Paris Twilight

by Russ Rymer

  In the center of the straining line was the most bizarre sight: an embolism, a vacant space half as large as a tennis lawn and placid as a drawing room, delineated only by the solid wall of bodies that respectfully surrounded it, an incredible bubble of peace. The eight or ten people inside the bubble seemed neither pressured nor concerned nor even noticeably interested in the rage without. A column of light from the gyring plane burrowed down constantly onto it, and the little group glistened sharply in the ray like diamonds in a display case. Some of the men (and the one woman I could see) were in uniform, the others in suits. Whatever game was under way evidently required on their part a display of bored equanimity equal to the fervor of the troops. It occurred to me that this was some ghastly mockery of the party I’d just left, the celebrants pacing their parlor absorbed in concentration or in conversation, lost in the mood of the moment, until regularly they coalesced again into a central huddle—all they lacked was stemware.

  By these odd rules of engagement, some vital brinkmanship was being advanced. I sensed beneath the bonhomie a massive mutual ongoing accounting of force and resource and nerve, for when one of the suited generalissimos looked out of the circle at the crowd, the crowd responded with a plebiscite of whistles and amplified roar. I recognized Massue’s ponytailed head.

  Then the row of shields parted, and through the opening, two new parties were admitted into the light. The first was Cassell, who stooped as though crawling from a culvert, and right behind him Emil. The newcomers shook hands around the group, and the huddle reconvened. There was evidently some contention or excitement, and people stepped away from and back into the conversation, and after five minutes or so it seemed a resolution had been hammered out, for there was more shaking of hands and a delegation struck off out of the bubble, tunneling through the crowd. The crowd that had seemed so impermeable found a way to let the delegation through. We (for Drôlet had spelunked up beside me) could follow their progress by the disruption roiling the pond. As they neared the far curb, a new beam, cast down from the whirlybird, landed ahead of them on the building façade. It illuminated, with a supernatural clarity, their destination, a second kingdom of utter calm even larger and even calmer than the one in the middle of the street, guarded by an outward-facing picket of rifle-bearing police. At its center, all alone, was Corie.

  XXIV

  SHE SEEMED, AT FIRST sight, more eerily oblivious even than the generals, more oddly insulated from the tumult. She was at the top of some sweeping steps, the building at her back, sitting in a lotus position, forearms on knees, an icon of contemplative serenity. Her gaze was concentrated on the ground just before her; the police guards at the foot of the stairs held the crowd at bay as though the girl were a bomb that might detonate. I discerned the source of their caution. In one outstretched hand was a large open bottle, and in her other an object that glinted like a heliograph in the searchlight and glowed like a candle whenever the beam skipped away. It was Saxe’s hurricane lamp, its wick aflame, missing its crystal chimney. The pavement around her glistened with spilled oil, and her jeans and coat were dark with it.

  The ripple through the crowd arrived at the steps and eddied there a minute, and then I could see the pickets relent to admit someone out of the swirl and through the cordon. Emil emerged onto the steps. He climbed them without haste or hesitation, neither slow nor especially fast. His walk was without worry, it had purpose without guile, and a destination without any urgency. It was a walk without qualities. His hands were in the pockets of his jacket, and his head was down, and I imagine the effect, as he approached her, must have been like one of those cobras I’ve read about that hypnotize their prey with a lullaby of swaying. If Corie felt threatened or had moved to ignite herself, I couldn’t discern it from where I was, but no flames rose and there was no conflagration. Emil strode to her without rush or pause, and with an almost blasé unconcern he sat himself down beside her, right in the puddle of fuel.

  Somewhere inside of me it occurred to my conscience that a man I’d accused of being so self-serving he would pilfer a stranger’s heart was engaged here selflessly in rescue, so selflessly he’d sat down in kerosene beside a stranger wielding an open flame, a stranger whose Armageddon he’d volunteered to share. Traitorous first impressions! Emil’s tuxedo jacket shone like the brightest snow, and they began their conversation.

