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The gift of life.

Credit: JACEY

From the operating table, Rosa Clarke watched the anaesthetist insert a line into her right hand. For a 15-year-old, she must have had difficult veins, because he had to poke her twice before the burgundy blood flashed back up the catheter. She didn't flinch.

Usually I don't enter the OR until the residents have prepped and draped the patient, but this one was special.

She was the youngest spontaneous donor we'd ever had, and arguably one of the smartest. I crossed to her side. “Are you sure?”

She nodded, but whispered, “My grandmother would kill me.” She looked about as pale and thin as the hospital sheet she was lying on. Her long, wavy, cinnamon-coloured hair was the brightest thing in the OR.

When she first walked into my clinic, all I saw was the hair. Recessive gene jackpot. I scanned her face: another check mark for mild to moderate freckles. Then she'd made me see her as an individual. First of all, she pointed out the high miscarriage rate. Even though we did our best at immunohistogenetic matching, our success rate was worse than any other transplant surgery.

I'd started to believe my own hype. The applause of my colleagues at conferences was addictive enough without the gifts, donations and documentaries of reci-moms. Just that morning, I had downloaded a mini-movie in which the reci-mom held a Doptone to her very pregnant belly, cut to a PG-13 shot of the labour, and ended with her holding newborn baby girl. “Thank you, Doctor Fletcher, for helping our dream come true.”

But Rosa had said: “Isn't it true that more than half the fetuses die? Even with you doing the surgery? And you're supposed to be the best, aren't you?”

Then she refused to answer questions about her parents. “I left that blank on purpose. You can ask everything about me, but not my parents.”

I'd objected to this question myself. We don't know how much of intelligence is genetic, and careers don't equal intelligence. The board psychiatrist had intoned, “IQ tests aren't practical. So for most spon donors, parental occupations are the best we'll get. Birth mothers want smart babies.”

So this strange, strong, red-haired girl was a woman after my own heart. At least, she was until she refused to answer my questions about her partner. “Rosa, it would help your embryo to answer these questions. The ones who don't get placed, well, you'd have to go back to the old-fashioned choices of abortion, adoption or raising the baby yourself.” Her green eyes revealed nothing. “Tell me anything. Like, does he have red hair?”

Rosa half-snorted. “No.”

Too bad. I wrote, non-red hair. “Anything else?”

“Anything to sell my baby?” she snapped.

I studied her for a minute. “Anything to play the game, so your baby has a better chance at life.”

“Ha.” She blinked away a tear. “What happened to just wanting a baby?”

I shook my head and didn't answer.

Her fists clenched. “I want it to have a good home. That's why I…” She cut herself off and stared at me. “I want to screen the birth parents back. I want to see them before they get…implanted.”

“Done.” Highly unusual, but no one would have to know.

“Now, about — him.” She thought a little. “He plays the trombone. He's good at science, and he has a great French accent.” A smile flickered. “He — likes children.”

In the silence, I said softly, “That's fine, Rosa. Thank you.”

She signed the consent forms so hard that her pen ripped the page.

So now, with Rosa before me, I asked her one more time. “Are you sure you want to donate your embryo?”

She turned her head away. “Just do it.”

The residents stopped talking. I felt the anaesthetist's and nurses' eyes on me. Finally, I said, “All right.”

Once she was under and prepped and draped, I made an incision just above the pubic hair, to open the abdominal layers down through the peritoneum. A resident retracted the bowels. I gently incised the uterus with a robotic scalpel. Under the microscope's guidance, I removed an embryo the size of my pinky nail as well as its placenta. The nurses sighed with relief when I slipped it into a nutri-gro bottle.

The anaesthetist woke up Rosa and wheeled her to recovery, and after a quick room-clean, the reci-mom rolled in, praying. Her husband stroked her hand. “Don't worry, Lorna. We'll have our little redhead yet, God willing.”

The embryo would have one recessive, red-haired gene from its mother. Artificial downregulation of the melanocortin-1 receptor could guarantee red hair, but it was still unpopular, especially with the religious candidates.

Two hours later, I ducked into step-down recovery to tell Rosa all had gone well. “Someone can take you home.”

She swung her legs over the side and grabbed the bed for balance. “I'll call a cab.”

“Rosa, you're still…”

“I'm fine.” She started to stand, then froze. I followed her gaze to a young man in the hallway. “Booker!”

He caught her before she fell. “Baby.”

“Booker.” He stroked her hair, and she wrapped her arms around him tightly. “Booker, you came.”

They looked so young, so right together. My throat ached. His dark cocoa fingers moved tenderly against her red, red hair.

A cry strangled in my throat.

“Doctor!” Rosa held herself just out of his arms. “Doctor, Booker is not the father.” He opened his mouth, but she sliced it off with a look.

I'd listed the father's race as unknown when the reci-parents signed. Now I had possible information that one of my patients wanted suppressed, and the other, more powerful patient, would want known.

There was no test for race — there were more molecular genetic similarities between races than differences. In the end, I'd probably have to do a second spontaneous donation. The chances of finding another compatible donor were very small. The chances of a couple wanting a half-white, half-black baby twice-removed were even smaller. The chances of the embryo surviving another transplant were almost nil.

Inside my office, I leaned against the door and wept.

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Yuan-Innes, M. Red. Nature 449, 946 (2007).

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