Mend the Living (23 page)

The little airport has been opened specially for them, the runway is edged with status lights, the tower lit up at the top; the machine sets itself down, shaken by spasms, the door slides open and the footbridge unfolds, Alice and Virgilio step down onto the tarmac, and from that moment it’s a single movement that carries them forward as though they were on a conveyor belt, a trajectory of a magical unbroken fluidity, crossing a barren exterior (this perimeter of pavement where you can hear the sea), a mobile and cozy interior (the taxi), an icy exterior (the hospital parking lot), and finally an interior where they know the codes (the department of surgery).

Thomas Remige waits for them like the master of the house. Handshakes, coffees tossed back, they introduce themselves, connections are made and as always the name Harfang radiates its aura. Thomas lists those who are assembled: each team is a tandem composed of a senior surgeon and an intern, to which are added the anaesthetist, the nurse anaesthetist, the O.R. nurse, the nurse’s aid, and himself – so thirteen of them altogether – it will be a lot of people inside, in the unassailable citadel, the secret cave accessible only to those who know the multiple pass codes, it’s gonna be crammed in there, thinks Thomas.

The O.R. is ready. The scialytic projects a white light onto the operating table, vertical, casting no shadow – spots gathered into a circular cluster converge their rays on the body of Simon Limbeau that has just been brought in, in his bed, and he still has this air of animation – they are moved to see him like this. He’s placed in the centre of the room – he is the heart of the world. A first circle around him demarcates a sterile zone that the circulating staff cannot cross: nothing can be touched, sullied, or infected – the organs they’re preparing to collect here are sacred objects.

In a corner of the room, Cordelia Owl is apprehensive. She’s changed her clothes, has left her cellphone in a locker in the change room, and the fact of being separated from it, no longer feeling the hard shape of the black case against her hip, vibratile and sly as a parasite, makes her shift into another reality, yes, it’s here that it happens, she thinks, with her eyes riveted on the boy who is stretched out before her, and I’m here too. Trained in the O.R., she recognizes the spaces but has never experienced anything but intense procedures aimed at saving patients, keeping them alive, and she struggles to grasp the reality of the operation that lies ahead, because the young man is already dead, isn’t he, and the procedure is aimed at healing people other than him. She has prepared the materials, laid out the tools, and now she quietly repeats to herself the order in which the organs are prepared, murmurs behind her mask: first, the kidneys; second, the liver; third, the lungs; and fourth, the heart; then she begins again, in reverse, recites to herself the steps of the retrieval established according to the length of ischemia the organ will tolerate; in other words, its survival time once blood flow is cut off: first, the heart; second, the lungs; third, the liver; and fourth, the kidneys.

The body is laid out, naked, arms outstretched to leave the rib cage and abdomen clear. It’s prepared, shaved, swabbed. Then covered with a sterile surgical drape that marks out a window of skin, a cutaneous perimeter over the thorax and the abdomen.

All right, we’re ready to go. The first team present in the O.R., the urologists, gets the ball rolling – they are the ones who open the body, and they will be the ones to close it up again at the end. The two men bustle about, an odd pair, Laurel and Hardy – the long and thin one is the surgeon and the short round one, the intern. It’s the former who leans over first and makes an incision – a laparotomy, so a kind of cross is drawn on the abdomen. The body is divided into two distinct areas at the level of the diaphragm: the abdominal area, holding the liver and kidneys, and the thoracic, holding the lungs and the heart. Next they place retractors at the edges of the incision, which are turned by hand to enlarge the opening – we can see that arm strength is called for, together with meticulous technical skill, and suddenly it’s possible to glimpse the manual aspect of the operation, the physical confrontation with the reality of what is required here. The inside of the body, a murky and seeping interior, glows beneath the lamps.

The practitioners will prepare their organs one by one. Rapid and rigorous blades cut around each organ to free it from its attachments and ligaments, from the various envelopes – but nothing is severed yet. The urologists, standing on either side of the table, talk during this sequence, the surgeon using the opportunity to train the intern; he leans over the kidneys, breaks down his movements and describes his technique while the student nods, asks the occasional question.

