Harvesting the Heart

  And so it was that on that Sunday I opened my eyes already disappointed, to hear my father tugging his suitcase down the hall and my mother whispering goodbye and reminding him to call us later, after we got home from Saint Christopher's, to tell us how it went.

  The morning started the way it always did. My mother made me breakfast--my favorite today, apple pancakes in the shape of my initials. She laid my pink lace last-year Easter dress on the foot of my bed. But when the time came to leave for Mass, my mother and I stepped into one of those perfect April days. The sun was as filling as a kiss, and the air held the promise of freshly mowed grass. My mother smiled and took my hand and headed up the street, away from Saint

  Christopher's. "On a day like this," she said, "God

  didn't mean for us to rot away indoors."

  It was the first time that I realized my mother had a second life, one that had nothing at all to do with my father. What I had always assumed was spirituality was really just the side effect of the energy that hovered around her like a magnetic field. I discovered that when my mother wasn't bending to someone else's whims, she could be a completely different person.

  We walked for blocks and blocks, coming closer to the lake, I knew, by the way the wind hung in the air. It became unseasonably warm as we walked, reaching into the high seventies, maybe even eighty. She let go of my hand as we came to the white walls of the Lincoln Park Zoo, which prided itself on its natural habitats. Instead of keeping the animals locked in, they cleverly kept the people out. There were few fences or concrete barriers. What kept the giraffes penned was a wide-holed grate that their legs would have slipped through; what kept the zebras in were gulleys too wide to leap. My mother smiled at me. "You'll love it here," she said, making me wonder if

  she came often, and if so, whom she brought instead of me.

  We were drawn to the polar bear exhibit simply because of the water. The free-form rocks and ledges were painted the cool blue of the Arctic, and the bears stretched in the sun, too warm in their winter fur.

  They slapped their paws at the water, which, my mother said, was just thirty-three degrees. There were two females and a cub. I wondered what the relationship was.

  My mother waited until the cub couldn't take the heat anymore, and then she pulled me down a few shadowed steps to the underwater viewing lounge, where you could see into the underwater tank through a window of thick plexiglass. The cub swam right toward us, sticking its nose against the plastic. "Look, Paige!" my mother said. "It's

  kissing you!" She held me up to the window so that I could get a closer look at the sad brown eyes and the slippery whiskers. "Don't you wish you could be in there?" my mother said, putting me down and dabbing at my forehead with the hem of her skirt. When I did not answer her, she began to walk back up into the heat, still talking quietly to herself. I followed her; what else could I do? "There are many places," I heard her whisper, "I'd like to be."

  Then she got an inspiration. She found the nearest totem pole directional sign and dragged me toward the elephants. African and Indian, they were two different breeds but similar enough to live in the same zoo space. They had wide bald foreheads and paper-thin ears, and their skin was folded and soft and spread with wrinkles, like the saggy, mapped neck of the old black woman who came to clean Saint

  Christopher's. The elephants shook their heads and swatted at gnats with their trunks. They followed each other from one end of their habitat to the other, stopping at trees and examining them as if they'd never seen them before. I looked at them and wondered what it would be like to have one eye on each side of my body. I didn't know if I'd like not being able to see things head-on.

  A moat separated us from the elephants. My mother sat down on the hot concrete and pulled off her high heels. She was not wearing

  stockings. She hiked up her dress and waded into the knee-high water.

  "It's lovely," she said, sighing. "But don't you come

  in, Paige. Really, I shouldn't be doing this. Really, I could get in trouble." She splashed me with the water, little bits of grass and dead flies sticking to the white lace collar of my dress. She sashayed and stomped and once almost lost her footing on the smooth bottom. She sang tunes from Broadway shows, but she made up her own lyrics, silly things about firm pachyderms and the wonder of Dumbo.

  When the zoo guard came up slowly, unsure of how to confront a grown woman in the elephant moat, my mother laughed and waved him away. She stepped out of the water with the grace of an angel and sat down on the concrete again. She pulled on her pumps, and when she stood, there was a dark oval on the ground where her damp bottom had been.

