Second Nature (16 page)

She could not ignore Aurelia.

Nor could she ignore the Irish laborer whose hundred-pound wife had pulled him out of their harvester. “He didn’t have a brilliant face, ever. But I was fond of it,” the wife said.

So many others could do hands. As Hollis’s mother, Evangeline, reminded her, it was a sin to refuse your own gift. At first, Hollis had done just that. At the age of seventeen, Hollis packed four sturdy boxes with things she could not live without—her favorite pillow, her shawls, her collected Shakespeare, her Bible, big plastic jars of her grandmother’s specially mixed spices, and all her Beatles and Nina Simone CDs. It was the first time she’d gone farther from her own parish than to Baton Rouge. She’d gotten on her first airplane, New Orleans to Edinburgh, and began her undergraduate study on a Rotary scholarship, courtesy of strings yanked none too subtly by one of her mother’s “ladies.” Hollis had meant to major in drama, seeing herself swathed in woolens, striding the Scottish streets mouthing classic lines from memory. Anatomy was only a scholarship elective, chosen in the same spirit as Hollis studied small engines in high school—a thirst to know how things worked. When she ended up repeating “The Carpus consists of the Scaphoid, the Lunate, the Triquetal, the Pisiform, the Hamate, the Capitate, the Trapezoid, and the Trapezium” with more passion than “O hateful hands, to tear such loving words!” Hollis realized that, unawares, she’d fallen in love. Grandmother’s spices and Nina Simone went back into the boxes and flew with Hollis to Madison, Wisconsin, where she began her graduate studies in research anatomy.

One night during her graduate school years at the University of Wisconsin in Madison, Ralph Mangiotti, the renowned burn surgeon, had come upon Hollis quietly studying his repairs on a young girl whose mother had held first her face then both her hands to the coils of an electric stove. Mangiotti asked what Hollis thought of reconstructive surgery.

“Well, I think that it is the closest thing on earth we know about salvation,” Hollis said.

“Why aren’t you doing it?” the doctor had asked.

At the advanced age of twenty-seven, Hollis entered medical school. Deep in the rigorous program at Madison, Hollis had scant time for any life, never mind a social life. Prospective surgeons on old nighttime soap operas had more sex in a one-hour episode than Hollis had in a semester. Her most significant relationship at that time wasn’t a love affair of the usual kind: It began nearly six years later, when Hollis represented the UW–Madison Burn Center at a conference in London. After Livingston spoke on the dental implications in future of full-face transplant, Hollis waylaid him, voracious for more. Livingston’s wife, Gwen, still told the story of calling Livingston once at midnight after the conference banquet would have been hours over, then five times between one and four in the morning, after which she decided there had been a mishap and began calling the various trauma units, starting with Livingston’s own. She was shocked to hear that her husband was indeed there, unhurt and deep in conversation over tea with a very pretty American, who was not hurt either. The fellowship post from St. Charles and Kings, Livingston liked to joke, nearly beat Hollis back to Wisconsin. After all the years since, a confirmed and contented expat, and Sidney, her husband, and the boys, when the offer came from Chicago for Hollis to be the one to found the first clinic dedicated entirely to face and limb transplants, she was surprised by the force of her desire to continue to expand the boundaries of this hopeful technology. She was surprised, even more, by the yearning, which ambushed her like an alarm through broken glass, to be home. The boxes made their final trans-Atlantic crossing.

“Look what she is doing,” Hollis now said to Eliza.

“These are my facial nerves,” Sicily was telling Polly, placing the thumb and finger of one hand on spots on her cheeks, just below the ears. “They say you can’t remember feelings, but I dream about my great-uncle letting me hold a duckling once and how its feathers felt on my cheek.” She placed both hands over her mouth. “The fifth cranial nerve has upper and lower divisions. Do you have a husband, Polly? Or a boyfriend?”

Polly Guthrie nodded, and Eliza and Hollis could measure, in the slow tempo of the nod, the psychologist’s perplexity.

“The fifth facial nerve lets you feel him kiss you. But the seventh facial nerve lets you make that motion with your mouth—what do they say?”

“Puckering up,” Polly said.

“That’s it. You can kiss him back. I was thirteen when I got burned. I’d never been kissed,” Sicily said. “I’ve got strong heredity. My grandparents on both sides are well into their eighties and they’re going strong.” Sicily moved her hands down until she cradled the lower portion of the bulbous projection that was her chin. “I want to use the zygomaticus major and risorius muscles, with the help of the buccinator.”

