Harvesting the Heart (71 page)

They
pull a long purple spaghetti string from the leg, and when I realize
it is a vein, I feel the bile rise in my throat. I have to sit down.
The vein is placed in a jar filled with clear fluid, and the doctors
working on the leg begin to sew with needles so small they seem
invisible. One of them takes two pieces of metal from a machine and
touches the leg, and I can swear I smell human flesh burning.

Then
Nicholas moves to the center of the patient. He reaches for a
knife—no, a scalpel—and traces a thin line down the
orange area of the patient's chest. Almost immediately the skin is
stained with dark blood. Then he does something I cannot believe: he
pulls a saw out of nowhere—an actual saw, like a Black &
Decker—and begins to slice through the breastbone.
I
think
I
can
see chips of bone, although I can't believe Nicholas would let that
happen. When I think I am surely going to faint, Nicholas hands the
saw to another doctor and spreads the chest open, holding it in place
with a metal device.

I
don't know what
I
was
expecting—maybe a red valentine heart. But what lies in the
center of this cavity once the blood is mopped away looks like a
yellow wall. Nicholas picks a pair of scissors off a tray, bends low
toward the chest, and fiddles around with his hands. He takes two
tubes that come from that complicated machine and attaches them to
places
I
cannot
quite see. Then he picks up a different pair of scissors and
looks at the yellow wall. He begins to snip at it. He peels back the
layer to reveal a writhing muscle, sort of pink and sort of gray,
which I know is the heart. It twitches with every beat, and when it
contracts it gets so small that it seems to be temporarily lost.
Nicholas says, "Let's put him on bypass," to the man who is
sitting at the machine, and in a quiet whir, red blood begins to run
through the tubes. Below his mask, I think I see Nicholas smile.

He
asks a nurse for cardioplegia, and she hands him a beaker filled with
a clear solution. He pours it over the heart, and just like that, it
stands still.
Dear
Jesus,
I
find myself thinking,
he's
killed the man.
But
Nicholas doesn't even stop for a moment. He picks up another pair of
scissors and moves close to the patient again.

All
of a sudden a spurt of blood covers Nicholas's cheek and the front of
another doctor's gown. Nicholas's hands move faster than I can follow
as he reaches into the open chest to stop the flow. I step back,
breathing hard. I wonder how Nicholas can do this every single
day.

The
second doctor reaches into the jar I've forgotten about and

takes
out the vein from the leg. And then Nicholas, sweat breaking out on
his brow, pulls a tiny needle repeatedly through the heart and
through that vein, using tweezers to place the point and to retrieve
it. The other surgeon steps back, and Nicholas taps the jellied heart
with a metal instrument. Just like that, it starts to beat. It stops,
and Nicholas asks for an internal defibrill-something. He touches it
to the heart and shocks it into moving again. The second doctor takes
the tubes from the top and bottom of the heart, and the blood stops
coursing through the machine. Instead, the heart, still on display,
begins to do what it was doing before—squeezing and expanding
in a simple rhythm.

Nicholas
lets the second surgeon do most of the work from that point—more
sutures, including wire for the ribs and thick stitches through the
orange skin that make me think of a Frankenstein monster. I
press my hands against the sloped glass wall of the gallery. My face
is so close that my breath clouds the window. Nicholas looks up and
sees me. I smile hesitantly, wondering at the power he must feel to
spend every morning giving life.

^chapter
39

_Nicholas

Nicholas
remembers having heard once that the person who has started a
relationship finds it easier to end it. Obviously, he thinks, that
person did not know Paige. He can't get rid of her. He has to give
her credit—he never thought she'd take it this far. But it is
distracting. Everywhere he turns, there she is. Arranging flowers for
his patients, wheeling them out of surgical ICU, eating lunch across
the cafeteria. It has reached the point where he actually misses her
when she isn't around.

The
drawings have got out of control. At first he ignored them, tacked
crudely to his office door like kindergarten paintings on a
refrigerator. But as people started to notice Paige's talent, he
couldn't help but look at them. He brings the ones she does of his
patients to their rooms, since it seems to brighten them up a
little—some of his incoming patients have even heard of the
portraits and ask for them at the pre-op exam. He pretends to throw
out the ones she does

of
him, but in fact he has been saving them in the locked bottom drawer
of the desk. When he has a minute, he pulls them out and looks at
them. Because he knows Paige, he knows what to look for. And sure
enough, in every single picture of him—even the ridiculous one
of him singing in a bowling shirt—there is something else.
Someone, actually. In the background of each drawing is a
slight, barely noticeable portrait of Paige herself. Nicholas finds
the same face over and over, and every time she is crying.

And
now her pictures are all over the entrance hall of Mass General.
The whole staff treats her like some kind of Picasso. Fans flock to
his office door to see the latest ones, and he actually has to push
through them to get into the room. The chief of staff—the
goddamned chief of staff!—ran into Nicholas in the hall
and complimented him on Paige's talent.

Nicholas
does not know how she has managed to win so many people to her side
in a matter of days. Now,
that's
Paige's
real talent—diplomacy. Every time he turns around, someone is
mentioning her name or, worse, she is standing there herself. It
reminds him of the ad agencies' "block" strategy, where
they run the same exact commercial at the same exact time on all
three network stations, so that even if you flip channels you see
their product. He can't get her out of his mind.

