Harvest (3 page)

Dr. Wettig turned to her, his eyebrow raised. "Yes?"

"The... pupillary changes - the extensor posturing of the limbs - they were high midbrain signs. Last night I assumed it was because of the subdural haematoma, pressing downwards on the midbrain. But since the patient hasn't improved, I... I guess that indicates I was mistaken."

"You guess?"

She let out a breath. "I was mistaken."

"What's your diagnosis now?"

"A midbrain haemorrhage. It could be due to shearing forces. Or residual damage from the subdural haematoma. The changes might not show up yet on CT scan."

Dr. Wettig regarded her for a moment, his expression unreadable. Then he returned to the other residents. "A midbrain haemorrhage is a reasonable assumption. With a combined Glasgow Coma Scale of three..." He glanced at Abby '... and a half," he amended, 'the prognosis is nil. The patient has no spontaneous respirations, no spontaneous movements, and she appears to have lost all brainstem reflexes. At the moment, I have no suggestions other than life support. And consideration of organ harvest." He gave Abby a curt nod. Then he moved on to the next patient.

One of the other residents gave Abby's arm a squeeze. "Hey, DiMatteo," he whispered. "Flying colours."

Wearily Abby nodded. "Thanks."

Chief surgical resident Dr. Vivian Chao was a legend among the other residents at Bayside Hospital. As the story went, two days into her very first rotation as an intern, her fellow intern suffered a psychotic break and had to be carted off, sobbing uncontrollably, to the loony ward. Vivian was forced to pick up the slack. For twenty-nine straight days, she was the one and only orthopaedic resident on duty, around the clock. She moved her belongings into the call room and promptly lost five pounds on an unrelenting diet of cafeteria food. For twenty-nine straight days, she did not step out of the hospital front doors. On the thirtieth day her rotation ended, and she walked out to her car, only to discover that it had been towed away a week before. The parking lot attendant had assumed it was abandoned.

Four days into the next rotation, vascular surgery, Vivian's fellow intern was struck by a city bus and hospitalized with a broken pelvis. Again, someone had to take up the slack.

Vivian Chao moved right back into the hospital call room.

In the eyes of the other residents, she had thus achieved honorary manhood, a lofty status which was later acknowledged at the yearly awards dinner when she was presented with a boxed pair of steel balls.

When Abby first heard the Vivian Chao stories, she'd had a hard time reconciling that steel-balls reputation with what she saw: a laconic Chinese woman who was so petite she had to stand on a footstool to operate. ThoughVivian seldom spoke during attending rounds, she could always be found standing fearlessly at the very front of the group, wearing an expression of cool dispassion.

It was with her usual air of detachment that Vivian approached Abby in the SICU that afternoon. By then Abby was moving through a sea of exhaustion, every step a struggle, every decision an act of pure will. She didn't even notice Vivian was standing beside her until the other woman said, "I hear you admitted an AB positive head trauma."

Abby looked up from the chart where she'd been recording patient progress notes. "Yes. Last night."

"Is the patient still alive?"

Abby glanced towards Bed 1 l's cubicle. "It depends what you mean by alive."

"Heart and lungs in good shape?"

"They're functioning."

"How old?"

"She's thirty-four. Why?"

"I've been following a medical patient on the teaching service. Endstage congestive failure. Blood type AB positive. He's been waiting for a new heart?Vivian went over to the chart rack. "Which bed?"

"Eleven."

Vivian pulled the chart out of the rack and flipped open the metal cover. Her face belied no emotion as she scanned the pages.

"She's not my patient any more," said Abby. "I transferred her to Neurosurgery. They drained a subdural hematoma."

Vivian just kept reading the chart.

"She's only ten hours post-op," said Abby. "It seems a little early to be talking harvest."

"No neurologic changes so far, I see."

"No. But there's a chance..."

"With a Glasgow Scale of three? I don't think so."Vivian slid the chart back in the rack and crossed to Bed 11.

Abby followed her.

