Second Nature: A Love Story

  When I called Mrs. Viola, we made some small talk about my grandparents and my aunt. Then I asked her, “Is there a girl at Sundial who’s going to be a donor for a face transplant?”

  Mrs. Viola didn’t even hesitate—no worries about patient privacy there! She said, “Yes, Sicily. There’s this beautiful little Irish girl and her sweet mother.” And then Mrs. Viola stopped and said, “Sicily? Get out of here! Are you kidding me?”

  I didn’t have to confirm or deny. I am sure that by the end of her shift, everyone on the West Side who had a phone or could lip-read knew. So I had to hurry up and connect with Beth, which I did. Two weeks later, on a Friday afternoon—Mrs. Viola’s day off, but she managed to switch with someone else to be there—we went to see Emma and Mrs. Cassidy at Sundial.

  When we walked in, Emma’s room looked like the kind of gift shop where grandmothers buy presents. There were things you would never use in real life: elaborate acrylic flower arrangements that looked real, and wooden birdhouses that were actually jewelry boxes with drawers that you knew would never close. Everything was pink or quilted or both. Mrs. Cassidy showed me one of the quilts, made by a close friend of hers, a longtime customer, and each square was a photo of Emma at a different age. All around the walls were framed drawings, some of them very accomplished, from Emma’s sketchbook. There was a chair for Beth and one for me, and we sat there as though we were at a wake, just, I suppose, out of respect.

  Mrs. Cassidy offered us coffee, which I refused politely and Beth said would be wonderful. Mrs. Viola was there with a mug of coffee in a flash, so we knew she’d been standing outside the door. I didn’t mind, because by then Mrs. Viola seemed to have some sort of trunk line to the universe. She acted as though she believed she was living what might have become of Victoria, if she had survived, through me. And wasn’t that the least Mrs. Viola deserved? She’d given her whole life to people, most of whom would never get better.

  “How often do you come to see Emma?” I asked, because it was obvious that Beth wasn’t going to say anything. It looked to me as though Beth was taking her camera entirely apart and putting it back together again.

  “Every day after work, and all day Friday and Sunday,” Mrs. Cassidy said. “I’m friends with some of the people who work here, like Gail. Sometimes we play cards or do a crossword. I’m pretty good at crosswords. English was my best subject in school, that and science.”

  At first, Mrs. Cassidy said, all of Emma’s friends who had been with her that night at the party came, two or three times a week. (“It wasn’t drugs,” said Mrs. Cassidy. “She had one beer. No one knows what caused it, and Emma’s heart is apparently still very healthy, although she can breathe only with the respirator.”) Emma’s hospital room was sort of a gathering place. Back then—nearly eighteen months ago—all the friends expected her to wake up, and they competed to be the one who would get her to react. They sang to her and talked about boys Emma had a crush on and called Emma’s cell phone. But then Emma’s best friend came. She fainted right there in the room, because Emma looked exactly like Emma. Her hair was in this little bob, and the roots hadn’t started to grow out. After the faint, which gave the best friend a lump on her head, the hospital wouldn’t let minors come to see Emma without their parents.

  “Do her friends still come? Here? Do they know that Emma isn’t going to be kept alive?” I asked Mrs. Cassidy. Beth looked at me like she wanted to crush my esophagus.

  “No,” Mrs. Cassidy said. “They want to remember her as she was, and they definitely don’t want to think about her being a transplant donor. Which is something I understand. It’s a highly emotional situation and not an issue that every person understands so well.”

  For a year, Mrs. Cassidy still acted as though Emma were alive and could see and feel and hear everything around her, which Mrs. Cassidy believed. She’d read all the articles about people who seemed to be in persistent vegetative states but who suddenly woke up and asked for cornflakes; slowly, though, the reality set in. With the kind of equipment that existed, that just didn’t happen anymore. But there was a million-in-one chance it could.

  Mrs. Cassidy said, “The person who came most often is Eric, who’s my business partner. I would ask him, ‘Do you think she sees me?’ And at first Eric would say, ‘Maybe, I think so, Julia.’ ”

  But in her hours alone, at night, Mrs. Cassidy had to admit that even if Emma had some level of awareness, like that of an exceptionally mentally challenged person, her daughter could not bear to live on, to signal her needs with a blink, for all the years left on earth to her, maybe after Mrs. Cassidy died.

