Body of Theseus

by

Parker McIntosh

“WHAT’S THE VERDICT DOC, is this the end of the line?”

Dr. Cicely stood at the door to the patient’s room, taking a moment to gather her thoughts while she looked at him. He was taking the situation better than some patients she’d treated, though she knew how quickly the emotional pendulum swung from jaunty fatalism to denial, anger, acceptance, and a thousand other emotions. She smiled a practiced smile, darned her eyes, and stepped into the room, shutting the door behind her to keep out the other hospital sounds.

“No one can say for sure when the line ends for any of us,” she said. Not the first time she’d said those specific words, and about the thousandth time she’d said some iteration of them. “I’ve seen stranger things. There’s always a chance.”

“Always a chance,” Teddy said with a dark little laugh. “You know, there was always a chance I’d hit the Powerball too, back when I played with my grandma.”

“There’s still time. It’s at what, nine figures? I think I heard it on the radio this morning.”

“I couldn’t spend the money if I had two more of my lifetimes. Abridged or otherwise.”

Teddy Bover’s eyes twinkled dark blue, but they shone wet like stars reflected in a still pool of water. He was on a precipice, Dr. Cicely thought. She imagined him tipping at the edge, already slipping down a steep slope but looking up, obstinately, at the sky. There was darkness behind him, and he knew it. He was refusing to turn and stare it down. 

“So, the results aren’t good,” Teddy said. Dr. Cicely pursed her lips and shook her head. “Liver?”

“Liver.”

“Damn.”

Teddy was afflicted by at least two cancers, one in his colon which had metastasized all over his body. Another ravaged his bone marrow. Surgery and precise radiation initially took care of the colon but couldn’t touch the myeloma. A bone marrow transplant had appeared successful but the immunosuppressants he needed for his body to accept the new bone marrow led to liver failure. They’d tried two more times, agreeing this would be the last. Sometimes the things that don’t kill you, kill you anyway.

“There’s evidence the colon cancer is back as well,” Dr. Cicely said. “We believe that, absent the immunosuppressants, your body will reject the bone marrow and the myeloma will return.”

“I think I’m playing the wrong lottery, doc. What are the options now?”

“At this point, we should discuss palliative care.”

“Pump me full of drugs and send me down the river happy?”

Dr. Cicely held her face still. She understood why Teddy was making light of it. He was young for cancer. Mid-forties, healthy, no family history of chronic disease. In six months, he’d endured a half dozen surgeries, lost a full head of hair, and suffered sleepless, nauseating nights. He’d dropped from a fit hundred and ninety pounds to a gaunt one-twenty. He recently commented to her that he’d found ribs he didn’t know he had. It was a nightmare runaway train, and he just wanted to wake up or get off. Trying to laugh it off, it was his way of dealing with uncomfortable truths. Dr. Cicely didn’t condone, as a caregiver, making light of terminal illness. But she understood it.

“There are clinical trials,” she said.

“Trials?”

“I have to warn you, there’s no evidence to support they’d be more successful than previous treatment. They could be,” she paused, tripping over her words. “They could become, well, they could lead to significantly more discomfort than you’ve already endured.”

She hated that she had to tell him. She’d ignited something inside him. A kindling behind his eyes. There was fire where a spark of fight had nearly suffocated. Hope was a fickle thing. It saved lives and caused untold suffering. Dr. Cicely had her own opinions on what constituted enough care. Though, she thought, she’d never been in the position to put those beliefs into self practice.

“But yes, there are clinical trials. Experimental chemotherapy cocktails. Genetically modified viral vectors. Cell therapies.”

“What about my insurance?” Teddy asked. His insurance was notoriously bad. The hospital would be fighting the insurance company over bills long after he died, even if an experimental drug miraculously cured him of his cancer.

“The experimental wing of the hospital is grant funded,” she said. “Assuming you sign over the right to the data.”

It wasn’t much to ask of a hopeless, dying man. He looked at her with stoked fire in his eyes. She told him the odds weren’t good, but it was as good as telling a drunk that alcohol was bad for them. Teddy’s vitality, however fleeting, proved stronger than Dr. Cicely’s reasoning.

