From the author: Love, sacrifice, and stem cell organ printing.
"Nine hundred and twenty-five thousand dollars, above insurance." The price, finally uttered, erased everything said before. The doctor's mellow tones, his reassurances.
Karen gripped Dave's hand, and his gray face became grayer.
Fine. Karen would sell the cars. Remortgage the house. Or they could move to a smaller place, maybe a basement suite. There were bonds, investments. She could pick up more hours tutoring after school, put off retirement, quit her volunteer work at the hospice and get summer jobs. Hell, she could work nights at the local Denny's.
She reached out and took Dave's hand, her fingers cold, her grip hard and commanding.
"No." Dave's mouth set.
"We have to talk about it," Karen was quick to interject.
Dave glared at her, sidelong, jaw clamped, and she heard nothing as Dr. Campbell's quiet voice continued from behind his desk. She was calculating. They had four thousand dollars in their savings account. They had their retirement savings and a line of credit. And they'd simply cut up the credit cards.
"...bring you some coffee." And the cherry door eased closed with a click.
Karen spun in her chair, perching on the edge of the supple leather, and grasped both of Dave's hands in her own.
Fury flared through her, a flash of heat. "How can you do this to me?" She wanted to claw his face and shake him and hold him close to her and never let go. "You want me to be a widow? Live the next forty years alone? Go to bed every night without you? You're being offered one of their last batches of special cells. How can you even think of saying no?"
His lips, pressed closed over that tight jaw, quivered, but remained resolute. His fingers gripped hers just as hard, spilling love in their painful grasp.
He couldn't talk. She knew he couldn't talk. He would not defend his position, just stick to it. But she couldn't keep the words inside. "Money is only money." She had to organize her arguments logically, make him see. "So we go without a few things. Go into debt. I cannot--I will not--" Her throat closed.
Agony etched itself into every line on his face, glistened in his eyes. "You think I want to leave you?" he managed to whisper. "It's too much. Didn't you hear Dr. Campbell? A million dollars. And the surgery's experimental."
"It's not experimental. The organ printing process has been approved by the, whatever, MHPD. The government. They don't use your defective cells. They use the cells from some weird person who doesn't have proteins, or something. No risk of rejection. No anti-rejection drugs. No complications from reduced immunity."
"There'll be something. Hidden costs."
"No. That's the bottom line. He said it." She jerked her head toward the polished door.
Dave pulled one hand from hers to rub his nose and look out the window. The immense window. Under an over-height ceiling. In a cherrywood paneled office.
She followed his gaze over the gray, silent bustle of the city below, to sun splashed fields and far blue mountains. Their Heaven. Their retirement, together, road trips and fishing and quiet mountain brooks. Slipping away into a hazy distance.
His hand shook in hers, his grip tightening.
She slipped from her chair to kneel by him, press her belly against his knee and slide her hand around his neck, rest her head against his shaking chest. There weren't enough donated livers, not nearly enough. Hers was incompatible. His body wasn't tolerating the medications he'd been given. And Dave had an something, maybe the result of the years he'd spent in the dye factory, that made organs printed from his own cells shrivel within weeks.
Karen had no choice. She had to assert herself. "When Dr. Campbell comes back in, I'm telling him we've decided to do the transplant."
Dave's fist trembled in hers for a moment. Then he engulfed her with his other arm, laid his head on hers, puffing out a shuddered exhalation.
Jessica's heart went out to the woman in front of her. She'd met Karen a few times as she and her husband toured the facility, here in the countryside. Later, Karen had haunted the clinic and its quiet grounds during her husband's tests. Jessica had liked her from their first meeting, sensing Karen had hidden strength. Now, though, Karen was here on her own, perched on the leather chair as though she would be changed forever if she allowed herself to sit properly in it.
"I know the surgery is coming up next Thursday, and we have the money for the next installment--we do--but I was wondering, Dave wanted me to ask, if you had, um, a room that was just, say, a little plainer than the others--"
"You're finding the financing difficult." Jessica leaned forward, resting her hand across her desk, willing Karen to look up from her fingers, look up from worrying her purse in her lap.
