Bobby “The Butcher” DiSimone, Franky “The Fence” Fornacci, and an associate sit at Sparks Steak House on the Upper East Side. The well-dressed men tuck in, take account of each other, and begin negotiating.
The Fence: So, I want to pick your brain and make your time as productive as possible. How much time do you have? I want to make sure we’re not—
Bobby checks his Rolex.
The Butcher: I have a meeting at 4.
The Fence: Okay, Picking your brain. Picking your brain, and having a glass of wine?
The Butcher: What are you guys having?
The Fence: For food? I like the look of the salmon, with the cherry tomato and the
The Butcher: Oh, then it has to be white. It has to be.
The Fence: It does not have to be.
The Butcher: It does. We can do a rosé as well. I’ll let them pick, I like to do it based on what we’re eating.
The wine arrives, Bobby tastes and approves it. They clink glasses, and Franky gets down to business.
The Fence: So, the main thing, well, not the main thing that I would like to discuss is, I’d really like to connect with people who feel they don’t know we’re out there. They don’t know there’s this opportunity. And that could be a little touchy, for them more for us, and I want to be delicate to any reservations.
Bobby leans back, lights a cigarette. Offers one to Franky, who refuses.
The Butcher: Yeah, you know, I don’t think it’s a reservations issue so much as a perception issue, because I think every provider has had patients who want to donate their tissue, and they absolutely want to accommodate them. They just want to do it in a way that is not perceived as, ‘This clinic is selling tissue, this clinic is making money off of this.’
The Fence: Okay, so, when you are, or the affiliate is determining what that monetary—so that it doesn’t create, raising a question of this is what it’s about, this is the main—what price range, would you—?
Bobby puts out his smoke and smiles a wry smile.
The Butcher: You know, I would throw a number out, I would say it’s probably anywhere from $30 to $100 [per specimen], depending on the facility and what’s involved. It just has to do with space issues, are you sending someone there who’s going to be doing everything, is there shipping involved, is somebody gonna have to take it out. You know, I think everybody just wants—it’s really just about if anyone were ever to ask them, ‘What do you do for this $60? How can you justify that? Or are you basically just doing something completely egregious, that you should be doing for free.’ So it just needs to be justifiable. And, look, we have 67 affiliates. They all have different practice environments, different staff, and so that number—
Bobby pauses, as a plate of lightly fried, locally sourced calf livers arrives as a starter.
The Fence: Did you say 67? Okay. And so of that number, how much would personality of the personnel in there, would play into it as far as how we’re speaking to them—
Bobby eats with relish the inner organs.
The Butcher: I think for affiliates, at the end of the day, they’re a non-profit, they just don’t want to—they want to break even. And if they can do a little better than break even, and do so in a way that seems reasonable, they’re happy to do that.
The Fence: I think it’s kinda the primary concern. Uh, to be established with a collection site for fetal tissue locally.
The Butcher: Exactly. So, ideally if what we can provide is to be able to source as locally as possible to where a given research client is, that would be really, a huge competitive advantage for us.
Franky reaches for the last of the fried calf livers
The Fence: And then, what gestational age range were you thinking? When can you start? Because you know, I’ve worked with people who start at nine weeks. I’ve had the ones who wanted the higher gestational ages.
Bobby belches, having enjoyed the starter and his many glasses of red wine.
The Butcher: From my perspective, I think it’s not going to be reasonable to be collecting at a site that does not have the capability to go farther up in to the second trimester. It doesn’t mean that the facility needs to go all the way up to 24 weeks every time, but to be able to at least say we can go up to 12 and 16—12 and 18 would probably be better, for the age protocols that require later gestational tissue, 18 weeks is kind of the lowest range, 18 to 20, 24 for certain things. So, if we could get up to 18, that would make it worth it to be operating at that site.
The Fence: Okay.
The Butcher: So, in general what I’m saying you’ll probably get up to 20, and then after 20 you’re getting feticide.
The Fence: When we were talking saying the $30 to $100 price range it’s per specimen that we’re talking about, right?
The Butcher: Per specimen. Yes.
The Fence: Yea, that’s what I was going to say. If we take kidney, liver, thymus and, say, bone marrow—
Bobby looks around for the waiter, feeling ignored.
The Butcher: Yeah, to us it’s all just one.
The Fence: Because when we charge, that’s four different specimens to a researcher.
Bobby rolls his eyes as the waiter brings the lemon he requested.
The Butcher: That’s basically the way that they do their work. The way they budget is by the amount of time they spend on one patient. That’s one bunch of tissue, they handle the tissue, they do what they do, you know, in that way, so. But yea, that’s the way. It depends, if you’re expecting somebody to process, and package, identify tissue for you, it’s going to be at the higher end of the range.
The Fence: And, you’re even saying that if you can have the conversation earlier, the earlier the better.
Bobby: Well, we like—there’s always concerns too about kind of coercion.
The nervous waiter returns with “The Butcher’s” lemon wedge.
The Fence: Well, it can’t hurt if I’m in an area that I’m not familiar with, so, I don’t even know how to phrase it. If there is a particular organ that we need, would the procedure be any longer?
The Butcher: So, that’s a whole ‘nother issue, and that’s kind of an ethical issue too, ideally you shouldn’t do the procedure in any other way.
The Fence: We need liver and we prefer, you know, an actual liver, not a bunch of shredded up—
The Butcher: Piece of liver.
Bobby and Franky share a laugh
The Fence: Yeah. Or especially brain is where it’s actually a big issue, hemispheres need to be intact.
Bobby lights another cigarette. Now it’s getting real. It’s nice to talk to talk with someone like-minded.
The Butcher: It makes a huge difference. I’d say a lot of people want liver. And for that reason, most providers will do this case under ultrasound guidance, so they’ll know where they’re putting their forceps. The kind of rate-limiting step of the procedure is the calvarium, the head is basically the biggest part. Most of the other stuff can come out intact. It’s very rare to have a patient that doesn’t have enough dilation to evacuate all the other parts intact.
The Fence: Bring the body cavity out intact and all that?
The Butcher: Exactly.
Bobby and Franky exchange a high five.
The Butcher: So then you’re just kind of cognizant of where you put your graspers, you try to intentionally go above and below the thorax, so that, you know, we’ve been very good at getting heart, lung, liver, because we know that, so I’m not gonna crush that part, I’m going to basically crush below, I’m gonna crush above, and I’m gonna see if I can get it all intact.
The Fence: Okay. Yesterday was a clinic day. So for example, what did you procure?
The Butcher: You know, I asked her at the beginning of the day what she wanted, yesterday she wanted, she’s been asking, a lot of people want intact hearts. And then, like I said, always as many intact livers as possible. People just want—
The Fence: (laughing) Yeah, liver is huge right now.
The Butcher: Some people want lower extremities, too, which, that’s simple. That’s easy. I don’t know what they’re doing with it, I guess if they want muscle.
The Fence: Yeah. A dime a dozen.
The Butcher: Mhm.
The Fence: Yeah. This has been good. Thank you so much for being able to take the time to—
The Butcher: Thank you for being persistent. That’s what it takes with me, because I am busy and have many things going on at one time. Alright, I am going to say my farewell then, so good to see you, thank you.
Bobby leaves, knowing he isn’t paying the bill.