When the King and the members of the royal family have occupied their seats, the Nobel Prize laureates will enter the platform of the assembly hall through the centre doors, conducted by the representatives of the various Nobel committees. This procession will be joined, as well, by the Nobel Prize laureates from previous years present at the Ceremony, and the other members of the Nobel committees which have proposed the award of the Nobel Prizes for this year, their arrival being likewise announced by trumpet calls. The members of the procession will please proceed in the following order—the Nobel Prize laureates to the right—Professor Max Stratman, Mr. Andrew Craig, Dr. Claude Marceau, Dr. Denise Marceau, Dr. Carlo Farelli, Dr. John Garrett, with respective representatives of the matching Nobel committees to their left.
The laureates, after making their reverence to the King, will please occupy the seats reserved for them on the right-hand side of the platform, looking from their entrance door to the centre.
After the salutatory oration by Count Bertil Jacobsson of the Nobel Foundation, the proclamation of the laureates will take place in speeches held by one representative of each prize-giving academy. The speeches are to be held in Swedish but followed by a short address in the language of the respective laureates. The laureate thus addressed will please rise, and will be asked at the end of the short speech to step down from the platform in order to receive from the hands of H.M. the King the Nobel gold medal, the diploma and an assignation for the prize. Due to a change in schedule, the acceptance speeches of the laureates will be made upon their return to the platform, instead of at the banquet held afterwards in the City Hall, as had been customary.
After the ceremony the laureates may, before leaving the assembly hall, deliver their medals and diplomas to the head attendant, who brought them into the hands of H.M. the King and who will afterwards bring them to the City Hall, where they are to be exhibited during the evening. At the conclusion of the Ceremony, cars will be in waiting to convey the laureates and their families to the farewell banquet in the City Hall.’
Having finished the official announcement uninterrupted, Jacobsson returned the duplicated schedule to his manila folder. From the pitcher before him, he poured a glass of water, drank, then set down the glass.
‘Now, if you have any questions concerning the afternoon Ceremony at Concert Hall—?’
A hand went up, and Jacobsson acknowledged it.
‘Will the proceedings be televised?’
‘Yes,’ said Jacobsson, unhappily, for he remembered better days and felt the modern monstrosity of the camera as intrusive as a circus act. ‘This is an innovation begun by the Swedish Broadcasting Company in 1957. The entire Ceremony will be shown on government television.’
Another hand went up. ‘How many people have been invited to attend the Ceremony? To whom were the invitations sent?’
Jacobsson took another sip of water. ‘Besides His Royal Highness the King and his family, the laureates and their families, members of the Nobel academies and committees and their families, winners in previous years, invitations have been posted to members of the diplomatic corps—with priority to those nations represented this afternoon by prize-winners—and to accredited members of the press. That is the limit of the invitations. The general public is allowed to apply for tickets to extra seats on a first come, first served basis. By five o’clock this afternoon, there will be approximately twenty-one hundred persons in the assembly or auditorium of Concert Hall.’
Sue Wiley was standing, one arm half lifted, and Jacobsson nodded in her direction and braced himself for a livelier question. He was not disappointed.
‘Count Jacobsson,’ said Miss Wiley, ‘this is my first visit to a Nobel Ceremony. I am told, by those who have previously attended, that the occasion is always impressive but very stuffy and exact. Doesn’t anything exciting ever happen?’ A titter went through the conference room, and Sue Wiley smiled to those around her, and then added, ‘I mean, are there any embarrassing moments or any blunders or anything like that?’
Everyone waited now upon Jacobsson’s reaction, and he, eager to have the friendliness of the press, ransacked his memory for something harmless and yet possessed of colour.
‘Well, Miss Wiley, there is never perfection,’ he said. ‘From time to time, we do have our—our trifling embarrassments. I do recall the time that our late beloved King Gustaf V, who had known Queen Victoria and was giving out Nobel medallions and diplomas when he was in his nineties, and who had become extremely near-sighted in his advanced years, gave a Nobel Prize to his own secretary instead of the laureate by mistake.’
