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BEDSIDE CONVERSATIONS

“It’s not entirely unprecedented,” said the doctor, “but so far as I know, this is the first time it’s happened in the present medical context—which means, of course, that it poses a novel moral problem. I’ll have to refer it to the hospital’s Ethics Committee, of course, and they’ll want to interview you, but I’m certain that the essential decision will be left in your hands.”

Gerald heard what was being said to him, but couldn’t find a sensible way to react to it. It was as though his thought-processes had seized up, leaving all the ideas in his head stuck fast, grinding against one another painfully as he tried to force them into motion again.

Dr. McClelland waited politely for an answer, but when none came he repeated the last phrase, for the sake of emphasis. “In your hands,” he said, as though he were bestowing a favour.

Gerald found his voice again. “What did you say it was called?” he asked.

“Fetus in fetu. What happens, you see, is that the fertilized ovum divides, as it does when producing identical twins—but then one embryo develops faster than the other, growing around it. Usually, development of the engulfed embryo is simply suspended and never restarts; even in those cases where it does restart it rarely produces a perfect fetus.”

“This has happened before, then?”

“Oh yes. The first reported case was in the late nineteenth century, when the French surgeon Dupuytren found an apparently-entire fetus in the body of a thirteen-year-old boy. In England at a slightly later date Blundell tracked the development of a similar fetus in a nine-year-old, which was contained in a sac and connected to the abdominal wall by an umbilical cord. At thirty-one you might be the oldest person on record to have the problem, but you’re certainly not the first.”

“What happened to the two boys?”

“Those particular ones both died. But you needn’t worry about that, Mr. Duncan; this is the twenty-first century, not the nineteenth. You’re in no danger at all. The twentieth-century cases fared better. A surgeon named McIntyre operated to remove a similar fetus from an eleven-year-old boy in the 1920s; the boy made a full recovery. I found records of three later operations, all successful—but the last one was in 1992, before the first successful experiments in tissue-reconstruction.”

Gerald found a lump in his throat, which he couldn’t quite contrive to swallow. He was possessed by a perverse mix of emotions. On the one hand, he was deeply relieved that the tumor had turned out not to be malign; on the other hand, he was horrified by the revelation that it wasn’t really a cancer tumor at all, but the phantom embryo of a twin brother he’d never had. He pressed his right hand to the bulge that was distending his abdomen to the side of his navel. Four months had passed since he first noticed the swelling—two since he had belatedly become anxious enough to seek medical advice.

“How soon will you need to operate?” he asked, numbly.

“It’s not as simple as that,” replied McClelland, patiently. “That’s what I’ve been trying to explain. It has to go to the Ethics Committee—but I really am certain that the final decision will be left to you.”

“What decision?”

“What will happen to the embryo, of course. That’s why there’s a new precedent to be established, you see. In none of the cases I’ve cited could there be any question of the embryo surviving and coming to term, so the only possible course of action in each case was to remove it. Nowadays, though, we have other options. If we act promptly, it’s possible that we could transplant the embryo into a host mother. On the other hand, we could use tissue-reconstruction to stimulate your own cells so that they’d develop a viable placenta. In fact, the Ethics Committee might take the view that the one thing we can’t do is to treat the fetus as if it were a tumor—they could well conclude that an operation to remove it would count as an abortion, in which case it would be illegal by reason of the twenty-week time-limit.

“As far as I can tell, the fetus is at the same developmental stage one would expect of a twenty-four- or twenty-five-week embryo. It’s smaller, of course, but I have no evidence to suggest that it’s damaged. In my experience, Ethics Committees always look for the closest thing to a precedent they can find—and they’re likely to take the view that you should be viewed as if you were a pregnant mother who, for some reason, can’t actually give birth.”

“I’m pregnant,” said Gerald, feeling that the notion was more than slightly surreal, “and I can’t get an abortion.”

“That’s not unprecedented either,” said the doctor. “In fact....”

