The Assembler of Parts: A Novel (29 page)

He showers, and for the first time in four days, he shaves.

His hand is almost steady. It quivers only until the razor is against his skin, then stops. There are no more nicks and cuts. Afterward, looking in the mirror, he convinces himself there is a little light in the dark center of his eyes. A thin sheen of luster only, but light.

As he begins to dress, he is amazed: his stomach growls. And growls again. “Hungry,” he says with disbelief. For food.

He has a box of Cheerios but the milk has gone sour. He eats the cereal by the handfuls right from the box. Like a pregnant woman with the morning sickness, he muses.

He thinks of Rose Mary. He thinks of Mother.

He thinks of me.

His hunger leaves, chased by sadness and oats.

He goes upstairs and brushes his teeth. He gets his car keys and drives. The cemetery first, then the house. We are all in our own graves, and he addresses us all, me and Joey and Rose Mary and now his mother, Carina. His voice is flat like the land in winter. Nothing rises in green between the graves. But there is a summer softness to his words, like the chords in his music. He plays his voice until it is choked. Then he stands on the hard ground ignoring the cold.

At our house, no one is home.

Burke is the only one who frets over the meeting planned for Monday. Eileen Marshall, Vincent Garraway, and Pat O’Neil agree to come. They enter the date and time and place into their PalmPilots and go about their weekends unencumbered by the prospects of confronting a family grieving the loss of a child.

For Garraway and O’Neil, their detachment is both practical and ethical. They routinely deal with children afflicted with conditions that bring early death. They would deny the callus on their hearts from the rub of these many deaths, but it is there, hard and horny. And it is good it is there. Without it they could not go on bringing their care to other needy families, many of whom will not suffer this early loss. And, just as importantly, both feel absolved of any error in my care. Neither was charged with the evaluation of my cardiovascular system. Neither contributed to Eileen Marshall’s missed diagnosis.

Vincent Garraway takes his wife to a movie Saturday night, a comedy, and his kids bowling on Sunday afternoon, also a comedy, if you were ever to see him bowl. He’s an ostrich doing ballet when he rolls that ball. He laughs Saturday night at the punch lines and Sunday afternoon at the gutterballs.

Pat O’Neil is on call for ENT for the weekend. At three in the morning Sunday, he treats a four-year-old for epiglottitis, an infection of the flap covering the trachea that can be just as rapidly fatal as was my airway infection. He rushes from home and bed to the hospital with unbrushed hair that looks like Woody Woodpecker’s, sees the child with compromised respirations on her gurney in the ER, and intubates her then and there, saving her life in about twenty seconds. He carries his fatigue with him like a badge all day Sunday, feeling tired and sluggish, but special, heroic. He sleeps soundly Sunday night, arising Monday morning feeling utterly refreshed, and godlike.

Friday night Eileen Marshall dictates a scathing letter to the administrator in charge of the sonography library, lambasting him for negligence in securing the echocardiograms that had been entrusted to his safekeeping. It is the last piece in the paper trail she has diligently constructed about the missing studies of Jessica Mary Jackson. Saturday she shops for shoes. Sunday she goes to church and takes her mother out to dinner, then gets a full night’s sleep.

Burke suffers guilt and confusion in equal measure throughout the weekend. He does not feel guilty over my death—Eileen Marshall is the only member of his team who can interpret the images from an echo—but he feels guilty that he attempted to sidestep the difficult emotional work of dealing with its aftermath. And his aversion to that process is what confuses him. He wonders if he lacks the gene for empathy. He wonders if there are others like him, physicians who are tireless in their dedication to the complex care of children, even of those children with the most tenuous of grasps on life, on “normalcy,” but then who are entirely divorced from the circumstances after their deaths. It is as if he doesn’t value death, as if death is all loss, and one’s involvement in death is like throwing good money after bad. He doesn’t know why he is like this; he wishes he wasn’t, and it saddens him he is, but he’d just like them all to go away when the child dies. He did his best, always does his best. But with death, end of contract. No more service. Time to start over, fresh, alive, newborn.

If you don’t call them back to answer their questions about a dead child, he likes to think, eventually they will stop asking, grow quiet for a time, grieve their loss, reattach, have another baby, remember his good care, and make an appointment.

It was not the first faxed autopsy report he conveniently misplaced, thinking, maybe they’ll call the ME and get him to answer the questions.

