Change of Heart (15 page)

Sharlie was lying very still inside her body, listening to the hum. It was all darkness, there were no voices, no faces, no colors, just a black, suffocating, hot cloud. Again she tried to open her mouth, but there was no connection left between her will and her ability to exercise it. No speech. No possibility of communicating to the humming place that what she wanted now was to die. It wasn't pain exactly. More a sensation of drowning in heat, of being buried alive under a ton of boiling earth, like the citizens of Pompeii. Away, far above her, through the seething molten clay, the faint buzz of life went on, but her relationship to it seemed a feeble thread, about to snap under the weight of all that lava. Being even minimally conscious in the airless grave made her frantic, and she screamed, Brian! She howled through the oppressive layers, Brian! Help me die!

But she was powerless to move her mouth, and her screams melted unheard into the hot darkness inside her head.

“How long will we have to wait?” Margaret asked Dr. Diller. Her voice sounded calm, but she was gripping Walter's hand so hard that he finally uncurled her fingers and showed her the bright-red crescents she'd left in his flesh with her nails.

“Less than twenty-four hours,” Diller replied.

The three of them sat lined up as usual in the chairs in front of Diller's desk. Brian felt alert and relaxed now that something was happening. He'd passed through the last few days like a shell-shock victim, his eyes vague and expressionless, his mind blank. It was as if his central nervous system had been overloaded with stimuli and finally short-circuited. The sensation, or rather the lack of sensation, made him wonder if he'd been so completely burned-out by the merciless waves of fear and hope and dread and loss, that nothing could possibly rouse him anymore. But now word had arrived from New York about a gunshot victim—brain death had occurred, but his heart was strong. It only remained to obtain permission from his mother to use his organs for transplantation. She wanted to speak with her minister first, but Diller had been assured that she was receptive.

“We need somebody in New York to take responsibility for getting the guy out here,” Diller said.

“The whole guy?” Brian asked.

Diller nodded. “We can't keep the heart alive anywhere else except inside the donor.”

“What about Dr. Parkiss?” asked Margaret.

“In Minneapolis for a convention.”

“Figures,” Walter said.

“How about Mary MacDonald?” Brian asked.

Diller looked at Brian thoughtfully.

“But she's only a nurse,” Margaret protested. “Shouldn't it be somebody with a little more training?”

Walter said, “There isn't anybody more competent than MacDonald. I don't give a damn about training.”

Brian said, “Think she'd do it? She runs the show on Eleven.”

Diller picked up his phone and buzzed the secretary they'd provided for him during his “sabbatical.” While they waited, Diller crossed his elegant hands on his desk and spoke quietly to them. “There's a lot that can go wrong between New York and the operating room.”

They all stared back at him with stubborn faith in their faces. Diller thought, They think I'm Jesus Christ. He felt the headache begin to pulse behind his right eye. “I have very little control over what transpires at that end,” he continued. “How they get the donor shipped, what condition he's in when he gets here. We'll do as many tests as possible beforehand. They can do blood work-ups, we can have tissue samples flown ahead for matching. But it's a long trip, and the equipment isn't foolproof.”

Walter broke in, “We won't hold you responsible for screwups. Except the ones in OR.”

Foxy bastard, Diller thought, giving Walter a forced smile. “I'll share with you the one fact I'm sure of, and that's if they get the donor here, and if we have a match and the heart's in good shape and your daughter is still alive, then there's not going to be any slipup in the operating room. I'll make it work.”

Brian resisted the impulse to say, “With a little help from Jason Lewis, Super-surgeon.” But Walter and Margaret gazed at Diller with desperately hopeful faces. Diller wearily accepted his habitual burden of irrational, unquestioning trust. Even in the suspicious face of Walter Converse the ferocious need was evident—to believe in the performance of a miracle.

Mary MacDonald went straight to Jason Lewis's office and asked him if she could observe the operation. She had felt torn about it, thinking it might be the first time she'd humiliate herself by passing out in OR, but the idea of just sitting around wringing her hands with the relatives cinched it.

