by Jill Wolfson
On machines on both sides of the bed, the girl’s vital statistics scrolled across screens: oxygen ratios, pulse, blood volume. Nancy was taking the place of a brain that no longer functioned. She fussed over a set of intravenous drips, releasing the right amount of antidiuretics, thyroid hormones, antibiotics, steroids to calm the heart and give it a chance to recover from its near-death experience.
Without this delicate balance of solids, fluids and gases, how quickly everything would fall apart. Potassium levels would drop, and salt would build up, opening the gates for fluids to pour out of cells. Sugar would quickly build up in the blood. The heart would grow twitchy and irritable, ripe for cardiac arrest. With the pituitary system off-line, the muscles would fill with lactic acid and go as limp as the legs of an exhausted marathon runner. Next to arrive would be a parade of unstable, highly reactive molecules called free radicals. Even though she was a medical professional, Nancy couldn’t not imagine these molecules as wild, dangerous bearded men who rampaged unchecked through the body.
Her job was about preventing this irreversible march to chaos, to keep the heart and liver and lungs and kidneys alive until the last possible minute before the surgeons were ready to remove them for transplant. Her job in the ICU that night was to worry, fuss and keep this dead girl as healthy as a live one.
It was going to be a busy night, not just for Nancy, but for the nurses and doctors attending others. A man burned in a car crash moaned constantly, and a woman with advanced lung cancer struggled to breathe. A woman brought in hemorrhaging was on the cusp of bleeding to death. As far as outward appearance, Nancy’s charge was far and away in the best shape of them all, as if she didn’t even belong in the same wing as such desperately ill patients.
In her years in this job, Nancy had come to think of each one of her cases not as a cadaver or a body, but as a patient – many patients, really, a patient heart, two patient lungs, two patient kidneys. What she wanted was what all nurses want, for her patients to live.
So all night, in her lookout for declining function, she checked blood pressure, urine output, heart rhythms and oxygen saturation. Over the chest, she placed a vest that was wired to gently shake her patient. Then Nancy, taking the place of a cough, suctioned out the loosened phlegm before it pooled in the lungs.
At 3:30 A.M., just as the nurse picked up a magazine to glance through, a lab tech called, alerting her to a drop in calcium level. To mimic the function of the now-shut-down parathyroid gland, Nancy added calcium to the intravenous drip, and the body responded positively. “Good, good,” she said.
At 5:30, as Nancy made a minor adjustment to the ventilator, something made her jump backward. She almost sent the IV pole toppling to the floor. In awe, she watched the arms of her patient slowly stretch out, cross against the chest, and then drop with a chilling finality alongside the torso.
It was the Lazarus sign, a primitive spinal reflex unconnected to the brain, to life, to any kind of hope. Nancy had been trained to expect this medical phenomenon. But how could anyone really be prepared for such a sight? It was always a shock. Her inhalation remained high and tight in her chest until she remembered to breathe.
In early morning as her shift was about to end, the transplant team arrived, filling the room with new energy, like four fully charged batteries. The surgeons knew that once outside the body, a heart can only survive two to four hours at most, a liver six to eight hours, the more hearty kidneys up to twenty-four hours. So overnight while the nurse had been staving off death, they took care of all the prep work, lining up potential matches, performing blood tests, ruling out some recipients and preparing others for transplant.
The lead heart surgeon patted Nancy on the back and told her, “Good job. We’ve found homes for all the organs.”
As she gathered her things to leave, Nancy admitted to herself that she had grown more attached to this patient than she liked to. There was something so vulnerable about the girl, her muscular yet thin arms and the soft down on the sides of both cheeks. She made a silent apology. If only she really did have the ability to trick death. But her powers, even backed by millions of dollars’ worth of high-tech medical equipment, were small, laughable, inadequate.
Nancy wanted to do something dramatic then, make some kind of protest about the unfairness of this girl’s short life. But what to do?
