The Prize (36 page)

There was friendly laughter in the conference room, and Jacobsson felt encouraged. ‘King Gustaf—the Mr. G. of so many tennis tournaments—presented more Nobel medallions and diplomas than any other one of our monarchs. Every laureate left with admiration for his obvious nobility yet democratic bearing. I remember that Anatole France had just become a Communist when he met King Gustaf. It was thought that Anatole France might have some resentment for royalty. But King Gustaf’s simplicity won the old laureate over completely. Afterwards, Anatole France said, “The King of Sweden is a Bernadotte. He is accustomed to power. A President, on the other hand, always strikes one as a little new at the game.” As a sidelight, it may interest you to know that of all the many laureates that King Gustaf met and awarded prizes to, his favourite was the Irish poet, W. B. Yeats. On more than one occasion, I heard the King say that he admired Yeats the most because the poet had “the manners of a courtier”.’

Jacobsson realized that Sue Wiley was still standing, and he addressed himself to her. ‘But you were inquiring about excitements and embarrassments, were you not, Miss Wiley? I can think of one excitement where embarrassment was cleverly avoided. You know, on Ceremony afternoon, this afternoon, it is protocol that a laureate, after receiving his award from the King, retire backwards from the orchestra and up the steps to his seat on the platform. I remember that Mrs. Pearl Buck was much concerned about this. Dr. Enrico Fermi had received his award before her, and had made his way backwards to his seat with no difficulty. Pearl Buck wore a gold evening gown with a long train, and was distinctly handicapped. Nevertheless, her backward march from the King was made successfully amid thunderous applause from the audience. She had managed it, she told a friend later, by memorizing the pattern of the Oriental rug at her feet and following the design to her chair on the platform. However, another embarrassing incident took place at one Ceremony when two British laureates—it would be improper to identify them—accepted their awards from the King, forgot protocol, and turned their backs on the King as they went back to their seats. The Swedish people in the audience were deeply offended. In surprising contrast to omissions by democratic laureates, the Russians have always been unfailingly correct, their courtesy impeccable, their bows to His Majesty the deepest. I recall distinctly that in 1958 the Soviet nuclear authority, Dr. Igor Tamm, who was one of the three physics laureates, bowed so deeply that he almost dropped all his awards. Beyond such trifles, I fear I have nothing else, Miss Wiley. Our Ceremony usually takes place without incident, as you shall see for yourself at five o’clock this afternoon.’ He looked about him. ‘Are there any more questions?’

A hand fluttered high. ‘Count Jacobsson—’

‘Yes?’

‘What about the laureates today? They must be nervous, waiting for the Ceremony. Do you know what they are doing?’

‘I know what they should be doing,’ said Jacobsson. ‘They should be on their way to Concert Hall for a half-hour’s informal rehearsal of this afternoon’s Ceremony. However, yesterday the rehearsal was cancelled. So I am certain they are almost all resting at the Grand Hotel.’

‘Why was the rehearsal cancelled?’

‘Two laureates were unable to attend. There will be an announcement about this early in the afternoon from the Caroline Institute. I am permitted to say only this much—Dr. Farelli and Dr. Garrett are not resting—are engaged, this very moment, in an activity connected with their specialties. . . .”

It was 10.52 in the morning.

In this outskirt area of Stockholm, the structure weirdly framed behind the steadily falling snow—as if Seurat had pecked out a building in pointillism, white-dotted dabs on transparent glass instead of canvas—was the Caroline Hospital. Blending with the moving snow were the shimmering rows of yellow lights shining through the winter morning from the infirmary corridors and wards.

Inside the Caroline Hospital, inside the third-floor surgery room, the banks of lights were the brightest, not dull yellow like the corridor bulbs, not stark white like the falling snow, but silvery clear and steady as the luminosity of a summer’s day in the early sunrise.

On the operating table, partially exposed but otherwise draped and shrouded, lay the unconscious patient, Count Rolf Ramstedt, seventy-two-year-old relative of H.R.H. the King of Sweden. Seconds ago, divested of the failing old heart that had been ravaged and weakened by atherosclerotic coronaries, he was being kept alive only by the five-thousand-dollar heart-lung bypass machine that supported his body tissues with oxygenated blood, while the gaping pericardium waited to be filled.

Bent over the patient now, in the disguise of the modern image of the Creator—gauze mask, gown, rubber gloves—was Dr. Erik
ض
hman, preparing to suture the living calf’s heart to the great vessels of the host. Flanking
ض
hman, also masked, gowned, and gloved, were the three young Swedish nurses and the lanky an
و
sthetist, now checking blood pressure.

Far away, the minute hand of the ivory clock ticked and jumped ahead.

At the foot of the table, performing his role of observer, Dr. John Garrett exhaled tension through his mask and knew that the cardiac surgery, scheduled to last an hour and a half (after the long interlude of hooking the patient to the bypass machine), was at the midway mark. Soon, all too soon, Garrett would be able to return his attention to the taller, bulkier gowned figure of Dr. Carlo Farelli beside him.