Lewis impressed her. Like most of the personnel at Saint Joseph's, Mary had followed the progress of the first heart transplant operations, somehow breaking away to watch the press briefings on the lounge television. Lewis was a distinguished-looking man, tall, with a full head of prematurely pure-white hair. He spoke dispassionately about his patients, answering the reporters' eager questions with calm detachment But the third transplant was performed on a ten-year-old boy. It had been a particularly risky case—the desperate search for a suitable heart had produced only that of a middle-aged man whose tissue type was less than ideally matched. When it became apparent that the child was rejecting his new heart, Lewis had stood in front of the microphones and detailed in his quiet voice the circumstances of the boy's imminent death. The great surgeon let the tears roll down his cheeks without shame or apology as he talked, and Mary, when she spoke with him now, kept seeing his face as it was then, all wet and shiny in the glare of the television lights.

Mary's admiration was reciprocated. Lewis was impressed by the efficiency with which the donor was delivered to California, and correctly gave Mary the credit. He told her in his soft voice that he would be honored to have her observe.

The operating room looked like a very clean garage. There was an atmosphere of controlled chaos as the technicians bustled about, setting up their equipment. Machines hummed and clanked and ticked, and the nurses made nervous jokes. There hadn't been a heart transplant in nearly three months, and everyone was excited. Diller would assist, of course.

Mary watched the two men scrub together and listened with a wry smile as Diller complained about the ever-present reporters downstairs. Then she entered OR to watch the assistants prepare Sharlie, remembering, as she stood transfixed, the first time she had assisted in open-heart surgery—how, after the initial incision, the breastbone was opened with a saw and the ribs were separated with rib retractors. Mary had thought then that OR seemed like a body shop. This morning she listened to the hoarse buzz of the saw and swallowed hard, reminding herself that this was Sharlie's only chance.

Diller and Lewis entered now, and the team stood hushed as the men stared down into Sharlie's open incision.

“Holy God,” Lewis said. “How'd you keep her alive?”

Diller shook his head at the pale, flabby heart, so enlarged it seemed to bulge out of the chest cavity.

“Let's get that thing out of there,” Lewis said softly, and began to free Sharlie's heart.

Soon she lay on the table, chest cavity empty, her life supported only by the electronic wizardry of the heart-lung machine.

Lewis said, “All right,” and his nurse opened the door to the adjoining operating room. Mary caught a quick glimpse of a body, swathed in sheets, on the table.

Within seconds the nurse reappeared, carrying a stainless steel basin. Mary averted her eyes and found herself suddenly whispering a Hail Mary. After all the years of assisting in surgery, the impulse surprised her. She fought to remind herself that she was observing a medical procedure, that the object in the shiny basin was merely a hunk of human muscle, not some evil offering for a black-magic ceremony. Diller and Lewis, masked and solemn, were really just technicians, not satanic priests performing a mysterious, dark ritual.

As the surgeons began the tedious process of attaching vena cava to vena cava, aorta to aorta, of the hooking up of coronary arteries, Mary relaxed, responding to the comfortable familiarity of surgical activity. She shook her head, chiding herself for her foolish notions.

It was nearly two hours before Diller and Lewis finished off their minute sewing and straightened up to stretch cramped muscles. The healthy heart seemed tiny inside Sharlie's chest, a fist clenching and unclenching within a vast empty hole. They all watched it in silence, delaying the moment when the new organ must be severed from the heart-lung machine. Finally Lewis murmured, “Okay, let's go.”

Someone switched off the machine. The first second seemed like a long, long time, but suddenly the little fist pulsed, then relaxed, then pulsed again. A jubilant shout rose up from the surgical team, and Mary laughed out loud. Lewis handed his instruments to his scrub nurse and left the room abruptly. Diller remained behind to close the incision and asked casually if the news people were still hanging around outside. He wouldn't mind having a quick word with them.

