“What do you think I should do?” I was half-teasing. I didn’t expect anyone to decide for me. But I did want to know what she thought.
“I’d prefer you not die a painful death,” Gina said. She blinked a bit too quickly and took a slow and measured breath. She was still struggling to compose herself. “But whatever you decide, I’ll stand by you.”
“Like you’ve been doing,” I said. “For thirty years.” I knew she felt as if she failed me because she couldn’t be the one to figure out how to fix us. But it wasn’t on her shoulders, what happened. It wasn’t on any one person’s shoulders.
I only have a few days left to make the decision. Should I choose the rock? Or the hard place?
One of the doctors said it might help me cope if I started writing down my thoughts and feelings if they became too overwhelming, or even if they were manageable.
I should be panicked, angry, sad, depressed even, anxious, at everything I lost. And panicked, angry, sad, and anxious about everything I still have to lose. And will lose. But I’ve spoken to so many psychiatrists and psychologists and therapists that I feel like I’d be wasting time. I don’t have much of it left. I don’t have time to feel sorry for myself. I’ll let other people take care of stuff like that. I do want to make sense of it. I do think it’s a good idea to write something down. I need to sort it all out in my head. Maybe it will help me make the decision.
They call me a Blood Sleeper. There are nine of us left here at home. Out in the world? Who knows. We are the last people in the world to still have Modern Blood flowing through our veins.
***
I’m no scientist, but I ended up learning a lot about blood when I was young. I have—or had—an inherited condition called thalassemia major. My medical charts have all the details. I don’t need to go over it. Suffice it to say, I had a fairly serious version of the condition and had to get regular blood transfusions. And because the transfusions raised my iron levels, I had to get something called chelation therapy. And I had to worry about dying before my parents. And leaving my little sister, Gina, all by herself to deal with everything.
Along came Modern Blood.
Over the ages, lots of people have tried making artificial blood or putting stuff in our blood vessels that they hoped would be even better than natural blood. I remember reading about the earliest recorded blood transfusion and how some folks in the 1600s or thereabouts were trying to replace blood with milk or salt solution. Blood does a lot of things for us. The red blood cells carry oxygen. The white blood cells fight infections. The platelets form clots when we get cuts. Blood carries away waste and carries nutrients, hormones, and enzymes to where they’re needed.
In modern times, people were able to make artificial blood that could carry oxygen. But it didn’t do all that other stuff. I think there was some military research about making red blood cells that could do more than carry oxygen, like maybe carrying and releasing anti-toxins. I remember being excited about all of that research and wondering when it would be coming to a doctor’s office near me.
Then I started reading about an international project that was trying to go one better and make a synthetic blood stem cell. We have natural blood stem cells that mature into all the cells that float around in our blood, the red, the white, the platelets. These natural stem cells are called—and I’ll check my spelling later—hematopoietic stem cells. They live in our bone marrow. That’s where they grow and mature.
The synthetic cell, called the hemosynole, was designed and made to do whatever the natural blood stem cell could do and more. The one thing it couldn’t do was replicate, because the scientists didn’t want the hemosynole cells to turned cancerous. And they didn’t want the hemosynole cells to get into the marrow, so they were designed to mature when they got to the gut. The hemosynole cells made something called flexi-clot that replaced platelets and could seal wounds faster, even a gushing wound. They made a whole slew of immune-type cells. And they made a modified version of hemoglobin, the protein that carries oxygen. My messed up hemoglobin is—was—the bane of my existence. So once again, I got excited. I tried not to. It all sounded too good to be true. And it was all happening so fast.
The synthetic blood made from hemosynole cells and other specialized components was never meant to interfere with natural blood. Only to enhance it, add to it. They built a few molecular kill switches into each hemosynole cell, just in case it decided to get unruly. They tested the blood. Not on animals. They tested it on human volunteers. It had to be humans. There were so many people working on every aspect. So much coordination, cooperation, and organization, that they received permission in one small country somewhere in the east, to do the human trials.
It was working. News broke. Studies were published. One of the scientists who spoke for the project kept using the phrase, “blood for modern times,” or “blood for the modern era.” So some joker reporter started calling it Modern Blood. It was a lot easier to remember than the sequence of numbers and letters the scientists used in their papers. So the name stuck. Everyone liked it.
When the time for trials was over and when only a few manageable side effects were found, Modern Blood was ready for business.
