Harvesting the Heart

by Jodi Picoult

  Mrs. McCrory beams and grabs Paige's hand, which is the nearest one. Paige, startled, gasps and almost overturns a vase of peonies. "Take it easy," Nicholas says dryly. "I don't have room in my agenda for an unscheduled heart attack."

  At this unexpected attention, Paige turns. Mrs. McCrory eyes her critically. "He doesn't bite, dear," she says.

  "I know," Paige murmurs. "He's my husband."

  Mrs. McCrory claps her hands together, thrilled by this news. Nicholas mutters something unintelligible, amazed at how easily Paige can ruin his good mood. "Don't you have somewhere else to be?" he says.

  "No," Paige says. "I'm supposed to go wherever you go. It's my job."

  Nicholas tosses the chart down on Mrs. McCrory's bed. "That is not a volunteer's assignment. I've been here long enough to know the standard rounds, Paige. Ambulatory, patient transport, admitting. Volunteers are never assigned to doctors."

  Paige shrugs, but it looks more like a shiver. "They made an exception."

  For the first time in minutes, Nicholas remembers Mrs. McCrory. "Excuse us," he says, grabbing Paige's upper arm and dragging her out of the room.

  "Oh, stay!" Mrs. McCrory exclaims after them. "You're better than Burns and Allen."

  Reaching the hallway, Nicholas leans against the wall and releases

  Paige. He wanted to yell and to complain, but suddenly he can't remember what he was going to say. He wonders if the whole hospital is laughing at him. "Thank God they don't let you in surgery," he says.

  "They did. I watched you today." Paige touches his sleeve gently. "Dr. Saget arranged it for me, and I was in the observation room. Oh, Nicholas, it's incredible to be able to do that."

  Nicholas does not know what makes him more angry: the fact that Saget let Paige watch him doing surgery without his consent, or the fact that his imagined angel was really just his wife. "It's my job," he snaps. "I do it every day." He looks at Paige, and that expression is back in her eyes--the one that probably made him fall in love with her. Like his patients, Paige is seeing him as someone who is flawless. But he has a sense that unlike them, she would have been just as impressed if she'd watched him mopping the hospital's halls.

  The thought chafes around his neck. Nicholas pulls at his collar and thinks about going right back to his office and calling Oakie Peterborough and getting this over. "Well," Paige says softly, "I wish I were that good at fixing things."

  Nicholas turns and walks down the hall to see another patient, a transplant recipient from last week. When he is half inside the room, he glances around, to find Paige at the door. "I'll change the damn water," he says. "Just get out of here."

  Her hands are braced on either side of the doorway, and her hair is working its way out of her braid. Her volunteer uniform, two sizes too big, billows around her waist, falls to her shins. "I wanted to tell you," she says, "I think Max is getting sick."

  Nicholas laughs, but it comes out as a snort. "Of course," he says, "you're an expert."

  Paige lowers her voice and peeks into the hallway to make sure no one is around. "He's constipated," she says, "and he spit up twice today."

  Nicholas smirks. "Did you give him creamed spinach?" Paige nods. "He's allergic."

  "But there aren't any welts," Paige says, "and anyway it's more than that. He's been crabby, and, well, Nicholas, he just isn't himself."

  Nicholas shakes his head at her and takes a step into the patient's room. As much as he doesn't want to admit it, when he sees Paige standing in the doorway, arms outstretched as if she is being crucified, she looks very much like an angel. "He's not himself," Nicholas repeats. "How the hell would you know?"

  chapter 40

  Paige

  When Astrid hands Max over to Nicholas that night, something still is wrong. He has been crying on and off all day. "I wouldn't worry," Astrid says to me. "He's been a colicky baby." But it is not his crying that bothers me. It's the way the fight has gone out of his eyes.

  I stand on the staircase while Nicholas takes Max. He hoists the diaper bag and some favorite toys over his free arm. He ignores me until he reaches the door, about to leave. "You might want to get a good lawyer," he says. "I'm meeting with mine tomorrow."

  My knees give out under me, and I stumble against the banister. I feel as if I have been swiftly punched. It isn't his words that hurt so much; it is knowing that I have been too late. I can run in circles until I drop, but I cannot change the course of my life.