“Never mind the precedents,” Gerald interrupted him. “Let’s stick to me. Are you telling me that I might be forced to carry this fetus until it’s capable of independent life—that you won’t cut it out until you’re sure that it can survive in an incubator?”

“No, I’m not saying that,” replied McClelland, testily. “The fetus is still viable now, but that doesn’t guarantee that you can carry it to term—not, at any rate, without considerable tissue-restructuring to make sure that you can sustain it while it grows. It might be better—indeed, it might be a matter of some urgency—to transplant it into a woman’s womb, or into one of the new artificial wombs under test at St. Mary’s. That’s a decision you’ll have to make, but it must be an informed decision, morally as well as medically—which is where the Ethics Committee comes in.

“I’ve already sent in my preliminary report, but the committee will want a more detailed one as soon as I’ve collated all the data. We can’t discharge you—and we must respectfully demand that you don’t discharge yourself—until the committee has met and made its views known to you. But you really mustn’t worry; what we all want is to figure out where your best interests lie, and where the best interests of your brother lie.”

The vital phrase—”the best interests of your brother”—lingered in Gerald’s mind long after the doctor had gone.

* * * * * * *

“I’m pregnant” said Gerald, flatly.

“If that’s a joke, dear heart,” said Mark Cleminson, “it’s in very bad taste, and it isn’t even funny.”

“It’s not a joke,” Gerald assured him. “It’s a fetus in fetu.”

While he explained, with painstaking patience, he studied Mark’s face very carefully.

Mark and Gerald had been together for five years, and married for two. They had married, in fact, a mere three days after the law had at last been amended to permit same-sex marriages. They had—not unnaturally—been carried away by the triumphant feeling that a great victory had been won for justice and equality, and that its potential must be exploited to the full. Alas, Gerald sometimes felt that their relationship had failed to live up to the expectations into which that moral and political victory had seduced them. Like most marriages made on earth, theirs had fared no better than those supposedly made in Heaven, and he was no longer sure whether or not Mark still loved him—or, for that matter, whether Mark had ever really loved him. He couldn’t help wondering whether this might be the acid test which would reveal the truth of the matter.

“It’s a trifle macabre,” said Mark, when the explanation was complete, “to think of you swallowing up your little brother-to-be like that. One expects a certain amount of sibling rivalry, of course, but prenatal cannibalism is taking things a little too far, don’t you think?”

Gerald pursed his lips, but dutifully suppressed his impatient ire. “It’s not a joke, Mark,” he repeated, patiently.

“Oh, cheer up,” Mark retorted. “Yesterday we thought you might have some dreadful cancer devouring you from the bowel outwards. I’m sorry if I sound flippant, but it’s mostly relief, I assure you. You did say that it isn’t dangerous, didn’t you?”

“It isn’t dangerous,” admitted Gerald, “but it isn’t straightforward either.” He explained about the Ethics Committee, carefully gauging Mark’s reaction to every point in the chain of argument. He knew that he was going to have to go through this whole thing again, at least twice more. His parents would have to know, and so would his employers. He hoped that it might not be necessary to tell anyone else, but he could hardly avoid the dreadful fear that the media might get hold of the story. It would be news anyhow, but the fact that he was married to another man would give the headline-writers a field day.

He already knew how his parents would react to the story, because they always reacted the same way to everything he did—with pain, shock and horror. They subscribed very heavily to the where-did-we-go-wrong school of rhetoric, and they would try to make him feel as guilty about this as every other respect in which he offended them. In fact, he had a nasty suspicion that his mother, at least, would instantly begin to believe that her life would have been much less troubled if only Gerald had been the embryo that was engulfed.

It was harder to guess how they would react at the office; everyone there had been supremely sympathetic and supportive while it seemed that he might have cancer, but this was something else.

All in all, Gerald felt that he had just undergone an instantaneous role-switch from brave invalid to freak, and he badly needed some reassurance from his first and closest confidant to the effect that other people could ride with the punch.

