(2006) When Crickets Cry (38 page)

"First helicopter ride?" I said.

She nodded. "And last, hopefully."

Annie grabbed my hand. "What's Dr. Royer doing right now?"

I wondered how to best answer her question. "He's flying to Texas, to go get your heart."

Annie pulled me closer and spoke quietly into the microphone that looped around her face from ear to lips. The sound of the motor and rotor blades made a dull roar above us.

"No," she said, "tell me what he's doing."

The heart was going inside her; I figured she had a right to know. "You sure?"

She thought for a moment, then nodded slowly.

"Right now, Dr. Royer is flying to a hospital in Texas. Once there, he'll open up the donor, inject a solution into the heart to make it stop, and the doctor across from him will declare a time of death."

Annie swallowed hard, and a tear puddled in the corner of her eye.

"Then he'll pour buckets of ice-cold saline onto the heart to try to get it as cold as possible. About five liters of real cold stuff. What they call either Ringer's lactate or normal saline."

The detail seemed to lessen the personal and emotional blow for Annie, and for Cindy, who couldn't help but listen.

"It won't take him but a couple of minutes to cut out the heart. The instant it's cut free, ischemic time starts-when no blood flows to the heart. From then on, every second counts. He'll put the heart in a sterile bowl, rinse it thoroughly to get rid of the old blood, stick it in double plastic bags, and then into a red-and-white plastic container-like the ones you see at the beach."

Annie attempted a smile.

"Then he'll hop back on that same plane and jet back to Atlanta, where you and I will be waiting for him."

Annie swallowed. "What's going to happen to me?"

"We'll get you to the hospital, whisk you up to your room, put you to sleep, and in a few hours, you'll wake up with a new ticker."

"That's not what I meant."

I thought for a moment. "Do you believe in the tooth fairy?"

Annie shook her head.

"Remember when you used to?"

She nodded.

"Well, let's just say that I still believe in the tooth fairy, and sometimes the best things happen while you're asleep."

Annie looked out the window into the darkness that was speeding beneath us at just over a hundred miles an hour. A few minutes later she asked, "Do you know anything about the person in Texas?"

I nodded.

Annie's eyes waited expectantly while her shoulders tensed.

"Somebody who was in a real bad car accident, who's not ever going to wake up, who's alive because there's a machine keeping her alive, and whose loved one wants you to have a new heart."

Annie coughed, and her eyes crowded in toward her nose, almost wrinkling the pale skin above her eyes. "It's a girl?" she asked. "How old is she?"

I made it a practice never to tell recipients information about their donors until after they had recovered, but something in Annie's eyes told me she wasn't asking for her benefit. She was asking for the donor's. "Mid-twenties."

Annie's eyes whirled around the inside of the helicopter, studying the lights, gauges, and odd mixture of medical supplies with aeronautical function and design. "Do you think she's already in heaven?"

I shrugged. "I don't know, Annie. I guess she's the only one who really knows that right now."

Annie thought for a minute, rubbed her sandal, and said, "God knows."

I nodded. "I guess He knows too."

Annie continued studying the instruments around her. Her pulse was elevated, but her color was good and her breathing, while forced, was deep and controlled. Her eyes steadied on mine. "Reese?"

"Yes. "

Just then, Steve crackled from the pilot's seat, "Donny?"

I looked up front and saw the lights of Atlanta growing closer through the glass.

"Royer's calling from Texas. I'm patching him through."

I nodded, understanding that Steve could selectively do so and would patch him through to only my set of headphones.

Joniiy?„

"Go ahead."

"We've landed and I've had a look at her. The donor's BP has not dropped, which is good, seeing as how they've weaned her from dopamine. The electrocardiogram looks good, heart rate normal, and from what I can tell, the heart muscle itself suffered no damage. 'Course I won't know for sure until I open her up. The chest X-ray is clear, neither lung is collapsed, and no pneumonia. We're at 90 percent go."

I made several mental notes and said, "Call me when you know."

"Will do."

Royer hung up and no doubt returned to the OR, where other doctors were performing their tests to determine if other tissues were also viable. The sequence of removal follows the best physiological progression, not the order of arrival. First the heart, then liver, kidneys, corneas, bone, and then other tissue, like skin. That meant nobody would touch the donor until after Royer was finished.

Annie squeezed my hand again and brought my thoughts eastward from Texas, up through the kitchen floor at the lake, and down into the helicopter. "Reese?"

"Yes?"

"Don't worry. Okay?"

I nodded and watched Atlanta growing closer over Steve's shoulder.

Annie tugged on my arm and pulled me closer. "Reese?"

My face hung just a few inches from hers. I didn't say a word.

"You don't need to worry," she said again.

I tried to smile and shrug her off and act as though my attention were needed up front.

She tapped my hand and feigned a smile. "What would Shakespeare say about all this?"

I thought for a moment and attempted the same smile. My ability to remember the words that had brought me such comfort had disappeared. I had almost completely forgotten every passage I'd ever read. It was as if they knew they were no longer needed, so they had taken flight and found another soul in need. I pawed at the air, trying to remember. When nothing came, I felt lonely and cold. "No, not tonight."

She pulled my ear to her lips, tapped her chest, and whispered, "Whether or not I wake up ... I'll have a new heart."

Cindy covered her mouth and looked out the window toward the east and the lights of Stone Mountain. The darkness hid her eyes, but the blue glow from the instrument panel lit tip the shiny streaks cascading down her face. Before us spread the urban sprawl of Atlanta, which now covered Sherman's once-scorched earth.

Highway 400 stretched out below us, marked by the occasional junction lights or northbound headlights. We circled once, then landed amid a sea of lights and scurrying medical personnel, many of whom seemed as anxious to see me as Annie. Word had spread fast, and I knew my life of anonymity was over.