  Astrid calls out to me as I pull myself up the stairs to my room, but I do not listen. I think about phoning my father, but he'll only

  lecture me on God's will, and that won't give me any comfort. What if I don't happen to like God's will? What if I want to keep the end from

  coming?

  I do what I always do when I am in pain; I draw. I pick up my sketch pad and I draw image after image on the same page until it is nothing more than a dismal black knot. I flip the page and do this all over again, and I keep on doing this until little by little some of the rage leaves my body, seeping through my fingertips onto the page.

  When I no longer feel I am being eaten alive from the inside, I put down my charcoal and I decide to start over.

  This time I draw in pastels. I rarely use them because I'm a lefty and they get all over the side of my hand and make me look strangely bruised. But right now I want color, and that is the only way I can think of getting it. I find that I am drawing Cuchulainn's mother, Dechtire, which seems natural after thinking of my father and the whims of the gods. Her long sapphire robes mist around her sandaled feet, and her hair flies behind her in a sleek arc. I draw her

  suspended in midair, somewhere between heaven and earth. One arm reaches down to a man silhouetted against the ground, one arm reaches up toward Lugh, the powerful god who carries the sun.

  I make her fingers brush those of her husband below, and as I do it I get a physical jolt. Then I lengthen her other arm, seeing her torso twist and stretch on the page as she reaches into the sky. It takes all the effort in my fingers to make Dechtire's hand touch the sun god's, and when it does I begin to draw furiously, obliterating Dechtire's porcelain face and the solid body of her husband and the bronze arm of Lugh. I draw flames that cover all the characters, erupting in fiery sparks and bursting across the sky and the

  earth. I draw a blaze that feeds on itself, that shimmers and flares and sucks away all the air. Even as I cannot breathe anymore, I see that my picture has turned into a holocaust, an inferno. I throw the scorching pastels across the room, red and yellow and orange and sienna. I stare sadly at the ruined image of Dechtire, amazed that I have never before seen the obvious: when you play with fire, you are likely to get burned.

  I fall asleep fitfully that night, and when I wake, sleet is rattling

  against the window. I sit up in bed and try to remember what has awakened me, and I get a sinking feeling in the pit of my stomach. I know what is coming. It is like that feeling I used to have about Jake, when we were so closely connected that I could sense when he stepped into his home at night, when he thought of my name, when he needed to see me.

  I jump out of bed and pull on the pants and shirt I wore yesterday. I don't even think to find socks, tying up my sneakers over bare feet.

  I gather my hair into a tangled ponytail and secure it with the

  rubber band from a bag of gummy fish. Then I pull my jacket off the doorknob and run downstairs.

  When I open the door, Nicholas stands before me, assaulted by the ice and the rain. Just beyond him, in the yellow interior light of his car, I can see Max, oddly silent, his mouth in a raw red circle of pain.

  Nicholas is already closing the door behind me and pulling me into the storm. "He's sick," Nicholas says. "Let's go."

  chapter 4 1

  Nicholas

  He watches the hands of people he does not know poke and prod at his son's body. John Dorset, the resident pediatrician on call last night, stands over Max now. Every time his fingers
brush Max's abdomen, the baby shrieks in pain and curls into a ball. It reminds Nicholas of the sea anemones he played with on Caribbean beaches as a child, the ones that folded around his finger at the slightest touch.

  Max hadn't gone to sleep easily last night, although that wasn't cause in itself for alarm. It was the way he kept waking up every half hour, screaming as if he were being tortured, fat clear tears rolling down his face. Nothing helped. But then Nicholas had gone to change the diaper, and he'd almost passed out at the sight of so much jellied blood.

  Paige trembles beside him. She grabbed his hand the minute Max was brought into the emergency room, and she hasn't let go since.

  Nicholas can feel the pressure of her nails cutting into his skin, and he is grateful. He needs the pain to remind him that this isn't a nightmare after all.

  Max's regular pediatrician, Jack Rourke, gives Nicholas a warm smile and steps into the examination room. Nicholas watches the heads of the two doctors pressed together in consultation over the kicking feet of his son. He clenches his fists, powerless. He wants to be in there. He should be in there.

