A Heartbeat Away

Dedicated with love to my mom,
Mildred Brunk Kraus
August 26, 1926–May 8, 2011

Contents

Acknowledgments

Special thanks to Mark Mynheir, friend, novelist, and former homicide detective, who assisted me with police matters.

I will give you a new heart, and a new spirit I will put within you. And I will remove the heart of stone from your flesh and give you a heart of flesh.

Ezekiel 36:26

1

Between the gods and men.

Are surgeons.

That's the way Victoria “Tori” Anne Taylor, MD, always explained it to the sea of gaping medical-student faces as they prepared to begin their clinical rotations. She would pause for effect after the word
men
, turning one sentence into two and solidifying her own near-godlike status among the students who may have been book smart but didn't know a normal S-2 heart sound from the bass rhythms throbbing through their iPod earbuds.

Tori looked around the busy anesthesia holding area and reviewed the operation, going over every step, imagining each movement as a choreographed symphony of dissection. She'd once heard that the best professional baseball hitters did the same thing as they stood on deck, just before entering the batter's box. They saw the windup, the delivery, and the anticipated trajectory of the fastball, knee-high, just painting the inside corner of the plate. They saw their swing and the bat impacting the ball. Imagination led to success. Hitters who could see what would happen before it happened were the ones the fans adored.

And so it was with oncology surgeon Tori Taylor. Her operations were a thing of beauty, her even rows of sutures lining up like little soldiers on a Civil War battlefield. Predictably, home runs for Dr. Taylor were the norm. And behind her mask, she enjoyed the students' worship.

But today was different.

Today the operation she imagined was not going to be performed
by
her; it was going to be performed
on
her. The mental review of her surgery was her way of coping, a vain attempt, a desperate grasping at something she was loath to give up: control.

Illness had changed everything. No longer was she wearing the stethoscope; it was being gently laid over her sternum. And the eyes that couldn't hide concern were not hers but the eyes of her surgeon. The blade of the scalpel pointed toward her, not away. Up was down. In was out. Black was white, and control was a mirage, a wavering image floating above the minds of lost desert nomads or surgeons who thought they could predict outcomes because of their obsessive grip around everything manageable.

She'd lost control.

And that terrified her.

The face of a nurse appeared over her. Tori had seen this particular nurse a thousand times during her own tenure as a cancer surgeon, but, like all of the others, he was a background person, a nameless helper in orbit around her.

But today was different. She wanted—no, she
needed
to know the nurse's name. She strained to lean forward, gripping the railings of the stretcher, and grunted. She attempted to focus on his name tag. Her voice was as weak as she felt, barely a whisper. “Jeff.”

“Don't try to talk now, Dr. Taylor. They should be coming to get you soon. Dr. Parrish is closing on the case in front of you.”

That “case” has a name
, she thought. Tori closed her eyes, annoyed but understanding. The nurse wasn't allowed to mention a name.

“Don't be afraid,” the nurse continued. “Dr. Parrish is the best.”

Do I look afraid? I'm not afraid!

Fear, Tori thought, was another needless emotion. She prided herself on operating on a higher plane than those mortals who struggled with the baggage of feelings. Emotions interfered with her ability to make tough decisions. When your enemy was cancer, being touchy-feely paralyzed your ability to cure.
My enemy has no feelings. Cancer attacks without respect to beauty, form, or function. In order to win, a surgeon must match her foe.

She watched the staff scurry about, activities that Tori would have participated in just a few months ago without thinking. Hanging an IV, walking from bed to bed checking vital signs, pushing a stretcher. These were the mundane and unappreciated acts made possible by a functioning and efficient heart—something she no longer had.

As the staff cast furtive glances in her direction, Tori recognized contempt in some, pity in others. Their eyes sent the message:
Oh, how the mighty have fallen
. She may have stepped on them, reprimanding inefficiency, ineptitude—or worse, laziness—in this field where the stakes were health or illness, life or death. But now the tables were turned. She lay dying, her heart whimpering with each beat.