  She told me with the serious demeanor she'd used to tell me the Golden Rule that sometimes one had to take chances.

  Several times that day I found myself looking at my mother with a strange tangle of feelings. I had no doubt that when my father called, she would tell him we'd been at Saint Christopher's and that it had been just as it always was. I loved being part of a conspiracy. At one point I even wondered if the girlfriend I'd been seeing night after night in my dreams was really just my own mother. I thought of how convenient and wonderful that might be.

  We sat on a low bench beside a lady who was selling a cloud of banana balloons. My mother had been reading my thoughts. "Today,"

  she said, "today let's say I'm not your mother. Today I'll just be May. Just your friend May." And of course I didn't argue,

  because this was what I had been hoping anyway, and besides, she wasn't acting like my mother, at least not the one I knew. We told the man cleaning out the ape cage our white lie, and although he did not look up from his work, one large, ruddy gorilla came forward and stared at us, a very human exhaustion in her eyes, which seemed to say, Yes, I believe you.

  The last place we visited in the Lincoln Park Zoo was the penguin and seabird house. It was dark and smelled of herring and was fully enclosed. It sat partially under the ground to maintain its cool temperature. The viewing area was a twisty hallway with windows exposing penguins behind thick glass. They were striking in

  their formal wear, and they tap-danced like society men on floes of white ice. "Your father," May said, "looked no

  different than that at our wedding." She leaned in close to the glass. "In fact, I'd be hard-pressed to pick one groom from the next. They're all the same, you know." And I said I did, even

  though I had no idea what she was talking about.

  I left her staring at a penguin that had slipped into the water

  belly-up to do rolling, slow-motion calisthenics. I disappeared around a bend, pulled toward the other half of the house, where the puffins were. I didn't know what a puffin was, but I liked the way the word sounded: soft and squashed and a little bit bruised, the way your lips looked after you'd eaten wild blackberries. It was a long, narrow walkway, and my eyes had not adjusted to the lack of

  light. I took very tiny steps, because I did not know where I was going, and I held my hands in front of me like a blind man. I walked for what felt like hours, but I could not find those puffins, or the sliver of silver daylight near the door, or even the places where I had already been. My heart swelled up into my throat. I knew the way you know these things that I was going to scream or to cry or to sink to my knees and become invisible forever. For some reason I was not surprised when, in total darkness, my fingers found the comforting shape of May, who

  turned back into my mother, and she wrapped her arms around me. I never understood how she wound up in front of me, since I'd left her with the penguins and I hadn't seen her pass. My mother's hair fell like a dark curtain over my eyes and tickled my nose. Her breath echoed against my cheek. Black shadows wrapped around us like an artificial night, but my mother's voice seemed solid, like something I could grab for support. "I thought I'd never find you," my mother said, words I held on to and breathed like a litany for the rest of my life.

  chapter 6

  Nicholas

  Nicholas was having a he
ll of a week. One of his patients had died on the table during a gallbladder removal. He'd had to tell a thirty-six-year-old woman that the tumor in her breast was malignant. Today his surgical rotation had changed; he was back in cardiothoracic, which meant a whole new list of patients and treatments. He'd been at the hospital since five in the morning and had missed lunch because of afternoon conferences; he still hadn't written up notes on his rounds; and if all that wasn't enough of a bitch, he was the resident on call and would be for thirty-six hours.

  He'd been summoned to the emergency room with one of his interns--a third-year Harvard student named Gary who was green around the gills and reminded Nicholas nothing of himself. Gary had cleaned and quickly prepped the patient, a forty-year-old woman with superficial head and face wounds that were bleeding profusely. She

  had been assaulted, most likely by her husband. Nicholas let Gary continue, supervising his actions, his touches. As Gary sewed up the lacerations on her face, the patient began to scream. "Fuck you," she yelled. "Don't you touch my face." Gary's hands began to shake, and finally Nicholas swore under his breath and told Gary to get the hell out. He finished the job himself, as the woman cursed him out from beneath the sterile drapes. "Goddamned fucking pig asshole," she shouted. "Get the fuck away from me."