  Finally, Jack steps out into the pediatric waiting room. It is now morning, and the staff nurses are starting to arrive, pulling out a box of Big Bird Band-Aids and sunny smiley-face stickers for the day's patients. Nicholas knew Jack when they were at Harvard Med together, but he hasn't really kept in touch, and suddenly he is furious at himself. He should have been having lunch with him at least once a week; he should have talked to him about Max's health before anything like this ever happened; he should have caught it on his own.

  He should have caught it. That is what bothers Nicholas more than anything else--how can he call himself a physician and not notice something as obvious as an abdominal mass? How can he have missed the symptoms?

  "Nicholas," Jack says, watching his colleague pick up Max and sit him upright. "I have a good idea of what it might be."

  Paige leans forward and catches at the sleeve of Jack's white coat. Her touch is light and insubstantial, like a sprite's. "Is Max all right?" she asks, and then she swallows back her tears. "Is he going to be all right?"

  Jack ignores her questions, which infuriates Nicholas. Paige is the baby's mother, for Christ's sake, and she's worried as hell, and that isn't the way to treat her. He is about to open up his mouth, when John Dorset carries Max past them. Max, seeing Paige, reaches out his arms and starts to cry.

  A sound comes out of Paige's throat, a cross between a keen and a wail, but she doesn't take the baby. "We're going to do a sonogram," Jack says to Nicholas, Nicholas only. "And if I can verify the mass--I think it's sausage-shaped, right at the small bowel--we'll do a barium enema. That might reduce the intussusception, but it depends on the severity of the lesion."

  Paige tears her gaze away from the doorway where Max and the doctor have disappeared. She grabs Jack Rourke's lapels. "Tell me," she shouts. "Tell me in normal words."

  Nicholas puts his arm around Paige's shoulders and lets her bury her face against his chest. He whispers to her and tells her what she wants to know. "It's his small intestine, they think," Nicholas says. "It kind of telescopes into itself. If they don't take care of it, it ruptures."

  "And Max dies," Paige whispers.

  "Only if they can't fix it," Nicholas says, "but they can. They always can."

  Paige looks up to him, trusting him. "Always?" she repeats.

  Nicholas knows better than to give false hope, but he puts on his strongest smile. "Always," he says.

  He sits across from her in the pediatric waiting room, watching healthy doddering toddlers fight each other for toys and crawl all over a big blue plastic ladder and slide. Paige goes up to ask about Max, but none of the nurses have been given any information; two don't even know his name. When Jack Rourke comes in hours later, Nicholas jumps to his feet and has to restrain himself from throwing his colleague against the wall. "Where is my son?" he says, biting off each word.

  Jack looks from Nicholas to Paige and back to Nicholas. "We're prepping him," he says. "Emergency surgery."

  Nicholas has never sat in Mass General's surgical waiting room. It is dingy and gray, with red cubes of seats that are stained with coffee and tears. Nicholas would rather be anywhere else.

  Paige is chewing the Styrofoam edge of a coffee cup. Nicholas has not seen her take a sip yet, and she's been holding it for a half hour. She stares straight ahead at the doors that lead to the operating suites, as if she expects an answer, a magical ticker-tape billboard.

  Nicholas had wanted to be in the operating room, but it was against medical ethics. He was too close to the situation, and honestly he didn't know how he would react. He would renounce his salary and his title, just to get back the detachment about surgery that he had only yesterday. What had Paige said after the bypass? He was incredible. Good at fixing. And yet he couldn't do a damn thing to help Max.

  When Nicholas was standing over a bypass patient whom he hardly knew, it was very easy to put life and death into black-and-white terms. When a patient died on the table, he was upset but he did not take it personally. He couldn't. Doctors learn early that death is only a part of life. But parents shouldn't have to.

  What are the chances of a six-month-old making it through intestinal surgery? Nicholas racks his brain, but he can't come up with the statistics. He does not even know the doctor operating in there. He's never heard of the damn guy. It strikes Nicholas that he and every other surgeon live a lie: The surgeon is not God, he is not omnipotent. He cannot create life at all; he can only keep it going. And even that is touch and go.