The older woman's chin snapped up, eyes round. "We can get the money," she repeated. "We want the surgery."
"Sometimes you have to piece things together," Jessica supplied. "Pull a little from here and a little from there."
"Yes. Yes, that's it." She clutched her purse harder. "Well, for instance, eight days' recovery in the clinic. Could he spend a bit more of it at home? Dave wanted me to ask."
This was one part of her job Jessica hated. The work was important, the money excellent, and Dr. Campbell was an amazing boss. But conversations such as this could be hard. "Studies have been done, Mrs. Stenner," she said gently. "Hiring one-on-one care at home is not only more expensive, it's less reliable. Here at the clinic, we have trained staff--"
The flick of panic in the woman's eyes confirmed she'd had no intention of hiring a nurse. Or, likely, of staying home from work to care for her husband.
"It's not just your husband's health that we have to be concerned about, although that is foremost. We cannot in good conscience release a patient unless he is fit for discharge. You can see it from our position, Mrs. Stenner. We are licensed. We can't afford to jeopardize that. Or our reputation for safety and patient care. Our insurance."
The woman breathed out, eyes fixed on hers, a shaky nod. Jessica didn't know what the Stenners had done to "get the money," but whatever it was, it twisted this woman inside out.
"Hey. Listen." Jessica slipped from her chair, her tall heels silent on the thick carpet, and sat on the chair next to Karen. "You've come to the right person. It's my job to do whatever I can to help with our clients' financial situations."
Karen sniffed and Jessica gave her a tissue.
"You came to us because you heard about our transplant programs. But, perhaps you haven't heard about our collection programs."
The woman blinked in confusion and pushed a strand of limp hair from her face. "No."
"We pay for plasma donations. And there are certain circumstances--insufficient suitable donors for certain of our programs, for instance--where we pay other expenses."
Karen blanched. "You don't buy organs?"
"No!" Jessica laughed. "We actually print them, just as you were told. But we do buy plasma."
The woman frowned as if calculating how much blood she would need to give to earn a million dollars.
Jessica reached for a brochure on the side table. Dr. Campbell's corporate model was not to pressure clients, but when a match worked out, people benefited. "Would you give permission for a background check? Financial and medical? That way we could see which of our programs you might qualify for."
The woman clutched the glossy trifold. She shook her head and closed her eyes. "Yes. Please. God bless you."
Surgery. Karen bit her knuckle, staring through the double glass doors at the immaculate grounds and wide driveway of the clinic, blurred now, with rain. A few more hours. Then Dave would be done.
Karen sipped her coffee, her third, and the caffeine wasn't helping. She'd fled the waiting room. The lounge was no better, though at least here, there was a human presence. A man at the far end watched television. A woman read a book.
The long hand on the clock clicked from six minutes past three, to seven minutes past three.
A young couple and their toddler came in from the corridor. They stopped at a chair near the rain-streaked door.
"It's not the money." The woman held the sleeve of a duckling-yellow raincoat open as the man guided the little girl's hand into it.
Money. Karen wasn't the only one obsessing about it.
"But we'd pay," the husband said, steering the child's other hand into the second sleeve. "They know we'd pay."
Here was a family that didn't have the worries Karen did.
"They don't have the special cells." The mom put a rubber boot on the child's foot. "They can't grow the pancreas."
Karen's gaze snapped to the little girl. Heartbreakingly thin. Yellow cast to her skin. Pain-pinched eyes.
"You can get anything with money," the dad argued, pulling on his own raincoat. "We'll offer them more."
"If they don't have the cells, they don't have the cells." The mom held her hand out, and the child took it. "Linsy, stay with me, baby."
An ache sprang up in Karen's chest. The poor child. The poor parents.
She watched the family go through the glass doors, the father opening a wide umbrella.
By God, she and Dave were lucky. So lucky. Karen wished there was something she could do. Share her good fortune.