  Impressions. Daniel, you must forgive me, I cannot seem to keep the whole thing straight. It all conflates from midnight on, Emil and Corie sitting at the top of the steps so side by side, so grave and close and calm in the jitter of the hovering beam—they derange in my mind with the other quiet huddle under the other and closer lamp, the lab coat Willem always liked to wear, like a lucky garment beneath his scrubs, as white as Emil’s tuxedo. The street crowd had fallen in two as Emil ascended and sat, and its sound was cleaved in two, for everyone on the boulevard who was close enough to see fell silent, and the silence echoed off the wall of chant persisting from far corners. The silence spread by word of mouth, grew deeper. Wall to wall, the block became a chapel, you could hear the masses breathe into the apse of the sky as the whistling stopped and the drumming against the shields stopped and the only sound was the sound of waiting and the dry pulse of the helicopter rotors in the high distance, and Willem announced, “Begin quiet,” and the Bach invention that had accompanied our preparations was killed with a punch to a button on the CD player, and our work began in earnest.

  I had arrived at the hospital on the morning after the night that followed the night of the demonstration, knowing with relief that Corie was alive and Sahran somewhere, but not knowing where they might be. In jail, I assumed, in Corie’s case, and in Emil’s? Had he headed out so soon? Without so much as a word?

  I used irritation to keep my anxiety at bay during the empty intervening day between those nights, but it hardly worked. My Sunday was spent in a torpor of agitation. The trauma of the standoff on the steps, of Corie’s flirtation with death and Emil’s hinting about it, induced a sort of narcolepsy in me whenever I thought about it. Every excitement incited deeper somnolence, and I lay physically exhausted to the precise degree that I was racked by worry inside. I was thankful when the next day dawned and my morning call to Mahlev brought a summons to the hospital. Drôlet drove me over, and I distracted myself with routines, chatting with Odile about this and that as she settled her system and we awaited word of when an organ might arrive.

  The moment word came, our surgery would commence. Once a heart is cut from the donor’s chest by a harvest team, it has only four or five vital hours before a metabolic despair sets in and it begins to die, a loneliness of tissue. That single imperative sets the pace for everything else that happens: transport alone can eat up an hour—or longer, certainly, depending on where the donor is. The first thing required is readiness. This was the event I’d come for. I slept the last night in the hospital, in an empty patient’s room.

  Willem was nowhere to be seen during that day of hospital waiting. Then, in the evening, I heard his voice in Mahlev’s office. There was some eleventh-hour fracas over the arrangements, and in the lounge down the hall where a couple of us had gathered, we could hear the tenor, though not the details, of the discussion. It wasn’t hard to guess the situation—these things are common at the last minute. Was there a holdup? A likely donor discovered to be inappropriate? But at five the next morning I was awakened by Mahlev, who let me know with a knock and a whisper that we were on. I washed and got into my scrubs and hustled to the theater. When the transport arrives with the donor heart, the recipient should be open.

  “Still There Drips In Sleep Against the Heart,” I murmured to myself, running through my equipment and my drugs. I stroked Odile’s hand. The hypnotic had been added to the IV, and she was succumbing; her talk had faltered into senselessness and soon it would stop. “Grief of memory.” Memory: my meter—the pulse oximeter—was attached to her fingertip; her vitals were scrolling across the display. Her voice was supplanted
by a different and deeper reporting.

  Her repose at this moment was the profile I consider the most unfathomable and most disquieting point in surgery (it’s the aspect some observers find the most unbearable, aside from the smell), the hardest thing to acclimate one’s mind to, for surgery’s most remarkable aspect isn’t its violence; “That’s just what’s bound to happen when those most weak are prostrate before those most ambitious,” as Maasterlich liked to say. It was the weakness itself, the breathtaking vulnerability of the anesthetized patient. The patient, as Odile now, lay exposed before God, a sacrifice, utterly naked and unconscious and defenseless, supine on the tabernacle, inert as a roll of veal, a billowy bag of acids.

  No one but God noticed, generally. The crew was now quite busy. Odile was officially a thing. She’d been unrobed and slathered orange-yellow with antiseptic, her gentle belly jiggly as tired aspic as they swabbed her, the swabbing as unceremonious as painting an apartment wall or basting a fowl, her legs spread wide. The circulator nurse was bent between her legs, parting away from the brown folds of her labia the stray thin wisps of her pubic beard as he fed a catheter into her urethra.