  Because we were coming, Mrs. Cassidy had washed and trimmed and styled Emma’s hair. As she always did, she tried to uncurl the crablike clench of Emma’s little fingers. They could be pried into a semblance of the attitude of a normal hand. But as soon as her mother let them go, they stubbornly curled again. Emma’s brain wanted her fingers—and her small pale feet as well—to point in and down. Cortical contractions would be agony if the person felt them. Mrs. Cassidy had to believe Emma couldn’t. But what if she did? For months now, Mrs. Cassidy’s only relative, Ryan, a brother who lived in Florida, had said, “Julia, let her go.” But her brother had no child, just a stepson he referred to as “The Couch,” because the guy was twenty-three and had never had a job. When The Couch was a child, Mrs. Cassidy’s brother didn’t even know him.

  “It’s true that Emma was the vainest girl,” said Mrs. Cassidy. “She had a will of iron, and if she got five pounds over the magic number on the scale, she could go a week and eat nothing but apples. Apples and water. And vitamin C. And D. Not long ago, I dreamed she came into my bed, like she used to when she was little, like she used to even when she was big when there was some huge windstorm or something—Emma was terrified of windstorms, because of The Wizard of Oz—and she said to me, Mom, let me go to my daddy. This was just recent, did I say that?”

  Jared Cassidy had died very young. He’d fallen off the bleachers, drunk, after a softball game, and broken his neck, the year he and Julia were married. The fall couldn’t have been more than six feet. But Mrs. Cassidy was only twenty then, and she still had Emma to live for. Emma grew up lovely and lively and enraptured by words and music, telling her mother that one day, she might write songs.

  Then came the accident when Emma was sixteen, at a party. No one knew why. Emma had drunk one beer and felt dizzy, so she lay down on a friend’s bed. By the time someone checked on her, she looked like she was napping but her lips were already dark; no one could tell how much she was breathing. “She had a strong young heart and they brought her back right away. But she never woke up,” said Mrs. Cassidy. “We prayed, and all the best brain people, the top ones in the Midwest, came to see her. She opened her eyes, but after a while I couldn’t make believe she saw me.”

  For the longest time, Mrs. Cassidy said, having Emma at all was enough. At least she could care for her the way she had when Emma was a baby, washing between her toes and under the folds of her hard little arms, still hard from all those push-ups Emma had done since she was only, what? Twelve? She could read aloud to Emma and sing to her. She could climb into the bed beside Emma and fall asleep. Mrs. Cassidy could cut and style Emma’s hair and whisper in her ear that she loved her little girl more than any mommy ever loved a little girl. And it was true that, even this way, she still did love Emma. She loved everything about Emma.

  Beth got up at that point and said she had to wash her hands before she handled her film, but I knew that wasn’t true. Beth had had a lot of grief in her life, but she hadn’t seen as many heartbreaking and frankly gruesome things as I had, in my work and in my life, and Beth, unlike me, was a mother. I was pretty composed as Mrs. Cassidy went on and on; she needed to tell me these things, I supposed—about the fact that she more or less gave up eating and styling her own hair after Emma “was taken,” but Eric had pointed out to her that it could be difficult for a client to have confidence in a stylist who did
not seem to bother with her own appearance. “Eric said, ‘Julia, you are still a young woman and a pretty woman, and you have to do something. Join a bowling league. Go to a gym.’ But I considered it my duty to be at Emma’s bedside.”

  When the muscle contractures had begun, it was the mark of no return. “The neurologist told me that even faith and hope have realistic limits.” He said that when Mrs. Cassidy was ready—and that might not be for years—they would discuss options. She knew he meant organ donation, but when they did have that discussion, the neurologist also raised the subject of a face transplant. It was this that made Mrs. Cassidy see the way clear to stop the life support. She understood how it would be if Emma’s strong heart and clear eyes and lungs never polluted by smoke would help someone else live and see and breathe. But Emma was beautiful. She was more beautiful than a real doll. “There were pictures of her as a child that my brother, Ryan, took, before he moved. He colored them with paints so they looked like oil paintings. There was one of Emma with her hair marcelled. And anyone who saw that picture said she was just a live doll, she was.”