“Will you still be my doctor?” Teddy asked with a hint of apprehension. Dr. Cicely had already turned and opened the door. She was surprised. She hadn’t expected any more questions, or, if there were questions, they would be things like, ‘When does the first trial start?’ or ‘What will they try on me?’ Experimental trials were exciting to a patient. A new frontier of medicine that they assumed already worked. They often didn’t fully grasp the years of studies, the tick marks indicating what still proved fatal but showed promise and what did nothing. The mountains of data required to file for a medical patent that rendered them from patients into numbers, data points for statisticians and regulators. Teddy’s question took Dr. Cicely off guard because it was touching. She’d been a part of his treatment team since the beginning when he presented to the hospital with acute stomach pain and impaired mobility. They’d discussed the chance he had appendicitis, as well as the more frightening diagnosis he received later. She’d held his hand as they put him under for each of his surgeries. She’d met his family, close and extended, and watched their fervor wax and wane. Sometimes she felt like it wasn’t fair. She made connections with her patients. She was part teacher, part counselor, part authority figure, part mother. And, one way or another, they left her.

She turned to Teddy and behind all the fire and excitement in his eyes she saw uncertainty and fear. The same emotions she’d seen that first day. The same ones she saw in new patients almost every day. 

“What did I tell you on our first consultation?” she asked him.

Teddy looked inward, his eyes glazing over for a moment in memory, and he smiled. It drew his cheeks taut, and the pale jagged skin of his lips cracked. 

“You told me this was it. You would be with me until I left the hospital, one way or another.”

Dr. Cicely shook her head in affirmation and left the room.

THE EXPERIMENTAL DIVISION knew that Teddy was on an uncertain timeline and their treatments started quickly. They immediately assigned him a number, plopped entire books’ worth of paperwork in front of him, and gave him a rundown of the treatments they would try.

First was a viral doctor, who wanted to inject antibodies that would specifically target cancerous cells utilizing a virus that naturally evaded human immune responses. The virus was tagged with fluorescent genes and Teddy peed bright blue for a week. There was no impact to his cancer and the virologist, a Germanic looking man with a pointed beard, cursed in a harsh foreign tongue and Teddy never saw him again.

The next doctor didn’t look old enough to have attended college, let alone earn the alphabet soup of letters included on her lab coat both before and after her name. She read from a treatment sheet without looking at Teddy once. She implanted Teddy with bone marrow surrounded by benign tumors that were lab grown from his own cheek cells so that his body would accept them. The tumors looked like lacrosse balls embedded under his skin but unfortunately, while the tumors themselves were accepted, the blood cells created by the bone marrow were rejected. Teddy suffered acute pain all over his body and started bleeding from his orifices. The young doctor promised to write a paper regarding the successful tumor implantation and thanked Teddy. The fact that no progress was made against the cancer didn’t seem to bother her.

The next three doctors all tried variations of novel chemotherapy drugs and radiation. Teddy lost his hair again and threw up so much that his stomach acid burned holes in his esophagus. When the cancer didn’t react in the way they’d hoped, the three doctors decided they could try all three combinations at the same time. For two months Teddy languished in a nauseated stupor. It didn’t touch his disease. He came to in a new room that he didn’t recognize, a tray with a half-empty cup of applesauce on the table next to him that he didn’t remember eating. For once, his mind was clear.

“I guess they gave up,” he said to himself and closed his eyes. The dim light coming under the shades caused them to ache and with his eyelids closed he could feel his heart pounding through the thin skin.

“They don’t want to put you through any more unnecessary discomfort,” Dr. Cicely said. Teddy jumped. He hadn’t seen her in the chair next to his bed, but he smiled when he recognized her. She’d made sure he understood each of his treatments before they started and coaxed him through some of the more unpleasant moments, so her presence now at his bedside wasn’t unusual.

“Discomfort is a funny word,” he said. “It doesn’t quite do all that justice.” He waved his hands in the air at the past year of treatments. “Is that it? Are you here to discuss the palliative option again?”

“There’s one more doctor here to see you,” Dr. Cicely said.

“I thought we exhausted the experimental treatments. That kitchen sink cocktail was the last scratch-off ticket and we came up bust.”

“We’ve been approached by a visiting doctor who is aware of your case. He’d like to talk to you about a theoretical cell-therapy.”

Teddy breathed in and held it, his ribs elevated and visible through the hospital gown. His skin was yellow and a tube was held in place by one red and cracked nostril. His arms were thin and knobby, and his legs didn’t look like they’d support his weight. He let out the breath in a long, raspy, exhale. Dr. Cicely thought she saw resignation in his wraith of a body. And then he opened his eyes.

“What’s his theory?”

There was still an ember of hope. Dr. Cicely shook her head in as much admiration as apprehension for him. She’d watched him go through as much as any patient in the late stages of disease. He put his body through torture for a fraction of a percentage of hope. Despite all the failure and discomfort, Teddy still wanted to try. She couldn’t suppress a smile. “Have you ever heard of the ship of Theseus?”