  The bustle in the room, the general obliviousness to the profundity of this human frailness, exacerbated the impression I always had, whenever I thought to notice it, that the patient was an invisible angel. She might have descended out of her celestial plane just as unnoticed to levitate anywhere—over a city sidewalk or midfield in a playground—but she had chosen to descend to the center of OR 5. The impression was exact. We in our scrubs were proudly at our knitting, busy people busy with our worldliest routines, while Odile, divested of all will (and all clothes) and tossed so thoroughly out of conceivable existence, reposed in a submission so complete it was tantamount to grace. I gathered two short pieces of transparent tape and moved to seal her eyelids to her cheeks, to keep her eyes protectively closed, as is customary, and then I paused—and then put the tape on anyway.

  Willem had come in and was leaning against the tile wall completing his paperwork. The scrub nurse was counting her array of calibrated gold and silver clamps, and the perfusionist had pulled up a stool behind the heart-lung bypass machine, a contraption the size of an upright piano made of stainless steel, a carillon of big and little bottles and long and longer tubes. When Odile drifted off, I took her to the final level, administered the paralytic, and prepared to put the line in.

  I swabbed her neck, and inserted the hypodermic. I could feel it enter the vessel right away, and I pulled back on the syringe and checked the color of the blood. It was dark, not arterial crimson, thankfully—there was always a tiny ping of relief; you didn’t want to get that one wrong—and I said to myself, “Jugular,” and fed in the guide wire. I made a nick in the skin around the wire to accommodate the large hollow dilator sheath. I floated the catheter over the guide wire, slowly, pushing an increment with each throb of her pulse, down the living tube. The vein coursed beneath the skin of her neck before submarining into her chest. I advanced the catheter to the vena cava, just above the heart, removed the guide wire, verified the blood flow, and then sutured the catheter in place. “Line’s in,” I announced when I’d gotten it arranged the way I wanted it.

  I inspected Odile’s pharynx with a laryngoscope, and edged a breathing tube down her throat and between her vocal cords, lungward. She accepted it easily, the dear. Some throats are so resistant (some in fact almost impossible). I attached the bag and squeezed the pleated fabric and released, and squeezed it again, and watched the rise and collapse of her shiny chest.

  “We’re breathing,” I told the room.

  The yellow corpus was gone now. The circulator nurse had packed Odile carefully in prodigious layers of Sanidrape, so that only a rectangle of her chest was visible through the sky of blue shrouds, and her face and neck, and I stretched the ether shield across her neck, the blood-brain barrier between Willem’s world and mine: his rectangle of thorax, my cradled head. Soon Odile would be an inert mound of cornflower blue trailing gussets of reddest red through seven-foot-long tubes into a contraption by her feet.

  Willem said loudly, “Hard stop.”

  Activity ceased, even the flurry of fingers, even the shuffling of clogs, and there was only the slow electronic beep, beep of heartbeat on the monitor. The circulator nurse reached for his checklist.

  “Patient name?” Willem said.

  “Sahran, Odile,” the nurse said.

  “Procedure?”

  “Transplant, simple.”

  “Organ?”

  “Heart.”

  “Surgical site?”

  The assisting surgeon said, “Not marked.”

  “Allergies?”

  “None,” I said.

  “Any clinical or nonroutine issues?” It wasn’t for me to answer, but no one else spoke.

  “Cerebral palsy,” I said. “From birth. Lower-limb paralysis, blindness. Past surgeries for associated complications, abdominal and orthopedic.”

  “Have you given any pre-op antibiotics?” he asked me.

  “No.”

  He looked up and around the huddle.

  “Does anyone have anything to disclose?”

  A brief silence, then six consecutive individual noes, followed by another, final.

  “No,” Willem declared.