There was friendly laughter in the conference room, and Jacobsson felt encouraged. ‘King Gustaf—the Mr. G. of so many tennis tournaments—presented more Nobel medallions and diplomas than any other one of our monarchs. Every laureate left with admiration for his obvious nobility yet democratic bearing. I remember that Anatole France had just become a Communist when he met King Gustaf. It was thought that Anatole France might have some resentment for royalty. But King Gustaf’s simplicity won the old laureate over completely. Afterwards, Anatole France said, “The King of Sweden is a Bernadotte. He is accustomed to power. A President, on the other hand, always strikes one as a little new at the game.” As a sidelight, it may interest you to know that of all the many laureates that King Gustaf met and awarded prizes to, his favourite was the Irish poet, W. B. Yeats. On more than one occasion, I heard the King say that he admired Yeats the most because the poet had “the manners of a courtier”.’
Jacobsson realized that Sue Wiley was still standing, and he addressed himself to her. ‘But you were inquiring about excitements and embarrassments, were you not, Miss Wiley? I can think of one excitement where embarrassment was cleverly avoided. You know, on Ceremony afternoon, this afternoon, it is protocol that a laureate, after receiving his award from the King, retire backwards from the orchestra and up the steps to his seat on the platform. I remember that Mrs. Pearl Buck was much concerned about this. Dr. Enrico Fermi had received his award before her, and had made his way backwards to his seat with no difficulty. Pearl Buck wore a gold evening gown with a long train, and was distinctly handicapped. Nevertheless, her backward march from the King was made successfully amid thunderous applause from the audience. She had managed it, she told a friend later, by memorizing the pattern of the Oriental rug at her feet and following the design to her chair on the platform. However, another embarrassing incident took place at one Ceremony when two British laureates—it would be improper to identify them—accepted their awards from the King, forgot protocol, and turned their backs on the King as they went back to their seats. The Swedish people in the audience were deeply offended. In surprising contrast to omissions by democratic laureates, the Russians have always been unfailingly correct, their courtesy impeccable, their bows to His Majesty the deepest. I recall distinctly that in 1958 the Soviet nuclear authority, Dr. Igor Tamm, who was one of the three physics laureates, bowed so deeply that he almost dropped all his awards. Beyond such trifles, I fear I have nothing else, Miss Wiley. Our Ceremony usually takes place without incident, as you shall see for yourself at five o’clock this afternoon.’ He looked about him. ‘Are there any more questions?’
A hand fluttered high. ‘Count Jacobsson—’
‘Yes?’
‘What about the laureates today? They must be nervous, waiting for the Ceremony. Do you know what they are doing?’
‘I know what they should be doing,’ said Jacobsson. ‘They should be on their way to Concert Hall for a half-hour’s informal rehearsal of this afternoon’s Ceremony. However, yesterday the rehearsal was cancelled. So I am certain they are almost all resting at the Grand Hotel.’
‘Why was the rehearsal cancelled?’
‘Two laureates were unable to attend. There will be an announcement about this early in the afternoon from the Caroline Institute. I am permitted to say only this much—Dr. Farelli and Dr. Garrett are not resting—are engaged, this very mo
ment, in an activity connected with their specialties. . . .”
It was 10.52 in the morning.
In this outskirt area of Stockholm, the structure weirdly framed behind the steadily falling snow—as if Seurat had pecked out a building in pointillism, white-dotted dabs on transparent glass instead of canvas—was the Caroline Hospital. Blending with the moving snow were the shimmering rows of yellow lights shining through the winter morning from the infirmary corridors and wards.
Inside the Caroline Hospital, inside the third-floor surgery room, the banks of lights were the brightest, not dull yellow like the corridor bulbs, not stark white like the falling snow, but silvery clear and steady as the luminosity of a summer’s day in the early sunrise.
On the operating table, partially exposed but otherwise draped and shrouded, lay the unconscious patient, Count Rolf Ramstedt, seventy-two-year-old relative of H.R.H. the King of Sweden. Seconds ago, divested of the failing old heart that had been ravaged and weakened by atherosclerotic coronaries, he was being kept alive only by the five-thousand-dollar heart-lung bypass machine that supported his body tissues with oxygenated blood, while the gaping pericardium waited to be filled.