She heard low murmurings from beyond the curtain. The staff didn't seem to know what to do. It's neither professional nor personally satisfying to gloat over the dying.

Her heart had been ravaged by an evil lover of sorts, a virus that followed a cold-like illness, something Tori had pushed through, taking Tylenol and Sudafed until she just became so
weak
. At first, she'd just thought she had been pushing too hard, working late, performing too many operations in spite of the flu.

Later, she had awakened one night breathless and sat up gasping for air that suddenly seemed too thin to satisfy. She coughed frothy sputum into a Kleenex and stared down at her bare feet.
Where did my ankles go?
Extra fluid had taken up residence in her lungs and formerly shapely legs. Tori picked up her phone and dialed 911, explaining to the rescue squad that she was in acute heart failure. She demanded and received morphine, oxygen, and Lasix. Control.

Her heart-lover had a name: coxsackievirus B. It embraced the muscle layer of her heart with a savage jealousy, inflaming the muscle into submission and weakness. Regular medications improved things a little, chasing bully symptoms off the playground for a few hours, but then they would return and remind her to take the tablets that made life's menial tasks possible.

But medicine could not provide a cure. Only surgery could do that. Only the transplantation of a new heart could cure.

Ironic
, Tori thought,
that a surgeon can only be cured with the knife
. Finally, the woman who had not had so much as a childhood tonsillectomy would be submitted to the same controlled violence that she had inflicted on thousands of others.

Another face appeared above her, a female of about fifty-five with short, cropped gray hair and a no-nonsense demeanor. She turned to face a mobile computer monitor. “I'll need you to verify your identification,” she said. She lifted Tori's arm and studied her wristband.

“Victoria Anne Taylor,” she whispered, rolling her eyes.
Protocol.

“And what operation are you having today?”

“Heart transplant.”

The nurse entered the data, clicking boxes on the computer screen. A moment later, her face appeared again. This time she was holding a small electric hair trimmer. “I have to prepare the operative field.”

Tori shook her head. “I don't have any hair on my chest.”

“Just routine,” the nurse responded, lifting and pushing Tori's gown up under her chin.

The nurse studied Tori's chest for a moment before lowering the gown again, but not before Tori's eyes met those of a passing orderly who seemed to be enjoying a quick peek at Tori's ample anatomy.

Tori shook her head. “You should have pulled the curtain.”

“Dr. Taylor,” the nurse responded, “you've never cared much about that before.” She offered a plastic smile. “It's only business.”

Tori winced. She must have slighted this nurse a time or two in the past. Or maybe a hundred times or two.
How petty. A taste of my own medicine.

The nurse studied Tori's face. “You'll need to be aware of the pain scale,” she said. “In recovery, the nurses will want you to rate your pain on a scale of one to ten. One is a slight annoyance. Ten is the worst agony you've ever felt.”

“I understand.”

“Who will be waiting for word from Dr. Parrish when the operation is over? Parents?”

Tori shook her head and spoke with effort but not emotion. “My parents are dead.”

The skin around the nurse's lips tightened, highlighting a series of wrinkles like little spokes radiating from the hub of a wheel. “A friend, perhaps?”

She stayed quiet and shook her head.

“Husband?”

“There is no one.”

“Would you like the chaplain to come by before you go into surgery? He can offer prayer—”

“No thanks.”

The nurse walked away, but not before noisily pulling the curtain to shield Tori from the clinical traffic.

Tori closed her eyes and adjusted the prongs of the oxygen tubing, seating them more comfortably in her nose. She made an attempt to look at her situation objectively. What exactly should she think about as someone was preparing to lift out her damaged heart?

Her first thought struck her as overly sentimental.
Someone had to die last night. A life cut short so that I can continue mine.

Whose heart will be beating in my chest? What was her life like? Was she a professional like me?

What will it feel like knowing my heart spent years pumping someone else's blood?

She heard the curtain rings sing against the rod again.
Probably the protocol nurse.
Instead, when she opened her eyes, she saw Jarrod Baker, a radiation oncologist.

