Mend the Living (17 page)

The first match between donor and recipient is the blood group – the ABO compatibility. A heart transplant requires a compatible ABO and Rh factor, and since Simon Limbeau is B negative, a first skimming shortens the initial list that contained nearly three hundred patients waiting for a transplant – Marthe Carrare’s fingers fly over the keyboard, and you can feel her rushing in search of the recipient, intoxicated, perhaps, at this moment, forgetting everything else. Next she examines the tissue compatibility with the HLA (human leukocyte antigen) system, equally essential: the HLA code is the subject’s biological I.D., involved in immune defence and, although it’s practically impossible to find a donor with an HLA code that is exactly identical to the recipient’s, these must be as close as possible for the transplant to have the best chance of success, and in order to lower the risk of a rejection.

Marthe Carrare has entered Simon’s age into the computer application, and so the list of pediatric receivers is consulted in priority. Then she checks whether there’s a compatible patient on the high-emergency national list, a patient whose life is in danger, who could die from one moment to the next and thus has a priority position on this list – she, too, carefully follows a sophisticated protocol, in which each step is dictated by the previous one and determines the next to come. For the heart, besides the blood-type and immune-system compatibility, the physical structure of the organ, its morphology, and its dimensions come into play, the size and weight criteria further whittling down the list of potential recipients – the heart of a tall, strong adult cannot be transplanted into the body of a child, for example, nor the inverse – and the geography parameters for the transplant are determined by an intangible fact: between the moment when the heart is stopped inside the body of the donor and the moment when it begins to beat again inside that of the recipient, the organ can be stored for a maximum of four hours.

The research crystallizes and Marthe moves her face toward the screen, her eyes enormous and anamorphosed behind the lenses of her glasses. Abruptly, her fingers – yellowed along the inner edge of the third digit – stop the mouse: an emergency is identified for the heart – a woman, fifty-one years old, blood group B, five feet, six inches, 143 pounds, a patient at Pitié-Salpêtrière, the teaching hospital in Paris, in Professor Harfang’s ward. She takes her time carefully reading and rereading the data onscreen, knows that the call she’s about to make will cause a general and marked acceleration at the other end of the line, an influx of electricity in brain synapses, an injection of energy in bodies – in other words: hope.

Hi, this is the Agency of Biomedicine – surfeit of diligence and attention from the department’s receptionist – calls bounce from switchboard to extensions and all the way to the operating room, and then a voice cuts straight through, Harfang here, and Marthe Carrare launches in, fast and direct, Doctor Carrare, Agency of Biomedicine, I have a heart – it’s crazy, she says it in these terms, vocal cords with their patina of forty years of cigarettes and nicotine balls batted back and forth against her palatal fossa – I have a heart for a patient in your ward who’s waiting for a transplant, a compatible heart. Immediate response – not the least sliver of silence – okay, send me the file. And Carrare concludes: it’s done, you have twenty minutes.

Then she moves down to the next recipient in the list onscreen and calls the teaching hospital in Nantes, another cardiac surgery department where the same dialogue plays out concerning a seven-year-old child who has been waiting nearly forty days – Carrare specifies, we’re waiting for an answer from the Pitié, then, once again: you have twenty minutes. A third department is also contacted at the Timone hospital in Marseille.

The wait begins, its tempo measured by telephone calls between the doctor in Saint-Denis and the coordinator in Le Havre, in order to synchronize arrangements for the operation, to prepare the O.R. and the operating teams, and to be as informed as possible about the donor’s hemodynamic condition – stable for the moment. Marthe Carrare knows Thomas Remige well, has met him several times in training courses organized by the agency, seminars where she gave presentations both as an anaesthetist and as a pioneer of the organization, and she’s glad that he’s her spokesperson now, she trusts him, knows he’s reliable, technical and courteous, he’s someone you can count on, they say, and she probably appreciates him all the more because his focus keeps a lid on his agitation, never letting anything other than level-headed intensity show, and because he disparages the dramatic plains of hysteria even though it would often be so easy to take advantage of the human tragedy that lies just behind all organ transplant procedures – the whole world can call itself lucky to have a guy like him around.