I prayed that I wasn’t in that small part of the population that their profiling studies had determined might be harmed by Modern Blood. Over time, the researchers believed they would be able to tweak their invention, improve it, build on it, until there came a time when blood donations would be a thing of the past. And so would antibiotics, vaccines, allergy medications and the like. The hemosynole component of Modern Blood was designed to give rise to far more sophisticated immune cells, ones that were better at detecting the “bad guys” than our natural cells, and better at eliminating those threats without the kind of collateral damage that our natural immune response created. It all sounded so advanced, so improbably complex. We couldn’t even cure the common cold, but now we were on the verge of eradicating disease with this new miraculous invention?
At first, Modern Blood rose to every challenge. It was a marvel, and while blood donations were still collected, they started tapering off in some countries. Modern Blood could be given to any blood type. It was free of disease, able to replicate the functions of natural blood and more, improving overall vigor. I was about twenty when it started. But I waited. Like a lot of people. I waited and watched. Time went by. I waited for news that Modern Blood had caused allergies or that hemosynoles were turning into tumor cells or that the cells had gained intelligence and were taking over our bodies. The worst things I could imagine. But it was working. It was working how it was supposed to. It wasn’t miraculously healing people. It didn’t grow limbs or make wheelchair-bound people walk again or blind people see again. It was just blood. It was only life itself.
Even before it passed through trials, there was talk about replacing the blood of healthy people with Modern Blood to improve the overall health of the world’s populations and bring down the overall costs of health care. But it wasn’t all ticker tape parades and keys to cities. Modern Blood had its detractors. Some fanatical. Some quite reasonable.
There was suspicion and backlash from sectors of the scientific and medical communities and also from the public. There were entire countries who refused to allow the use of Modern Blood until it could pass through more rigorous testing and decades more of safety and efficacy studies.
Even the international team of scientists who developed Modern Blood through a university-industry partnership at three top-of-line research and development facilities warned caution. But a dire need and a desperate demand grew. And a relentless propaganda machine took over. It was no one person’s fault that the disaster to come could not be stopped.
***
I had decided to get the transfusion when I was twenty-four. I couldn’t wait any longer. I wanted to get the transfusion, so I could see if it would work on me, give me the promise of a normal life span. Just a chance. That was all I hoped for. I got the transfusion at twenty-five. It changed everything. I felt so…vibrant. I was vibrating. I felt like I was giving off energy. I felt so strong, stronger than ever in my life. I started exercising for fun and my friends laughed at me, but they were happy for me. I started joking with my mom and dad about what they wanted me to say at their funerals, now that I had my chance to outlive them. They loved it. And I told Gina I’d be around to make sure she made something of herself and her life. At the time, she was nineteen and in college with an undeclared major. The happiest year of my life passed.
And then six months after I turned twenty-six, news starting breaking of people getting sick. They were developing fevers, flu-like symptoms that came from no discernible infectious agent. It was not bacterium or virus or yeast or fungus. It was our own blood. And it was not turning against us. It was just trying to do what it was designed to do, but our existing physiologies were not quite compatible.
The fear had been of tumors or tissue rejection. Tumors were not detected. And they wouldn’t be in all the coming years. There had been some instances of rejection, when desperate people who were banned from the transfusion list bought Modern Blood on the black market. So at first, it was believed the illnesses were due to rejection of the transfused blood. But tests didn’t support that belief.
They’re still working on sorting through the data even all these years later, but there seems to be a general consensus that the problem was caused when the hemosynole cells tried to invade the bone marrow and replace our natural blood stem cells. Most people’s bodies reacted, tried to reject the cells. The kill switches worked as designed. The sick people were injected with a compound that was supposed to cause all the hemosynole cells to self-destruct, then given transfusions of donated blood. Cell counts were conducted and none of the sick or even healthy Modern Blood recipients seemed to have any extra hemosynole cells.
There were deaths. Some of them happened because people didn’t get treatment. Some of them happened because once Modern Blood was recalled and then banned, there was not enough donated blood to go around. The media started to call it the Modern Blight. I don’t remember much after. I just remember getting sick. I remember feeling disappointed because I thought the Modern Blood didn’t work, or that it had stopped working. I remember Gina taking me to the hospital.
And then I remember waking up here in this government research hospital with tubes in my arms. A woman who looked like Gina was dozing in a chair nearby and when she woke, she started telling me what had happened, breaking the news gently, slowly, bracing me for the answer to the question of why she looked so different. The woman who looked like Gina was Gina.