His stomach bothers him all weekend. He leaves his son’s basketball game early Saturday afternoon with a headache. He cuts his finger carving a roast chicken Sunday night. There is blood everywhere before he realizes it. The white meat is inedible.

He’s awake in his study reading journals until two a.m., not tired for sleep. Finally, in bed at two thirty, he says to the night air, “The dead. The damn dead.”

There is not a single star on his black ceiling.

Cassidy learns about my autopsy results Saturday night at dinner. He understands the words well enough—the blood vessel obstructing my breathing, the croup closing off the airway unexpectedly—but Saturday he has difficulty getting his reawakening brain around the emotions that seem to pour out of Mother and Father, Nana and Ned. They are relaxed and happy one moment in celebration of their innocence. They are sad and weepy the next because they grieve my loss, because my body sits disassembled onto three printed pages with headings such as “Thorax,” “Abdomen,” and “Integument.” And they are angry and vengeful the next about Burke’s lies and Marshall’s error. Cassidy feels nothing but a creeping sadness inside his heart as sobriety begins to operate in the absence of Valium’s numbing suppression of his brain. Things in his head seem to be returning to normal, whatever that might be. He gets hungry. He gets sleepy. He awakens from a nap refreshed. He remembers. More, he remembers and then wants to forget. He laughs, he cries. He is content in his sadness.

Sunday he attends Mass with my family. His eyes close over at the homily. Behind his eyelids he sees me look up from the pew where I sit next to him. My finger goes to my nose and twists. He sees himself nod and smile at me and mouth, “Yeah. Boring.” He laughs aloud and Nana takes his arm. He opens his eyes with a start. He begins to whisper, “Sorry,” but stops and gives the sign he’d just seen in better times. Nana shakes her head, but she smiles.

That night after dinner he starts reading
D’Aulaires’ Book of Greek Myths
to BJ. They sit in her room for an hour. His voice is inflective and strong. It scares her, the parts about Cronus and the babies. It makes her laugh, the stone wrapped in baby’s clothes. She does not want him to stop. She cries in her bed when Mother intervenes.

He is invited to the meeting with Burke. “No,” he says. “I think I’ll pass.” It is enough simply to be sad.

Burke’s conference room we habitually used always seemed small to me, even when I was very young. There often wasn’t enough room for everyone to sit on chairs around the table. Sometimes residents or students stood lining the walls like minor gods attending Zeus on Mount Olympus. But on the tape of the autopsy meeting, the room seems even smaller than usual. I think it’s because Burke tried to arrange the chairs so that the physicians would be well separated from the family. The four chairs for Mother, Father, Nana, and Ned are bunched together and there’s hardly room for shoulders and arms, legs and feet to exist individually. The body parts touch and seem to merge. The same goes for Burke, O’Neil, Marshall, and Garraway at the other end of the table.

Before they sit, each physician approaches my family to shake hands and again extend condolences. They all say the same things—how are you doing now with all of this? Is it getting any better? Such a beautiful wake—though Garraway asks Mother about her current pregnancy and promises to visit her and the new baby in the hospital. “And I’m sure it will just be a social visit,” he says taking hold of her hand.

When the meeting starts, Burke holds up a copy of my autopsy report. “I know everyone here has seen this. So I’m not going to go through it organ by organ unless someone,” and he nods to my family’s end of the table, “needs me to. Instead, I want to get down to the main issue coming from the study of Jess’s body after death. She had a vascular anomaly—an artery that arose from the heart in the wrong place and went behind her windpipe, partly blocking it—and no one knew about it.

“I want to know why that was the case. And I’m sure the family feels the same. I don’t read echocardiograms, so I have no idea whether one of those should show a vessel like this. That’s why Dr. Marshall has come today, to shed some light on this issue. So, Dr. Marshall. Eileen. Please.”

Father is pleased that Burke is tackling the issue head-on. It is exactly the question he and Ned had formulated for Marshall when they talked over their strategy for the meeting. Okay, Burke, he thinks. Point for you, but I’m still watching for lies.