Bent over the patient now, in the disguise of the modern image of the Creator—gauze mask, gown, rubber gloves—was Dr. Erik Öhman, preparing to suture the living calf’s heart to the great vessels of the host. Flanking Öhman, also masked, gowned, and gloved, were the three young Swedish nurses and the lanky anæsthetist, now checking blood pressure.
Far away, the minute hand of the ivory clock ticked and jumped ahead.
At the foot of the table, performing his role of observer, Dr. John Garrett exhaled tension through his mask and knew that the cardiac surgery, scheduled to last an hour and a half (after the long interlude of hooking the patient to the bypass machine), was at the midway mark. Soon, all too soon, Garrett would be able to return his attention to the taller, bulkier gowned figure of Dr. Carlo Farelli beside him.
Earlier, in Öhman’s office, in the dawn indistinguishable from the night, he and Farelli had met face to face without the exchange of a single cordial word. Öhman, sensitive to their animosity, had deftly come between them to seek their advice in charting the difficult cardiac transplantation. Except for two interruptions—one by a colleague on the telephone to discuss some youngster’s congenital heart defect (cor triloculare bi-atriatum), and the other by another colleague, who had poked his head in, fretting, to report on the impending miscarriage, this morning, of the wife of a mutual friend—the team of three had worked steadily. Garrett had soon become absorbed in the preparations that had taken place, especially in the record of Anti-reactive Substance S administered.
They had debated all of the problems, so familar and elementary to them, of the new surgical technique for removal and replacement of the heart, putting special emphasis on preventing clotting within the blood circuits, and on fastening of artificial materials to the blood vessels, so that there would be leakproof connections that would also discourage clotting. Garrett had brought up the possible discrepancy in the blood vessel sizes—those of the calf’s heart might be smaller than the ones to which they must be attached—but Öhman had anticipated this and described his nonreactive adaptors. Farelli had brought up the advisability of a heterotopic transplant, but both Garrett and Öhman had supported locating the new heart in the normal anatomical position. Three mammalian hearts, only hours old, had been stored, and Öhman, Farelli, and Garrett had unanimously agreed upon the one to be grafted.
At last they had been summoned to surgery, and Count Ramstedt had been wheeled in. Everything had been efficiently readied. The patient had already been anesthætized, chest shaved and prepped, and merthiolate applied. The patient had received mild hypothermy to cool his system to 30° C. and he had received heparin intravenously to prevent clotting. The huge heart-lung machine stood ready, and the 4,000 c.c. of whole blood, cross-matched, awaited use in the event of emergency.
In his concern for the patient, Garrett had forgotten the presence of Farelli. At first, what was so well known to him—materials, procedure—seemed strange and otherworldly because of the quick singsong of the Swedish words that went from Öhman to his nurses and aides—läkaren and hud and bröstkorg and blod and ådra and skoterska and bedöva—and once, pulsen är mycket oregelbunden, which Garrett understood to mean that the pulse was irregular—and constantly, over and over, hjärta, hjärta, hjärta, which Garrett came to realize was heart, heart, heart.
But then, as Öhman flexed his fingers in the rubber gloves, and took the slap of the scalpel, complaining that there was a troublesome halation on the instrument and having one light adjusted, and then, as he performed the median sternotomy—the incision from the neck base down the middle of the sternum to the bottom of the breastbone—there was nothing any longer strange or otherworldly to Garrett.
As he observed what followed, Garrett’s pride swelled. This was his discovery, his immortality. Critically, yet with continuing inflated ego, Garrett watched a son of Hippocrates attempt to raise a Lazarus from the dead. Garrett watched, his head involuntarily nodding its approval . . . the rubber-shod clamps . . . the open chest wall . . . the anticoagulant . . . the endless connecting of the plastic heart-lung apparatus to provide oxygenation of the blood and to remove carbon dioxide . . . the withdrawal of all blood from the major venous return before it reached the ailing heart, bypassing heart and lungs, diverting the blood through the pump and then returning it to the arterial circulation system . . . the crucial minutes of surgery with the delicate excavation of the old heart, transecting the pulmonary artery and the aorta beyond their valves and cutting across the region of the atria at the back portion. . . .
It was 10.52 in the morning.