“That’s repulsive,” said Mark, when he’d finished. “Do they seriously imagine that you’d consent to tissue-reconstruction just so that you can carry the fetus until they’ll condescend to whip it out? Hell, it’s like one of those old twentieth century jokes about homosexual couples, which should have been laid to rest with the Dark Ages. Holy shit, they will keep it quiet, won’t they?”

“I suppose they’ll try,” Gerald replied unhappily. “At least, they will if they remove the fetus. If they don’t...well, news is bound to get around if I have to put in an application for maternity leave.”

“Now who needs reminding that it’s not a joke? Thank God it’s your decision—it will be your decision, won’t it?”

“So the doctor says—but it has to be an informed decision, medically and morally. He was very clear about that. Whatever’s best for baby....”

“Whatever’s best for both of you. The greatest good of the greatest number, remember. Don’t let the bastards talk you into anything. I wouldn’t trust a doctor as far as I could throw a feather into a headwind.”

Neither would I, thought Gerald. That’s why I delayed going to see one, and thus made certain that this would become a matter of some urgency. Aloud, he said: “I won’t. But Dr. McClelland’s right—it does have to be an informed decision, and it has to be taken very carefully.”

Mark stared at him, his grey eyes as hard as flints. Gerald couldn’t figure out, now, just why he’d once thought that those eyes were extraordinarily sexy and sensitive.

“Gerry,” said Mark, in a voice which was suddenly rather cold, “you couldn’t possibly think that you might carry this kid around for the next God-knows-how-long. You couldn’t possibly.”

“It would only be for three months at the most, Mark,” Gerald pointed out. “And when all’s said and done, he ain’t heavy—he’s my brother.” He couldn’t suppress a giggle, despite the fact that he was trying to be serious. The flippancy, in fact, was only a way of concealing just how serious he was.

An informed decision, medically and morally--that was what it was all about. The doctor was right.

“That’s not funny, Gerry,” said Mark, who was of course correct for all the wrong reasons. “That’s not funny at all.”

* * * * * * *

“Your father and I talked about it all night,” said Leonie Duncan positively, “and we’re agreed that there’s only one thing to be done.”

“Oh yes,” said Gerald, hollowly. “And what’s that, mother?”

“The baby has to be transplanted, as soon as possible.”

“Well,” said Gerald, dubiously, “that may turn out to be the best decision—but I’m not sure as yet. Dr. McClelland’s given me the results of the latest tests, and I had a long conversation with the secretary of the Ethics Committee this morning. He’s convening a meeting this evening, so that we can go over the alternatives very carefully. Until then, it just won’t be possible to make a final decision, no matter what you and Dad may think.”

“Committees can’t make decisions, Gerry,” said Leonie, with the casual air of one stating the obvious. “The committee that set out to design the horse came up with the camel. It’s as plain as day what should be done, and we don’t need any committee confusing the issue.”

“But it’s not as plain as day, mother,” said Gerald, wearily. “It’s really rather complicated, medically speaking.”

“Well I’m not speaking medically,” she said. “I’m speaking about right and wrong, and there’s only one rightful place for that baby.”

She was looking at him so assertively, and yet with such awkward embarrassment, that he was quite confused. Several seconds passed before he suddenly realized what she meant.

“Oh my God!” he said. “You can’t be serious!”

“He’s my child,” she said, assertiveness tipping over into naked aggression. “He’s not your child—he’s mine. He doesn’t belong in an artificial womb, and he certainly doesn’t belong inside you. He’s my son, and nobody has any right to put him anywhere else but in my womb. I’m willing to do it, Gerry, and I’m willing to go to court to establish my rights.”

“Mother,” said Gerald, feeling once again that strange sense of the surreality of his condition, “you’re fifty-seven years old. What makes you think your womb’s in any fit condition to carry a fetus?”

“Don’t be ridiculous, darling,” Leonie replied. “I may be menopausal, but I’m in perfect working order—and if I’m not, I’m certain that it would be far easier to reconstruct my tissues than it would be to reconstruct yours. After all, I do have the right equipment, even if it hasn’t been used for a while. And afterwards, the child would be with its natural parents.”