The doors fell closed and the family blurred into the rain.
"Hey." Dave turned his head on the raised pillow and grasped Karen's hand, a sleepy smile lighting his amazing face, bringing tears of joy and relief to hers.
Fresh flowers scented the table in the bay window overlooking the gardens and pond. Afternoon sunshine slanted through the balcony doors to warm the tiles before the fire place. An extra bed, so Karen could stay over when she wasn't at work, filled a nook on the other side of the ensuite.
She kissed him and inched her chair closer. "How was your nap?"
He let his eyes close and lines of worry creased his brow. "Good."
"And your pain?"
"Good." He turned to the window. "You made the follow-up payment on the surgery?"
"Bank get the lien on the house?"
"I signed the papers on my lunch break."
"And they gave you the full amount? In spite of us drawing down the line of credit?"
"Ninety per cent of what we asked for."
Dave chewed the inside of his lip.
"It'll be enough." She wasn't sure she believed it, and she knew Dave didn't, but she had to say it anyway. "I worked the figures." Fifteen times. More.
He rolled his head back. "How about your sister?"
"She's good for now. She'll help us."
"And her husband?"
"I don't think she told him about the loan."
Dave studied her face, calculating the implications.
"Listen. I've got you, and that's all I care about. She'll make him come around." And if she didn't--what? Theft? Fraud?
"You look tired." Dave took her hand. "You're not sleeping. I'll come out of this with fifty more years, and you'll drop dead at my feet."
"Morbid!" She swatted him. Then she reached over and surrounded him with her hug. "I have no intention of dying."
He held her to him. "You're a good soul, Karen."
The day before Dave's discharge, Karen met with Jessica and Dr. Campbell after work.
The doctor, tall and heavy with a healthy head of dark curls, rose from his chair at the polished conference table. "Mrs. Stenner. Welcome." He shook her hand and indicated a high-backed chair. "Please, have a seat."
The thrum of rush hour traffic, muted by triple-paned glass and velvet drapes, deepened the headache from the tension of her work day and the anxieties of the long night. At least the lighting was subtle, illuminating only the cherry table and its scatter of papers and water glasses. She felt brittle.
"Congratulations." Jessica held out her hand, smiling broadly. "Your approvals for our alternative programs came through, as I knew they would. I thought you'd want to know right away."
Karen lowered herself to the chair, its bumpy leather too luxurious to touch. "You certainly checked everything." The words came out almost peevishly, like an accusation, which Karen didn't exactly intend...though the invasion of her privacy had gone far further than she'd expected. "Even my volunteer work at the hospice."
Jessica lit up, as though Karen's comment had been a compliment. "You care a great deal about helping others." She pushed back long, sprayed hair with a perfect red nail. "It's important to us that you recognize how your altruism, through our programs, will benefit recipients like your husband."
"My brother-in-law said you spoke to him. So, I guess you know my sister's finances, too."
"We pride ourselves on being thorough." Jessica leaned into the light. "The good news is, you're eligible for any of our contributors' programs."
Wasn't the financier listening? "I read the brochure. You pay three hundred dollars for a pint of plasma." Karen's nails bit into her palms.
"Ah." Jessica folded her hands. "But you might have noticed the bottom of the brochure asks you to contact us if you're interested in other programs not listed. You qualify for our Enhanced Blood Acquisition Program."
Karen had seen the notice. "Your brochure didn't give details on the other programs."
"That is because very few people do qualify for EBAP," the doctor said. "Mrs. Stenner, what can I say? In simple terms, you have a type of blood chemistry particularly suited to our organization. One we can work with."
Jessica leaned forward. "The EBAP is a monthly, full blood collection paid at substantially higher rates, wherein we provide you with an enhancer that fortifies your blood."
Karen tilted her head. "Like what? Daily vitamins?"
"Similar." Dr. Campbell sat back in his leather chair. "An injection. The fortifier helps your body to increase its blood production, making it possible for you to contribute more often. It also makes the product more flexible for use with a wider variety of patients."