The strain began to leave Garrett as his protégé inserted the cooled fresh calf’s heart—two young mammalian auricles and two ventricles—and then sutured the walls of the atria together, avoiding separate anastomoses of the veins leading to the heart. Now, for the final suture by the Russian vessel instrument, woven dacron to hook up the aorta, the pulmonary artery, the four pulmonary veins, the superior vena cava, the inferior vena cava.
Garrett and Farelli looked on tightly, as Öhman completed the transplantation. With the new heart freed of air to avoid air embolism, Öhman released the aorta to permit fresh oxygenated blood from the great plastic outer machine to pass into the coronary vessels. The new mammalian heart warmed and was filled with fresh oxygenated blood. Gradually, gradually, the new heart began to contract, to take over circulation on its own, receiving and pumping plasma. The patient breathed on. Lazarus alive.
Garrett’s gaze narrowed. Rhythm excellent. No electrical defibrillation necessary. He was about to speak up—there was another thing—he must remind Öhman to administer Polybrene to neutralize the heparin and to allow the resumption of normal blood clotting, but then he knew it was too soon and Öhman would not forget, anyway.
The lanky anæsthetist spoke. ‘Oxygenation satisfactory. He is also maintaining satisfactory blood pressure.’
Seventy beats a minute, thought Garrett, and 5,600 c.c. of blood pumping a minute—with a transplanted heart! His own private heart swelled once more.
‘Go off bypass,’ said Öhman.
The glass cardiopulmonary heart-lung machine was disconnected. The new heart was on its own.
Only three times, in English made awkward by emergency, had Öhman consulted with Garrett and Farelli in the hour gone by, and three times they had confirmed what he had planned, once both supplementing his ideas with ideas of their own, and now, at last, the transplantation had been successfully accomplished. All that remained was the routine removal of clamps and catheters, the closing of the chest cavity, the addition of Polybrene, the injection of growth-inhibiting hormones to contain the calf’s heart, and finally, the observation of life renewed and extended.
Öhman turned to the Nobel winners, and Garrett thought that he might be smiling wearily b
eneath the mask. ‘His Majesty will be relieved,’ said Öhman in an undertone. ‘It is done.’
‘Benissimo,’ said Farelli. ‘Felicitazioni!’
‘Congratulations, Dr. Öhman,’ said Garrett.
‘No—no—it is I who congratulate both of you for this,’ said Öhman. ‘I can handle the rest myself. Why do you not wash up and wait in the office? Nurse Nilsson will show you the way. I shall join you very soon.’
He had already returned to the patient, and the tiniest of the three nurses came towards Farelli, and Garrett followed them out of surgery into the antiseptic, tiled washroom of the Caroline Hospital. The nurse hung back as Garrett and Farelli worked free their rubber gloves and removed their surgical masks, and then, still unspeaking, bent over separate basins to scrub the starch from their hands with nylon brushes. Drying his hands, while Farelli still washed, Garrett was relieved by the presence of the nurse.
When they both were ready, the nurse said, ‘This way.’ They went with her into the corridor, and then into a small office, barren of all but a cigarette-scarred table holding several ashtrays and surrounded by five straight chairs.
But then, to Garrett’s dismay, the nurse left, and he found himself alone with Farelli. He extracted a cigar, and made much of preparing it, and when he looked up, he saw that the Italian was already drawing deeply on a cigarette as he stood by the window.
‘Still snowing,’ said Farelli.
Garrett said nothing. Now that the surgery was over, now that the worth of his discovery had been dramatized so remarkably and would soon be known around the world, the exhilaration had gone out of him. There could be no pleasure, he knew again, because Farelli existed, and somehow the transplantation would not be Öhman’s or even Garrett’s, but Farelli’s own, just as the discovery itself and the Nobel Prize in physiology and medicine this afternoon would be Farelli’s own.
As long as Farelli lived, Garrett’s instinct told him, Farelli would be the savant and the man, and he, himself, would be the shadow. Yet what could be done about it? He had tried everything, and everything had failed. There was only one hope. Öhman had been against it. Craig had deterred him from it. Or perhaps what had restrained him, actually, had been neither one of them, but his own good conscience.
(1961) The Prize Page 81