The scrub nurse looked at Mary over her mask, and the two women smiled at each other with their eyes.

They put her in special isolation and kept everyone out except the transplant staff. The immunosuppressive drugs helped deactivate her body's antigens, preventing them from attacking the alien tissue of the new heart But as a result she was vulnerable to infection from every stray germ. Even the common cold virus could prove deadly during this critical period of her recovery. Along with the elaborate equipment in her room, someone from the transplant staff remained with her at all times.

She hadn't awakened from the anesthesia, but she could be watched through an observation window. Mary MacDonald stood next to Brian, peering at Sharlie's companion, who, at the moment was Nurse Wynick.

“Goddamn cowboys, who the hell do they think they are?” Mary muttered, her substantial body quivering with indignation. “I ought to know something about isolation, for Christ's sake.”

Brian put his arm around her waist, enjoying the bright-pink fury of her face and the muscular girth under his hand. Nurse Wynick glanced at them, frowning slightly.

“Bitch,” Mary said, then sighed. “Ah, well, I suppose I'd do the same if they stuck their freckled California noses into Saint Joe's, be sure I would.”

Brian leaned his forehead against the cold surface of the window. “I hope she never finds out about the donor,” he whispered, as if Sharlie might hear him through the glass.

“We'll just have to make sure she doesn't,” Mary said. “Come on, let's go get some coffee.”

Sitting in the cafeteria, Brian said, “I barely recognized her. She looks so withered.”

“Oh, you'll get your pretty girl back soon enough, if all goes well,” Mary said, cupping her hands around the styrofoam mug. “It's a miracle what happens to some people when they get their new hearts. So much misery they've had, and suddenly they feel brand new.”

“Let it happen to her,” Brian said. Then he went on, guiltily, “Besides, I shouldn't give a damn what she looks like as long as she's okay.”

“You going to get married?”

“She's been talking to the psychiatrist about it.”

“They got the shrinks after her now, do they? Well, that'll screw her up for fair.”

“Gee, thanks,” Brian remarked morosely, and Mary laughed.

They sipped their coffee in companionable silence for a moment. Then Brian said, “Mary, have I told you how glad I am you're here?”

“Mmm,” she replied. “You mentioned it.”

“I wish you could have been around through the whole damn thing.”

“What about the Converses?”

Brian just smiled at her, and suddenly Mary was sputtering again. “That woman, she's a cold fish if I ever saw one. I don't think she gives a flying frog if her daughter lives or dies. Just fancying around in her lah-dee-dah clothes and her false eyelashes—”

Brian interrupted delightedly. “She doesn't really wear false eyelashes, does she?”

Mary looked away. “Well, maybe she does and maybe she doesn't, but she's the type, all right. This California trip's a great excuse to go out and buy herself a whole new wardrobe.”

“She cares about Sharlie,” Brian said.

Mary sniffed into her paper cup.

Brian hesitated, then said slowly, “I'm going to tell you something you're going to find tough to believe.”

Instantly Mary's eyes bored into Brian's face.

“You hang around hospitals long enough, you get to know people,” Brian continued. “They start telling you things they probably shouldn't.”

“Go on,” she said impatiently.

“A couple of days ago, before they found the donor, Margaret Converse tried to persuade Diller to use her own heart for the transplant.”

Mary's face didn't change, her stare just stiffened. “I
don't
believe it,” she whispered.

He nodded. ‘True.”

“Jesus Mary,” she breathed at last, then, after another moment of thinking it over, muttered, “Well, all right, but she's still a cold fish.”

Brian sent Mary back to her motel with an obliging nurse who was going off duty and would be driving that way. Then he went back upstairs to watch Sharlie some more. He waved at the nurse now on duty, a stranger, and leaned against the window to gaze at the lifeless figure amid the hardware—electronic ticking and whirring beside the dehumanized lump that was once his warm, beautiful girl. A shrunken face, an emaciated body with wires and tubes sticking out of her flesh like tentacles.