Flexible? "What sort of injection?"
"To be clear," Dr. Campbell looked her straight in they eye, "the material strips cells of their identifying proteins."
To print organs for any recipient. Like Dave. "What rates?"
Jessica topped up her water glass. "Eight thousand dollars per withdrawal."
Karen stared at Jessica. "That's impossible."
"I agree, it is generous," Jessica said. "But there are certain factors you need to be aware of. The fine print."
But...eight thousand dollars a month? That was far more than she brought home, teaching. More than Dave's pension.
"...and because we are still waiting for MHPD approval, it is considered experimental. Technically, you'd be part of a clinical trial," Jessica was saying. "Also, the enhanced program comes with full--free--medical benefits covering any condition related to the procedure."
One word caught Karen's attention. "Experimental." She pushed herself deeper into the chair. She'd be one of those weird people without proteins. "There could be side effects? Is it safe?"
Jessica's gaze flicked to Dr. Campbell.
The doctor spread his hands. "Every procedure has side effects. I'll provide you with a drug information sheet that lists them."
"So..." She looked from one to the other. "What's the catch?"
Jessica pushed a nonexistent strand of hair from her face. "I'd advise you to read the drug information sheet thoroughly, Mrs. Stenner, and be sure to write down any questions you have before our next meeting. Also, there is a non-disclosure agreement. You would have to sign it, and so would anyone planning to come with you to the contribution clinic."
Karen's skin prickled with disappointment. She didn't want there to be a catch. "Like those pesticide test subjects in the sixties?" she asked bitterly.
Jessica covered her hand, encouraging. "A blood enhancer's not a pesticide."
Dr. Campbell spoke. "We signed a non-disclosure agreement with the sponsor of the clinical trials, so I am not at liberty to share any information about it with you. A good number of scientists' and clinicians' jobs are at stake."
"Patents," Jessica said. "It takes years for us to recoup research costs, and we don't want another company bringing out something similar based on our work. You see why we have to be careful. Thorough background checks."
"And, why this program's not on your brochure," Karen said. The secrecy made sense. At least now, Jessica was being open and honest, which Karen appreciated.
"Precisely." Jessica sat back in her chair. "Is this program one you think you might consider?"
Eight thousand dollars a month. She'd have to do the math--there'd be taxes--but--
A chance to grasp that life she and Dave had dreamed of for so long. And...a chance to serve others. Even save lives. Linsy. "Can I think about it?"
"Certainly." Jessica took a piece of paper from a folder and pushed it across the table to her. "I printed out the drug information sheet in case you were interested. It includes a description of the program and any side effects you can expect. You may want to talk to your husband."
Karen took the page and stood. "Thank you. I will."
Jessica stood as well. "You can enter the program at any time, but I do need to remind you that Dave will be discharged tomorrow, and your final payment will be due. However, should you decide to join us, we are more than willing to waive the final payment in lieu of a series of blood withdrawals. For that matter, we could refund your first two payments, as well. We can work all that out in the contract tomorrow, if you like."
The final payment.
No need to borrow from her sister. No need to draw on the line of credit. The house would be theirs again. Their life would be theirs again. Patients like Linsy...
"Thank you. I'll think about it."
Karen didn't tell Dave about the blood collection program right away.
He felt good, and the hospital staff served them both dinner at the table in the bay window overlooking the pond. He was worried about their finances, she could tell, but he didn't talk about it, and the sunset was so lovely she didn't want to bring up money. They sat, long after the meal was done, fingers intertwined, silent with gratitude for the prospect of a long life together. Whatever the fine print in the contract said, Karen thanked God for Dr. Campbell's clinic; Dave was one part of her life she would never lose.
Later, they snuggled together on his bed watching T.V., and then the nurse came with his sleeping pill. They slept together all night on his tall, skinny bed with the sides up, like two spoons in a drawer. In the morning, the nurses woke them early and technicians came to draw Dave's blood. Dr. Campbell had to examine him, and Jessica was waiting for Karen in her office.