  Ryan had come only once to see Emma, early on. It frightened him when Emma’s eyes flew open.

  “At first I could not sign the consent papers, and the doctor said there was no pressure. Emma was healthy, and this was not the kind of decision a person could make with her mind alone. Then I met a woman who had pulled the plug, right here. Her son was only ten. She said that the family felt that they were keeping a body without a soul. And that is when I made the commitment.”

  After a while, when there was nothing more to do, Beth set up her equipment and closed the blinds and then opened them again partway, without talking to anyone. I had known her for only two weeks, but I could see that she was furious. She set the little camera up on top and began to take pictures—dozens of pictures, a hundred pictures. When she was finished taking some, she would pass the camera over to Mrs. Cassidy without a word and show her the ones that Beth thought were best. I looked at them too.

  “Now, Sicily, I would like a photo of you with Emma,” Beth said, and her eyes were gleaming. Beth can be a hard one when she wants.

  “I don’t think so,” I said. “I did, but now I’m scared.”

  “Before and after,” Beth said.

  “No one has taken a picture of my face in twelve years,” I told her.

  “Before and after,” Beth said. “This was your idea.”

  So she took a picture in which you can see all of Emma’s face but only a quarter of mine. The rest is covered by my hair. And the way it’s shadowed haunts me. My hair is so dark and Emma’s is so light that I later said to Beth that I looked like the Angel of Death. She said not to be dramatic.

  When Beth said she was finished, Mrs. Cassidy took a deep breath and asked, “Beth, if it’s no bother, would you take one of me with Emma?”

  Beth nodded.

  Mrs. Cassidy leaned down next to Emma, who started to wake up and move and thrash and make hissing noises through the respirator. Coma patients have waking and sleeping cycles. Beth was crying so hard by then that snot was running down over the corners of her lips and I kept giving her tissues. She finally got a picture in which it almost looked as though Emma was gazing up at her mother. Then Beth picked up her tripod, didn’t even fold it, and, when she walked past me, said, “Screw this.” I had to run to catch her in the parking lot.

  Between that day at Sundial and this last morning had fallen away seventy-odd calendar days, each one longer as the hours flexed and stretched toward spring—days and nights of work on projects I needed to finish in order give myself fully to nothing but this, long days of interviews and of medical assays in all their variety, pages of spiked graphs describing my heart and respirations, tubes of my blood and Emma’s in ranks like graduates in green and violet caps, images of Emma’s gentle cheekbones and my vaulted cheekbones, eerie sculptures of Emma’s sweetly pointed chin and my own, small but square and declarative, photos taken by Beth in which the shadows spoke as frankly as the light, stark photos taken by the hospital team in which every shadow was a potential pitfall. There had been six meetings with Mrs. Cassidy since the conference at the hospital, including a meal with my aunts and my grandparents, several afternoons that Beth and I spent at Sundial, and a dinner that Mrs. Cassidy had alone with me, during which she visibly flinched every time a new person came into the restaurant and was stopped in midstride by the sight of my face.

  Where was Mrs. Cassidy right now? I knew that she had taken ten days off work, although she would barely be able to pay for Emma’s funeral, to be held on Wednesday. This was Monday. “I just know that on the day, and afterwards, I wouldn’t be worth anything with a scissors in my hand,” she told me the last time we spoke. It had been just two days before, a conference call with the social worker, Kelli, who wanted everyone on the same page, even though these were pages that would have been separated by a whole blank book in a more orthodox scenario. Before she hung up, Mrs. Cassidy told me that her grandmother used to sing an old song to her, a lullaby that went “Sounds of the rude world, heard in the day, lulled by the moonlight have all passed away.” She told me she was singing this to Emma for the last time.

  “Do you do that every night?” I said.

  “Yes,” said Mrs. Cassidy.

  “What’s the name of it?”

  “ ‘Beautiful Dreamer.’ The song is called ‘Beautiful Dreamer,’ ” Mrs. Cassidy said. Even by pretending I had to cough, I couldn’t cover up the sound of Kelli sniffling.