I had fallen into a coma. And thirty years had passed.
***
She gave me a day to absorb the news, and said there was much more she needed to tell me, and that there was a difficult decision ahead of me. I spent the day trying to remember, as if I could bring up memories of things I’d heard in the hospital room while I was sleeping. I thought I remembered some dreams. But nothing more. It was as if I’d gone to bed and simply woke up thirty years later. Machines had aided in my bodily functions. And I felt a little flabby. But other than that, I didn’t feel different. I felt pretty good. I still looked pretty good. And that, I was later to find out, was because Modern Blood still coursed through my veins.
I learned about what happened after I fell into a coma. I wasn’t the only one. Thousands of Modern Blood recipients fell into comas. The kill switches turned off the hemosynole cells, but for some reason, the cells didn’t clear out of these patients’ bloodstreams. A third of the coma patients died. There were protests, riots, lawsuits. And yet the scientists who invented Modern Blood said they could save lives by correcting what was wrong with it.
They tested every lot and batch of Modern Blood. They analyzed the manufacturing records and traced the problem to a contaminant in the later batches. It was never discovered if the contaminant was there by accident, something missed by the quality control procedures, if it was there on purpose, for sabotage or terror, or if it was never recognized to be a contaminant in the first place. They could have made more Modern Blood, with more rigorous screening. But now demand swung the other way. The demand was to get rid of Modern Blood. But everyone recognized that there was still a need for synthetic blood. Somehow, the science team convinced the public to allow them to manufacture a simpler alternative.
They simplified the tissue design. No more hemosynole. The new stuff replicated natural human blood as closely as they could. It was called Factory Blood. They had made it before and shown it to be as safe as natural blood. But with Modern Blood on the market, no one thought a simpler product would be profitable. Modern Blood versus Factory Blood. It wasn’t like choosing between chocolate and vanilla. Factory Blood was inferior. And yet, it was manufactured and used to save thousands of lives. Even those who didn’t seem adversely affected by Modern Blood and were still benefiting from it were given the Factory Blood treatment. It was an unprecedented event. By all rights, the tragedy of Modern Blood should have halted the artificial blood project. But humanity was just so desperately in need of blood.
Factory Blood worked where Modern Blood failed. It was a modest cousin of the first flashy product. It didn’t have any of the properties that made Modern Blood so revolutionary. Most of the comatose patients who hadn’t died woke up within months of receiving a Factory Blood transfusion. And their blood was found to be free of hemosynole cells at last.
But there were a small number who did not wake, even after multiple transfusions with Factory Blood over the course of several months. In fact, blood tests indicated that the Factory Blood didn’t take, that Modern Blood with its formidable hemosynole cells, continued to circulate.
***
The patients were moved to a government facility, a research hospital, where only family members were allowed to visit and stay with the patients, while scientists monitored them and tested them over time. I was one of those patients. Among themselves, the scientists and even the families started calling us the Blood Sleepers.
While I slept, the world got a safe and effective artificial blood product at last. Factory Blood was plain and simple. It couldn’t fight off infections, not without some help sometimes from antibiotics. It couldn’t prevent allergies or instantly clot a gushing wound. But it was better than donated blood. It was free of disease and it could match any human blood type.
Not enough time had passed since the Modern Blight for people to let down their guard. Everyone seemed to be waiting for the other shoe to drop. But Factory Blood has been going strong for over a decade now. And scientists are slowly adding components to it, starting with mature synthetic blood cells that have differentiated to perform specific functions, as opposed to synthetic stem cells. Certain populations, like people with blood diseases and soldiers in active war zones, had been given transfusions of the Factory Blood Enhanced or “Factory Blend,” as it was colloquially named, and had seen benefits.
Slowly, the wrongs of the Modern Blight were being righted. And the mystery of the Modern Blight was being solved. One curiosity remained. The Blood Sleepers.
But the contaminant was not the only flaw in Modern Blood. The behavior of the hemosynole cells continued to stump the researchers. The hemosynole cells had succeeded in entering the bone marrow in the Sleepers and in replacing the natural blood system. That was why transfusions of Factory Blood hadn’t managed to sweep away the hemosynole cells. In the Sleepers, the hemosynole cells had found a way to replicate themselves. Maybe they had come into contact with natural blood stem cells and they had merged. But why and how had the cells attempted to override the natural blood system in some people but not in others?