The Alsatians make their entrance an hour later, two women of the same height and build; the surgeon, a rising star in the relatively select field of hepatic surgery, doesn’t utter a single word, maintaining an impassive gaze behind little wire-rimmed glasses and working on her liver with a determination that resembles a battle, totally engaged in this action that seems to find its fullness through its very exertion, through practice, and her teammate doesn’t let her eyes leave these hands for a second, hands of an unmatched dexterity.

Thirty-five more minutes pass and then the thoracic surgeons arrive. It’s Virgilio’s play now, his moment has come. He tells the Alsatians he’s ready to make an incision, then cuts along the longitudinal section of the sternum. Unlike the others, he doesn’t lean over – he keeps his back straight, head inclined, and arms held out in front of him – a way of keeping his distance from the body. The thorax is open and now Virgilio uncovers the heart,
his
heart, considers its volume, examines the ventricles, the atria, observes its beautiful contractile movement, and Alice watches him appreciating the organ. The heart is magnificent.

He proceeds with astounding rapidity, quarterback’s arm and lace-maker’s fingers, dissects the aorta and then, one by one, the venae cavae: he isolates the muscle. Alice, facing him on the other side of the operating table, is captivated by what she sees, by the procession around this body, by the sum of actions of which it is the object; as she watches Virgilio’s face, asks herself what it means for him to operate on a dead person, what he feels and what he’s thinking, and space suddenly pitches around her, as though in this place the separation between the living and the dead didn’t exist anymore.

When the dissection is complete, they cannulate. The vessels are pierced with a needle so that tiny tubes can be inserted, injecting a liquid to keep the organs cool. The anaesthetist monitors the donor’s hemodynamic state on display screens, it’s completely stable, while Cordelia furnishes the practitioners with the right tools, taking care to repeat the name of the compress or the number of the clamp or blade as she places it in the hollow of the hand outstretched before her, gloved in nitrile, and the more she distributes, the more sure her voice grows, the more she has the feeling of finding her place. It’s ready now, the cannulation is done, they will be able to clamp the aorta – and all the practitioners in the O.R. identify what they have come to take on the anatomical cartography, pick out the piece intended for them.

Can we cross-clamp? Virgilio’s voice, loud in the room even though it’s stifled by the mask, makes Thomas start. No, wait! He shouts it. All eyes turn toward him, hands go still above the body, arms at right angles, they suspend the operation as the coordinator weaves through to reach the bed and lean close to Simon Limbeau’s ear. What he murmurs then, in his most human voice, even though he knows that his words sink into a lethal void, is the promised litany, the names of those who accompany him: he whispers that Sean and Marianne are with him, and Lou, too, and Grammy, he murmurs that Juliette is there – Juliette who knows, now, about Simon, a call from Sean around ten o’clock after she had left several messages on Marianne’s cellphone, each one more distraught, an incomprehensible call, because Simon’s father seemed to be erring outside language, unable to formulate a single phrase anymore, only moans, chopped-up syllables, stuttered phonemes, choking sounds, and Juliette understood that there was nothing else to hear, that there were no words, that this was what she had to hear, and answered in a whisper I’m coming, then threw herself into the night, racing toward the Limbeaus’ apartment, hurtling down the long hill, no coat, no scarf or anything, an elf in sneakers, keys in one hand phone in the other, and soon the glassy cold became a burn, she consumed herself in the slope, dismantled figurine who nearly fell several times, she was trying so hard to coordinate her stride, and breathing poorly, not at all the way Simon had taught her to breathe, keeping no semblance of a regular rhythm and forgetting to exhale, the fronts of her tibias aching and heels burning, ears heavy as when the plane lands, and stitches piercing her abdomen, she doubled over but kept running along the narrow sidewalk, scraping her elbow on the high stone wall that lined the curve; she hurtled down this same road that he had climbed for her five months earlier, the same turn in the opposite direction, that day of the
Ballade des pendus
and the lovers’ capsule in red plastic that had lifted them up together, that day, that first day, she ran breathless now, and the cars that passed her as they drove up the hill slowed, catching her in the white rays of their headlights, the dumbstruck drivers continuing to watch her for a long time in their rear-view mirrors, a kid in a T-shirt in the street, at this hour, in this cold, and how panicked she looked! then she came into view of the bay window of the living room, dark, and ran even faster, entered the building, crossing a space barbed with flowerbeds and hedges that seemed like a hostile jungle, and rushed up the front steps where she stumbled and fell, the carpet of leaves congealed by the cold forming a skating rink, she scratched her face, her temple and chin covered in mud, then the stairwell, three floors, and when she reached the landing, disfigured as the rest of them, unrecognizable, Sean opened the door before she even rang and took her in his arms, held her tightly, while behind him, in the dark, Marianne stood smoking in her coat near a sleeping Lou, oh Juliette, and then the tears came – Thomas takes the headphones he has sterilized out of his pocket and puts them in Simon’s ears, turns on the MP3 player, track seven, and the last wave forms on the horizon, it rises before the cliffs until it envelops the whole sky, forms and deforms, unfurling the chaos of matter and the perfection of the spiral in its metamorphosis, it scrapes the bottom of the ocean, stirs the sedimentary layers and shakes the alluvium, it uncovers fossils and tips over treasure chests, reveals invertebrates that deepen the thickness of time, hundred-and-fifty-million-year-old shelled ammonites and beer bottles, plane carcasses and handguns, bones whitened like bark, the sea floor as fascinating as a gigantic depository and an ultrasensitive membrane, a pure biology; it lifts the earth’s skin, turns memory over, regenerates the ground where Simon Limbeau lived – the soft cleft of the dune where he shared a plate of fries and ketchup with Juliette, the pine forest where they took shelter during the squall and the bamboo thicket just behind, forty-metre stalks with their Asiatic sway; that day the warm drops had perforated the grey sand and the smells had mixed together, sharp and salty, Juliette’s lips grapefruit coloured that time – until it finally explodes, it’s a conflagration and a sparkling, and around the operating table the silence thickens, they wait, gazes meet above the body, toes shuffle, fingers wait it out, but each person allows for this pause at the moment of stopping Simon Limbeau’s heart. At the end of the track, Thomas takes the headphones off and goes back to his place. Again: can we cross-clamp?