Responses for the liver, the kidneys, and the lungs come one after the other following this same procedure – Strasbourg will take the liver (a little six-year-old girl), Lyon the lungs (a seventeen-year-old girl), Rouen the kidneys (a nine-year-old boy) – while over there, in the twists and turns of the stadium, jackets are unzipped sharply, the same way you’d set a plan in action, zzzzip – black leather jackets, khaki bombers with orange linings – scarves are pulled over faces like bandits when they attack the stagecoach or students at a protest when the tear gas is released, and hundreds of smoke grenades are pulled out by expert hands, smuggled in under sweaters, tucked in the back of waistbands, stuffed inside pants – but how did these objects make it past security? The pins are pulled out of the first ones when the players’ buses arrive at Porte de la Chapelle, red smoke, green smoke, white smoke, the clamour intensifies in the bleachers as a long banner is unfolded – Managers, Players, Coaches, Go Home! – the extremist bleachers flex their muscles, compact, brimming, a block of power and aggression, a hostile mass, and those who are just arriving rush forward, rapt, while the security guards’ foreheads grow furrowed with lines and they set off at a gallop, bundled inside their suits, jackets unbuttoned and ties flapping against paunches, they yell into walkie-talkies, the north section is getting worked up, we can’t let it get out of hand, names of birds are shouted out by fans, the buses with tinted windows have just turned off the highway, comfortable and fantastically silent vehicles currently driving along the VIP routes that enlace the arena, finally stopping before the entrances reserved for players. Marthe gets up, opens the window: silhouettes pass before the building of the agency and rush up the avenue toward the stadium, young people from the neighbourhood who know the territory, she sends a laconic text to her daughter – emergency at the abm, call you tomorrow, mom – and then taps the box of gum against the balcony railing, digs a finger beneath the dispenser tab, discovers that the box is empty, and bites her lip – she knows she’s scattered cigarettes all around this office, invented hiding places she’s not sure she’ll be able to find again now, but for the moment decides to chew a little longer.

She imagines thousands of people assembled in a circle over there, around a field of such brilliant green you’d think it had been varnished with a brush, each blade of grass illuminated by a substance mixing resin and essence of turpentine or lavender and which, after the evaporation of the solvent, would have formed this solid and transparent film like a silvery sheen, like the sizing on new cotton, a waxed sail, and thinks that at the moment of matching Simon Limbeau’s living organs, at the moment of sharing them out among ailing bodies, thousands of lungs are inflating together over there, thousands of livers are being inundated with beer, thousands of kidneys are filtering the body’s substances in unison, thousands of hearts are pumping in the charged atmosphere, and suddenly she is struck by the fragmentation of the world, by the absolute discontinuity of reality, humanity pulverized into an infinite divergence of trajectories – an anguished feeling she has felt before, that day in March 1984, sitting in the 69 bus heading to a clinic in the 19th arrondissement for an abortion, less than six months after the birth of her daughter who she was raising alone; rain streamed down the windows and she had looked one by one at the faces of the few passengers around her, faces you see in Parisian buses in the middle of the morning, faces with eyes fleeting toward the faraway or riveted to safety instructions listed within a pictogram, fixated on the emergency button, lost inside the pavilion of a human ear, eyes that avoid each other, old women with shopping bags, young mothers with children in carriers, retired folks heading for the city library to read their daily paper, the chronically unemployed in dubious suits and ties, plunged into their newspapers although they can’t manage to read a single line, not the tiniest glint of sense springing forth from the page, but they cling to the paper as though to keep their heads above water in a world that no longer has room for them, where soon they won’t have enough to live on, people sometimes sitting less than twenty centimetres away from her, none of whom know what she is about to do, this decision she has made and that, in two hours, will be irreversible, people who are living their lives and with whom she shares nothing, nothing, besides this bus caught in a sudden downpour, these worn-out seats and these sticky plastic handholds suspended from the ceiling like nooses knotted to hang yourself, nothing – each one has a life, each one their own, that’s all, and she had felt her eyes swimming in tears, had squeezed the metal bar harder so she wouldn’t fall, and in that moment she probably felt it: the true experience of solitude.

The first police car sirens are heard around seven thirty. She closes the window again – the cold – an hour still until kickoff, it will be difficult to keep the fans’ excitement under control, all those hearts together is too much, who’s playing tonight? Time passes. Marthe Carrare looks at the first folder again, strangely satisfied by how well it matches the donor’s file, they won’t find a better one, what are they waiting for at the Pitié? In that very second the phone rings, it’s Harfang: we’ll take it.