  Nicholas stares at Paige. She has done what I can never do, Nicholas thinks. She has given birth.

  Paige has put down the Styrofoam cup and suddenly stands. "I'm going to get some more coffee," she announces. "Do you need anything?"

  Nicholas stares at her. "You haven't touched the coffee you just bought."

  Paige crosses her arms and rakes her fingernails into her skin, leaving raw red lines that she doesn't notice at all. "It's cold," she says, "way too cold."

  A collection of nurses walks by. They are dressed in simple white uniforms but wear felt ears in their hair, and their faces are made up with whiskers and fur. They stop to talk to the devil. He is some kind of physician, a red cape whirling over his blue scrubs. He has a forked tail and a shiny goatee and a hot chili pepper clipped to his stethoscope. Paige looks at Nicholas, and for a second Nicholas's mind goes blank. Then he remembers that it is Halloween. "Some of the people dress up," he explains. "It cheers up the kids in pediatrics." Like Max, he thinks, but he does not say it.

  Paige tries to smile, but only half her mouth turns up. "Well," she says. "Coffee." But she doesn't move. Then, like the demolition of a building, she begins to crumble from the top down. Her head sinks and then her shoulders droop and her face sags into her hands. By the time her knees give way beneath her, Nicholas is standing, ready to catch her before she falls. He settles her into one of the stiff canvas seats. "This is all my fault," she says.

  "This isn't your fault," Nicholas says. "This could have happened to any kid."

  Paige doesn't seem to have heard him. "It was the best way to get even," she whispers, "but He should have hurt me instead."

  "Who?" Nicholas says, irritated. Maybe there is someone responsible. Maybe there is someone he can blame. "Who are you talking about?"

  Paige looks at him as if he is crazy. "God," she says.

  When he had changed Max's diaper and seen the blood, he didn't even stop to think. He bundled Max in a blanket and ran out the door without a diaper bag, without his wallet. But he hadn't driven straight to the hospital; he'd gone to his parents'. Instinctively, he had come for Paige. When it came right down to it, it didn't matter why Paige had left him, it didn't matter why she had returned. It didn't matter that for eight years she'd kept a secret from him he felt he had every right to know. What mattered was that she was Max's mother. That was their truth, and that was
their starting point to reconnect. At the very least, they had that connection. They would always have that connection.

  If Max was all right.

  Nicholas looks at Paige, crying softly into her hands, and knows that there are many things that depend on the success of this operation. "Hey," he says. "Hey, Paige. Honey. Let me get you that coffee."

  He walks down the hall, passing goblins and hoboes and Raggedy Anns, and he whistles to keep out the roaring sound of the silence.

  They should have come out to report on the progress. It has been so long that the sun has gone down. Nicholas doesn't notice until he goes outside to stretch his legs. On the street he hears the catcalls of trick-or-treaters and steps on crushed jewel-colored candy. This hospital is like an artificial world. Walk inside and lose all track of time, all sense of reality.

  Paige appears at the door. She waves her hands frantically, as if she is drowning. "Come inside," she mouths against the glass.

  She grabs at Nicholas's arm when he gets through the doorway. "Dr. Cahill said it went okay," she says, searching his face for answers. "That's good, isn't it? He wouldn't hold anything back from me?"

  Nicholas narrows his eyes, wondering where the hell Cahill could have gone so fast. Then he sees him writing notes at the nurses' station around the corner. He runs down the hall and spins the surgeon around by the shoulder. Nicholas does not say a word.

  "I think Max is going to be fine," Cahill says. "We tried to manually manipulate the intestines, but we wound up having to do an actual resection of the bowel. The next twenty-four hours will be critical, as expected for such a young child. But I'd say the prognosis is excellent."

  Nicholas nods. "He's in recovery?"

  "For a while. I'll check him in ICU, and if all is well we'll move him up to pediatrics." Cahill shrugs, as if this case is just like any other. "You might want to get some sleep, Dr. Prescott. The baby is sedated; he's going to sleep for a while. You, on the other hand, look like hell."