  The circulator nurse tied the strings of Willem’s mask behind his head, and as I watched him nudge his goggles back onto his nose my affection overwhelmed me. It had been a long time since we’d worked together, and I was reminded why I liked to, because he was so very thorough. Not every attending surgeon does a hard-stop time-out, but Willem always did, assuring we had set out to commit the right acts on the right patient. Everything up to now was reversible. What was to come was not. With a scalpel, he sliced a shallow, straight incision from clavicle to diaphragm down the center of Odile’s chest, parting her skin to expose the fascia beneath.

  “Bovie,” Willem said, and the scrub nurse handed him the hot-tipped wand of the cauterizing knife. Out in the night air—the air of a couple nights past—the conversation had lasted nearly half an hour, and the impatient crowd had set up its clamor again. For a while, the pair on the steps had occupied the center of an excruciating concentrated quiet. I was glad when the resuming roar gave them back their privacy. I stood immobile in the crush and tumble, feeling, except for Drôlet’s protective, restraining arm around my waist, untouched and alone.

  Across the avenue the two of them sat, tiny adjacent figures in their bubble of back-and-forth. I could see the talk ebb at times to nothing, to sulk, and then come animating all the way back to argument. I tried to conjure the words at play, the moments of risk and reassurance, whether the end would spell life or disaster for both. And ahead of the crowd’s noticing, I noticed. And my heart whistled long, so long, before the crowd’s great deafening whistle marked the moment when she moved her arm and reached out to hand Emil the lamp, and before he reached to set it aside on the stair and rolled back to hug her with her head in his hand and pulled her temple against his chest, and before the centurions turned from guards to jailers and rushed to bury them in a mountainous tackle, I saw him draw down the wicked wick and, between tongue-moistened fingers, pinch the heat out of the flame, and the little puff of ash-smoke ascended like an offering on the air. Willem lay the hot point of the Bovie knife to the top of the incision in Odile’s chest, and drew down the first long line. The yellow flesh cringed from the livid scorch to reveal an arroyo of magenta and honey, and the white puff rose, and with it the atrocious aroma of Odile burnt to bacon.

  XXV

  BY THE TIME I SENSED trouble, she was split full open, her rib cage pulled akimbo by the windlass clamped into her sternum, her pericardium unzipped and her heart exposed. For a girl who’d been on the dance floor several nights ago, she sure did need a new heart. Oh, it beat like a bean, dancing away merrily in there, bumping with insurrection like it would leap out onto the table, but you could see right away what the trou
ble was. It was big. It was congested and far too large and its bump was gimp. It didn’t have the nice rolling ventricular gallop that marks the contractions of a healthy beating heart. Some of the muscle of the wall or septum had probably died to deadweight. It would pull the rest down eventually. Willem snipped into the aorta above this antic creature and sewed in the cannula for the bypass machine, banging on the tube to get the air out, and after I’d got the anticoagulant started and had announced, “Heparin is in,” the plastic hoses flushed table-length with that indescribable, electric bruise-bright crimson of heart blood, and the perfusionist said to the room, “We’re on the pump.”

  The room temperature was plummeting by then, toward the high 50s Fahrenheit that would slow Odile’s metabolism and keep the iced replacement heart from warming up and beginning its rot before we could get it into her. The climate would convince the rest of us we were descending into the crypt, and soon I would reach for a blanket to shawl my shoulders, in ecstasy. I could feel myself back in the current of surgery’s lovely, seductive sway, reentering the altered state it had always allowed me.

  Patients after an operation notice the constrained, private look on the surgeon’s face and assume he’s being stoic about all the gore and corruption he’s been made to witness, and they feel a bit chagrined about putting him through such horror. They want to say that they’re better than this, that their best side’s more human than their insides, but they’re wrong. What the surgeon can’t confess is that he’s already witnessed them at their most magnificent, seen a side of them they’ll never have the privilege of knowing, so brilliant and extraordinary, so exceptional to their dreary daily exterior that to admit the preference in its full blunt force would trouble people, would seem to revel in a ghoulish perversion of blood-love. For blood-love it is, an awe for the whole wet, mad, divine, ingenious jalopy, and even its genius afflictions, because the tumor and the lesion also attest to miracle, are full of the mystery of striving.