Aside from the fact that we were comatose, we all seemed quite healthy. In fact, we didn’t exhibit any of the usual symptoms of patients who are bedridden. No pressure ulcers or sores developed on our skin. No infections or pneumonia. We didn’t lose much muscle or bone density.
And we didn’t seem to be aging.
There were dozens of Sleepers scattered around the world. At home, there were fourteen. Only fourteen, though it was conceivable that other Sleepers were out there, hidden away by loved ones or allies who did not trust the scientists and government officials whom they blamed for causing the Modern Blight in the first place to fix the problem. So it was fourteen. Then one died abruptly, giving no sign or indication beforehand. An autopsy was performed, but no apparent cause of death was found officially. Unofficially, it was believed that somehow Modern Blood had caused the man’s death.
The rest of us were watched even more carefully after that. Exactly one year later, another Sleeper abruptly did something unexpected. He woke up. Two months before I woke.
***
Some had theorized that the hemosynole cells in Modern Blood had tried to migrate to the brain and pass through the formidable cellular wall that protects our delicate brains from any dangerous things in the bloodstream. But autopsies on Blighted coma patients revealed no hemosynoles in their brains.
So others wondered if the combination of Modern Blood and each of the Sleeper’s individual body chemistries led to change in our physiologies that required so much focus and concentration that it shut down conscious function in the brain, an unintended effect, being as how conscious functions such as eating were eventually required to sustain us.
Gina had made something of herself. She was a hematologist. She was helping with the research on the artificial blood project. So she explained some of the theories and findings to me. Much was still unknown since there were limits to how they could study us Sleepers.
The day after I woke, Gina came with Mom. They told me that Dad had passed away just the previous year. I had indeed outlived him, but not in the way I’d expected. He left me some messages in case I ever woke. I’m saving them for later. I was sad about Dad, but I was hopeful too. I’d missed out on a lot during the thirty years. Giving a goofy toast at my sister’s wedding. Watching my nephews and niece grow up. Throwing a surprise fiftieth anniversary party for my parents. But there were some things that were still ahead of me. I was supposed to be in my mid-fifties. But I hadn’t aged more than a year. I still had time to figure out my own future. To have a career, a family of my own. To see what had changed.
Gina let me dream while Mom was there. But the third day after I woke, my sister came back alone. And she explained some things. The goods news. And the bad.
***
“It would appear that the synthetic stem cell differentiated into a number of different cell types,” Gina said, holding up a tablet and swiping through microscope images. “When we examined the blood samples from all of you, we noted some of these, but thought they were just intermediate stages. We have a catalog of the cells. We even suspect we know what some of them can do. Increased protection against radiation. The ability to change the composition of the body’s microbiota—that’s all the bacteria that live on and in us. There are even white blood cells that seem to be generating a slight electric field. And a family of others that we call the triage lymphocytes because they can tag cells that are at differing levels of health.”
“Doctor, I’ve been in a coma for thirty years,” I said. “If that’s because my mind needed to focus on making major renovations to my body, I would think I’d have more to show for it than a slightly increased ability to withstand radiation.”
Gina frowned, believing I was teasing by calling her “Doctor.” I was, a little. But mostly I was just proud. I’d had a little sister. And now I’d know what it would be like to have an older sister. We were still on the good news. I’d been doing treadmill tests and memory exercises and psychiatric evaluations. It was my third day awake from a thirty-year coma but I felt as sharp and strong as if I’d been training for a marathon and studying for finals for months.
We were sitting outside the cafeteria in the patio area. There was no one else around. Gina took a deep breath and put her hand on mine. Her eyes began to water. She blinked, took another breath, and cleared her throat.
“It’s called blood madness,” she said, and she told me all about it.
The thirteen Sleepers were waking. First one and another soon after woke a few months prior. Four had woken a month after that. Three others woke within days of each other and me. The others still slept. They would have been expected to wake soon if not for that first Sleeper who died a year past. Maybe he was an outlier.
I and the three others who woke with me were being carefully watched and monitored because the first two to wake had succumbed to something that the scientists started calling “blood madness.” They seemed fine at first, exhibiting all the wondrous effects of Modern Blood, including some of the new never-before-seen cells that I and my fellow Sleepers—or Wakers now, I guess—were sporting. The cells that Gina was trying to tell me about. After a week or so, their vital signs started showing abnormalities. Then they went berserk. They caused a tremendous amount of damage because they were so strong from the blood. They had a high tolerance for pain, so tasers didn’t work to subdue them. The first two died after wrecking a lab and putting seven people in the hospital. One of them was shot to death. The other collapsed and was later found to have suffered a severely ruptured heart. Each of the four that woke later, exhibited the same warning symptoms before also flying into what seemed a psychotic rage. All four were shot with tranquilizers. The tranquilizers didn’t work until high doses, far above safe levels for humans, were used. On two of the patients, the tranquilizers wore off and then stopped working. They were strapped down. They died within days.