Eileen Marshall stands. In her hand she holds what she thinks is the one extant echocardiographic study of my heart, as well as a second patient’s echo. She goes to the door, opens it, and wheels in a portable echo player. “I just wanted to show the family two tapes. The first one”—she grunts trying to flip the switch that opens the spool holder—“is from a child of about one with the same lesion Jess had. Aberrant right subclavian. The second is Jess’s echo.” She sets the first tape. The screen lights up and begins to display gray shadows and squiggles that seem to float and jump like fish. “Dr. Burke, the lights please.” She advances the tape as the room goes dark, and stops. “This is the other child’s heart.” She points with the tip of her Bic pen. “And this is the arch of the aorta, at the top of the heart where the major arteries branch off. Now, you can see here this shadow,” and she manually advances the spool while pointing to a gray blur that seems to appear out of a stormy sea of gray and black. “That’s the aberrant right subclavian artery.” She rewinds the tape and plays it again so the vessel reappears. She rewinds a second time and replays.

“Now, to be really certain it is an aberrant RSCA, you need to do an arteriogram, but this is what we see on an echo to suggest its presence. Now,” she says, removing the first study and replacing it with mine, “this is Jess. Same views. Same machine. Same magnification. Look here.” She sounds to me like a magician preparing the audience for a sleight-of-hand trick: now you see it, now you . . .

“There’s the aortic arch off the top of the heart.” Her pen makes a nice sweep from dark chamber to a half-moon grayish structure. “And then, nothing here. Nothing. Her aberrant subclavian artery is not visible. I’m not saying it’s not there. It
has
to be there. But it simply is not visible. Possibly the size, possibly surrounding structures competing for the sound waves, who really knows, who will ever know, but it’s not there to see.” She is facing the screen looking away from my parents. “Again.” She replays the study. “Not there, just not there for us to see.” She removes the tape of my heart.

The room is black but for the grainy gray light from the machine. She stands in the dark, above the light, invisible to the seated viewers, smiling.

Burke stands, fumbles for the light switch and throws the room into brightness. Everyone blinks. Father is speechless. More than speechless, thought-less. He simply is unprepared for this display of . . . of innocence. He thinks: She looked for it. It’s not there to be seen. What is anyone to do? What?

Burke reads the blank faces of my family. Time to wrap this up, he thinks. “Dr. Marshall. Thank you. I . . . we . . . Medicine is both an art and a science. Sometimes it fails by art. Sometimes by science. Here, technology failed us, failed Jess. But the sadness is the same, no matter the cause.” He shoots a quick glance to the echo player. He shakes his head side to side like a scold to a naughty child and returns his gaze to my family. “Is there anything else? Any part of the autopsy we can clarify for you? Terminology? The anatomy? The conclusions are self-evident. Jess’s death was an act of God, nothing more, nothing less.” He hangs his head and stops.

Mother has tears in her eyes. It is the sadness of her loss and the joy of her innocence again at work. She wants nothing more than to walk out of this conference room and go home to remember me, her dead child, to love BJ, her live one, and to await her coming labor. Nana and Ned both are satisfied with the explanation they have just heard, and they are relieved the book can be closed now, once and for all, on the question Father pressed all weekend, the question of justice.

Father stands, though his shoulders slump forward, his spine seems to bend. “Thank you all for coming,” he says in a half whisper. “We really appreciate it.” He shakes hands again with the four departing physicians. Eileen Marshall’s hand is cold as ice.

He walks alone to get the car, to spare Mother the steps. “Act of God,” he tells himself over and over. “Act of God.”

Brian Joseph Jackson is born two days later. The labor is short and comparatively easy. Mother is not even tired the morning after, even though Brian Joseph’s arrival has kept her awake until the sun has also made its appearance. He weighs eight pounds and one ounce and has ten fingers and ten toes, two normal ears, and the heart of a racehorse, according to Burke who spends five minutes in silent concentration listening to that internal canter. Nana and Ned, BJ and Cassidy arrive late morning to visit. The chorus of “oohs” and “ahs” meets BJ’s rebuttal kicks and screams when it is time to leave. She wants to stay with Mother and voices her displeasure, no, her “hate” for everyone else in the room, especially the stupid baby boy who sleeps pinkly and peacefully in his blue blanket. Cassidy cajoles her with the promise of “winter ice cream” and the gift of a new box of crayons. She leaves holding his hand, demanding the “big, big box.” They are calling her Jeanine now. “BJ” is handed down to Brian Joseph, at least until he’s old enough to choose “Brian” or “Joe.” All is right in the world.