“Dad’s sixty-three. Are you telling me he wants to be a parent again?”

“He already is a parent,” said Leonie decisively. “It’s not a matter of want—it’s a matter of fact.”

“If the fetus is to be transplanted,” Gerald said, trying to sound gentle, “and if we decide against an artificial womb, I think it would be best to look for a younger and healthier surrogate mother.”

“Well I don’t,” she retorted. “And if that’s what your Ethics Committee decides—or if that’s what you decide—I’ll fight it. This is my baby, and no one else has a better right to carry him and give birth to him—and there isn’t a court in the land which would award custody of him to anyone else.”

“Mother,” said Gerald, patiently and soothingly, “I don’t think you ought to be thinking like this. Mark and I would far rather keep the whole thing quiet—we certainly don’t want any tabloid publicity. If you go near a court, you’ll have every newsvid team in the country baying at our heels. Whatever I decide to do will be in the best interests of everyone, I promise you—but you must see how difficult it is. Imagine that it was one of your friends—what would you say if you found out that Margery Lingard was proposing to have a fetus transplanted into her womb? You’d be horrified, wouldn’t you?”

“He’s my baby,” said Leonie Duncan, doggedly. “He’s not yours, he’s mine. My son. My natural son.”

Gerald winced at the double meaning, and saw his mother smile thinly. She knew perfectly well what she’d said; he knew perfectly well what she meant.

He knew, also, what Mark would have said had he been here. “Let the bitch have it, and welcome” he’d have said. Mark didn’t usually want Leonie Duncan to have her own way about anything, but this would be too good to miss—in Mark’s view, it would be killing two birds with one stone. And he’d be right: one stone, two dead birds. Maybe really dead.

“I’m going to see your blessed Ethics Committee,” said Leonie, defiantly. “I’m going to see them right now, and I’m going to make sure they know what I think. An informed decision is what you want—and an informed decision is what you’re going to get. They’ll give me this baby—or else.

Gerald watched her go, feeling infinitely wearier than he had when she first came in. She always had that effect on him, and he guessed that she always would. Nothing could change that; nothing at all.

* * * * * * *

“How did the meeting go?” asked Mary Blake, anxious curiosity very evident within her gentle politeness. Mary was Gerald’s Head of Department, and his only friend of the opposite sex. Gerald was hoping fervently that she’d be just disinterested enough to provide him with a little honest sympathy.

“Efficiently ponderous would be the best description, I think,” he said. Then, as if quoting from a book of regulations, he intoned: “The Ethics Committee of this hospital consists of five people: a senior consultant, a hospital administrator, a social worker, a lawyer and a lay adviser. The administrator acts as secretary, the lawyer as chairman.

“Also present at the meeting to decide the fate of Fetus Duncan were Drs. McClelland and Digby, expert witnesses. Mr. Duncan was duly informed that he had the right to be represented by an advocate, which opportunity he duly refused, it having been made clear to him that the meeting was not supposed to be an adversarial situation, and that everyone’s hope was to reach a unanimous decision as to what could and ought to be done.”

“Sounds dire,” said Mary.

“Not really,” said Gerald. “They had to take pains, you see, to make sure that everything was understood, and everything was taken into account. They weren’t just being pompous.”

“And what did they decide, in the end?”

“An Ethics Committee,” he intoned again, “is not a decision-making body. It acts in an advisory capacity only—but its duty is to advise the hospital as well as the patient, and if it considers the patient’s decision to be ill-founded, has a duty to advise the hospital of any such judgment.”

“I mean,” she amended, “what did you decide?”

“I haven’t, yet,” he admitted. “I have to make up my mind by six o’clock, so that the Committee can meet again and decide whether to endorse my decision or do the other thing. Time is standing still while I ponder the issues involved, weighing the pros and cons as carefully as I can.”

“Of course,” said Mary, “it’s none of my business really.”