Polly Guthrie nodded again.

“I’d give two years of my life to smile.”

“She knows what she wants,” Hollis said to Eliza. “Let’s transplant this young woman.”

“There will be no documentation,” said the hospital’s lawyer, Joel Brodsky. “If it’s not medically necessary, it can’t happen.”

“It can happen,” said Sicily. “It just hasn’t happened so
far.
”

“Let me tell you why,” said the lawyer. “Sicily, it’s not personal.” The guy explained that the first and most obvious objection—and, Beth thought, escape hatch—was the way in which documenting an entire face transplant, from the location of the donor and the recipient to the aftermath, would violate federal health privacy law. “The Health Insurance Portability and Accountability Act was signed into law in 1996, mostly to protect those with chronic health conditions from being denied health-insurance coverage. But even where that doesn’t apply, patient privacy is a primary concern at this institution, not for the protection of our staff but for our patients. This means that Mrs. Cappadora cannot observe the surgery, and there can be no way she could photograph it.”

“She agreed,” Sicily said.

“It’s not a consideration,” Joel Brodsky put in. “Mrs. Cappadora—”

“I don’t mean Mrs. Cappadora. The donor agreed. She’s sixteen. She’s a minor. Or she was. Her mother has her health directive,” Sicily said. “And she would be eighteen under the law now, and she signed—”

“Dr. Grigsby,” Kelli Buoté, the social worker, pleaded.

Dr. Grigsby held up an admonitory finger. The twelve representatives of the University of Illinois Chicago Circle Transplant Clinic regarded Sicily, Beth, Marie, and Julia Cassidy.

“Mrs. Cassidy is Emma’s mother,” Sicily said. “Emma is my donor. Mrs. Cassidy knows that and I know that. I have visited Emma and spoken with Mrs. Cassidy on several occasions, and so has my aunt, Marie Caruso, who is my adoptive mom, and my friend, Beth Cappadora, who will do the photographs.”

“This is an end run,” Kelli said.

“And the legal risks are incalculable,” Joel Brodsky added, replacing his wire readers as if to announce that the discussion was over.

“What if you were to die, Sicily?” asked Kelli.

“I wouldn’t die because Beth was taking pictures. Obviously, if I died during the surgery, it wouldn’t be such a good aesthetic and public awareness tool. What if I
were
to die? Write up some form and my aunt will sign it. She has my health directive, just as Mrs. Cassidy has Emma’s.”

“It would be a disaster,” said the attorney.

“As it is a disaster, personal and professional, when any patient dies,” said Dr. Grigsby. The tall, slim, dark woman said nothing else but lifted an eyebrow in Eliza’s direction.

This is how she gets her way
, Beth thought.
She’s so used to being the alpha female
.

“Eliza approached Sicily at your bidding,” Beth said. Eliza winced.

“My … bidding?” Dr. Grigsby said softly.

“If you didn’t tell her to do it, then, as her mentor, you made it implicit.” Beth took a deep breath. “I didn’t want to do this either. But Sicily is determined—”

“I do not doubt that for one moment,” said Dr. Grigsby.

“She is committed to … to … letting people see how this process could change lives. More lives. That’s in your interest,” Beth said. Dr. Grigsby said nothing—which was a skill Beth Cappadora had never mastered. This woman put Beth on edge: Her face had the kind of serenity that God seemed to offer only to black women, and only some of those. Her hands did not seek each other out to twitch and wrestle, as Beth’s did, the tapering tip of each well-tended finger lay motionless on the conference-room table. She wore not even an earring or a wedding band. By comparison, Marie Caruso, although demure in a black silk suit, appeared almost gaudy with her diamond studs and two opal rings.

“You … you … violated the law even by meeting with Mrs. Cassidy,” Kelli spluttered, her knuckles white as the coffee cup, her other hand drumming. “You—and your friend here—were never supposed to meet the donor. This is still new land, Sicily. But there are minefields we know enough to avoid. There’s a process. And the legal and emotional ramifications are real.” Kelli’s eyes filled. “Sicily, you know better than this. You’ve been around the block. Why? Why?”

