Harvesting the Heart (14 page)

After
Kim had disappeared, Nicholas went upstairs to round his new cardiac
patients. That was the hardest part about being a resident in general
surgery—the constant changes from department to department.
Nicholas had swung through urology, neurosurgery, emergency
room, anesthesia. He'd done a stint in transplants, and one in
orthopedics, and one in plastic surgery and burns. Still, coming back
to cardiac was better than the others; cardiac surgery felt like
home. And indeed Nicholas had been rotated through cardiothoracic
more than was normal for a third-year, because he had made it clear
to Alistair Fogerty that one day he was going to have his job.

Fogerty
was exactly what Nicholas had pictured a cardiac surgeon to be like:
tall, fit, in his late fifties, with piercing blue eyes and a
handshake that could cripple. He was a hospital "untouchable,"
his reputation having evolved into a surgical gold standard. There
had once been a scandal about him—something involving a candy
striper—but the rumors were squelched and there had been no
divorce and that was that.

Fogerty
had been Nicholas's attending physician during his internship,
and one day last year Nicholas had gone to him in his office and told
him his plans. "Listen," he'd said, even though his throat
had been dry and his palms had been quivering. "I want to cut
through the bullshit, Alistair. You know and I know I'm the best
surgical resident you've got here, and I want to specialize in
cardiothoracic. I know what I can do for you and for the
hospital. I want to know what you can do for
me."

For
a long moment, Alistair Fogerty had sat on the edge of his mahogany
desk, riffling through a patient's file. When he finally lifted his
head, his eyes were dark and angry, but in no way surprised. "You,
Doctor
Prescott,"
he said, "have got bigger balls than even me."

Alistair
Fogerty had got to be director of cardiac surgery by sticking
his neck out, taking chances, and courting Fate so that it seemed to
stay on his side. When he'd begun doing transplants, the newspapers
dubbed him "The Miracle Maker." He was calculating,
stubborn, and usually right. He liked Nicholas Prescott a hell
of a lot.

And
so even when Nicholas was rounding his regular patients in general
surgery, and working under other attendings in other disciplines,
he still found time to meet with Fogerty. When he had the chance, he
rounded Fogerty's patients, did the quick daily pre- and
postoperative exams, moved patients in and out of surgical ICU—in
short, acted like a cardiothoracic fellow, a seventh-year resident.
And in return, Fogerty had him in cardiac surgery more often than not
and was grooming him to be the best there was—after Fogerty
himself.

Nicholas
moved quietly into the recovery room, where Fogerty's latest patient
was resting. He read the vitals: here was a sixty-two-year-old man
who had had aortic stenosis—the valve leading from the end of
his ventricle to the aorta had been scarred down. Nicholas could have
easily diagnosed this case from the symptoms: congestive heart
failure, syncope, angina. He surveyed the clean white gauze over the
patient's chest, the gelatinous orange antiseptic that still coated
the skin. Fogerty's work, as always, would be perfect: the native
valve removed and a pig valve sewn into its place. Nicholas checked
the patient's pulse, tugged the sheet up, and sat down beside him for
a moment.

It
was cold in recovery. Nicholas crossed his arms and rubbed his hands
up and down, wondering how the patient, naked, could be faring. But
there, the pink circles at his fingertips and his toes proved that
the heart, marvelous muscle, was still working.

It
was merely fortuitous that he saw it then, the heart breaking down.
He had been watching the steady rise and fall, the classic heartbeat
pattern of the monitor, when everything went wrong. The steady
blip-blip-blip
of
the machines accelerated, and Nicholas checked to see a sinusoidal
pattern, the heart racing at nearly one hundred beats per minute. For
a quick second, Nicholas held his hands over the patient like a faith
healer. It was an arrhythmia—ventricular fibrillation.
Nicholas had seen cases of it before, when a heart was exposed
in the chest: beating like a bag of worms, swollen and writhing, not
pumping blood at all. "Code!" he yelled over his shoulder,
seeing the nurses at the nearby station spring into motion. The
patient's heart had been traumatized, operated on, but Nicholas had
little choice. In a matter of minutes, the man would be dead. Where
was Fogerty?

Almost
immediately, recovery was filled with at least twenty
people—anesthesiologists, surgeons, interns, and nurses.
Nicholas applied wet gel pads to the patient's raw chest, then
put the defibrillator paddles to the skin. The body jumped with the
shock, but the heart did not correct itself. Nicholas nodded to a
nurse, who adjusted the charge. He ran his hand across his forehead,
pushing back his hair. His mind was filled with the god-awful sound
of the monitor, irregular and screeching, and the rustle of the
nurses' starched dresses as they moved around him. He was not
certain, but he thought he could smell death.

Nicholas
cleared the defibrillators and replaced the paddles on the patient's
chest. This time the shock was so violent that Nicholas took a step
away, artificial life kicking back like a rifle's recoil.
You
will live,
he
willed silently. He raised his eyes to the monitor screen, seeing the
thin green line dip and peak and dip and peak, the craggy crests of a
normal heartbeat. Alistair Fogerty entered the recovery room as
Nicholas pushed past him, deafened by the muted touches and calls of
congratulation, suddenly a hero.