  Nicholas found Gary sitting on a stained cube sofa in one of Mass General's emergency room lounges. He'd drawn his knees up and was doubled over like a fetus. When he saw Nicholas coming toward him, he jumped to his feet, and Nicholas sighed. Gary was terrified of Nicholas; of doing anything wrong; of, really, being the surgeon he hoped to be. "I'm sorry," he murmured. "I shouldn't have let her get to me."

  "No," Nicholas said evenly, "you shouldn't have." He thought of telling Gary everything that had gone wrong for himself today. See, he'd say, all that, and I'm still standing up, doing my job. Sometimes you just have to keep pushing, he'd say. But in the end he did not say anything to his intern. Gary would figure it out eventually, and Nicholas didn't really want to recount his own failures to a subordinate. He turned away from Gary, a dismissal, feeling every bit the arrogant son of a bitch that he was reputed to be.

  For years now, Nicholas had not gauged time by its usual measures. Months and days meant little; hours were things you logged onto a patient's fact sheet. He saw his life passing in blocks, in places where he spent his days and in medical specialties where he filled his mind with details. At first, at Harvard, he'd counted off the semesters by their courses: histology, neurophysiology, anatomy, pathology. His last two years of rotations had run together, experiences blending at the edges. Sometimes he'd be remembering an orthopedic patient at the Brigham, but he'd picture the decor of the orthopedic floor at Massachusetts General. He'd started his rotations with internal medicine; then came a month of psychiatry, eight weeks of general surgery, a month of radiology, twelve weeks of obstetrics/gynecology and pediatrics, and so on. He had forgotten about seasons for a while, shuttling from discipline to discipline and hospital to hospital like a foster child.

  He'd decided on cardiac surgery--a long haul. The match had placed him at his first-choice hospital, Mass General. It was a large place, impersonal and disorganized and unfriendly. In cardiothoracic surgery, the attendings were a brilliant group of men and women. They were opinionated and impulsive; they wore pristine white lab coats over their cool, efficient demeanors. Nicholas loved it. Even during his postgraduate year one, he'd observe the easy motions of general surgery, waiting to be rotated back to the cardiac unit, where he'd marvel at Alistair Fogerty performing open-heart operations. Nicholas would stand for six hours at a time, listening to the thin ring of metal instruments on trays and the rustle of his own breath against his blue mask, watching life being put on hold and then recalled.

  "Nicholas." At the sound of his name, he turned to see Kim Westin, a pretty woman who'd been in his graduating class and was now in her third year of residency in internal medicine. "How's it going?" She came closer and squeezed his arm, propelling him down the hall in the direction he'd been walking.

  "Hey," Nicholas said. "You don't have anything to eat, do you?"

  Kim shook her head. "No, and I've got to run up to five, but I wanted to see you. Serena's back."

  Serena was a patient they'd shared during their final year of rotations at Harvard. She was thirty-nine and she was black and she had AIDS--which, four years earlier, had still been rare. She'd come and gone in the hospital over the years, but Kim, in internal medicine, had more contact with her than Nicholas. Nicholas did not ask Kim what Serena's status was. "I'll go by," he said. "What's the room?"

  After Kim had disappeared, Nicholas went upstairs to round his new cardiac patients. That was the hardest part about being a resident in general surgery--the constant changes from department to department. Nicholas had swung through urology, neurosurgery, emergency room, anesthesia. He'd done a stint in transplants, and one in orthopedics, and one in plastic surgery and burns. Still, coming back to cardiac was better than the others; cardiac surgery felt like home. And indeed Nicholas had been rotated through cardiothoracic more than was normal for a third-year, because he had made it clear to Alistair Fogerty that one day he was going to have his job.

  Fogerty was exactly what Nicholas had pictured a cardiac surgeon to be like: tall, fit, in his late fifties, with piercing blue eyes and a handshake that could cripple. He was a hospital "untouchable," his reputation having evolved into a surgical gold standard. There had once been a scandal about him--something involving a candy striper--but the rumors were squelched and there had been no divorce and that was that.