“Yes it is,” he told her, dolorously. “It’s your business, and Mark’s, and my mother’s and my father’s, and McClelland’s. Whatever I decide to do, it will affect other people—that’s one of the things I have to bear in mind. There’s the surgeon who might have to transplant the fetus, the surrogate mother who might have to carry it, the doctor in charge of the artificial womb which might otherwise have to carry it, etcetera, etcetera. God, wasn’t life simple when it was only a tumor that might have metastasized, leaving me with six months to live?”

“Nobody gets six months to live any more,” she said. “This is 2003. Everything’s curable these days.”

“Even a fetus in fetu,” he agreed. “The wonders of tissue-reconstruction. Did you know that more than a hundred men have carried fetuses to term, worldwide? That’s in spite of the bans in the EC and America. One hundred and seven successful Caesarian births—mind you, there have been some messy miscarriages too.”

“Wouldn’t the transplant option be easier?” she asked. “Safer for everyone.”

“Safer for the corporation’s image,” he agreed. “Unobtrusive­ness is the life-blood of our promotion prospects, isn’t it?”

“That’s not what I meant,” she said, in an aggrieved tone.

“No,” he admitted. “I know it’s not. And maybe it would be easier in strictly medical terms. Except that I can’t help feeling that I might be pitching the poor little proto-person into a bear pit, where various contending parties might contrive to rip it apart while trying to save it.”

“You mean that the artificial womb people may start fighting with the supporters of surrogate mothers? I suppose we’re overdue for some kind of test case in that particular debate.”

“Actually,” he said, mournfully, “I was thinking about my mother. But you’re right, of course. The artificial womb people might well be looking for a soft target, and a fetus in fetu is certainly softer than a little bundle of cells in its own mummy’s tummy.”

“Is Leonie likely to make trouble?”

“Trouble,” he said, “is far too mild a word for it. Hell hath no fury like a woman’s who has finally discovered the perfect way to pay back her only begotten son for being gay.”

“Shit,” said Mary, sympathetically.

“Couldn’t have put it better myself,” he said.

“So what are you going to do?”

Gerald looked at his wristwatch. Normally he found the old-fashioned display reassuring, but today the second-hand seemed to be going round in an unnaturally hasty manner. He couldn’t help feeling that a digital might have had a little more decorum.

“I’ll know,” he said, “in just over two hours’ time. Anything sooner would be bound to seem hasty, wouldn’t it?”

“I wish you the best of luck,” she said.

“Luck,” he assured her, with a sigh, “has absolutely nothing to do with it. It’s purely a matter of moral and medical reasoning. I have all the necessary information—all that remains is to convert it by the power of pure reasoning into the right decision.”

“I still wish you the best of luck,” she said. “And however the dice come down—I’ll do whatever I can.”

“Thanks,” he said—and meant it.

* * * * * * *

Inevitably, it transpired that when six o’clock came, Mary Blake was the only one who had the decency not to be there and waiting. Leonie Duncan and Mark Cleminson turned up on the dot, and so did Dr. McClelland—but Gerald had no intention of making a speech.

“I’ll see you one at a time,” he insisted. “First the doctor, then you, mother, and Mark last. Please don’t argue about the order of precedence—there isn’t time for that sort of nonsense.”

He watched Mark and his mother exchanging resentful glances, neither one of them quite sure whether or not they had been awarded the most favored position in the queue. In the end, though, they had to accept it. It was his decision, after all.

When they had both gone, and the door was closed, Gerald told Dr. McClelland what he had decided.

“You don’t think,” said McClelland, dubiously, “that it’s going a bit far? It’s at least one step beyond what’s strictly necessary.”

“You can do it,” said Gerald, “can’t you? It’s by no means unprecedented.”

“In itself, no,” admitted the doctor. “But for this reason...you haven’t, I suppose, had any leanings in this direction before?”

“None at all,” Gerald confessed, feeling that the seriousness of the occasion precluded a diplomatic lie. “But circumstances alter cases, don’t they?”

The doctor nodded. “I’ll have to refer it to the Committee,” he said, “but I think they’ll go along with it. As I’ve always said, I think they’d go along with anything you decided to do, except perhaps....” He nodded in the direction of the closed door.