DR. HOBBES LOOKED MORE LIKE A PHILOSOPHER than a doctor. He was both. MD as well as PhDs in a number of different subjects were included in the litany of awards and accolades that accompanied his title. Teddy’s eyes glazed over reading it all. What he took away was that this Dr. Hobbes was new and shiny. He conducted supposedly earth-shattering research from the heart of biotechnology, mostly on animals, some of whom had apparently survived. That he was talking with Teddy meant Teddy’s case was sufficiently hopeless that he could apply to make the jump to humans. He called his technique Thesean Therapy.

“Consider a ship,” Dr. Hobbes told him on their first visit. He wore a professor’s knit sweater and jeans. His dark and curly hair was unkempt in a way that was still professional. His glasses were rimless but reflected the hospital lights such that they illuminated entirely, giving him a robot’s eyes. “This ship leaves port for a many years’ journey and on this journey the planks of the ship begin to rot. Piecemeal, they replace the deck, the mast, the helm, the rudder. Every splinter of the ship is replaced by new wood acquired throughout their travels. Every stitch of sail is resewn with new thread. Let’s say even the captain and crew are replaced so that no one remembers the original ship. And after all of this transpires, the ship returns to its home port. Is it the same boat?”

Dr. Hobbes stopped and looked at Teddy like a debater waiting to be challenged. He had an academic smirk that was just a few degrees from punchable. But Teddy had stopped paying attention. He was transfixed by the glasses. He was sure he’d seen other doctors with glasses, but these turned to two full moons, two spotlights trained on him. He almost wanted to ask them to turn the lights off to see if the glasses would stay illuminated.

When Teddy didn’t respond Dr. Hobbes’s smirk dropped a few degrees but he pressed on.

“Well, however you lean philosophically, we’ve perfected the technique in rats, pigs, and now monkeys with acceptable survival rates. We’d like to try it on humans. On you.”

“You want to clone me?” Teddy asked. His voice felt slow and far away, like he was hypnotized. Hobbes smiled and shifted his face. His glasses suddenly lost their bright opacity.

His eyes were green, Teddy saw. Teddy shocked back to reality and shook his head.

“Clone? No. We would simply begin a process to replace every cell in your body.”

“Wouldn’t that just replace the cancer?”

“Your cancer isn’t a result of a preexisting genetic issue in your healthy DNA. As a result, the new body wouldn’t have cancer. It would, in a sense, be shed in the replication.”

“How do you . . . how?”

Dr. Hobbes leaned forward, grinning now. Philosophy or medicine, he appeared just happy to talk.

“We take some of your skin cells and allow them to replicate but then cause them to revert back to stem cells. By providing them with the right environment they become different types of cells. Heart, kidney, liver, even nerve cells. We implant them into your body with a little fluorescent genetic tag that initiates a cascading effect on all related cells. Over a period of months, the cells regenerate as stem cells, mature as their respected cell type, and replace existing ones. It continues until all your cells contain that genetic prompter. And then, well, you’re made of all new wood, so to speak.”

Teddy shook his head slowly. It sounded like cloning but not cloning. They were his cells, but were they his cells if they were changed? It was like a question posed at the beginning of a meditation session that was supposed to clear your mind but instead rattled around inside your head and wouldn’t let you settle.

“Would I still be . . . me?”

“That’s the question, isn’t it?” Dr. Hobbes leaned so far forward he almost fell out of his chair. “It’s been the subject of a lot of philosophical debate. Plutarch says that Theseus posed the question around the founding of Athens. But most societies had some version of the same conundrum. Some describe a knife that is rehandled and resharpened over generations and generations. Some people liken it to a pot of soup that is replenished for years and years but never taken off the stove. Is it the same knife, the same soup?”

Dr. Hobbes looked prepared to launch into a full lecture, history lesson and all, and Teddy cut him off.

“Ok,” Teddy said. “You can do it.”

“Do you want some time to think about it?” Dr. Cicely said. She’d been waiting in a chair opposite Teddy’s bed in silence, growing more and more uncomfortable. Dr. Hobbes’s enthusiasm was palpable, like sunlight warming a room, but she’d seen Teddy’s initial wariness.

The last few years, and the most recent six months in particular, had been exhausting for him. He’d gone from treatment to treatment, informed and full of positive energy. But now he just looked resigned. There was hope, sure, but such a tiny amount. “It’s one more treatment,” Teddy said. “One more.”

TEDDY PREPARED HIS FAMILY AGAIN, making calls that were becoming routine. It was a risky therapy. This could be it. They’d grown progressively easier to make but something about the rasping finality in his voice prompted a number of visits as the therapy date approached. Family he hadn’t seen in years stopped in and were shocked at his wan appearance. Dr. Cicely had grown used to Teddy’s emaciated body. She’d watched it waste in degrees. They were seeing the skeleton of a man they had pictured, if not healthy, at least close to their memory of him before he fell ill.