  Fogerty had been Nicholas's attending physician during his internship, and one day last year Nicholas had gone to him in his office and told him his plans. "Listen," he'd said, even though his throat had been dry and his palms had been quivering. "I want to cut through the bullshit, Alistair. You know and I know I'm the best surgical resident you've got here, and I want to specialize in cardiothoracic. I know what I can do for you and for the hospital. I want to know what you can do for me."

  For a long moment, Alistair Fogerty had sat on the edge of his mahogany desk, riffling through a patient's file. When he finally lifted his head, his eyes were dark and angry, but in no way surprised. "You, Doctor Prescott," he said, "have got bigger balls than even me."

  Alistair Fogerty had got to be director of cardiac surgery by sticking his neck out, taking chances, and courting Fate so that it seemed to stay on his side. When he'd begun doing transplants, the newspapers dubbed him "The Miracle Maker." He was calculating, stubborn, and usually right. He liked Nicholas Prescott a hell of a lot.

  And so even when Nicholas was rounding his regular patients in general surgery, and working under other attendings in other disciplines, he still found time to meet with Fogerty. When he had the chance, he rounded Fogerty's patients, did the quick daily pre-and postoperative exams, moved patients in and out of surgical ICU--in short, acted like a cardiothoracic fellow, a seventh-year resident. And in return, Fogerty had him in cardiac surgery more often than not and was grooming him to be the best there was--after Fogerty himself.

  Nicholas moved quietly into the recovery room, where Fogerty's latest patient was resting. He read the vitals: here was a sixty-two-year-old man who had had aortic stenosis--the valve leading from the end of his ventricle to the aorta had been scarred down. Nicholas could have easily diagnosed this case from the symptoms: congestive heart failure, syncope, angina. He surveyed the clean white gauze over the patient's chest, the gelatinous orange antiseptic that still coated the skin. Fogerty's work, as always, would be perfect: the native valve removed and a pig valve sewn into its place. Nicholas checked the patient's pulse, tugged the sheet up, and sat down beside him for a moment.

  It was cold in recovery. Nicholas crossed his arms and rubbed his hands up and down, wondering how the patient, naked, could be faring. But there, the pink circles at his fingertips and his toes proved that the heart, marvelous muscle, was st
ill working.

  It was merely fortuitous that he saw it then, the heart breaking down. He had been watching the steady rise and fall, the classic heartbeat pattern of the monitor, when everything went wrong. The steady blip-blip-blip of the machines accelerated, and Nicholas checked to see a sinusoidal pattern, the heart racing at nearly one hundred beats per minute. For a quick second, Nicholas held his hands over the patient like a faith healer. It was an arrhythmia--ventricular fibrillation. Nicholas had seen cases of it before, when a heart was exposed in the chest: beating like a bag of worms, swollen and writhing, not pumping blood at all. "Code!" he yelled over his shoulder, seeing the nurses at the nearby station spring into motion. The patient's heart had been traumatized, operated on, but Nicholas had little choice. In a matter of minutes, the man would be dead. Where was Fogerty?

  Almost immediately, recovery was filled with at least twenty people--anesthesiologists, surgeons, interns, and nurses. Nicholas applied wet gel pads to the patient's raw chest, then put the defibrillator paddles to the skin. The body jumped with the shock, but the heart did not correct itself. Nicholas nodded to a nurse, who adjusted the charge. He ran his hand across his forehead, pushing back his hair. His mind was filled with the god-awful sound of the monitor, irregular and screeching, and the rustle of the nurses' starched dresses as they moved around him. He was not certain, but he thought he could smell death.

  Nicholas cleared the defibrillators and replaced the paddles on the patient's chest. This time the shock was so violent that Nicholas took a step away, artificial life kicking back like a rifle's recoil. You will live, he willed silently. He raised his eyes to the monitor screen, seeing the thin green line dip and peak and dip and peak, the craggy crests of a normal heartbeat. Alistair Fogerty entered the recovery room as Nicholas pushed past him, deafened by the muted touches and calls of congratulation, suddenly a hero.