The two remaining patients responded to the tranquilizers and sedatives. And their vital signs seemed to return to normal. Some had a hunch. So doctors put the two into forced comas, as dangerous as that was. Those two were and are still alive. So by the time I woke, we Sleepers were down to nine. And the scientists were afraid of what the bigger picture might be in the link between Modern Blood and whatever changes were being made to the minds of the Sleepers.
That’s what made Gina wonder if Modern Blood in addition to improving physical health was attempting, by an extension of its original purpose and design, to improve mental health, and had overreached itself.
I saw my future slip away again. Not by disease this time. This time, by the cure.
Tears were dripping down Gina’s face, but she wiped them away and composed herself.
“So if they put me back to sleep…”
Gina nodded. “You’ll live.”
“And I won’t go mad while I sleep?”
She shook her head. “We can’t tell for sure, but I believe so. We’re working on figuring it out. But we can’t predict how long it will take. I can’t predict if we’ll figure it out in my lifetime, or even yours, whatever your lifespan will be once you’re sleeping again.”
“How does blood do all of that? Keep us young? Make us sleep? Wake us up? Drive us mad?”
Gina shook her head. She frowned. I could tell she was angry at life on my behalf.
“Do I get to meet my niece and nephews and give my brother-in-law a once over before all the bad stuff goes down?”
And that broke my little sister’s composure. She start crying. And I got up and knelt beside her and hugged her. And I remembered doing that once when she was six and I was twelve and something had made her terribly and deeply sad.
Death or a coma, I thought.
Gina let go and pulled back. She was smiling, but her smile faded. “Since you’re awake now, you can make a choice. Do you want to sleep? Do you want to be left alone while you sleep? Or will you allow the testing to continue? Or you can choose to die.” She was still gripping my shoulders and her grip tightened. “Not like the others did, in a mad rage with your heart torn apart. We can gather around, the whole family, and any friends you want. We have time for that.”
“If I stay awake and let nature take its course, and let them study me, would they be able to learn enough to help the others?”
“Don’t make that choice.” Gina shook her head. “I’ve only seen video and heard stories. It will be a horrible death. I’d be lying if I said we couldn’t learn anything if we restrained you and had you hooked up to monitors. But the question isn’t whether or not we could learn anything. It’s whether or not it would be worth it for all the suffering you’d go through. It wouldn’t be worth it.”
“So my two choices are eternal sleep or…eternal sleep?”
Gina looked stricken.
“I want to get out of here, then. There’s some stuff I want to do.”
Gina smiled again. “We’ll have you over on Saturday. Mom and I will make your favorite.”
I was monitored and watched even when I was outside the facility, but allowed to do what I wanted until I started exhibiting symptoms. I met my nephews and my niece and their menagerie of pets. Gina didn’t lie to them. They knew I would be going away and this was their chance to spend time with me, and apparently to try and impress me with armpit farts and bad celebrity impressions. My brother-in-law never got the once over. He wasn’t trying, but he impressed me. I never dreamed that my sister would get over the deadbeat types she used to like and end up with an upstanding guy who didn’t let her get away with anything.
I didn’t visit any friends. It had been too long and I didn’t want to cause anyone else more pain and confusion after they had mourned me and moved on. I went to a few favorite places alone. I tried to make a bucket list. I cried like a baby over the messages my dad left me. I tried learning as much as I could about the synthetic blood story. I asked the opinion of some of the researchers whom I’d come to know. I asked them how much it would help the other Sleepers if they could monitor me while I allowed myself to succumb to blood madness. I asked them what kinds of new tests they planned on running on me if I gave permission. A week passed. I wasn’t showing any symptoms of the madness yet. But two of the other Wakers were. I’d met them once, asked them what choice they were making.
Gina had told me I still had time, but I called her on the seventh night of my waking. She answered and I tried to fix the sound of her voice in my head as I closed my eyes and spoke.
“I’ve made my decision.”
Copyright © 2015 by Nila L. Patel.