Six months ago, the hospital grapevine had proclaimed that Jarrod and Tori were an “item.” They had been, in fact, the ultimate medical power couple, gracing the social network, each with his and her own ties to the movers and shakers within the university. Professionally, they matched, their fields a natural complement. He killed cancer with radiation beams; she wielded a scalpel in the same battle.

They'd shared meals and movies, walks in the park, and racquetball. But Jarrod had wanted more from their relationship. For a while, he had pursued her. He did not seem to mind that others spoke of Tori as the “ice princess.” For Jarrod, it seemed he had struck gold: benefits without all the emotional baggage.

Tori was only mildly annoyed at his persistence—a number one on the pain scale. For Tori, their relationship was detached convenience. She was expected to date. Jarrod fit the bill.

Was she so used to steeling herself against the baggage of negative emotions that threatened her professional decisions that she'd been unable to unwrap her heart?

But a month ago, Jarrod had stopped calling. As they'd both prided themselves in being above emotion, Tori's illness created the elephant in the room that kept them from moving forward. She didn't ask for empathy, and apparently, he was unprepared to help her face the looming grim reaper.

The hospital grapevine told her he'd moved on. There was an emotional respiratory therapist named Tami who'd just joined the staff. She cried at movies and dotted the
i
in her name with a heart. Sweet.

Tori watched his eyes widen as he assessed her new clinical situation.

“Do I look that bad?”

He shook his head. “No, no,” he stuttered. “You look great.” He paused, looking at the monitor and not at her. “It's your big day. I heard the residents say a heart was available.”

She felt him take her hand. She looked away.

“Tori,” he began. “I'm so sorry—”

She silenced him with a squeeze of the hand.

“I should have called.” He hesitated, seemingly unable to meet her eyes. “I didn't know what to say.”

Ironic
, she thought,
a man who deals with death in his clinical practice doesn't know how to deal with personal loss
.

She watched as he rubbed out a few wrinkles on the cotton sheet. “Your guilt doesn't help.” She paused. “I would have pushed you away anyhow. It's the way we're wired.”

“I'm supposed to be here giving you support.”

“I'll be fine.”

He nodded. “Yeah, Tori, you always are.”

She let the comment pass. She was just too tired.

He shuffled his feet. She could see he wanted to say more. He didn't. Finally, he just gave her hand a squeeze and said, “Your clinic nurse is outside.”

That brought a smile to Tori's face. “Thanks for coming by.”

He nodded again and slipped away, pulling back the curtain to allow Brittney Simms to enter. Although Tori was demanding of Brittney, the outpatient setting allowed Tori to step down a notch, and her relationship with Brittney was strong, built on years of teamwork.

Brittney smiled and wiped the corner of her eyes with the back of her hand. “Hi, Doc.”

“Hey, no cryin' here. This is the best day of my new life.”

The nurse pushed a rebellious strand of red hair behind her ear and nodded. “I know.” She held out a large envelope. “It's from the patients in the clinic. I've been collecting comments, knowing this day would come.”

Tori slipped the card from the envelope. A seascape decorated the cover. Inside, it simply said, “Wishing you a rapid recovery.” There were comments from at least thirty patients.

She read over the names. It read like a who's who of patients in major abdominal surgery. Mr. Jones had a Whipple resection, a delicate and detailed removal of the head of the pancreas and the duodenum. Charles Smith had an extended right hepatectomy, a removal of two-thirds of his liver for cancer. Melody Jane had her rectum removed. Paige Withersby had a thyroidectomy.

Brittney smiled. “These patients would be dead without you.”

“Don't be melodramatic, Brittney. They'd have found another surgeon.”

She shook her head. “Not a better one.”

Tori handed back the card. “Keep it for me. I want to read the comments after my surgery.”

An orderly appeared, pulling back the curtain. “Showtime,” he said.

Tori looked at him and frowned, motioning him closer. When his ear was within a foot of her mouth, Tori exploded in an emphatic whisper. “Don't ever say that again! This isn't a show. This is my life we're talking about.”

The orderly, a college-age boy with blond hair and a bad case of acne, backpedaled. “S-sorry. I didn't mean anything by it.”