Karen pulled the information sheet from her purse in the receptionist's office and took it to the window to read in the morning light. Blood withdrawals once a month. Accompanying weakness and lethargy. Immunodeficiency--
"Mrs. Stenner." Jessica stood in the doorway to her office.
"Yes. Sorry." She found her way into the conference room. Today, the drapes were open and cheery sunlight poured through the windows.
"Did you have any questions about the procedure?" Jessica asked, once Karen had taken a seat. A pen lay on the table.
"Yes..." Now that the time had come, all moisture had fled from her mouth. "How many participants do you have in this...EBAP program?"
"Five." Jessica eased herself into her chair.
Karen was confused. The image of Linsy, pale, pushing a small fist into her raincoat popped into Karen's mind. "I was under the impression you had no donors, now."
A crease formed between Jessica's brows.
"Another applicant?" Jessica pressed her lips closed, eyes downcast a though she, too, thought of Linsy. "The cells are difficult to culture, and each organ we print requires a number of contributors. We have no cells, currently. I wish could say otherwise."
Dave was one of the last recipients. "And the side effects? The drug sheet said weakness and immuno--"
"Immunodeficiency. The weakness would be temporary after each blood withdrawal, and you would be at increased risk to become ill. You would have to be more careful than most people to avoid germs."
"How careful?" She envisioned herself and Dave in their RV.
"It varies with each contributor." Jessica pressed her lips together. "I wish I could be more specific. We've had some contributors with a good energy level and others who needed more rest. As for germs, it is simply best to stay away from people who are sick."
Karen's hand hesitated over the contract.
"Mrs. Stenner, no one is forcing you to join our program. If you are uncomfortable..."
But--Dave. The money. Her sister.
And Linsy. Not only could Karen help her own situation, but she could help so many others.
A clench of certainty wrapped icy fingers around Karen's heart, and her skin flashed cold. There was no choice. "No. I'll sign." She scratched a quick scribble.
Karen and Dave were driving on a winding, sun dappled road amongst orange-gold poplars and dark spruce. They'd woken that morning to sweet autumn perfumes and a hint of frost, crunched on toast and bacon by a wood fire, walked on rustling leaves to the shore of a tiny lake, and stood hushed, hand in hand, watching a pair of swallows dive for early insects. Now--
A touch woke Karen. "Hey."
She blinked in the dim light. The beige curtains of her familiar cubicle surrounded her. The musty, antiseptic smell returned.
She smiled, taking Dave's hand to her lips to kiss. "Remembering our trip to the mountains."
She nodded and closed her eyes, still tired, still gripping his thumb. The clinic was a vast, shadowy space infused by the silence of humming machines.
"I found something."
She opened her eyes.
Dave held a scrap of paper in his other hand. "Your math."
She wasn't sure what he was talking about.
"Eight thousand dollars per withdrawal. After taxes, you contracted to make two hundred contributions."
She shook her head, not following.
"Ten years, Karen. More."
Sleep rose up around her again.
The urgency in his voice brought her awake.
"Since you entered the clinic in September, you've been home twice. Twice!"
But she could not keep her eyes open. And that day, that beautiful day, waited for her in sleep.
"What did you say to me, back then, back when we were in Dr. Campbell's office? You asked how I could do this to you." There was something in his voice. A tremble. "Make you live the next forty years alone."
She struggled to bring him into focus, to bring the meaning of his words home. Something...something was sad, not right. Something she'd done. She reached out a leaden hand. I love you, she wanted to say, but the words would not form on her tongue.
And then...the thought was gone.
She rolled over. Dave was all right. He was well. That was what mattered.
"I go to bed every night without you. Karen, I'm alone--" His fingers tightened on hers, hurting.
But Linsy was saved. Wasn't she? Karen felt good about that. And, so many others.
Karen let her eyes drift closed. The sun splashed fields waited for her. She, too, would be all right.
This story originally appeared in Analog.