  That first photo Beth had taken of Emma and me would not disappear from the easel in my mind. I lay counting the holes in the acoustical tile—as I had three dozen times over the course of a dozen years in a dozen hospital rooms just like this one—trying to calm down. Even I, not at all given to magical thinking, remembered that picture and was tempted to tally as prophecy each improbable element that had fallen into place. Looking through a series of linking crystals, each crystal the defeat of another obstacle to this end, I wanted to see the shimmer of some sort of fate on this enterprise for a magnificent outcome.

  What if it were only adequate, only enough to draw off some of the stares and let me daintily siphon up my spaghetti? Would that mean I’d squandered Emma’s gift? At last, I got out of bed and began pacing as far as the monitors would allow, two steps in one direction, then two back. A nurse came in, sat me back down, and said, “What’s all this?” I couldn’t tell her. I couldn’t say anything coherent at all. She went off and brought back one of the anesthesiologists, who asked me if I was more than normally frightened.

  “I’m not frightened at all,” I said. “I’m overwhelmed.”

  The doctor asked me if I wanted ten milligrams of IV Valium. I said, “Ten milligrams? Are you kidding me?”

  “Atta girl,” said the anesthesiologist. She gave me twenty and I fell asleep.

  When I woke, Hollis Grigsby was sitting on the foot of my bed, with her head in a paper cap and that pink quilt with photos of Emma on it across her knees. She looked more contemplative than I’d seen her through all the preparations.

  “So, Sicily,” she said. “Are you ready?”

  “Is that for me?” I asked.

  “Mrs. Cassidy wanted you to have it. She brought … other things for us to place around Emma.”

  “How is she?”

  “She is remarkable,” said Hollis. “Of course, she has her faith, and her faith sustains her.”

  “Are you religious?” I asked.

  “I am,” said Hollis. “I’m conventionally religious. I’m a Catholic woman, as you are. But I could not be a doctor if I believed that what happened to you and Emma Cassidy was the will of God.”

  “My aunt Christina would.”

  “Have I met her?”

  I shook my head. “She’ll come today to be with my aunt Marie and my grandparents and Kit. But she’s a nun and hates to interrupt her nunning.”

  “Sicily, you make me smile,” Hollis said.
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  “How do you think of God?”

  “As a good parent, I should guess. Who cannot save us from all harm but can comfort us.”

  “Are you doing the surgery yourself?”

  “No. I did the removal with Emma, primarily for her mother’s sake.”

  “What am I, chopped liver?” It was an unfortunate choice of words.

  “No, but you have a lifetime of healthy tomorrows ahead of you, and at this moment Julia Cassidy has only her yesterdays.” Hollis got up and folded the quilt, laying it gently across my feet. “You have changed the mojo here, miss.”

  “How?”

  “Well, ordinarily we would be exchanging anonymous letters years from now, not in advance of the surgery.” She lifted a corner of the quilt and gave me a long, pure gaze. “You are also the youngest person ever to have a face transplant.”

  “I am?”

  “Yes, by several years at least.”

  “Do you mind that I call you by your first name, Hollis?”

  “No,” she said. She reached up tall and stretched one side of her spine, then the other. “My grandfather called me Vanny, because I was supposed to be named Evangeline, after my mother. Once she was in delivery, my mother quickly decided that she would never go through labor again—although she did, four more times. She named me Hollis Evangeline, after both her parents. My grandfather didn’t approve. He didn’t approve of very much about me. Said a girl oughtn’t have a boy’s name. Said a woman wasn’t cut out to be hoisting up dead men’s arms and sticking them back on …” She began to laugh. “Everyone else in the family was so proud! Little skinny girl grows up to be a doctor! But not Grandfather.”

  “You loved him, though.”

  “Why, of course! He taught me some of the most important skills of doctoring I have.”

  “Like what?”

  “Well, tying knots,” Hollis said. “He taught me to tie every knot. To fillet a bluegill expertly. To set a bird’s broken wing and calm it down at the same time. He never had a grandson, so I was the next best thing. Now, Sicily, we have talked enough. We are at the hour. I’m going to go ahead of you. I’ll see you and Mrs. Cappadora in there.”