Late
at night on the patient floors, Nicholas learned to listen. He could
tell by the flat beat of soles on the tiles when the nurses were
making the midnight rounds. He saw old men recovering from surgery
meet in the patient kitchens at 3:00
a.m
.
to steal the red jello. He waited for the slosh and whistle of the
heavy industrial rag mops, shuffled up and down the halls by
half-blind old Hispanic janitors. He noticed every patient call
sounded at the nurses' desk, the tear of sterile paper that revealed
virgin gauze, the sucked-in breath of a syringe. When he was on call
and things were quiet, Nicholas liked to wander around the floors,
his hands deep in the pockets of his white lab coat. He did not stop
into patient rooms, not even when he was on a general surgery
rotation and the patients were more than just names and charts posted
on the door. Instead he moved like an insomniac, roaming,
interrupting the night with his own shrouded footsteps.

Nicholas
did not wake Serena LeBeauf when he entered her room in the AIDS
ward. It was well after two in the morning by the time he could spare
a minute. He sat down in the stark black plastic chair beside her
bed, amazed by her deterioration. Her vitals indicated that she
weighed less than seventy pounds now; that she had pancreatitis,
respiratory failure. An oxygen mask covered her face, and morphine
dripped into her continuously.

Nicholas
had done something very wrong the first time he met Serena—he
let her get under his skin. It was something he had hardened
himself to, seeing death every day the way he did. But Serena had a
wide smile, with shocking white teeth; eyes light like a tiger's. She
had come in with her three children, three boys, all of different
fathers. The youngest, Joshua, was six back then, a skinny kid—
Nicholas could see the bumps of his backbone under his thin green
T-shirt. Serena did not tell them she had AIDS; she wanted to spare
them the stigma. Nicholas remembered sitting in the consultation room
with the attending physician when she learned she was HIV positive.
She had straightened her spine and had gripped the chair so tight
that her fingers whitened. "Well," she had said, her voice
soft like a child's. "That's not what I expected." She did
not cry, and she asked her doctor for all the information she could
get, and then, almost shyly, she asked him not to mention this to her
boys. She told them, and her neighbors and distant relatives, that it
was leukemia.

Serena
stirred, and Nicholas pulled the chair closer. He reached for her
wrist, telling himself it was to check her pulse, but he knew it was
just to hold her hand. Her skin was dry and hot. He waited for her to
open her eyes or to say something, but in the end he held his palm
soft against her cheek, wishing he could take away the gray haze of
her pain.

Nicholas
began believing in miracles his fourth year of medical school. He had
been married just months when he decided to do a rotation in Winslow,
Arizona, for the Indian Health Service. It was only four weeks, he'd
said to Paige. He was tired of doing the scut work of interns at
Boston-based hospitals: patient histories and physical exams,
clerking for residents and attendings and anyone ranked above you.
He'd heard about the rotation on the reservation. They were so
short-staffed that you did everything.
Everything.

It
was a three-hour drive from Phoenix. There was no town of Winslow.
Black houses, abandoned shops and apartments, stood impassively
around Nicholas, their empty windows blinking back at him like the
eyes of the blind. As he waited for his ride, tumbleweed edged across
the road, just like in the movies, skittering over his shoes.

Fine
dust covered everything. The clinic was just a concrete building
set into a cloud of earth. He'd taken a red-eye flight, and the
doctor who'd met him in Winslow had been there by 6:00
a.m
.
The clinic wasn't open yet, not officially, but there were several
parked pickup trucks, waiting in the cold, their exhaust hanging in
the air like the breath of dragons.

The
Navajo were quiet people, stoic and reserved. Even in December,
the children had played outside. Nicholas remembered that —the
brown-skinned babies in short sleeves, making snow angels in the
frosted sand, and nobody bothering to dress them more warmly. He
remembered the heavy silver jewelry of the women: headbands and belt
buckles, brooches that glittered against purple and deep-turquoise
calico dresses. Nicholas also could remember the things that had
shocked him when he first arrived: the endless alcoholism; the
toddler who bit her lip, determined not to cry as Nicholas probed a
painful skin infection; the thirteen-year-old girls in the prenatal
clinic, their bellies grotesquely swollen, like the neck of a snake
that has swallowed an egg.

On
Nicholas's first morning at the clinic, he was called into the
emergency room. A severely diabetic elderly man had consulted a
shaman, a tribal medicine man, who had poured hot tar on his legs as
part of the treatment. Horrible sores blistered up, and two
physicians were trying to hold down his legs while a third
examined the extent of the damage. Nicholas had hung back, not
certain what he was needed to do, and then the second patient was
brought in. Another diabetic, a sixty-year-old woman with heart
disease, who had gone into cardiopulmonary arrest. One of the staff
doctors had been jamming a plastic tube down the woman's throat to
manage the airway and to breathe for her. He did not look up as
he shouted at Nicholas. "What the hell are you waiting for?"
he said, and Nicholas stepped up to the patient and began CPR.
Together they had tried to get the heart moving again, forty minutes
of CPR, defibrillation, and drugs, but in the end the woman died.

During
the month that Nicholas spent in Winslow, he had more autonomy than
he'd ever had as a student at Harvard. He was given his own patients.
He wrote up his own notes and plans and ran them by the eight staff
physicians. He rode with public health nurses in four-wheel-drive
vehicles to find those Navajos with no true addresses, who lived off
the paths of roads, in huts with doors that faced the east. "I
live eight miles west of Black Rock," they wrote on their face
sheets, "just down the hill from the red tree whose trunk is
cleaved in two."

At
night Nicholas would write to Paige. He mentioned the dirty hands and
feet of the toddlers, the cramped huts of the reservation, the
glowing eyes of an elder who knew he was going to die. More often
than not, the letters came out sounding like a list of his heroic
medical feats, and when this happened Nicholas burned them. He kept
seeing the unwritten line that ran through the back of his mind:
Thank
God this isn't the kind of doctor that I'm going to be
—words
never committed to paper that were still, he knew, indelible.