Teddy was placed into a medically induced coma. He squeezed Dr. Cicely’s hand as he went under and offered her a smile that his facial muscles couldn’t quite complete. A team of doctors and PhD students descended on his room. It became a hotbed for people in white lab coats wearing protective goggles and blue nitrile gloves. The number of beeping machines hooked to Teddy’s body quadrupled. There was laboratory equipment that needed to be installed nearby. Beakers of growing cells shook on the counters. Researchers ran out carrying samples and back in with stained cell pictures and reams of data.

A month later, they started to inject him with viscous cell solutions. They started with his appendix, an organ that could be removed quickly if the replication went awry and shouldn’t cause too much lasting damage. When the appendix was biopsied a week later, one hundred percent of the cells showed evidence of a new genetic marker. Dr. Hobbes made an appearance the day those results came in, shaking hands with everyone including random passers-by in the hospital hallway. Dr. Cicely watched him crack open a bottle of champagne and had to ask the researchers to leave the patient’s room. They almost asked her why. He was in a coma, after all, they argued. But she was still listed as Teddy’s primary doctor, and her stern voice carried enough shame-inducing disapproval that they filed out quickly, a few of them embarrassed enough to offer quiet apologies. Dr. Hobbes was last. His face was quizzical. His odd glasses two beacons of mechanical light.

Bolstered by the success of the appendix they started on the other organ systems in tandem. The spleen and stomach. The intestines, both large and small. Colon, kidneys, connective tissues. When the bulk of the viscera was confirmed a replica, they moved on to the bones, the bone marrow. When complete, the marrow pumped new blood and they hooked him up to dialysis machines until every sample glowed with bright green fluorescent markers. They moved on to the blood vessels themselves, which in turn cascaded through the heart and lungs. A small skin graft spread like a flush across his body, until every last hair cell viewed under the microscope showed evidence of novelty.

There was a turning point at which the new body rejected the failings of the old. The cancer was filtered out through lymph and blood and waste. But more than that. An old scar across Teddy’s chin disappeared overnight. The crow’s feet at his eyes tightened as if they were attached to a string pulled from behind his head. Freckles receded like they were absorbing back into his skin until he glowed with youth, even under the harsh hospital lights. The data showed he was cured and deemed the trial a success. Moreover, he looked like a healthy young man. He wasn’t showing the battle signs of a brutal bout with cancer.

DR. HOBBES WOKE TEDDY IN A CROWDED ROOM. Dr. Cicely insisted the bulk of the researchers stand at the back of the room but that forced a whole crowd out into the hallway, craning their necks to see the moment the new man woke up. She looked sternly at them, holding Teddy’s hand and rubbing his arm. His skin felt smooth, like plastic. Dr. Hobbes nodded to her, and she injected a syringe into his IV bag.

Teddy woke up slowly. His eyes fluttered and his breathing deepened. Finally, with a gasp, he opened his eyes. The room they’d moved him to was one of the dearest in the hospital. A room a patient’s insurance would never cover. The lighting was softer and there was a huge window overlooking a lush forest. When Teddy opened his eyes, the sun was rising in the sky and shone through the window. The light caught his eyes and they appeared to glow electric green. The effect was so surprising that Dr. Cicely looked to Dr. Hobbes to see if he had noticed, but his glasses were reflecting as well. Two bright circles.

“Teddy, can you hear me? Can you tell me what you feel?”

Dr. Hobbes was manipulating Teddy’s hands and tapping his arms, elbows, knees, and toes. He moved quickly, assessing flexibility and talking over himself without waiting for Teddy to answer. Dr. Cicely could see him typing the abstract behind those illuminated, inhuman eyes.

He was already trying to figure out a title, both witty and scientific. Something for the headlines.

“Am I better, doc?” Teddy asked, looking at Dr. Cicely. She fought back a cruel smile at Dr. Hobbes and then gave in to an overwhelming good feeling and nodded vigorously. “How long was I out?”

“Seven months,” Dr. Hobbes said, writing quickly on Teddy’s medical chart and making notes on a tablet.

“Seven months!”

“We’ve rebuilt your entire body. It took your mother nine the first time around. And even then, you were just a baby.” Dr. Hobbes said.

There were several dozen other form questions and then Dr. Hobbes posed for a picture with Teddy. Several other researchers crowded around for a larger group picture and then they left. More champagne, Dr. Cicely thought. Sooner than she expected, she was alone with Teddy.