At first they were afraid to say hello, but when we placed Annie in the chair, and the two electric doors closed behind us, I turned to Mike Ramirez and said, "How's your family?"

He smiled a wide grin and said, "Fine." His chest swelled a bit, and his grin grew wider. "The boys are in school, and we have two little girls at home."

One by one, nurses and doctors came to wish Annie well and shake my hand or offer a quiet hug. We loaded onto the elevator, and while the doors closed, I reminded myself that while I needed those hugs and handshakes, this wasn't about me. And we weren't simply taking out a girl's tonsils. We were taking out her heart.

e descended two floors in the elevator, and I thought about Royer. When he first inspected the heart, he had to be absolutely certain. I knew he would look for signs of damage. He would feel for flutters-like water running rapidly through a pipe-that meant the heart was not functioning properly. Next he would run his finger down each of the three major coronary arteries, the vessels that lie on the surface of the heart, that feed it with oxygen and nutrients. He'd look for plaque, any sign of hardening, the first signs of disease. Like Charlie, Royer would "read" the heart with his hands.

We rolled Annie into her room at the end of a long and quiet hall in the heart wing of the hospital. Immediately, the nurses began invisibly flurrying about, performing a battery of tests. After a few minutes, a nurse I did not know whispered, "Doctor?" When I didn't move, she whispered again, this time louder, "Doctor."

Finally, Cindy got my attention and pointed discreetly at the nurse.

I turned and read fenny on the shoulder of her scrubs. She held two things: a white jacket with Jonny stitched above the topright pocket and two syringes, out of Annie's view.

I had been expecting the syringes, but not the jacket.

She held it forth and whispered, "Royer's had this hanging on the back of his door for I don't know how long. Said to give it to you when you arrived."

I nodded, and she helped me slip into it, like a tailor at a men's shop. In the pocket I found a stethoscope. I unfolded it, and she whispered again, "He's been keeping that for you too. Said he's been waiting till it fit you again." She hung it around my neck and smiled.

Then she held the syringes, eyed Annie, and said, "You or me?"

"Me," I whispered. It was a kind gesture, and I appreciated her offering. Those shots were the first step, and a very painful one, in what would become a lifetime routine of taking immunosuppressants. The shots had to be given in the thigh, and Annie was not going to like it.

Jenny stood behind me, ready to help but not in my way, and I turned to Cindy. "You might ought to leave us alone a minute."

Cindy shook her head, grasped Annie's hand, and gritted her teeth. I looked at Annie, and she eyed the needles in my hand.

"Dr. Royer told me about those." She lifted her gown, I swabbed the skin, and she grabbed my hand. She looked up with a forced smile and whispered, "I keep a close watch on this heart of mine. I keep my eyes wide open all the time. Because you're mine, I walk the line."

The rhyme puzzled me, and I knew I'd heard it someplace before.

Annie tilted her head. "My mom was a big fan ofJohnny Cash."

She closed her eyes, gritted her teeth, and I quickly injected the drugs. She winced, and her eyelids squeezed the tears out from underneath. I straightened her gown, kissed her on the forehead, and she looked up at me, offering another whisper through still-gritted teeth. "I guess sometimes it's got to hurt before it can get better."

I nodded. "Hearts are like that."

Jenny returned with a small cup of water and a pill, which would put Annie on a more sedated field. It wouldn't quite put her to sleep, but it'd take away any anxiety.

Annie swallowed obediently, and someone paged me over the intercom. "Dr. Mitchell? Dr. Morgan's on line two."

I checked my watch. He was three seconds early.

I stepped out into the hall and picked up the phone. "Talk to me."

"I'm here. Other doctors are checking her out now; I'll have a look in ten minutes or so. I'd say, get Annie to sleep and get her prepped. This woman looks healthy. I'll call you in twenty when I know for sure."

I hung up, and Jenny ran the IV into Annie's arm. The drugs worked slowly, giving us about five minutes. I sat down next to the bed, and Annie slid her hand beneath mine. For the next three minutes I watched her fight a losing battle against her eyelids. During that time, her mouth said nothing, but her heart spoke volumes.

A minute later, she was asleep.

Cindy waited in the room while I walked down the hall to the OR and met, or got reacquainted with, the team. When I entered OR4, the phone lit up and the perfusionist, who stood closest, picked it up. She turned to me. "It's Royer." His calling meant bad news. I took the phone.

"Reese, the heart is showing signs of disease. Getting crunchy. Not a problem now. We can put it in her, but then we've got to tell her that she's got to go through this again in five years or so. How do you think she'll handle that?"

"Probably not too well."

"You've spent time with her. Day-in, day-out time. What's your call?"

I leaned against the wall, closed my eyes, and thought of Annie, trusting me with her life. I wondered whether she had the strength to wake up and hear that she didn't have a new heart. I also wondered whether we had time to find another one.

`Donny," Royer said, "at best, this is a Band-Aid. Can she hold off?"

One of the most difficult aspects of transplantation was making decisions with people's lives that could kill them if you were wrong. It made it that much worse when you loved them.

"Yes."

"Let her sleep, and we'll break the news tomorrow. The rest will do her some good."

"See you in a few hours."

"And, Jonny?" I heard my friend talking, not my partner. "We'll find one."

"See you shortly."

On the surface, Cindy took the news pretty well. When I suggested we go to the Varsity and grab a chocolate shake, she nodded, and not until we got in the car and away from the hospital did she crack. The tears came all at once. Niagara Falls and she cried loudly.

I pulled off the interstate and wound through the buildings at Georgia Tech. When I found an open parking spot, I parked, and Cindy fell against my shoulder. She shook, clenched her fists, buried her face in my chest, and screamed at the top of her lungs. The years of worry and holding it all together had finally crumbled.