“She thinks it is the right thing,” Beth answered for Sicily, sensing a wobble in her. Though she’d known Sicily Coyne only a few weeks, already Sicily roused the Irish in Beth. If Beth had lived a life strange in the magnitude of its losses and blessings, then Sicily’s was the life of a saint. To her own surprise, Beth realized that she had all her chips in. Even her mother-in-law had encouraged Beth, saying, “Of course I remember that poor child. Elizabeth, there was nobody who didn’t have a child or a niece or a friend’s child in that fire. It had an effect on people’s lives all over the West Side.” And Beth remembered how self-absorbed she had been then, twelve years before, with Vincent dropping in and out of college, with fighting Pat, who wanted her to be a lady of leisure, to take her career back. Such petty, petty tempests, seen from her vantage today.

Recovering her nerve, Sicily said, “I’m sorry. But Beth is correct. Meeting Emma was the right thing. For me and for Mrs. Cassidy. She feels comforted by knowing where Emma’s face is going.”

Kelli said, “She doesn’t know where her daughter’s donated heart is going. My apologies, Mrs. Cassidy.”

“A heart isn’t a face,” Sicily said. “Hundreds of heart-transplant recipients have met their donors’ families and corresponded and … all that.”

“We can legally …” Joel Brodsky began. “We’re talking here about twenty physicians and skilled surgical nurses. Even they have certain rights.”

“That’s not true,” Dr. Grigsby said. “We might object, but we submit our work to colleagues and students every day, and there is no legal prohibition to this. Livingston?”

“Just so,” said Dr. Grigsby’s co-chair.

“Why are you seeing this as a wrong thing?” Julia Cassidy asked. She pulled a creased sheet of paper from her pocket. “Listen to this. Emma wrote it before she died, right before she went to that party and never woke up afterward.” She read:
“What is the meaning of life? I have no idea. Making others happy is the whole tortilla.”

“I don’t think the problem here is legal,” Dr. Livingston said. “It was a bridge we would cross in due time in any case, since the ideal donor has geographic proximity.”

Facial tissue survived, Beth knew from Sicily, for about eight hours. Six hours was better. Four hours was better than six.

Julia caressed the elaborate festoon of her updo. She was a hairstylist, and the “girl” who rented the chair next to hers had come in early to prepare Julia for this meeting. Julia, too, wore a silk suit, in bright lapis, and brown heels, which troubled Beth more than the updo. But she spoke her case convincingly. “It was as though my Emma knew. She signed her donor card just two months before it happened, when she got her first driver’s license. It was later than most people, because she kept having to take the class over, sophomore and junior year, so she was almost seventeen; it came harder to Emma for those decisions we have to make all at the same time, like, do I turn now, or do I wait until the next light? Those just weren’t instinct for her at first. It was all overwhelming to her, but when she finally got it, she was totally an excellent driver. She never got a ticket. A warning once, but that was at the place that’s basically a speed trap, where the sign says forty-five on one side and twenty-five ten feet later. You practically have to slam on the brakes.”

“Mrs. Cassidy, no one thinks Emma’s heart was anything other than pure,” Joel Brodsky said, in the kind of tone that might have induced vegan Buddhists to at least try a hamburger. “If Emma was here now—”

“She is here,” Julia said.

“If she was here at this table—” said Joel Brodsky.

“She is here at this table,” Julia insisted. “Her spirit is here.”

“Well, if she could speak for herself, I’m sure she would say that she’d do whatever she had to, to help, as she wrote. But you and Emma have already done the right thing by consenting. This is an invasion of your family’s privacy that you will regret later. Think of your relatives and how they will react to seeing very graphic depictions of Emma’s tissue.”

“It’s her face,” Julia said. “Her face and neck. And we have no family. I’m it. No one but Emma and me. Jared’s mother is in a nursing home; she has dementia. It was an early thing, and Emma was heartbroken because she adored her Grammy Linda—”

“You have no other family?” Beth said. “Your daughter is your only family?”

Julia said, “I’m a widow. You know that. And I have a brother I don’t see. So, yes.”

Beth smiled and thought,
Oh, fuck, no. This is impossible
.

“Come on,” Sicily said. “Everyone has to do something for the first time, or nothing would ever change. What could go so wrong that it would be worse than the Canadian nutcase?”

Hollis grimaced at Livingston, who could not suppress a smirk.

“And no one even talks about him anymore. Emma is not ashamed of her gift. Mrs. Cassidy is not ashamed of her choice. I am not ashamed to receive her gift. I’m honored.” Sicily turned to the hospital’s counsel. “Mr. Brodsky, no one is breaking the law. You are advancing it. If you didn’t want to handle junk like this, you should have done, like, real estate.”