Stiff (23 page)

The worry that one will take on traits of the heart donor is quite common, particularly when patients have received, or think that they have, a heart from a donor of a different gender or sexual orientation. According to a paper by James Tabler and Robert Frierson, recipients often wonder whether the donor "was promiscuous or oversexed, homosexual or bisexual, excessively masculine or feminine or afflicted with some sort of sexual dysfunction." They spoke to a man who fantasized that his donor had had a sexual "reputation" and said he had no choice but to live up to it. Rausch and Kneen describe a forty-two-year-old firefighter who worried that his new heart, which had belonged to a woman, would make him less masculine and that his firehouse buddies would no longer accept him. (A male heart, Oz says, is in fact slightly different from a female heart. A heart surgeon can tell one from the other by looking at the ECG, because the intervals are slightly different. When you put a female heart into a man, it will continue to beat like a female heart. And vice versa.)

From reading a paper by Kraft, it would seem that when men believe their new hearts came from another man, they often believe this man to have been a stud and that some measure of this studliness has somehow been imparted to them. Nurses on transplant wards often remark that male transplant patients show a renewed interest in sex. One reported that a patient asked her to wear "something other than that shapeless scrub so he could see her breasts." A post-op who had been impotent for seven years before the operation was found holding his penis and demonstrating an erection. Another nurse spoke of a man who left the fly of his pajamas unfastened to show her his penis. Conclude Tabler and Frierson, "This irrational but common belief that the recipient will somehow develop characteristics of the donor is generally transitory but may alter sexual patterns…." Let us hope that the man with the chicken heart was blessed with a patient and open-minded spouse.

The harvesting of H is winding down. The last organs to be taken, the kidneys, are being brought up and separated from the depths of her open torso. Her thorax and abdomen are filled with crushed ice, turned red from blood. "Cherry Sno-Kone," I write in my notepad. It's been almost four hours now, and H has begun to look more like a conventional cadaver, her skin dried and dulled at the edges of the incision.

The kidneys are placed in a blue plastic bowl with ice and perfusion fluid. A relief surgeon arrives for the final step of the recovery, cutting off pieces of veins and arteries to be included, like spare sweater buttons, along with the organs, in case the ones attached to them are too short to work with. A half hour later, the relief surgeon steps aside and the resident comes over to sew H up.

As he talks to Dr. Posselt about the stitching, the resident strokes the bank of fat along H's incision with his gloved hand, then pats it twice, as though comforting her. When he turns back to his work, I ask him if it feels different to be working on a dead patient.

"Oh, yes," he answers. "I mean, I would never use this kind of stitch." He has begun stitching more widely spaced, comparatively crude loops, rather than the tight, hidden stitches used on the living.

I rephrase the question: Does it feel odd to perform surgery on someone who isn't alive?

His answer is surprising. "The patient
was
alive." I suppose surgeons are used to thinking about patients—particularly ones they've never met—as no more than what they see of them: open plots of organs. And as far as that goes, I guess you could say H
was
alive. Because of the cloths covering all but her opened torso, the young man never saw her face, didn't know if she was male or female.

While the resident sews, a nurse picks stray danglies of skin and fat off the operating table with a pair of tongs and drops them inside the body cavity, as though H were a handy waste-basket. The nurse explains that this is done intentionally: "Anything not donated stays with her." The jigsaw puzzle put back in its box.

The incision is complete, and a nurse washes H off and covers her with a blanket for the trip to the morgue. Out of habit or respect, he chooses a fresh one. The transplant coordinator, Von, and the nurse lift H onto a gurney. Von wheels H into an elevator and down a hallway to the morgue. The workers are behind a set of swinging doors, in a back room.

"Can we leave this here?" Von shouts. H has become a "this." We are instructed to wheel the gurney into the cooler, where it joins five others.

H appears no different from the corpses already here.
[8]

But H
is
different. She has made three sick people well. She has brought them extra time on earth. To be able, as a dead person, to make a gift of this magnitude is phenomenal. Most people don't manage this sort of thing while they're alive. Cadavers like H are the dead's heros.

It is astounding to me, and achingly sad, that with eighty thousand people on the waiting list for donated hearts and livers and kidneys, with sixteen a day dying there on that list, that more than half of the people in the position H's family was in will say no, will choose to burn those organs or let them rot. We abide the surgeon's scalpel to save our own lives, our loved ones' lives, but not to save a stranger's life. H has no heart, but heartless is the last thing you'd call her.

Footnotes:

[
1]
I read on a Web site somewhere that this was the origin of the saying

"Saved by the bell." In fact, by one reckoning, not a single corpse of the million-plus sent to waiting mortuaries over a twenty-year period awakened. If the bell alerted the attendant, which it often did, it was due to the corpse's shifting and collapsing as it decomposed. This was the origin of the saying "Driven to seek new employment by the bell," which you don't hear much anymore and probably never did, because I made it up.

[
2]
Since the odds of our meeting at a cocktail party are slim and the odds of my managing to swing the conversation around to speculums slimmer still, let me take this opportunity to share: The earliest speculum dates from Hippocrates' day and was a rectal model. It was to be another five hundred years before the vaginal speculum made its debut. Dr. Grigg theorizes that this was because, in the Arabian model of medicine followed at the time, women could be examined only by women, and there were very few women doctors to do the examining. This implies that most women in Hippocrates' day never went to the gyno. Given that the Hippocratic gynecological cabinet included cow-dung pessaries and fumigation materials "of heavy and foul smell"—not to mention rectal speculums—they were probably better off.