– Clamp!

The heart stops beating. The body is slowly purged of its blood, which is replaced by a cooled liquid injected in a strong stream to rinse the organs from the inside, while ice cubes are immediately placed around them – and in that moment Virgilio probably casts a look at Alice Harfang to see if she’s about to faint, because the blood that flows out of the body pours into a bin, and the plastic of the receptacle amplifies sounds like an echo chamber – it’s really this sound more than the sight that makes an impression: but no, the young woman stands perfectly stoic, even though her forehead is pale and pearled with sweat, so he turns back to his work. The countdown has begun.

The thorax then becomes this site of ritual confrontation where heart surgeons and thoracic surgeons battle to gain a little more length in this stump of vein, or to gain a few extra millimetres of pulmonary artery – Virgilio, friendly but tense, finally fumes against the guy in front of him, think you could leave me a little slack, a centimetre or two, is that too much to ask?

Thomas Remige has slipped out of the O.R. to call the different departments where the transplants will take place and inform them of the time of the aortic clamping – 23:50 – a fact that immediately sharpens the timeline of the operation to come – preparation of the recipient, delivery of the organ, transplant. When he comes back, the first retrieval is happening in total silence. Virgilio moves on to the ablation of the heart: the two venae cavae, the four pulmonary veins, the aorta and the pulmonary artery are severed – impeccable caesuras. The heart is explanted from Simon Limbeau’s body. You can see it in the open air now, it’s crazy, for a brief moment you can apprehend its mass and its volume, try to perceive its symmetrical form, its double bulge, its beautiful carmine or vermilion colour, try to see the universal pictogram of love, the emblem of the playing card, the T-shirt logo – I
NY – the sculpted bas-relief from royal tombs and reliquaries, the symbol of Eros the charlatan, the portrayal of Jesus’s sacred heart in devotional imagery – the organ held in hand and presented to the world, streaming tears of blood but haloed by a radiant light – or any emoticon indicating the infinite strata of sentimental emotions. Virgilio takes it and plunges it into a jar full of a translucent liquid, a cardioplegic solution that guarantees a temperature of four degrees Celsius – the organ must be cooled quickly in order to be conserved – and then this is protected in a sterile security pouch, then inside a second pouch, and the whole thing is buried in crushed ice inside a wheeled isothermal crate.