He had participated in her humiliation, urging his reluctant lover into this awful arena of pain and degradation. Couldn't he have let her die with her beauty and humor and humanity still intact?

He looked down at his hand, now wrapped lightly in an elastic bandage. How many more bones can I break? he wondered.

As he was about to turn away, Sharlie's head moved on the pillow, and she looked him full in the face. He stared back at her stupidly, not knowing what to do with his eyes to hide his dismay. She began to smile and then rolled her eyes at him, making a small grimace with her mouth in the familiar way that said, Can you believe what I've gotten myself into this time? And suddenly he was grinning like a fool, waving and laughing and calling for everybody to come and see.

Diller attended Sharlie with the same kind of protective paranoia he reserved for his hands. No one else, except Jason Lewis, of course, was allowed to interpret her tests. She was his consuming passion, and he hovered at her bedside, fidgeting and fussing.

Margaret watched him with curiosity and amusement. Over the years she had come to realize that the surgeon's special interest in Sharlie focused more on Walter's wallet than on Sharlie's chest cavity. But now his absorption had become personal. Margaret wondered if Diller was bewitched by his own instant celebrity.

Since the transplant the waiting room had been crowded with newspapermen and television cameras. Sharlie's plight had come to the attention of a reporter in New York soon after the donor's demise on a dismal street in Queens. The writer, an ambitious young woman, discovered that frantic arrangements were underfoot to ship the body to California. She sensed exploitability in the story and began a series of articles describing the beautiful young woman on the brink of death awaiting a donor. She wrote about Martin Udstrom, how he had spent his short life attempting to make a splash in New York's criminal underworld, and traced his journey from petty larceny to assault and finally his graduation into homicide with the brutal murder of a shopkeeper in Jackson Heights. The story captured national attention—the hardened heart of a criminal implanted in the chest of a fragile girl—and the public eagerly devoured every word. The media hordes, pencils poised and cameras whirring, gathered daily for Diller's news bulletins.

Today Margaret encountered Diller outside the waiting room where he generally held court. This morning he would be taped for national broadcast, and he muttered to Margaret that the press with all the cameras and paraphernalia was getting in his way and wasting his time. He was fed up with newsmen underfoot all day every day. But she noticed that before he stepped into the room, he was careful to straighten his tie and brush his thick, gold-streaked hair back with his hands.

Margaret watched from the doorway as a jaded Los Angeles reporter asked, “When do we get to see the patient?”

Diller allowed himself a cool smile and turned his best side toward the camera. “I can't tell you that now, gentlemen. She'll be in partial isolation until we're certain she's past any danger of infection.”

“Is she conscious?”

“Yes,” said Diller. “We hope to take her off IV today.”

The New York reporter broke in, “What's the publicity doing to your career, Doctor? Do you see yourself becoming another Christiaan Barnard?”

Diller smiled at her ingratiatingly. “Oh, I'm not interested in notoriety. I just want to do my job.”

“But I understand you're due for several television appearances and speaking tours. Those things have to …

“I'm sure you understand,” Diller interrupted, “that all I want is to continue the work I'm doing. However, I do feel that the public is entitled to information about the kinds of strides being made in coronary surgery, and despite the sacrifice of time away from my patients, I believe I'm obligated to enlighten people who may benefit from these advances.”

Margaret heard suppressed snickers behind her and turned around. Three of the eighth-floor nurses were enjoying Diller's performance from the safety of the doorway across the hall. Diller, meanwhile, dismissed himself for the day, saying he was needed for follow-up on yesterday's surgical cases. He nodded his head graciously at the expressions of appreciation from the reporters and left the room. He touched Margaret's shoulder briefly, then stopped at the group of nurses who were red-faced with the effort to remain properly sober.

“Find out when they're showing that tape, will you?” he murmured, then went off down the hall. Margaret smiled at the nurses but then stared at Diller's retreating figure, wishing him, in her gratitude, a best-selling autobiography and a starring role opposite the actress of his choice.