Marthe Carrare hangs up and calls Le Havre right away, tells Thomas that a team from the Pitié-Salpêtrière will contact him to coordinate his arrival, the recipient is a patient in Harfang’s ward, do you know Harfang? I know the name. She smiles, adds: they have a good team there, they know what they’re doing. Thomas checks his watch, says: okay, we’ll go ahead with the harvesting, we should be in the O.R. in about three hours, we’ll be in touch. They hang up. Harfang. Marthe says his name aloud. She knows it too. Knew it even before she knew him, this strong name, this strange name that’s been running through the corridors of Parisian hospitals for more than a century – so that now people would say it’s a “Harfang” to conclude an exchange that had demonstrated the excellence of a practitioner, and they spoke of the “Harfang dynasty” to describe the family that had produced professors and practitioners by the dozen, Charles-Henris and Louises, Juleses, then Roberts and Bernards, and today Mathieus, Gilleses, and Vincents, doctors who had all worked, worked still in public institutions – and as they run the New York marathon in the fall, ski at Courchevel in winter, or regatta in the Gulf of Morbihan on single-hulled carbon boats in spring and summer, they like to say to themselves, we are servants of the state, thus distinguishing themselves from the greedy medical plebs, when in fact a number of them, among the youngest, went directly from finishing residency to opening private clinics in quiet, leafy neighbourhoods, sometimes going into partnership with other Harfangs in order to cover the whole spectrum of pathologies of the human body and to offer quick checkups to overweight businessmen, guys in a rush who are worried by surfeits of cholesterol, capillary desertification, prostate hassles, and declining libido – among them are five generations of pulmonologists, comfy within this patrilineal filiation that privileges the male primogeniture, every time, when the moment comes to pass on appointments as chair and department head; among them, one girl, Brigitte, who ranked first in residency in Paris in 1952 but left the profession two years later, persuaded that she was in love with one of her father’s protégés when really she was just giving in to a surreptitious pressure telling her she should make room, increase the vital space for young males of the clan; and him, Emmanuel Harfang, the surgeon.

Marthe remembers hanging out with a group headed by a pair of Harfang cousins during her residency. One was in pediatric cardiology, the other in gynecology. They had the “Harfang feather,” the same shock of white hair growing in a cowlick in the middle of their foreheads that they pushed back with a flick of the wrist – familial seal and visual marker, the vapour trail of a legend, follow my white plume and the whole impromptu swagger designed to soften women’s vigilance; they wore Levi’s 501s and oxford shirts, plaid-lined beige raincoats with the collars turned up, never went out in sneakers, wore Church’s even though they disdained tasselled loafers, stood at medium height, knobbly, with pale skin and golden eyes, thin lips, and Adam’s apples so protruding that Marthe too would begin to swallow when she saw them slide beneath the skin of their throats; they looked like each other and also like this Emmanuel Harfang who mends and transplants hearts at the Pitié-Salpêtrière, only ten years younger.

This last one descends the stairs of the auditorium exactly as the symposium starts, looking straight ahead, skipping the final step so he might be carried forward by his momentum and reach the desk with an athletic bound, a paper in his hand that he won’t read, beginning his talk without even greeting the audience, preferring blunt leads, abrupt openings, a way of getting straight to the point without adhering to etiquette, without weakening his family name, as though each person in the room was supposed to know already who he was – Harfang, son of Harfang, grandson of Harfang – and a way also, no doubt, of perking up an audience that has a tendency to nod off in the early afternoon, a little dulled after those infamous meals in nearby restaurants reserved for the occasion, improvised refectories where carafes of red wine are lined up on paper napkins, always that modest, full-bodied Corbières that goes well with rare meat, and beginning with Harfang’s first words, the room emerges from its digestive torpor, each one remembering, as they watch him so slim and athletic up there, that he is the pillar of a top-ranking cycling club, a team that wears the hospital colours in various races, guys able to ride two hundred kilometres on Sunday mornings as long as it fits in with department life, guys ready to get up at the crack of dawn to do it, even if they despair of not being able to sleep longer, caress their wives, make love, play with their kids, or just lie around listening to the radio, the bathroom always brighter and the smell of toast always more desirable on those mornings, guys who hope, then, to be admitted to this strange club, and who would have paid good money, even elbowed their way in to be chosen by Harfang – “pointed out” was the provisional term – because Harfang, suddenly aware of their presence, would point his index at them and tilt his head to the side to evaluate their physical constitution, making sure he had here a possible rival, and with a strange smile twisting his face, he would ask: so, you like biking?