She said good-bye by touching the girl’s right hand. Amanda’s hand. It was only slightly cooler than her own.
TEN
HEART SURGEON DR SEAN MCGARRY always liked a soundtrack while working. Music piped into the OR kept him focused and calm. Lately, he had a taste for opera. His choice this day was Carmen, the tragedy that ends with a jilted lover with bloody hands sobbing over a young woman’s body. The other staff had definitely preferred Dr McGarry’s classic rock phase. Pink Floyd for the routine operations and mellow Van Morrison when things promised to be trickier.
This surgery started like so many others. A nurse placed a blanket over the patient’s legs and tucked the arms against her sides. She painted on the antiseptic, neck to thigh, a guard against infection, before applying a sterile blue drape with a hole over the chest and abdomen. The anesthesiologist went to work. Even without a functioning brain, spinal reflexes can cause a body to buck in surgery.
A new resident had the honors of opening the abdomen. Nervous but grateful for the opportunity, she used a pencil-like electrocautery instrument to cut from the sternum to below the belly button. A burning smell immediately filled the room. To the veteran staff, it was a familiar scent, but one that nobody ever really got used to. It could be tasted at the back of the throat and made its way to the pit of the stomach. The resident gagged slightly.
The head abdominal surgeon then cut through skin, fat and a dense web of connective tissue. A retractor held open the strong rectus abdominal muscles. He plunged in his hands, the cut edge of the dermis – the thick pearly white layer between the fat and the outer skin – tightening like elastic around his forearm. He lifted the intestines, setting them aside outside the body.
As always, the abdomen was difficult to navigate through, all those organs crowded into a tiny space. If the belly were a room, there wouldn’t be an inch to spare. But the doctor’s fingers, knowing their destination, moved with confidence among the spongy organs, looking and feeling for cysts or too much fat. The aorta pulsed against his palm.
“The liver,” the surgeon announced. “Smooth, pink, with sharp edges. Looks great.”
Someone called the transplant center with the good news.
Through the loudspeaker, tenor Plácido Domingo sang in French, “This flower that you threw to me.” A blood pressure monitor beeped to an entirely different rhythm.
Now it was time for Dr McGarry to open the chest and take his look. The anesthesiologist stopped the ventilator, causing the lungs to deflate temporarily, like a breath held out. The saw buzzed, dropping slightly in pitch as it cut through bone. A retractor held the chest open. The exposed heart beat back and forth like a small animal that had been chased and was breathing hard, cornered in a cave of strange red rock.
Dr McGarry ran his fingers down the arteries. The heart looked good. The lungs looked good. More good news for the transplant center.
Now all the doctors leaned in and crowded around the patient, cutting off tendons and nerves, tying off any blood vessels that weren’t necessary.
Finally. The big event. “Ready to cross-clamp,” Dr McGarry announced.
He clamped the aorta and snipped across the vena cava. “Eleven thirty-nine A.M.,” he called out. This was when the clock started ticking for the lifespan of the organs. The anesthesia stopped. The ventilator stopped.
The music from Carmen continued:
L’oiseau que tu croyais surprendre… The bird you thought you had caught beat its wings and flew away.
Bright red blood from the chest and abdomen drained into tubing connected to canisters on the OR floor. The organs were flushed with a cold pr
eservation solution.
The heart came out first. Dr McGarry pronounced it first rate as he put it into a sterile plastic jar and then double-bagged it in plastic. He handed the bundle to a nurse who placed it into a blue picnic cooler filled with cubes from the hospital cafeteria ice maker.
Sometimes lungs come out a boggy, unusable mess. These were inflated like a set of fluffy pink pillows.
Within the hour, the other organs were removed. The liver, flat and shiny, resembled a river-polished rock. The kidneys and pancreas were packed into clear plastic jars with screw-top lids to protect them from damage during transport.
Carmen and Don José sang C’est toi? C’est moi. Is it you? It is me.