[
3]
We are fortunate that this is so, for we would otherwise have been faced with Celine Dion singing "My Liver Belongs to You" and movie houses playing
The Liver Is a Lonely Hunter
. Every Spanish love song that contains the word
corazon
, which is all of them, would contain the somewhat less lilting
higado
, and bumper stickers would proclaim, "I

[liver symbol] my Pekingese."

[
4]
I'd never heard of him, either.

[
5]
No matter, for Whytt could have kept his appointment book full with no other patient besides himself. According to R. K. French's biography of Whytt in the Wellcome Institute of the History of Medicine series, edited by F. N. L. Poynter, M.D., the physician suffered from gout, spastic bowels, "frequent flatulence," a "disordered stomach," "wind in the stomach," nightmares, giddiness, faintness, depression, diabetes, purple discolorations of the thighs and lower legs, coughing fits "producing a thick phlegm," and, according to two of Whytt's colleagues, hypochondria. When he died, at the age of fifty-two, he was found to have "some five pounds of fluid, mixed with a substance of gelatinous consistency and bluish color," in his chest, a "red spot the size of a shilling on the mucous membrane of the stomach," and concretions in the pancreas. (This is what happens when you put M.D.'s in charge of biographies.)

[
6]
What was going on in experiments like these? Hard to say. Perhaps the brain stem or spinal medulla had been left intact. Perhaps Dr. Redi, too, had his brain extracted from a hole in his skull the November past.

[
7]
People have trouble believing Thomas Edison to be a loopy individual. I offer as evidence the following passage on human memory, taken from his diaries: "We do not remember. A certain group of our little people do this for us. They live in that part of the brain which has become known as the 'fold of Broca.'…There may be twelve or fifteen shifts that change about and are on duty at different times like men in a factory….Therefore it seems likely that remembering a thing is all a matter of getting in touch with the shift that was on duty when the recording was done."

[
8]
Unless H's family is planning a naked open-casket service, no one at her funeral will be able to tell she's had organs removed. Only with tissue harvesting, which often includes leg and arm bones, does the body take on a slightly altered profile, and in this case PVC piping or dowels are inserted to normalize the form and make life easier for mortuary staff and others who need to move the otherwise somewhat noodle-ized body.

9

Just a Head

Decapitation, reanimation, and the human head transplant
If you really wanted to know for sure that the human soul resides in the brain, you could cut off a man's head and ask it. You would have to ask quickly, for the human brain cut off from its blood supply will slide into unconsciousness after ten or twelve seconds. You would, further, have to instruct the man to answer with blinks, for, having been divorced from his lungs, he can pull no air through his larynx and thus can no longer speak. But it could be done. And if the man seemed more or less the same individual he was before you cut off his head, perhaps a little less calm, then you would know that indeed the self is there in the brain.

In Paris, in 1795, an experiment very much like this was nearly undertaken. Four years before, the guillotine had replaced the noose as the executioner's official tool. The device was named after Dr. Joseph Ignace Guillotin, though he did not invent it. He merely lobbied for its use, on the grounds that the decapitating machine, as he preferred to call it, was an instantaneous, and thus more humane, way to kill.

And then he read this:

Do you know that it is not at all certain when

a head is severed from the body by the

guillotine that the feelings, personality and

ego are instantaneously abolished…? Don't you

know that the seat of the feelings and

appreciation is in the brain, that this seat

of consciousness can continue to operate even

when the circulation of the blood is cut off

from the brain…? Thus, for as long as the

brain retains its vital force the victim is

aware of his existence. Remember that Haller

insists that a head, having been removed from

the shoulders of a man, grimaced horribly when

a surgeon who was present stuck a finger into

the rachidian canal….Furthermore, credible

witnesses have assured me that they have seen

the teeth grind after the head has been

separated from the trunk. And I am convinced

that if the air could still circulate through

the organs of the voice…these heads would

speak….

…The guillotine is a terrible torture! We must

return to hanging.

It was a letter, published in the November 9, 1795, Paris
Moniteur
(and reprinted in André Soubiran's biography of Guillotin), written by the well-respected German anatomist S. T. Sömmering. Guillotin was horrified, the Paris medical community atwitter. Jean-Joseph Sue, the librarian at the Paris School of Medicine, came out in agreement with Sömmering, declaring his belief that the heads could see hear, smell, see, and think. He tried to convince his colleagues to undertake an experiment whereby "before the butchery of the victim," a few of the unfortunate's friends would arrange a code of eyelid or jaw movements which the head could use after the execution to indicate whether it was

"fully conscious of [its] agony." Sue's colleagues in the medical community dismissed his idea as ghastly and absurd, and the experiment was not carried out. Nonetheless, the notion of the living head had made its way into the public consciousness and even popular literature. Below is a conversation between a pair of fictional executioners, in Alexandre Dumas's
Mille et Un Phantomes
:

"Do you believe they're dead because they've

been guillotined?"

"Undoubtedly!"

"Well, one can see that you don't look in the

basket when they are all there together.