Nicholas
likes to look at the portraits in his drawer just before he goes down
to surgery—which, thank God, is the only place Paige hasn't
been allowed into yet. The pictures clear his head, and he likes to
have that kind of directed focus before doing an operation. He pulls
out the latest drawing: his hands poised in midair as if they are
going to cast a spell. Every line is deeply etched; his fingernails
are blunt and larger than life. In the shadow of the thumb is Paige's
face. The drawing reminds him of the photo his mother developed years
before to save her marriage, the one of her own hands folded beneath
his father's. Paige couldn't have known, and it strikes Nicholas as
uncanny.

He
leaves the portrait on the desk, on top of the scrawled sheets of
assets he is supposed to be preparing for Oakie Peterborough. He has
added nothing since the day he met the lawyer for lunch, a week ago.
He keeps thinking that he must call to set up a consultation, but he
forgets to mention it to his secretary and he is too busy to do it
himself.

The
operation this morning is a routine bypass, which Nicholas thinks he
could do with his eyes closed. He walks briskly to the locker room,
although he is not in a hurry; he changes into the soft laundered
blue scrubs. He pulls on paper booties and a paper cap and winds a
mask around his neck. Then he rakes a deep breath and goes to scrub,
thinking about the business of fixing hearts.

It's
strange being the chief of cardiac surgery. When he enters the
operating suite the patient is already prepped and the easy
conversation between the residents and the nurses and the
anesthesiologist comes to a dead halt. "Good morning, Dr.
Prescott," someone says finally, and Nicholas can't even tell
who it is because of the stupid masks. He wishes he knew what to do
to put them all at ease, but he hasn't had enough experience at it.
As a surgical fellow, he spent so much time clawing his way to the
top, he never bothered to consider whom he was crawling over to
get there. Patients are one thing: Nicholas believes that if someone
is going to trust you with his life and shell out $31,000 for five
hours' work, he or she deserves to be listened to and laughed with.
He has even sat on the edges of beds and held his patients' hands
while they prayed. But doctors are a different breed. They are so
busy looking behind them for an encroaching Brutus that everyone
becomes a potential threat. Especially a superior like Nicholas: with
one written criticism, he has the power to end a career. Nicholas
wishes he could look over the blue edge of a mask just once and see a
pair of smiling eyes. He wishes Marie, the stout, serious OR nurse,
would put a whoopee cushion under the patient, or set rubber vomit on
the instrument tray, or play some other practical joke. He wonders
what would happen if he walked in and said, "Have you heard the
one about the rabbi, the priest, and the call girl?"

Nicholas
speaks softly as the patient is intubated, and then he directs a
resident, a man his own age, to harvest the leg vein. His hands move
by themselves, making the incision and opening the ribs, dissecting
out the aorta and the vena cava for the bypass machine, sewing up and
cauterizing blood vessels that are accidentally cut.

When
the heart has been stopped—an action that never loses its
effect for Nicholas, who holds his breath as if his own body has been
affected—Nicholas peers through magnifying spectacles and
begins to cut away the diseased coronary arteries. He sews on the leg
vein, turned backward, to bypass the obstructions. At one point, when
a blood vessel begins spurting blood all over Nicholas and his first
assistant, Nicholas curses. The anesthesiologist looks up, because
he's never seen Dr. Prescott—the famous Dr. Prescott—lose
his cool. But even as he does so, Nicholas's hands are flying
quickly, clamping the vessel as the other doctor sews it up.

When
it is all over and Nicholas steps back to let his assistant close, he
does not feel as if five hours have passed. He never does. He is not
a religious man, but he leans against the tiled wall and beneath his
blue mask he whispers a prayer of thanks to God. In spite of the fact
that he knows he is skilled, that his expertise comes from years of
training and practice, Nicholas cannot help but believe a little bit
of luck has been thrown in, that someone is looking out for him.

That's
when he sees the angel. In the observation gallery is the figure of a
woman, her hands pressed to the window, her cheek flush against the
glass. She is wearing something loose that falls to her calves and
that glows in the reflected fluorescent light of the operating suite.
Nicholas cannot help himself; he takes a step forward and lifts his
hand a fraction of an inch as if he might touch her. He cannot see
her eyes, but somehow he knows this is only an apparition. The angel
glides away and disappears into the dark background of the gallery.
Nicholas knows that even if he has never seen her before, she has
always been with him, watching over his surgeries. He wishes, harder
than he has ever wished for anything in his life, that he could see
her face.

After
such a spiritual morning, it is a letdown for Nicholas to find Paige
in all his patients' rooms when he is doing afternoon rounds. Today
she has pulled her hair away from her face in a braid that hangs down
to her shoulder blades and moves like a thick switch when she leans
over to refill a water pitcher or to plump pillows. She's not wearing
makeup, she rarely does, and she looks about as old as a candy
striper.

Nicholas
flips over the metal cover of Mrs. McCrory's chart. The patient is a
woman in her late fifties who had a valve replacement done three days
ago and is almost ready to go home. He skims a finger across the
vitals recorded by one of the interns. "I think we're getting
ready to kick you out of here," he says, grinning down at her.