It was left then to the new resident to finish up. She gently put the whorl of intestines back into the belly. While closing up the body, she thought about how interesting the heart is. How it both pumps and secretes. How it is electrical and mechanical. How it is, at once, a basic machine and a monumental mystery. She took her time sewing. Only a few people would ever see her work, but she wanted to leave stitches that were as tiny, even and perfect as humanly possible.
Not long after that, a nurse switched off everything – the monitors, lights and finally the music. By all accounts, the surgery on Donor #364 was a success.
ELEVEN
“HEY, YOU!”
I was startled out of sleep.
“You, big girl. With the rotten old heart.”
I felt myself blinking into the dark with a spaced-out expression. At the foot of my bed, a silhouette began taking shape. Arms, legs, head, hair. Lots of hair.
Wendy.
I bolted upright, ready to defend the only thing standing between me and certain death. In a computer voice, I ordered, “Step away from the IV. Step away from the IV.” I pointed an accusing finger at her. “If you get any closer to those buttons, I’ll … I’ll call out the monster under my bed and he’ll use you as sandwich meat.”
Wendy was wearing pajamas that consisted of frilly pink pants and the kind of skimpy white top that girls my age wear in size extra small when they’re going for the slutty look. The word princess, the perfect clothing statement for Wendy, was written on it. In her right hand, she clutched a stuffed bunny by one long ear, like she had just nabbed it trying to escape. “I’m not scared of any monster. He’ll take one bite and spit me out because I have a dirty old rotten kidney.” She scowled at me. “I don’t believe you anyway. Mommy says there are no monsters.”
I switched on the nightstand lamp. “Your mother is only familiar with the nonexistence of house-inhabiting monsters. She obviously doesn’t know squat about the vicious species that lives under hospital beds.”
Wendy’s eyes widened for a moment, but only a moment. She stuck out her tongue. For a little kid with a failing kidney, she was pretty sharp, I had to give her that. I did notice, though, that she didn’t come any closer to the IV pole. In that totally random little-kid way, she changed the subject. “I took ballet before my kidney turned so rotten.” She jumped her feet apart and started sinking into the splits. I guess she was trying to impress me with her phenomenal flexibility, which wasn’t so very much since she collapsed forward and hit the floor.
“Who’s your best friend?” she asked and didn’t wait for my answer. “I have two. My best friends are Rachel and Rachel.”
“Doesn’t that get confusing?”
“What?”
“That they have the same name. Do you call them Rachel One and Rachel Two? Or Rachel and Rach? Or Chel and Rach?”
“Siiiiilly!” She gave the word five vowels. “I say, ‘Hi, Rachel,’ and she says, ‘Hi, Wendy,’ and then I say, ‘Hi, Rachel,’ and she says, ‘Hi, Wendy.’”
“Oh.” Fascinating.
“What’s the name of your heart?”
When I didn’t answer immediately because, pardon me, I wasn’t sure that I heard the question right, she repeated it, this time with an annoying full stop after each word. “What’s. the. name. of. your. heart?”
“A heart doesn’t have a name.” I said this despite knowing that there wasn’t much use arguing because rational thought doesn’t work with an age group that still half believes in monsters under beds and fully believes that parents know everything about everything, and other insane thoughts like that. I honestly believe that anyone under the age of eleven basically qualifies as being mentally ill.
“Siiiiilly. Of course your heart has a name. The name of my dirty old rotten kidney is Captain Ga-ga.”
“How do you know that?”
“Siiiiilly! He told me.”
“Your kidney talks to you?”
“Yeah, in dirty old rotten pirate talk. He says—”
“That makes no sense—”
“It does!”
“Let me finish! It makes no sense that your kidney is of the male gender, since your kidney is part of you, came from you and is, genetically speaking, the same as you. Your kidney would have to be a girl, too.”
“A girl? No!” Pause. “Are there girl pirates?”
