Harvesting the Heart (15 page)

On
his last day at the Indian Health Service, a young woman was brought
in, writhing in the throes of labor. Her baby was breech. Nicholas
had tried palpating the uterus, but it was clear a C-section was
going to be necessary. He mentioned this to the Navajo nurse who was
acting as translator, and the woman in labor shook her head, her hair
spilling over the table like a sea. A Hand Trembler was called in,
and Nicholas respectfully stepped back. The medicine woman put her
hands over the swollen belly, singing incantations in the language of
the People, massaging and circling the knotted womb. Nicholas told
the story when he returned to Boston the next day, still thinking of
the dark gnarled hands of the medicine woman, suspended above his
patient, the red earth flurrying outside and hazing the window. "You
can laugh," he said to his fellow interns, "but that baby
was born headfirst."

"Nicholas,"
Paige said, her voice thick with sleep. "Hi."

Nicholas
curled the metal cord of the pay phone around his wrist. He should
not have awakened Paige, but he hadn't spoken to her all day.
Sometimes he did this, called at three or four in the morning. He
knew she'd be asleep, and he could imagine her there with her hair
sticking up funny on the side she'd been sleeping on, her nightgown
tangled around her waist. He liked to picture the soft down
comforter, sunken in spots where her body had been before she had
reached to answer the phone. He liked to imagine that he was sleeping
next to her, his arms crossed under her breasts and his face pressed
into her neck, but this was unrealistic. They slept at opposite sides
of the bed, both fitful sleepers, unwilling to be tied by someone
else's movements or smothered by someone else's heated skin.

"Sorry
I didn't call this afternoon," Nicholas said. "I was busy
in ICU." He did not tell Paige about the patient he'd had to
code. She always wanted details, playing him for a superstar, and he
wasn't in the mood to go into it all over again.

"That's
okay," Paige said, and then she said something muffled into the
pillow.

Nicholas
did not ask her to repeat herself. "Mmm," he said. "Well,
I guess I don't have anything else to say." When Paige did not
respond, he hit the # button on the phone.

"Oh,"
Paige said. "Okay."

Nicholas
scanned the hall for signs of activity. A nurse stood at the far end,
dropping little red pills into cups that were lined up on a table.
"I'll see you tomorrow," Nicholas said.

Paige
rolled onto her back; Nicholas knew by the crinkling of the pillows
and the fluff of her hair when it settled. "I love you,"
Paige said.

Nicholas
watched the nurse, counting the pills. Eighteen, nineteen,
twenty. The nurse stopped, pressed her hands into the small of her
back as if she was suddenly weary. "Yes," Nicholas said.

The
next morning Nicholas did prerounds at five-thirty and then began
regular rounds with Fogerty and an intern. The patient Nicholas
had coded yesterday was doing fine, comfortably settled in surgical
ICU. By seven-thirty they were ready for their first surgery of the
day, a simple bypass. As they scrubbed, Fogerty turned to Nicholas.
"You did well with McLean," he said, "considering
you'd just come onto the rotation minutes before."

Nicholas
shrugged. "I did what anyone would have done," he said. He
scrubbed at invisible germs under his nails, around his wrists.

Fogerty
nodded to an OR nurse and shrugged into his sterile gown. "You
make decisions well, Dr. Prescott. I'd like you to act as chief
surgeon today."

Nicholas
looked up but did not let the surprise he felt show in his eyes.
Fogerty knew he'd been on call all night, knew he'd need a second
wind to measure up. Fogerty also knew it was virtually unheard
of for a third-year resident to lead a bypass operation. Nicholas
nodded. "You got it," he said.

Nicholas
spoke quietly to the patient as the anesthesiologist put him under.
He stood beside Fogerty as the second assistant, a resident more
senior than Nicholas who was obviously angry, shaved the legs, the
groin, the belly, and covered the body with Betadine solution. The
patient lay motionless, stark naked, stained orange, like a sacrifice
for a pagan god.

Nicholas
supervised the harvest of the leg vein, watching as blood vessels
were clamped off and sewn, or were cauterized, filling the operating
suite with the smell of burning human tissue. He waited until the
vein was settled in solution for its later use. Then, stepping up to
the patient, Nicholas took a deep breath. "Scalpel," he
said, waiting for the nurse to pick the instrument off a tray. He
made a clean incision in the patient's chest and then took the saw to
cut through the sternum. He held the ribs spread apart with a rib
spreader, and then he exhaled slowly, watching the heart beating
inside the man's chest.

It
never failed to amaze Nicholas how much power was in the human heart.
It was phenomenal to watch, the dark-red muscle pumping quickly,
turning hard and small with each contraction. Nicholas cut the
pericardium and separated out the aorta and the vena cava, connected
them to the bypass machine, which would oxygenate the blood for
the patient once his heart was stopped by Nicholas.

The
first assistant poured the cardioplegia liquid onto the heart, which
stopped its beating, and Nicholas, along with everyone else in the
room, turned his eyes to the bypass machine, to make sure it was
doing its job. He bent closer toward the heart, snipping at the two
coronary arteries that were blocked. Nicholas retrieved the leg vein,
delicate, and turned it so that the valves did not hold blood back
but let it through. With careful sutures he sewed the vein onto the
first coronary artery before the point of blockage, and then attached
the other end after the point of blockage. His hands moved with a
will of their own, precise and steady, fingers blunt and strong
beneath the translucent gloves. The next steps streamed through his
mind, but the procedure and his role in it had become so natural to
him, like breathing or batting right-handed, that Nicholas began to
smile. I
can
do this,
he
thought. I
can
really do this on my own.

