Mary Roach - Grunt

From off behind us comes the voice of James Spader. “If you don’t have a pair of cadaver shoes, you’re not doing enough research.”

In a previous session in the same lab, Tuffaha located a vessel coming off the femoral artery that perfuses the skin of the lower abdomen just above the penis. They’re rechecking this, to be sure it wasn’t an anomaly. Tuffaha reaches up to open the valve on the IV. Within seconds, a time-lapse bruise unfolds. The area expands and darkens, its boundaries made clear. “This is great,” says Redett. “We can take this whole area as part of the transplant.” Transplanting a penis is like transplanting a tree. You don’t just lop it off at the trunk. You take the ground around it and the roots that nourish it. In all, three to four veins, a like number of arteries, and two nerves will need to be connected.

The donor cadaver, the lean one, lies on his back, one forearm draped across his waist. It’s a relaxed pose, a movie pose—postcoital, maybe, or poolside chaise longue. It’s an odd visual, given the proceedings. Tuffaha and Redett have by now disconnected the whole package: penis, scrotum, and a peninsula of flesh above and to the side, which contains that critical artery Tuffaha found.

Redett needs photographs for an upcoming conference presentation. Tuffaha obliges by holding the unit in front of the camera. With thumbs and forefingers he dangles it by the two top corners of skin, then reverses it, so Redett can document the back side. Imagine a mother-to-be at a shower, holding up a baby sweater for guests to admire. It’s of similar size and floppiness, is what I mean. Possibly there was a better comparison to be made, but let’s move on.

I later asked Ronn Wade, who runs Maryland’s body donor program out of an office down the hall from the lab, what he would say in the event he was contacted by a family member wanting to know how this cadaver was used. He answered that he would tell them it was a “multi-use clinical/surgical specimen.” Having seen what I’ve seen, I understand the need for vagueness. Before you could expect a body donor’s family to accept the specifics of the research under way today, they would need to understand the specifics of its promise. They’d need to have a sense of what it’s like to be a soldier or Marine who wakes up from surgery after an IED blasts a hole in his life. They’d need to appreciate that the procedure being developed in this windowless horror movie of a room has the potential to restore the wholeness of a young man: his future, his relationships, his well-being. More graceful, I think, to leave the particulars of the gift unspoken.

THE DONOR’S work is done. Where his penis was, [18] In the same way amputees feel phantom pain in the space where the arm or leg once resided, penile amputees sometimes feel phantom pleasure. This, and phantom erections, were first described by the coiner of the phrase “phantom limb,” Silas Weir Mitchell. What gave Mitchell his particular expertise? He worked with Civil War amputees at the “Stump Hospital” in downtown Philadelphia. Oh, for the titular economy of yesteryear. The Stump Hospital is gone and in its place we have the likes of the Veterans Affairs Center of Excellence for Limb Loss Prevention and Prosthetic Engineering. Though all is not lost. We still have a Foot & Ankle Center in London, a Breast Clinic in New Delhi, a Kidney Hospital in Tehran, the Face & Mouth Hospital in Calcutta, New York’s Eye and Ear Infirmary, and the Clínica de Vulva in Mexico. The poor penis has no hospital to call its own. there’s a crimson rectangle, a loincloth of his own tidy gore. The testes, skinned, have been pulled off to the side of the hips. “You’re not taking these?” I ask Redett. As though he were packing for a trip. I’m thinking now of combatants whose injuries leave them unable to generate sperm. It might be nice to give them, along with a functioning penis, a reproductive future. What’s a few more ducts and tubes to hook up?

It’s trouble. That’s what it is. Hook up the testes, and now the penis donor is also a sperm donor. If the transplant recipient impregnates someone using the dead donor’s testes—and, more to the point, his genes—whose offspring will that child be? What if the donor’s widow tries to lay claim to her dead husband’s sperm, now being generated inside a different man? What if the dead man’s parents want a relationship with their biological grandchild? Cooney looks up from the stump: “It could get weird.”

I asked Ray Madoff about this. Madoff is a professor at Boston College Law School and the author of Immortality and the Law, the go-to book on the legal rights of the dead. “It’s no weirder a problem than we already have,” she said, meaning that the United States years ago entered the uncharted waters of donor sperm and donor dads. “Some countries, sensible countries, have statutes and regulations about what happens to the sperm of dead men.” The United States isn’t there yet. It’s a place where judges have ordered sperm donors to pay child support, and rapists have been granted visitation rights to a victim’s child.

For now, more practical matters stand in the way. It’s enough of a challenge to find people who’d be willing to let Rick Redett take the penis from their brain-dead, respirator-oxygenated loved one and stitch it onto another man. Taking the cellular lineage, too, would, as Cooney says, “be beyond the normal donation that most people would consider.” In the meantime, simpler options exist. The military could, as a matter of course, bank sperm from each male soldier prior to deployment.

Rob Dean, the Walter Reed andrologist from chapter 4, counters that even that isn’t simple. “It’s an elective procedure,” he said when I visited. “The military can’t say, ‘Line up, we’re going to make you donate sperm.’” There’s also a cost-benefit issue. Maybe three hundred veterans from Operation Enduring Freedom suffered injuries that left them infertile. “So for those three hundred you’re going to bank sperm for a hundred fifty thousand men?” In the current climate of Defense Department budget cuts, it’s a tough sell. Madoff surmised that military budgeteers might have an additional concern. A widow who uses a dead veteran’s banked sperm may be creating not just a baby but a government beneficiary.

A third option exists. Sperm typically live about forty-eight hours, so it’s possible—if things look testicularly dire—to extract the last batch, the soldier’s last shot at biological fatherhood, in the operating room. “But again,” said Dean. “If they haven’t consented, I can’t do it. I don’t know if this guy wanted to be a father, now or ever. I need to know that, or have a [prior] directive from a legal guardian or next of kin. The wives and girlfriends get upset, but it’s not their body.”

So education is what’s being done. Information about sperm banks is sent to service members before they deploy, so that at the very least they’re aware it’s an option.

Not good enough, says Stacy Fidler, a veterans’ reproductive rights advocate I spoke to at Walter Reed. With support from a national infertility nonprofit called Resolve, Fidler is pushing for on-base sperm banks. She lives with her son Mark, a Marine who has been recuperating in an apartment at Walter Reed National Military Medical Center since the propulsion charges on three grenades on his belt were set off by a nearby IED. Mark lost all of both legs and both buttocks. Although, quoting Stacy, “the big boy’s fine,” there was some damage to the testes, and the family doesn’t know whether Mark will be fertile once he heals.

MARK WAS on his bed when I arrived. It was midafternoon, and the curtains were closed. The Big Bang Theory was playing through a projector set up on his bedside table. I sat down in the one chair available, in the path of the projector’s beam. The actors sniped at each other on the side of my head until Mark reached for a remote and shut them down. Pressure sores made it too painful for him to sit upright. Without the cushioning of buttock muscle, the bony points of the pelvis can wear through the skin. Mark’s bed had become his couch, his office, and his dining table. Within arm’s reach were three remotes, an iPad, a plate of donuts, and that simplest of prostheses, the rattan back scratcher.