Mary Roach - Grunt

“It’s not,” Jezior says when the topic comes up, “as well situated as we’d like it to be…”

Dean cuts through it. “There’s nothing. There’s a vacuum.”

DesLauriers’ workgroup has spent seven years meeting with military boards, trying to get Defense Department funding for an on-staff sex therapist at Walter Reed. She gets lots of support, almost entirely verbal. The problem isn’t just budget cuts. “The problem is getting the US government to embrace sex.” She told me about a meeting several years ago with an admiral who headed up Walter Reed. “He said, ‘I don’t understand what we are teaching someone who doesn’t have a penis. What exactly are you going to help that person with?’”

There are so many things DesLauriers could have said to the admiral. She could have said, “Strap-ons, sir? Thigh riders?” She could have quoted from Ellis and Dennison’s book. “‘Incorporation of a residual limb in creative ways, such as stimulating a female partner’s clitoris,’ sir?” “‘Exploration of other areas that could provide more pleasure (e.g., nipples, neck, ears, prostate, rectum),’ sir?” She went with something more basic: “I said, ‘Sir, if I can be very candid with you. Does he have a tongue, and can he be taught?’”

“The other thing to keep in mind,” Jezior says, “is that in the early stages after a major injury, there’s a lot going on that makes sexual intimacy not necessarily the priority…”

Dean, nodding: “Like, Can I brush my own teeth now? ”

“And they’re heavily medicated to get them through this period.” Narcotics, nerve stabilizers, antidepressants. “So if they’re not getting a good erection, you say, ‘Let’s get you through this, get you off the pain meds, and then see how you’re doing.’”

Or, if you’re Christine DesLauriers, you say, “Can you handle a bit of pain? Cut back on the meds for four hours, have sex, go back on the meds.” Catheter in the way? Fold it back and put on a condom. “Absolutely you can have sex with an indwelling catheter!”

Aside from Christine DesLauriers, are there other promising developments? What’s on the urotrauma horizon? What about penis transplants? I’m only half-serious, but Jezior starts talking about experimental work going on at Johns Hopkins.

“Wait, they’re going to transplant a penis?” Some extraneous decibels on that. A couple look up from their paninis.

Jezior says, “Yeah”—the kind of yeah you give someone who’s asked if you want your receipt, or fries with that, like it’s nothing. He adds that one of the patients in the photographs we were looking at is a candidate. Though it won’t happen for at least six months. “They’re doing some cadaver work right now.”

“Really.”

THE ELDERLY DEAD—THE MEN, anyway—always seem to need a shave. Maybe it’s because their demise so often unfolds over a span of days. While dying leaves plenty of unscheduled time one could use for shaving, for trimming one’s toenails or arranging one’s hair, there is little energy for sprucing up and really no call. The two dead men lying on gurneys in the cadaver lab of the Maryland State Anatomy Board this morning share the look—stubble and bed hair—but aside from that, they appear nothing alike. One is fleshy and barrel-chested. His legs are splayed at the hip with knees bent, one higher than the other. The carefree legs of a man dancing a jig. The other cadaver is rigid and lean. His legs lie pressed together like chopsticks. You could almost slide him under a teller window. One body has a tattoo, the other has none.

One is circumcised, and one is not. Given that the surgery being worked out this morning is a penis transplant—a lead-up to the first such operation in the United States—this is the difference that stands out. Though of course it doesn’t matter. The recipient will never wake to see his new endowment. Thus the cadavers weren’t chosen for any particular genital attribute. “They are whoever happened to be on hand,” says Rick Redett, the surgeon heading up the session, “and male.”

Redett and the plastic and reconstructive surgeons assisting him—Damon Cooney and Sami Tuffaha—are from down the road, at Johns Hopkins University. The Hopkins School of Medicine, with funding from the Defense Department, has been the setting for a lot of innovation in the field of transplantation over the past decade. The members of the surgical team that performed the first double-hand and the first above-elbow transplant in the United States are there now. Hopkins transplanters helped refine a technique called marrow infusion, which greatly reduces the likelihood that a patient’s body will reject its new parts. This is especially helpful with transplants of composite tissue. A face or hand—unlike a liver or kidney—is a variety pack of skin, muscle, mucous membrane. If you’re talking about a penis, add erectile tissue to the list. The body may accept one or two kinds of tissue and reject another. Skin is especially problematic because it’s a protective barrier; immunologically, it’s on high alert. To fool the body’s sentries, patients receive an infusion of the donor’s bone marrow—marrow being a generator of immune cells. The donor’s marrow doesn’t replace the patient’s own, but it reprograms the immune agenda to an extent. The body may glower suspiciously at its new parts but stops short of wholesale eviction. A lower risk of rejection means fewer immune-suppressant drugs are needed, and at lower doses. That, in turn, means fewer side effects and healthier patients.

New techniques like marrow infusion have tipped the ethical balance for transplants that are non-life-saving. The benefits of a face or hand—and maybe a penis—transplant have begun to outweigh the drawbacks. (Legs are a less appealing type of transplant, partly because the nerves have so far to regrow. For now, prosthetics present a better option.)

Redett heads the Johns Hopkins transplant team’s reconstructive and plastic surgery arm, and, like me writing this sentence, will stick a body part most anywhere. Earlier he described separating a set of conjoined twins. The sentence ran like this: “…so we transplanted the dying sister’s leg and buttocks and a little bit of her pelvis and then we took her aorta and plugged it into…” Redett’s own features are solidly After-photo: the face well balanced, the nose small to average-sized, the eyes pleasingly spaced. His voice is the stand-out element. He sounds just like the actor James Spader.

Redett pulls on a surgical cap cut like a knight’s chain mail: all the way down over the ears and low across the forehead—the better to ward off cadaver lab smell. (He has a lunch meeting.) Cooney’s cap is a bright green luck-of-the-Irish clover-print number that belonged to his dad. Flashes of gray hair can be seen below it, at his temples, though you would not use the word distinguished to describe him. Adorable you might use. He is forty but looks thirty. He also, in tribute, wears the old man’s magnifying loupes, which are too big for his face and keep sliding down his nose. Today he has a cold, well timed given the odors of the morning.

Veterans from Walter Reed often come to Johns Hopkins for phalloplasty—a penis reconstruction made from a cannoli roll of their own forearm skin implanted with saline-inflatable rods. The resulting “neopenis” is impressively natural looking. It is a testament to Redett’s skill that some of the pictures on his phone could be mistaken for Anthony Wiener–style selfies.