From the cubicle doorway she stood and watched as Vivian briskly performed a physical exam. It was the same way Vivian performed in the OR, wasting no time or effort. During Abby's first year - the year of her internship - she had often observed Vivian in surgery, and she had admired those small, swift hands, had watched in awe as those delicate fingers spun perfect knots. Abby felt clumsy by comparison. She invested hours of practice and yards and yards of thread, learning to tie surgical knots on the handles of her bureau drawers. Though she could manage the mechanics competently enough, she knew she would never have Vivian Chao's magical hands.

Now, as she watched Vivian examine Karen Terrio, Abby found the efficiency of those hands profoundly chilling.

"No response to painful stimuli," Vivian observed.

"It's still early."

"Maybe. Maybe not." Vivian pulled a reflex hammer from her pocket and began tapping on tendons. "She/ AB positive?"

"Yes."

"A stroke of luck."

"I don't see how you can call it that."

"My patient in MICU is AB positive. He's been waiting a year for a heart. This is the best match that's come up for him."

Abby looked at Karen Terrio and she remembered, once again, the blue and white blouse. She wondered what the woman had been thinking as she'd buttoned it up that last time. Mundane thoughts, perhaps. Certainly not mortal thoughts. Not thoughts of a hospital bed or IV tubes or machines pumping air into her lungs.

"I'd like to go ahead with the lymphocyte crossmatch. Make sure they're compatible," said Vivian. "And we might as well start HLA typing for the other organs. The EEG's been done, hasn't it?"

"She's not on my service; said Abby. "And anyway, I think this is premature. No one's even talked to the husband about it."

"Someone's going to have to."

"She has kids. They'll need time for this to sink in."

"The organs don't have a lot of time."

"I know I know it's got to be done. But, as I said, she's only ten hours post-op."

Vivian went to the sink and washed her hands. "You aren't really expecting a miracle, are you?"

A SICU nurse appeared at the cubicle door. "The husband's back with the kids. They're waiting to visit. Will you be much longer?"

"I'm finished," saidVivian. She tossed the crumpled paper towel into the trash can and walked out.

"Can I send them in?" the nurse asked Abby.

Abby looked at KarenTerrio. In that instant she saw, with painful clarity, what a child would see gazing at that bed. "Wait," said Abby. "Not yet." She went to the bed and quickly smoothed out the blankets. She wet a paper towel in the sink and wiped away the flecks of dried mucus from the woman's cheek. She transferred the bag of urine around to the side of the bed, where it would not be so visible. Then, stepping back, she took one last look at KarenTerrio. And she realized that nothing she could do, nothing anyone could do, would lessen the pain of what was to come for those children.

She sighed and nodded to the nurse. "They can come in now."

By four-thirty that afternoon, Abby could barely concentrate on what she was writing, could barely keep her eyes focused. She had been on duty thirty-three and a half hours. Her afternoon rounds were completed. It was, at last, time to go home.

But as she closed the last chart, she found her gaze drawn, once again, to Bed 11. She stepped into the cubicle. There she lingered at the foot of the bed, gazing numbly at Karen Terrio. Trying to think of something else, anything else, that could be done.

She didn't hear the footsteps approaching from behind.

Only when a voice said: "Hello gorgeous," did Abby turn and see brown-haired, blue-eyed Dr. Mark Hodell smiling at her. It was a smile meant only for Abby, a smile she'd sorely missed seeing today. On most days, Abby and Mark managed to share a quick lunch together or, at the very least, exchange a wave in passing. Today, though, they had missed seeing each other entirely, and the sight of him now gave her a quiet rush of joy. He bent to kiss her. Then, stepping back, he eyed her uncombed hair and wrinkled scrub suit. "Must've been a bad night," he murmured sympathetically.

"How much sleep did you get?"

'! don't know. Half an hour."

"I heard rumours you batted a thousand with the General this morning."

She shrugged. "Let's just say he didn't use me to wipe the floor."

"That qualifies as a triumph."

She smiled. Then her gaze shifted back to Bed 11 and her smile faded. Karen Terrio was lost in all that equipment. The ventilator, the infusion pumps. The suction tubes and monitors for EKG and blood pressure and intracranial pressure. A gadget to measure every bodily function. In this new age of technology, why bother to feel for a pulse, to lay hands on a chest? What use were doctors when machines could do all the work?

