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 moment, 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.
Th
e 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 beneath 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.
Yet now this conscience of his did not seem good, but a weakness that would relegate him to eternal obscurity. But for this conscience, he would not have to live out the remainder of his days as pretender to the throne. Except for this conscience, he would have the throne.
He studied Farelli’s smug profile against the frosted window with undisguised contempt. There would never be another opportunity like this one. If he was not man enough to speak now, there would not be another chance. By late tomorrow, after they had their cheques from the Foundation, Farelli would be off on a triumphal tour of the continent, gathering all the laurels from here to Rome, and he would go back to Pasadena with his limited success, and his grief that only Saralee and Dr. Keller and the group would know. If he attempted to expose his enemy next year, it would be too late, like pelting a Nobel idol with minute sour grapes. It would have to be now or not at all.
How to begin? Casually, he decided, cautiously. No blunt accusation. Rather, the responsibility of power. Toy with the mouse, do not destroy it with one swipe of the paw, but let it destroy itself in its consternation and fear.
To begin, then. ‘The King will be happy with the result,’ said Garrett.
Farelli came around from the window, surprised to hear Garrett’s non-combative tone. ‘He will be extremely happy,’ said Farelli.
‘I heard you had breakfast with him yesterday.’
‘I was extremely pleased. I had taken the liberty to volunteer our-’
‘I know. I heard all about it.’ Garrett paused, wondering how the opening would come. ‘What did you find to talk about?’
‘He was gravely concerned about Count Ramstedt. I tried to reassure him by explaining details of the surgery. I told him of our experiences with-’
‘Your experiences,’ said Garrett. It was a small point. But Garrett wanted every point correct.
‘No, ours. I had read your papers and had some knowledge of your specific cases. He was gracious enough to inquire about our medical backgrounds. Here, I could only speak of myself.’
This was the opening, and blindly, his voice wavering, Garrett struck. ‘You told him about your-your visit to Dachau concentration camp, I presume? I mean, as part of your medical history?’
At once, Garrett saw that he had scored, and the thrill of impending mastery coursed through his veins.
Farelli’s Latin face was fixed in an attitude of historic wonderment, the face of Julius Caesar in the Senate chamber beneath Pompey’s statue, astonished by Tillius who had ripped the toga from him, the face of Caesar who saw Casca with the dagger of truth. Garrett waited on his lofty perch, almost expecting the Italian below to shout the classic ‘Casca, you madman, what are you doing?’ Then, at last, he would show him the madman’s full design.
But for all his wonderment, Farelli’s first voice was mild. ‘Did you say Dachau? How do you know about that?’
‘Oh, I just know it. Things get around.’
‘Something like that does not get around, as you say it. I have never spoken of that.’
‘I can’t say I blame you. In your boots, I wouldn’t speak of it either.’
Farelli shrugged. ‘There are some moments of one’s life one prefers to forget.’
At last, Garrett had his dominance. He addressed Farelli with the complacent censure of the superior to the weak. ‘What I want to know is this-how could you go through with it?’
‘How? Because I was forced to go through with it. I was a prisoner of the blackshirts in Regina Coeli, and I had no choice. It was a gamble to survive.’
‘But there are limits to what a man-’
‘One does not weigh or examine, under the choice of life or death. It is easy now, so far away in time, to be logical about what is unreal. But when the OVRA gave me the immediate choice of the firing squad or the experiment at Dachau-well, Dachau was an unknown quantity. I had heard, I had read-but I did not know. The muskets of the firing squad, I heard every morning at daybreak. I told myself-say no to the OVRA, Farelli, and you are surely dead-but say yes, and who knows what waits at Dachau. I was promised it would only be temporary, several days, no more. So I went through with it.’ He paused. ‘I do not think of it often any more. They brought five of us to Dachau-’
‘Yes, I know,’ said Garrett with scorn.
‘You know? I still am puzzled how you know.’
‘Dr. Brand of Berlin, Dr. Gorecki of Warsaw, Dr. Brauer of Munich, Dr. Stirbey of Bucharest-and you.’
Farelli’s bewilderment showed. ‘You are correct. That is correct. Poor Brand and Brauer, they had the worst of it. They were Jews, and I believe they were meant to be killed anyway. They died-terribly.’
‘How long after the experiment?’ asked Garrett. It was all coming out now, easier than he had expected, and Farelli was sealing his own doom.
‘After the experiment? No, they both died during it, each in their first time. I was made to watch them through the window of the Sky Ride Wagon-that was what the high-altitude box was called, the Sky Ride Wagon-Brauer, such a dece
nt young man, his lungs rupturing, and Brand choking, until his heart failed.’ Farelli had become excited. ‘You can imagine how I felt when they forced me into the high-altitude chamber. I thought I was the next victim-’
Garrett was positive that Farelli had made an error. He raised his voice, interrupting, voice cracking. ‘You-they-you say they put you in the experiment chamber-inside it?’
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