Tess Gerritsen - Harvest

"I've checked the schedule for September 23rd, 24th, and 25th. There are a couple of appendectomies, a cholecystectomy, and two Caesareans. But there's no organ harvest anywhere."

"There has to be. We got the heart."

"We're not the ones who sent it."

Abby scanned the OR nurses' notes and saw the notation: O105: Dr. Leonard Mapes arrived from Wilcox Memorial. She said, "One of the surgeons who scrubbed on the harvest was Dr. Leonard Mapes. That's the same guy who delivered it."

"We don't have any Dr. Mapes on our staff."

"He's a thoracic surgeon-'

"Look, there's no Dr. Mapes here. In fact, I don't know of any Dr. Mapes practising anywhere in Burlington. I don't know where you're getting your info, doctor, but it's obviously wrong. Maybe you should check again."

"But-'

"Try another hospital."

Slowly Abby hung up.

For a long time she sat staring at the phone. She thought about Victor Voss and his money, about all the things that money could buy. She thought about the amazing confluence of events that had granted Nina Voss a new heart. A matched heart.

She reached, once again, for the telephone.

"You're overreacting," said Mark, flipping through NinaVoss's SICU

chart. "There has to be a reasonable explanation for all of this."

"I'd like to know what it is," said Abby.

"It was a good excision. The heart came packed right, delivered right. And there were donor papers."

"Which now seem to be missing."

"The transplant coordinator will be in at nine. We can ask her about the papers then. I'm sure they're around somewhere."

"Mark, there's one more thing. I called the donor hospital. There's no surgeon named Leonard Mapes practising there. In fact there's no such surgeon practising in Burlington." She paused. Softly she said, "Do we really know where that heart came from?"

Mark said nothing. He seemed too dazed, too tired to be thinking straight. It was four-fifteen. After Abby's phone call, he'd dragged himself out of bed and driven to Bayside. Post-op fevers required immediate attention, and although he trusted Abby's findings, he had wanted to see the patient for himself. Now Mark sat in the gloom of the SICU, struggling to make sense of the paperwork in Nina Voss's chart. A bank of heart monitors faced him on the countertop, and three bright green lines traced across the reflection in his glasses. In the semidarkness nurses moved like shadows and spoke in hushed voices.

Mark closed the chart. Sighing, he pulled off his glasses and rubbed his eyes. "This fever. What the hell is causing the fever? That's what really concerns me."

"Could it be an infection passed from the donor?"

"Unlikely. I've never seen it happen with a heart."

"But we don't know anything about the donor. Or his medical history. We don't even know which hospital that heart came from."

"Abby, you're going off the deep end here. I know Archer spoke on the phone to the harvesting surgeon. I also know there were papers. They came in this brown envelope."

"I remember seeing it."

"All right. Then we saw the same thing."

"Where's the envelope now?"

"Hey, I was the one operating, OK? I'm up to my elbows in blood. I can't keep track of some goddamn envelope."

"Why is there all this secrecy about the donor, anyway?We don't have records. We don't know his name."

"That's standard procedure. Donor records are confidential. They're always kept separate from the recipient's chart. Otherwise you'd have families contacting each other. The donor side would expect undying gratitude, the recipient side would either resent it or feel guilty. It leads to one giant emotional mess." He sank back in his chair. "We're wasting time on this issue. It'll all be resolved in a few hours. So let's concentrate on the fever."

"All right. But if there's any question about this, New England Organ Bank wants to discuss it with you."

"How did NEOB get involved?"

"I called them. They have this twenty-four-hour line. I told them you or Archer would get back to them."

"Archer can handle it. He'll be here any minute."

"He's coming in?"

"He's worried about the fever. And we can't seem to get hold of Aaron. Have you paged him again?"

"Three times. No answer. Elaine told me he was driving in."

"Well, I know he got here. I just saw his car down in the parking lot. Maybe he got busy on the medical floor." Mark flipped through Nina Voss's chart to the order sheets. "I'm going to move on this without him."

Abby glanced towards NinaVoss's cubicle.The patient's eyes were closed, her chest rising and falling with the gentle rhythm of sleep. "I'm starting antibiotics," said Mark. "Broad spectrum."

"What infection are you treating?"

"I don't know. It's just a temporary bridge until the cultures come back. As immunosuppressed as she is, we can't take a chance she's infected somewhere." In frustration, Mark rose from the chair and walked over to the cubicle window. He stood there a moment, staring in at NinaVoss. The sight of her seemed to calm him. Abby came to stand beside him. They were very close, almost touching each other, and yet separated by the gulf of this crisis. On the other side of the window, Nina Voss slept peacefully.

"It could be a drug reaction," said Abby. "She's on so many things. Any one of them could cause a fever."

"That's a possibility. But not likely on steroids and cyclosporine."

"I couldn't find any source of infection. Anywhere."

"She's immunosuppressed. We miss something, she's dead." He turned to pick up the chart. "I'm starting the bug juice."

At 6 a.m. the first dose of IV Azactam was dripping into Nina's vein. A STAT infectious disease consult was requested, and at seven-fifteen the consultant, Dr. Moore, arrived. He concurred with Mark's decision. A fever in an immunosuppressed patient was too dangerous to go untreated.

At eight o'clock, a second antibiotic, Piperacillin, was infused. By then Abby was making morning SICU rounds, her wheeled cart piled six-deep with charts. It had been a bad call night — just one hour of sleep before that 2 a.m. phone call, and not a moment's rest since then. Fuelled by two cups of coffee and a view of the end in sight, she pushed her cart along the row of cubicles, thinking: Four hours and I'm out of here. Only four more hours until noon. She passed by Bed 15, and she glanced through the cubicle window.

Nina was awake. She saw Abby and weakly managed a beckoning wave.

Abby left her charts by the door, donned an isolation gown, and stepped into the cubicle.

"Good morning, Dr. DiMatteo," murmured Nina. "I'm afraid you didn't get much sleep because of me."

Abby smiled. "That's OK. I slept last week. How are you feeling?"

"Like quite the centre of attention." Nina glanced up at the bottle of IV antibiotics hanging over the bed. "Is that the cure?"

"We hope so. You're getting a combination of Piperacillin and Azactam. Broad spectrum antibiotics. If you have an infection, that should take care of it."

"And if this isn't an infection?"

"Then the fever won't respond. And we'll try something else."

"So you don't really know what's causing this."

Abby paused. "No," she admitted. "We don't. It's more of an educated shot in the dark."

Nina nodded. "I thought you'd tell the truth. Dr. Archer wouldn't, you know. He was here this morning, and he kept telling me not to worry. That everything was taken care of. He never admitted he didn't know." Nina gave a soft laugh, as though the fever, the antibiotics, all these tubes and machines were part of some whimsical illusion.

"I'm sure he didn't want to worry you," said Abby.

"But the truth doesn't scare me. Really it doesn't. Doctors don't tell the truth often enough." She looked straight at Abby. "We both know that."