"I admitted her last night," said Abby. "Thirty-four years old. A husband and two kids. Twin girls. They were here. I saw them just a little while ago. It's +strange, Mark, how they wouldn't touch her. They stood looking. Just looking at her. But they wouldn't touch her. I kept thinking, you have to. You have to touch her now because it could be your last chance. The last chance you'll ever have. But they wouldn't. And ! think, someday, they're going to wish..." She shook her head. Quickly she ran her hand across her eyes. "I hear the other guy was driving the wrong way, drunk. You know what pisses me off, Mark?And it really pisses me off. He'll survive. Right now he's sitting upstairs in the orthopaedic ward, whining about a few fucking broken bones." Abby took another deep breath and with the sigh that followed, all her anger seemed to dissipate. "Jesus, I'm supposed to save lives. And here I am wishing that guy was smeared all over the highway." She turned from the bed. "It must be time to go home."

Mark ran his hand down her back, a gesture of both comfort and possession. "Come on," he said. "I'll walk you out."

They left the SICU and stepped onto the elevator. As the doors slid shut, she felt herself wobble and melt against him. At once he took her into the warm and familiar circle of his arms. It was a place where she felt safe, where she'd always felt safe.

A year ago, Mark Hodell had seemed a far from reassuring presence. Abby had been an intern. Mark had been a thoracic surgery attending - not just any attending physician, but a key surgeon on the Bayside cardiac transplant team. They'd met in the OR over a trauma case. The patient, a ten-year-old boy, had been rushed in by ambulance with an arrow protruding from his chest -the result of a sibling argument combined with a bad choice in birthday presents. Mark had already been scrubbed and gowned when Abby entered the OR. It was only her first week as an intern, and she'd been nervous, intimidated by the thought of assisting the distinguished Dr. Hodell. She'd stepped up to the table. Shyly she'd glanced at the man standing across from her. What she saw, above his mask, was a broad, intelligent forehead and a pair of beautiful blue eyes. Very direct. Very inquisitive.

Together they operated. The kid survived.

A month later, Mark asked Abby for a date. She turned him down twice. Not because she didn't want to go out with him, but because she didn't think she should go out with him.

A month went by. He asked her out again. This time temptation won out. She accepted.

Five and a half months ago, Abby moved into Mark's Cambridge home. It hadn't been easy at first, learning to live with a forty-one-year-old bachelor who'd never before shared his life - or his home - with a woman. But now, as she felt Mark holding her, supporting her, she could not imagine living with, or loving, anyone else.

"Poor baby," he murmured, his breath warm in her hair. "Brutal, isn't it?"

"I'm not cut out for this. What the hell do I think I'm doing here?"

"You're doing what you always dreamed about. That's what you told me."

"I don't even remember what the dream was any more. I keep losing sight of it."

"I believe it had something to do with saving lives?"

"Right. And here I am wishing that drunk in the other car was dead." She shook her head in self-disgust.

"Abby, you're going through the worst of it now. You've got two more days on Trauma. You just have to survive two more days."

"Big deal. Then I start Thoracic--'

"A piece of cake in comparison. Trauma's always been the killer. Tough it out like everyone else."

She burrowed deeper into his arms. "If I switched to Psychiatry, would you lose all respect for me?"

"All respect. No doubt about it."

"You're such a jerk."

Laughing, he kissed the top of her head. "Many people think it, but you're the only one allowed to say it."

They stepped off on the first floor and walked out of the hospital. It was autumn already, but Boston was sweltering in the sixth day of a late-September heat wave. As they crossed the parking lot, she could feel her last reserves of strength wilting away. By the time they reached her car, she was scarcely able to drag her feet across the pavement. This is what it does to us, she thought. It's the fire we walk through to become surgeons. The long days, the mental and emotional abuse, the hours of pushing onward while bits and pieces of our lives peel away from us. She knew it was simply a winnowing process, ruthless and necessary. Mark had survived it; so would she.

He gave her another hug, another kiss. "Sure you're safe driving home?" he asked.

"I'll just put the car on automatic pilot."

"I'll be home in an hour. Shall I pick up a pizza?" Yawning, she slid behind the wheel. "None for me."

"Don't you want supper?"

She started the engine. "All I want tonight," she sighed, 'is a bed."