Tess Gerritsen - Harvest

"It isn't. There's only a certain amount of time before the organs start to go bad. Then they can't be used. And no one is helped by that, Joe."

He looked at her, across the body of his wife. "Did you bring the papers?"

"I have them."

He scarcely looked at the forms. He merely signed his name at the bottom and handed the papers back. An ICU nurse and Abby witnessed the signature. Copies of the form would go into Karen Terrio's record, to the New England Organ Bank, and Bayside's Transplant Coordinator files. Then the organs would be harvested.

Long after KarenTerrio was buried, bits and pieces of her would go on living. The heart that she'd once felt thudding in her chest when she'd played as a five-year-old, married as a twenty-year-old, and strained at childbirth as a twenty-one-year-old, would go on beating in the chest of a stranger. It was as close as one could come to immortality.

But it was scarcely much comfort to Joseph Terrio, who continued his silent vigil at the bedside of his wife.

Abby found Vivian Chao undressing in the OR locker room. Vivian had just emerged from four hours of emergency surgery, yet not a single blot of sweat stained the discarded scrub clothes lying on the bench beside her.

Abby said, "We have consent for the harvest."

"The papers are signed?" asked Vivian. "Yes."

"Good. I'll order the lymphocyte crossmatch." Vivian reached for a fresh scrub top. She was dressed only in her bra and underwear, and every rib seemed to stand out on her frail, flat chest. Honorary manhood, thought Abby, is a state of mind, not body. "How are her vitals?" asked Vivian.

"They're holding steady."

"Have to keep her blood pressure up. Kidneys perfused. It's not every day a nice pair of AB positive kidneys comes along." Vivian pulled on a pair of drawstring trousers and tucked in her shirt. Every movement she made was precise. Elegant.

"Will you be scrubbing in on the harvest?" asked Abby.

"If my patient gets the heart, I will. The harvest is the easy part. It's reattaching the plumbing that gets interesting." Vivian closed the locker door and snapped the padlock shut. "You have a minute?

I'll introduce you to Josh."

"Josh?"

"My patient on the teaching service. He's up in MICU."

They left the locker room and headed down the hall towards the elevator. Vivian made up for her short legs by her quick, almost fierce stride. "You can't judge the success of a heart transplant until you've seen the before and the after," said Vivian. "So I'm going to show you the before. Maybe it'll make things easier for you." 'what do you mean?"

"Your woman has a heart but no brain. My boy has a brain and practically no heart."The elevator door opened. Vivian stepped in. "Once you get past the tragedy, it all makes sense."

They rode the elevator in silence.

Of course it makes sense, thoughtAbby. It makes perfect sense. Vivian sees it clearly. But I can't seem to get past the image of two little girls standing by their mother's bed. Afraid to touch her… Vivian led the way to the Medical ICU. Joshua O" Day was asleep in Bed 4.

"He's sleeping a lot these days," whispered the nurse, a sweet faced blonde with Hannah Love, RN, on her nametag.

"Change in meds?" asked Vivian.

"I think it's depression." Hannah shook her head and sighed. "I've been his nurse for weeks. Ever since he was admitted. He's such a terrific kid, you know? Really nice. A little goofy. But lately, all he does is sleep. Or stare at his trophies." She nodded at the bedside stand, where a display of various awards and ribbons had been lovingly arranged. One ribbon went all the way back to the third grade — an honourable mention for a Cub Scout Pinewood Derby. Abby knew about pinewood derbies. Like Joshua O" Day, her brother had been a Cub Scout.

Abby moved to the bedside. The boy looked much younger than she had expected. Seventeen, according to the birthdate on Hannah Love's clipboard. He could have passed for fourteen. A thicket of plastic tubes surrounded his bed, IV's and arterial and Swan-Ganz lines. The last was used to monitor pressures in the right atrium and pulmonary artery. On the screen overhead, Abby could read the right atrial pressure. It was high. The boy's heart was too weak to pump effectively, and blood had backed up in his venous system. Even without the monitor, she could have reached that conclusion by a glance at his neck veins. They were bulging.

"You're looking at Redding High School's baseball star from two years ago," said Vivian. "I'm not into the game so I don't really know how to judge his batting average. But his dad seems pretty proud of it."

"Oh, his dad/s proud," said Hannah. "He was in here the other day with a ball and mitt. I had to kick him out when they started a game of catch." Hannah laughed. "The dad's as crazy as the kid!"

"How long has he been sick?" asked Abby.

"He hasn't been to school in a year," said Vivian. "The virus hit him about two years ago. CoxsackieVirus B. Within six months, he was in congestive heart failure. He's been in the ICU for a month now, just waiting for a heart." Vivian paused. And smiled. "Right, Josh?"

The boy's eyes were open. He seemed to be looking at them as though through layers of gauze. He blinked a few times, then smiled at Vivian. "Hey, Dr. Chao."

"I see some new ribbons on display," said Vivian.

"Oh. Those." Josh rolled his eyes. "I don't know where my Mom digs those up. She keeps everything, you know. She even has this plastic bag with all my baby teeth. I think it's pretty gross."

"Josh, I brought someone along to meet you. This is Dr. DiMatteo, one of our surgical residents."

"Hello, Josh," said Abby.

It seemed to take the boy a moment to fully refocus his gaze. He didn't say anything.

"Is it OK for Dr. DiMatteo to examine you?" asked Vivian. "Why?"

"When you get your new heart, you'll be like that crazy Road Runner on TV. We won't be able to tie you down long enough for an exam."

Josh smiled. "You're so full of it."

Abby moved to the bedside. Already, Josh had pulled up his gown and bared his chest. It was white and haitiess, not a teenager's chest but a boy's. She lay her hand over his heart and felt it fluttering like bird's wings against the cage of ribs. She lay her stethoscope against it and listened to the heartbeat, the whole time aware of the boy's gaze, wary and untrusting. She had seen such looks from children who have been too long in paediatric wards, children who've learned that every new pair of hands brings a new variety of pain. When she finally straightened and slipped her stethoscope back in her pocket, she saw the look of relief in the boy's face. "Is that all?" he said.

"That's all." Abby smoothed down his hospital gown. "So. Who's your favourite team, Josh?"

"Who else?"

"Ah. Red Sox."

"My dad taped all their games for me. We used to go to the park together, my dad and me. When I get home, I'm going to watch 'era all. All those tapes. Three straight days of baseball…" He took a deep breath of oxygen-infused air and looked up at the ceiling.

Softly he said, "I want to go home, Dr. Chao."

"I know," said Vivian.

"I want to see my room again. I miss my room." He swallowed, but he couldn't hold back the sob. "I want to see my room. That's all. I just want to see my room."

At once Hannah moved to his side. She gathered the boy into her arms and held him, rocked him. He was fighting not to cry, his fists clenched, his face buried in her hair. "It's OK," murmured Hannah. "Baby, you just go ahead and cry. I'm right here with you. I'm going to stay right here, Josh. As long as you need me. It's OK." Hannah's gaze met Abby's over the boy's shoulder. The tears on the nurse's face weren't Josh's, but her own.

In silence, Abby and Vivian left the room.