“So, how does it feel?” she asked, sitting on the edge of his bed. Teddy had confirmed he could feel pin pricks on his legs and arms. He’d touched finger to finger, followed a light with his eyes, and responded to questions about his childhood, the president. To all accounts his body was in the shape of a much younger man.

Teddy didn’t answer right away. He opened and closed his mouth several times and looked out the window. When he did speak his voice was raspy, like he wasn’t quite able to control it.

“I don’t know exactly. I feel like I could stand up and walk out right now. I feel like a new man. I guess I am a new man. I’m so used to being sick and always being tired. Always being on the verge of falling to pieces. I’d forgotten what healthy feels like.” He paused again and turned back from the window. “It feels a bit like that dream where you’re at work and you haven’t got any idea what you’re supposed to do. But there’s just this sense of urgency. A desperate feeling that you’re supposed to be doing something, but you don’t know what.”

He looked up at Dr. Cicely and his eyes were shining with unspent tears. Again, they glowed a shocking green, like they were flecked with electricity. She bit her lower lip and nodded slowly, hoping she was conveying a comfort she didn’t really feel. He at least still sounded like the Teddy she’d known for the last few years. But the first time she’d met him, Teddy had a prematurely aged countenance. Like his psyche was tired. The distressed leather of his eye skin had been stained and sagging. This new Teddy looked more like a son than the man. “Am I still me?” he asked, and Dr. Cicely could only continue to nod.

DR. HOBBES FLUTTERED THROUGH THE ROOM like a bird stuck in a room full of windows. He appeared in a fluster of questions and readings, taking pictures and disappearing just as quickly. It appeared Teddy would remain in the hospital, subject to a litany of diagnostic tests until they were certain the cancer was eradicated, and his cells weren’t his cells anymore. 

“When will you publish?” Dr. Cicely asked Dr. Hobbes, grabbing his arm as he escaped from the room holding a professional camera after taking photographs of Teddy’s face in dozens of profiles.

“Publish? Oh, we won’t publish. Not before we patent.”

“Patent?”

“This will change the world,” Dr. Hobbes said. “He’s a new man. Literally. A new man. He could be twenty-five, not forty-five. He might live to a hundred and fifty. If he underwent the procedure again, he might live twice as long.”

Dr. Cicely released his arm and took a step back.

“You intend to patent the cancer treatment. Put something this lifesaving behind a paywall and prevent anyone without money from being cured.”

“Cancer treatment?” Dr. Hobbes looked baffled, head cocked, eyes squinted. He bit his lower lip and looked at the ground, pressing the fingers of his free hand to his eyes. “Yes, of course, this will treat cancer. And in thirty years, when we’ve economized it, the public will benefit. We may very well eradicate the disease entirely. But that will cost billions. And where will it come from? People will pay those billions to erase their wrinkles and tighten their wobbling necks. Put an insured cancer patient and an aging celebrity in a free market and guess who will be priced out of it? Every dollar we earn will bring us closer to whatever medical utopia you’re imagining, but those dollars are necessary first. Did you see my team? Did you see the millions of dollars this cost for one man? Who do you think funded this study?”

Dr. Cicely stepped back, trying to remember the arcane, infinitesimal text on the thick reams of disclosures she’d worked through with Teddy.

“So Teddy’s the only lucky person, maybe in his generation, to see what it’s like to have transformational healthcare? He’s the only person who isn’t rich that gets to leave the hospital with a new life?”

“Leave the hospital?” Dr. Hobbes coughed. He pointed behind Dr. Cicely into the room. “There isn’t a single cell in that room that matches the original DNA of or that belongs to the man who was Teddy Bover. As far as the paperwork that he signed and my legal team are concerned, that’s my ship now.” Dr. Hobbes turned on his heel and walked away. Dr. Cicely looked back into the room. Teddy was looking away from her, out the window and over the trees. The room was comfortable and the evening light streaming into the window was yellow and warm. She imagined the dozens of hospital rooms like this one that were about to open around the country, instead of the thousands of less comfortable ones that could be. She might be alive to see the patents run their course, or the nonprofits and competitors sweep in to offer similar services. Then again, it might never prove profitable to rebuild just any person. She wondered if Teddy would survive the legal battles that were bound to ensue over his personhood. Was he Lazarus? Or, as Dr. Hobbes claimed, was his body a brand new ship? Was he a man, forty-five, cured of cancer, or, according to the medical establishment, a baby? He turned to her, the sun behind him casting his face in shadow. His eyes, new eyes, electric green, glowed in medicinal darkness.