Nicholas
finished the bypass five hours and ten minutes after he'd begun. He
let the first assistant close for him, and it was only after he'd
left the operating suite to scrub that he remembered Fogerty and
the fact that he hadn't slept in twenty-four hours. "What did
you think?" Nicholas said to Fogerty, who was coming up beside
him.

Fogerty
peeled off his own gloves and ran his hands under the hot water. "I
think," he said, "you should go home and get some sleep
now."

Nicholas
had been untying his mask, and in his shock he let it drop to the
floor. He had just done his first
bypass,
for
God's sake. Even an asshole like Fogerty should have some
constructive criticism, maybe a word of praise. He'd done a terrific
job, not one glitch, and even if it took an hour longer than
Fogerty's usually did, well, it was to be expected because it was his
first.

"Nicholas,"
Fogerty said, "I'll see you at evening rounds."

There
were many things about Paige that Nicholas did not know when they had
been married. He celebrated her birthday two weeks late because she
had never told him when it was. He couldn't have guessed her favorite
color until their first anniversary, when she picked emerald stud
earrings over sapphires because of their sea-green glow. He certainly
couldn't have predicted her disastrous cooking experiments, like
Miracle Whip Stew and Turkey-Marshmallow Kabobs. He didn't know she'd
sing car-commercial jingles when she dusted or that she'd have the
skill of stretching a paycheck to cover the interest on a graduate
student loan, groceries, condoms, and two tickets to the
discount movie theater.

In
Nicholas's defense, he did not have much time to discover his new
wife. His rotations kept him at the hospital more often than he was
at home, and after he graduated from Harvard, he was even more
pressured for time. When he did stumble into the apartment, starved
and blind with fatigue, Paige so seamlessly fed him, disrobed him,
and loved him to sleep that he began to expect the treatment and
sometimes forgot that Paige was connected to it.

When
he came home from performing his first solo bypass, he did not turn
the lights on in the apartment. Paige was at work. She was still
waiting tables at Mercy, but only in the mornings. Afternoons,
she worked at an
ob/gyn
office
as a receptionist. She had taken on the second job after some night
courses in architecture and literature at Harvard Extension
didn't work out. She hadn't been able to keep up with the reading and
the housework and told Nicholas that two incomes meant more money and
that more money meant they'd move out of debt more quickly so she
could go to college full time. Back then, Nicholas had wondered if it
was just an excuse to drop out of her classes. He'd seen her attempts
at writing papers, after all, which were really no more than
high-school caliber; and he'd almost said something to Paige, until
he remembered that it was just what they
would
be.

Nicholas
never voiced his doubts to Paige. For one thing, he didn't want her
to take it the wrong way. And also, Nicholas had hated seeing her
surrounded by yellowed used textbooks, her hair springing free of its
braid as she wound her fingers through it in concentration.
Truthfully, Nicholas liked having Paige all to himself.

She
was at the gynecologists' office, since it was well after two, but
she'd left him a meal to heat up in the oven. He didn't eat it,
although he was very hungry. He wanted Paige to be there, although he
knew it wasn't possible. He wanted to close his eyes and, for once,
become the patient, soothed by the cool ministrations of her tiny,
fine hands.

Nicholas
fell onto the bed, neatly made, amazed by the darkness and the cold
of the late day. He fell asleep listening to the beat of his own
heart, thinking of the directions patients gave at the Indian
reservation. My home is west of Mass General, he would say,
light-years beneath the brittle winter sun.

Serena
LeBeauf was dying. Her sons were heaped like huge puppies on the
edges of the hospital bed, holding her hand, her arm, her
ankle—whatever pieces of her they could hold. They had brought
things they thought would comfort her. There on her frail chest was
the cut-out travel-brochure picture of San Francisco, where she'd
lived when she was younger. Tucked under her arm were the stubby
remains of a threadbare stuffed monkey. Curled across the hollow
of her belly was her diploma, the college degree she'd worked so
damned hard for and received just a week before her AIDS was
diagnosed. Nicholas stood in the doorway, not wanting to intrude. He
watched the liquid brown eyes of Serena's sons as they stared at
their mother, and he wondered where they would all go, especially the
little one, when she died.

He
was paged, and he raced down three flights of stairs to surgical ICU,
where his bypass patient was lying. The room was a rush of activity,
physicians and nurses jockeying into place as the heart went into
failure. As if he were watching a replay of the day before, Nicholas
stripped the gown from his patient and gave an external shock. And
another. Sweat ran down his back and into his eyes, searing.
"Goddammit," he muttered.

Fogerty
was there. Within minutes he had moved the patient to an operating
suite. Fogerty cracked the chest open again and slid his hands into
the bloody cavity, massaging the heart. "Let's go," he said
softly. His gloved fingers slipped over the tissue, the still-new
sutures, rubbing and warming the muscle, kneading life. The heart did
not pulse, did not beat. Blood welled around Fogerty's fingers. "Take
over," he said.

Nicholas
slipped his own hand around the muscle, forgetting for a second that
there was a patient, that there was a past attached to this heart.
All that mattered was getting the thing going again. He caressed the
tissue, willing it to start. He pumped oxygen through his patient's
system manually for forty-five minutes, until Fogerty told him to
stop and signed the death certificate.