“There was never a chance of that,” said Gerald.

“Do you think she will go to court, now that you’ve decided?”

“I hope not. I hope Dad will talk her out of it. But if she does, so be it. After all, I can hardly hope to avoid publicity now that I’ve made my decision, can I?”

“No,” said the doctor, pensively. “I dare say you can’t.”

* * * * * * *

“You can’t” said Leonie Duncan, angrily. “It’s preposterous. You can’t do it.”

“Yes I can,” said Gerald, patiently. “It’s perfectly feasible, and it avoids the worst aspects of both the other solutions. Tissue reconstruction is done all the time—it’s just a matter of switching the right genes on and off.”

“It’s obscene,” she said. “It’s unnatural.”

“Mother,” he said, quietly, “everything that enables us to be human and civilized is unnatural. Wearing clothes is unnatural; speaking languages is unnatural; building houses and roads is unnatural; medicine is unnatural; in fact, every god-damned thing that makes life worth living is unnatural. The only natural thing in this whole affair is that ridiculous freak of a baby brother, which is slowly turning into a king-sized pain in my gut. Nature is all stupid accidents, mother—human life is about taking reasoned decisions to oppose and overcome the waywardness of nature. That’s what I’ve done. I won’t say that it will be easy, but I will defend the reasonableness of my decision in any and every court in the land, if I have to. So you’ll just have to go away, and decide what you’re going to do, and then do it, won’t you?”

Leonie Duncan burst into tears. “Whatever did we do wrong?” she wailed.

* * * * * * *

“You can’t,” said Mark Cleminson, in utter disbelief. “It’s preposterous. You can’t do it.”

“Yes I can,” said Gerald, patiently, conscientiously repeating himself. “It’s perfectly feasible, and it avoids the worst aspects of both the other solutions. Tissue reconstruction is....”

Mark didn’t wait to hear the rest of it. “But what about us!” he complained. “Don’t I figure in this at all?”

“Of course you do,” said Gerald. “We’re married, aren’t we? That doesn’t have to change, unless you want it to.”

“Doesn’t have to change! You’re mad, do you know that? Mad!”

Gerald studied those hard grey eyes. They looked like the eyes of a blind man, staring but not seeing.

“I suppose you’ll tell me now that this is what you’ve always wanted,” said Mark, converting his sense of injury into a sneer. “I suppose you’ve decided that you were never genuinely gay—that you were really a heterosexual woman in the wrong body. Well I’m gay, and there is no way I’m going to put up with this nonsense. I’m telling you straight: get this thing transplanted—I don’t give a damn whether it ends up in your mother, or a machine, or any place else—or we’re through. Finished. Kaput.”

“Suit yourself,” said Gerald, with a lack of remorse that surprised him more than a little. “It’s only tissue-replacement, you know, not an identity transplant. It needn’t even be permanent—I could change back after I stop breast-feeding. I’d still be me.”

“Like hell you would,” said Mark, as though he were spitting out powdered glass. “Like hell.”

* * * * * * *

Afterwards, when Gerald was alone—at last!—the doubts began to creep in. He laid his hand yet again on the fetus in fetu, wondering anxiously what the pangs of birth would actually be like. Like the torments of hell, perhaps...very possibly, in fact. It wasn’t something he was looking forward to. It wasn’t something he could look forward to—but women did it all the time, and by the time he had to do it, he’d be a woman too, at least for a while.

It wasn’t simply that he had to become a mother in order to compete with his own mother. It wasn’t that at all. It was the fetus in fetu whose needs had to be given top priority. Viable it might be, but it was facing a prospect that no proto-human individual had ever faced before in the history of the world. It had to be given every chance; he thought that he owed it everything he could give.

So he’d made his decision.

The trouble with informed decisions, he thought, is that there’s too much bloody information by half.

But it wasn’t heavy, and it was his brother...and sometimes, he figured, a man just had to do what a man had to do....

That was all there was to it, really.