it, as it were, to the insults of disease. Earlier, I mentioned the positive association between pain and tissue survival, but this obtains solely with respect to ablative surgery. It has not been demonstrated under myriad other circumstances, and this despite literally hundreds of studies to prove it so. The only possible conclusion, the only scientific one, is that pain, apart from its value as a mechanism of warning, has none of those attributes the algophilists ascribe to it. In my mind these practitioners are reprehensible moralists and should be barred from those specialties, such as surgery, where the problem is ubiquitous.
Needless to say, as soon as Mr. Reagan began to cry, I ordered a potent and long-lasting analgesic. For the first time since we began his face quieted and his eyes closed, and though I never questioned him on it, I like to think that his dreams were sweet and proud at what he, one man, had been able to offer thousands.
Save for the appendix, this is the whole of my report. Once again I apologize for omissions and refer the interested reader to the ample bibliography. We have demonstrated, I believe, the viability of extensive tissue ablation and its value in providing substrate for inductive and variant mitotics. Although it is an arduous undertaking, I believe it holds promise for selected patients in the future.
As of the writing of this document, the following items and respective quantities have been produced by our regeneration systems:
Item |
Source |
Quantity |
Oil, refined |
Testes: semniferous tubules |
3761 liters |
Perfumes and scents |
Same |
162 grams |
Meat, including patties, filets, and ground round |
Muscles |
13,318 kg |
Storage jugs |
Bladder |
2732 |
Balls, inflatable (recreational use) |
Same |
325 |
Cord, multi-purposed |
Ligaments |
1.2 kilometers |
Roofing material, e.g., for tents; flexible siding |
Skin: full thickness |
3.6 sq. km. |
Prophylactics |
Skin: stratum granulosum |
18.763 cartons of 10 ea. |
Various enzymes, medications, hormones |
Pancreas, adrenal glands, hepatic tissues |
272 grams |
Flexible struts and housing supports |
Bone |
453 sq. meters |
The vast majority of these have been distributed, principally to countries of the third world, but also to impoverished areas of our own nation. A follow-up study to update our data and provide a geographical breakdown by item will be conducted within the year.
Michael Blumlein, M.D. was an American fiction writer and a physician. Most of his writing is in or near the genres of science fiction, fantasy, and horror. His novels include The Healer, The Movement of Mountains and X, Y. He was been nominated for the World Fantasy Award and the Bram Stoker Award. His final work was the novella, Longer, which came out in 2019, a few months before he died of cancer.