Earlier, in
ض
hman’s office, in the dawn indistinguishable from the night, he and Farelli had met face to face without the exchange of a single cordial word.
ض
hman, sensitive to their animosity, had deftly come between them to seek their advice in charting the difficult cardiac transplantation. Except for two interruptions—one by a colleague on the telephone to discuss some youngster’s congenital heart defect (cor triloculare bi-atriatum), and the other by another colleague, who had poked his head in, fretting, to report on the impending miscarriage, this morning, of the wife of a mutual friend—the team of three had worked steadily. Garrett had soon become absorbed in the preparations that had taken place, especially in the record of Anti-reactive Substance S administered.

They had debated all of the problems, so familar and elementary to them, of the new surgical technique for removal and replacement of the heart, putting special emphasis on preventing clotting within the blood circuits, and on fastening of artificial materials to the blood vessels, so that there would be leakproof connections that would also discourage clotting. Garrett had brought up the possible discrepancy in the blood vessel sizes—those of the calf’s heart might be smaller than the ones to which they must be attached—but
ض
hman had anticipated this and described his nonreactive adaptors. Farelli had brought up the advisability of a heterotopic transplant, but both Garrett and
ض
hman had supported locating the new heart in the normal anatomical position. Three mammalian hearts, only hours old, had been stored, and
ض
hman, Farelli, and Garrett had unanimously agreed upon the one to be grafted.

At last they had been summoned to surgery, and Count Ramstedt had been wheeled in. Everything had been efficiently readied. The patient had already been anesth
و
tized, chest shaved and prepped, and merthiolate applied. The patient had received mild hypothermy to cool his system to 30° C. and he had received heparin intravenously to prevent clotting. The huge heart-lung machine stood ready, and the 4,000 c.c. of whole blood, cross-matched, awaited use in the event of emergency.

In his concern for the patient, Garrett had forgotten the presence of Farelli. At first, what was so well known to him—materials, procedure—seemed strange and otherworldly because of the quick singsong of the Swedish words that went from
ض
hman to his nurses and aides—
l
ن
karen
and
hud
and
brِstkorg
and
blod
and
ه
dra
and
skoterska
and
bedِva
—and once,
pulsen
ن
r mycket oregelbunden
, which Garrett understood to mean that the pulse was irregular—and constantly, over and over,
hj
ن
rta, hj
ن
rta, hj
ن
rta
, which Garrett came to realize was heart, heart, heart.

But then, as
ض
hman flexed his fingers in the rubber gloves, and took the slap of the scalpel, complaining that there was a troublesome halation on the instrument and having one light adjusted, and then, as he performed the median sternotomy—the incision from the neck base down the middle of the sternum to the bottom of the breastbone—there was nothing any longer strange or otherworldly to Garrett.

As he observed what followed, Garrett’s pride swelled. This was his discovery, his immortality. Critically, yet with continuing inflated ego, Garrett watched a son of Hippocrates attempt to raise a Lazarus from the dead. Garrett watched, his head involuntarily nodding its approval . . . the rubber-shod clamps . . . the open chest wall . . . the anticoagulant . . . the endless connecting of the plastic heart-lung apparatus to provide oxygenation of the blood and to remove carbon dioxide . . . the withdrawal of all blood from the major venous return before it reached the ailing heart, bypassing heart and lungs, diverting the blood through the pump and then returning it to the arterial circulation system . . . the crucial minutes of surgery with the delicate excavation of the old heart, transecting the pulmonary artery and the aorta beyond their valves and cutting across the region of the atria at the back portion. . . .

It was 10.52 in the morning.

The strain began to leave Garrett as his protégé inserted the cooled fresh calf’s heart—two young mammalian auricles and two ventricles—and then sutured the walls of the atria together, avoiding separate anastomoses of the veins leading to the heart. Now, for the final suture by the Russian vessel instrument, woven dacron to hook up the aorta, the pulmonary artery, the four pulmonary veins, the superior
vena cava
, the inferior
vena cava
.

Garrett and Farelli looked on tightly, as
ض
hman completed the transplantation. With the new heart freed of air to avoid air embolism,
ض
hman released the aorta to permit fresh oxygenated blood from the great plastic outer machine to pass into the coronary vessels. The new mammalian heart warmed and was filled with fresh oxygenated blood. Gradually, gradually, the new heart began to contract, to take over circulation on its own, receiving and pumping plasma. The patient breathed on. Lazarus alive.

Garrett’s gaze narrowed. Rhythm excellent. No electrical defibrillation necessary. He was about to speak up—there was another thing—he must remind
ض
hman to administer Polybrene to neutralize the heparin and to allow the resumption of normal blood clotting, but then he knew it was too soon and
ض
hman would not forget, anyway.

The lanky an
و
sthetist spoke. ‘Oxygenation satisfactory. He is also maintaining satisfactory blood pressure.’

Seventy beats a minute, thought Garrett, and 5,600 c.c. of blood pumping a minute—with a transplanted heart! His own private heart swelled once more.

‘Go off bypass,’ said
ض
hman.

The glass cardiopulmonary heart-lung machine was disconnected. The new heart was on its own.

Only three times, in English made awkward by emergency, had
ض
hman consulted with Garrett and Farelli in the hour gone by, and three times they had confirmed what he had planned, once both supplementing his ideas with ideas of their own, and now, at last, the transplantation had been successfully accomplished. All that remained was the routine removal of clamps and catheters, the closing of the chest cavity, the addition of Polybrene, the injection of growth-inhibiting hormones to contain the calf’s heart, and finally, the observation of life renewed and extended.