Tess Gerritsen - Harvest

At last Abby straightened and said: "Everything seems to be fine, But there must be a reason for the fever. We'll be getting a chest x-ray and collecting three different blood samples for cultures." She smiled apologetically. "I'm afraid you're not going to get much sleep tonight."

Nina shook her head. "I don't sleep much, anyway. All the dreams.

So many dreams…"

"Bad dreams?"

Nina took in a breath, slowly let it out. "About the boy."

"Which boy, Mrs Voss?"

"This boy." Softly she touched her hand to her chest. "They told me it was a boy's. I don't even know his name. Or how he died. All I know is, this was a boy's." She looked at Abby. "It was. Wasn't it?" Abby nodded. "That's what I heard in the operating room."

"You were there?"

"I assisted Dr. Hodell."

A small smile formed on Nina's lips. "Strange. That you should be there, after…" Her voice faded.

Neither one of them spoke for a moment, Abby silenced by guilt, Nina Voss by… what? The irony of this meeting? Abby dimmed the lights. Once again the cubicle took on its sepulchral gloom.

"MrsVoss," said Abby. "What happened a few days ago. The other heart, the first heart…" She looked away, unable to meet the other woman's gaze. "There was a boy. Seventeen. Boys that age, they want cars or girlfriends. But this boy, all he wanted was to go home. Nothing else, just to go home." She sighed. "In the end, I couldn't let it happen.! didn't know you, MrsVoss. You weren't the one lying in that bed. He was. And I had to make a choice." She blinked, felt tears wet her lashes. "He lived?"

"Yes. He lived."

Nina nodded. Again she touched her own chest. She seemed to be conferring with her heart. Listening, communicating. She said, "This boy. This boy's alive, too. I'm so aware of his heart. Every beat. Some people believe that the heart is where the soul lives. Maybe that's what his parents believe. I think about them, too. And how hard it must be. I never had a son. I never had a child." She closed her hand into a fist, pressed it against the bandages. "Don't you think it would be a comfort, to know that some part of him is still alive? If it was my son, I'd want to know. I'd want to know." She was crying now, the tears a sparkling trickle down her temple.

Abby reached for the woman's hand and was startled by the force of Nina's grasp, the skin feverish, the fingers tight with need. Nina was looking up at her, a gaze that seemed to shine with its own strange fire. If I had known you then, thought Abby, if I had watched you dying in one bed, and Josh O" Day in another, which one of you would I have chosen?

I don't know.

Above the bed, a line skipped across the green glow of the oscilloscope. The heart of an unknown boy, beating a hundred times a minute, pumping fevered blood through a stranger's veins.

Abby, holding Nina's hand, could feel the throb of a pulse. A slow, steady pulse.

Not Nina's, but her own.

It took twenty minutes for the x-ray tech to arrive and shoot the portable chest film, and another fifteen minutes before Abby had the developed x-ray in hand. She clipped it to the SICU viewing box and examined it for signs of pneumonia. She saw none.

It was 3 a.m. She called Aaron Levi's house.

Aaron's wife answered, her voice husky with sleep. "Hello?"

"Elaine, this is Abby DiMatteo. I'm sorry to bother you at this hour. May I speak with Aaron?"

"He left for the hospital."

"How long ago?"

"Uh… it was just after the second phone call. Isn't he there?"

"I haven't seen him," said Abby.

There was a silence on the other end of the line. "He left home an hour ago," said Elaine. "He should be there."

"I'll page his beeper. Don't worry about it, Elaine." Abby hung up, then dialled Aaron's beeper and waited for the phone to ring.

By three-fifteen, he still hadn't answered.

"Dr. D.?" said Sheila, NinaVoss's nurse. "The last blood culture's been drawn. Is there anything else you want to order?"

What have I missed? thought Abby. She leaned forward against the desk and massaged her temples, struggling to stay awake. Think. A post-op fever. Where was the infection coming from? What had she overlooked?

"What about the organ?" said Sheila.

Abby looked up. "The heart?"

"It was just something that occurred to me. But I guess it's not very likely…"

"What are you thinking, Sheila?"

The nurse hesitated. I've never seen it happen here. But before I came to Bayside, I used to work with a renal transplant service in Mayo. I remember we had this patient. A kidney recipient with post-op fevers. We didn't figure out what his infection was until after he died. It turned out to be fungal. Later they tracked down the donor record and found out the donor's blood cultures were positive, but the results didn't come back until a week after the kidney was harvested. By then it was too late for the recipient. Our patient."

Abby thought it over for a moment. She looked at the bank of monitors, at the heart tracing of Bed 15 dancing across the screen. "Where's the donor information kept?" asked Abby.

"It would be in the Transplant Coordinator's office downstairs. The Nursing Supervisor has the key."

"Could you ask her to get the file for me?"

Abby reopened NinaVoss's chart. She turned to the New England Organ Bank donor form — the sheet that had accompanied the heart from Vermont. Recorded there was the ABO blood type, HIV status, syphilis antibody titres, and a long list of other lab screens for various viral infections. The donor was not identified.

Fifteen minutes later, the phone rang. It was the nursing supervisor, calling for Abby.

"I can't find the donor file," she said.

"Isn't it under NinaVoss's name?"

"They're filed under the recipient's medical record number.

There's nothing here under Mrs Voss's number."

"Could it be misfiled?"

"I've looked in all the kidney and liver transplant files too. And I double-checked that record number. Are you sure it isn't somewhere up in the SICU?"

"I'll ask them to look. Thanks." Abby hung up and sighed. Missing paperwork. It was the last thing she felt like dealing with at this time of the morning. She looked at the SICU records shelf, where files from current patients' previous hospitalizations were kept. If the missing file was buried somewhere in that, she could be searching for an hour.

Or she could call the donor hospital directly. They could pull the record, tell her the donor's medical history and lab tests.

Directory assistance gave her the number for Wilcox Memorial. She dialled the number and asked for the nursing supervisor.

A moment later a woman answered: "Gail DeLeon speaking."

"This is Dr. DiMatteo calling from Bayside Hospital in Boston," said Abby. "We have a heart transplant recipient here who's running a post-op fever. We know the donor heart came from your OR. I need a little more information on the donor's medical history. I wonder if you might know the patient's name."

"The organ harvest was done here?"

"Yes. Three days ago. The donor was a boy. An adolescent."

"Let me check the OR log. I'll call you back."

Ten minutes later, she did — not with an answer but with a question: "Are you sure you have the right hospital, doctor?"

Abby glanced down at Nina's chart. "It says right here. Donor hospital was Wilcox Memorial. Burlington, Vermont."

"Well that's us. But I don't see a harvest on the log."

"Can you check your OR schedule? The date would have been…" Abby looked at the form. "September 24th. The harvest would've been done sometime around midnight."

"Hold on."

Over the receiver, Abby heard the sound of turning pages and the nurse's intermittent throat clearing. The voice came back. "Hello?"

"I'm here," said Abby.