I had her now. “How do you think all the little baby pirates come into the world?”
“How do they?” Pause and a giggle. “Oh, I get it. Mommy pirates.”
It felt gratifying to win this argument, like I had shined the light on a very dark corner of someone’s mind. Only, what argument had I really won? From outside in the hallway, I heard Nurse Joe’s voice – “Wendy!” – and the girl with the pirate kidney took off.
Neighbor #1 has got to be one of the strangest people I’ve ever met.
Early morning thought:
Fact: Cells are constantly dying, and new ones are taking their place.
Fact: Every second, fifty million of my cells die.
Fact: After seven years have gone by, every cell in my body has died and a new one has taken its place.
Do the math. That means that every seven years, I’m a totally new me. Not one of the old cells remains. Twice, I’ve had a total makeover.
So how does my body know not to put my nose where my eyes were? And why haven’t my cells organized themselves into a proper heart that sits on the proper side of my chest?
If every cell in my body has changed, if nothing is the same as it was, what holds me together? What is it that keeps me being me?
Early afternoon thought:
Let’s say that my heart did have a name – it’s absolutely ridiculous to consider such a thing, but if it did – what would it be?
Late afternoon thought:
I have a strange feeling. I ride it out to the end. If I had to name it, I’d call it, what? Not love. Definitely not that. A crush. I have a complete crush on Neighbor #2, swamped with fantasies of my lips meeting his in an explosive human volcanic reaction like when vinegar mixes with baking soda in a science fair project.
Fact: The previous thought doesn’t mean that I’m completely boy-obsessed and shallow. I spend a lot of time dwelling on what a girl who is this close to death would obviously dwell on. The Big Stuff, like the tragedy of the human condition and the age-old riddle of what happens to us after death.
That’s where Milo came in again. Was it mere coincidence that we wound up as next-door neighbors in Children’s Hospital?
No. This was destiny and not just because Milo happened to have those sexy crinkles around his mouth. He could provide answers. Before I had a chance to wimp out, I ordered my hand to pick up the receiver and punched in Milo’s room number. When his phone rang, my toes did a weird thing. They curled. Under the blanket, my feet played with each other.
A voice on the other end of the phone said, “’Sup?” and I put a throaty shiver into my voice so it sounded more womanly and mysterious. “Guess who?”
“Someone with a sore throat?”
I ignored that. “It’s moi. Dani.”
“Dani? Oh, yeah, the girl next door.”
There was a cough, and I figured that since I could hear that without the phone, his bed sat right up ag
ainst the wall, a mere few inches of plasterboard separating us. Our heads were almost touching. We were practically sharing a pillow. That was almost more than I could bear to think about.
“So, hi,” I said.
He cleared his throat again and asked why I had called, and I told him I wanted to know how he was feeling, and there was a more important reason why I called.
“Not that how you’re feeling isn’t important.”
“But this more important reason is?”
“I’ve been thinking about what you said.”
“What I said about what?”
“How you’re studying different philosophies, things that people believe in. Life, rituals, meaning, birth—”
“Death. That’s what I’m interested in. Stiff City, kick the bucket, Adios Park, human roadkill, bite the dust, pay the piper. The big D. The big sleep. Worm food, decay buffet, organic rot fest.”
I don’t have much firsthand experience about the mating rituals of modern boys, but I could tell that Milo wasn’t giving this his romantic all. It was more like he was baiting me, trying to get me to call him sick and perverted, which is what I suppose the less bedridden girls of his acquaintance would have done. But I remained unshocked. Actually I giggled, totally inappropriate, but I guess that’s because nervousness and laughter are very closely related in the brain.
“What’s so funny?”
For once, I thought of an interesting comeback – not ten minutes after I hung up the phone, but right when I was supposed to say it. “Cowards die many times before their death. Shakespeare said that. My heart may be screwed up, but I have a strong stomach. I really do want to know everything you know about death.”
