Harvesting the Heart (15 page)

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.

Minutes before Nicholas left the hospital for the night, Fogerty called him to his office. He was sitting behind the mahogany desk, his face shadowed by the slatted vertical blinds. He did not motion for Nicholas to enter, did not even lift his head from the paper he was writing upon. “You couldn't have done a thing,” he said.

Nicholas pulled on his jacket and wandered toward his car in the parking garage, wondering if he'd ever be given a bypass to do again. He searched his memory to find something he'd overlooked, a torn capillary or an additional blockage, something Fogerty smugly hadn't mentioned after the operation that day, something that might have saved the guy. He pictured the still amber eyes of Serena LeBeauf's youngest son, mirrors of what her own used to be like. He thought about the Navajo Hand Trembler and wondered what potions and blessings and magic decrees might fall between the cracks of common knowledge.