Jodi Picoult - Harvesting the Heart

I have never seen Nicholas truly doing his job. Yes, I have seen him with his patients, drawing them out of their fear and being more understanding with them than he has been with his own family. But I want to see what all the training is for; what his hands are so skilled at. Elliot frowns at me when I ask. “You may not like it very much,” he says. “Lots of blood and battle scars.”

But I stand my ground. “I’m much tougher than I look,” I say.

And so this morning there will be no picture of Nicholas’s patient tacked to his door. Instead I sit alone in the gallery above the operating suite and wait for Nicholas to enter the room. There are already seven other people: anesthesiologists, nurses, residents, someone sitting beside a complicated machine with coils and tubes. The patient, lying naked on the table, is painted a strange shade of orange.

Nicholas enters, still stretching the gloves on his hands, and all the heads in the room turn toward him. I stand up. There is an audio monitor in the gallery, so I can hear Nicholas’s low voice, rustling behind his paper mask, greeting everyone. He checks beneath the sterile drapes and watches as a tube is set in the patient’s throat. He says something to a nearby doctor, youngish-looking, his hair in a neat ponytail. The young doctor nods and begins to make an incision in the patient’s leg.

All of the doctors wear weird glasses on their heads, which they flip down to cover their eyes when they bend over the patient. It makes me smile: I keep expecting this to be some kind of joke costume, with googly eyeballs popping out on springs. Nicholas stands to the side while two doctors work over the patient’s leg. I cannot see very well what they are doing, but they take different instruments from a cloth-covered tray, things that look like nail scissors and eyebrow tweezers.

They pull a long purple spaghetti string from the leg, and when I realize it is a vein, I t›‹ñ€†feel the bile rise in my throat. I have to sit down. The vein is placed in a jar filled with clear fluid, and the doctors working on the leg begin to sew with needles so small they seem invisible. One of them takes two pieces of metal from a machine and touches the leg, and I can swear I smell human flesh burning.

Then Nicholas moves to the center of the patient. He reaches for a knife-no, a scalpel-and traces a thin line down the orange area of the patient’s chest. Almost immediately the skin is stained with dark blood. Then he does something I cannot believe: he pulls a saw out of nowhere-an actual saw, like a Black & Decker-and begins to slice through the breastbone. I think I can see chips of bone, although I can’t believe Nicholas would let that happen. When I think I am surely going to faint, Nicholas hands the saw to another doctor and spreads the chest open, holding it in place with a metal device.

I don’t know what I was expecting-maybe a red valentine heart. But what lies in the center of this cavity once the blood is mopped away looks like a yellow wall. Nicholas picks a pair of scissors off a tray, bends low toward the chest, and fiddles around with his hands. He takes two tubes that come from that complicated machine and attaches them to places I cannot quite see. Then he picks up a different pair of scissors and looks at the yellow wall. He begins to snip at it. He peels back the layer to reveal a writhing muscle, sort of pink and sort of gray, which I know is the heart. It twitches with every beat, and when it contracts it gets so small that it seems to be temporarily lost. Nicholas says, “Let’s put him on bypass,” to the man who is sitting at the machine, and in a quiet whir, red blood begins to run through the tubes. Below his mask, I think I see Nicholas smile.

He asks a nurse for cardioplegia, and she hands him a beaker filled with a clear solution. He pours it over the heart, and just like that, it stands still. Dear Jesus, I find myself thinking, he’s killed the man. But Nicholas doesn’t even stop for a moment. He picks up another pair of scissors and moves close to the patient again.

All of a sudden a spurt of blood covers Nicholas’s cheek and the front of another doctor’s gown. Nicholas’s hands move faster than I can follow as he reaches into the open chest to stop the flow. I step back, breathing hard. I wonder how Nicholas can do this every single day.

The second doctor reaches into the jar I’ve forgotten about and takes out the vein from the leg. And then Nicholas, sweat breaking out on his brow, pulls a tiny needle repeatedly through the heart and through that vein, using tweezers to place the point and to retrieve it. The other surgeon steps back, and Nicholas taps the jellied heart with a metal instrument. Just like that, it starts to beat. It stops, and Nicholas asks for an internal defibrill-something. He touches it to the heart and shocks it into moving again. The second doctor takes the tubes from the top and bottom of the heart, and the blood stops coursing through the machine. Instead, the heart, still on display, begins to do what it was doing before-squeezing and expanding in a simple rhythm.

Nicholas lets the second surgeon do most of the work from that point-more sutures, including wire for the ribs and thick stitches through the orange skin that make me think of a Frankenstein monster. I press my hands against the sloped glass wall of the gallery. My face is so close that my breath cloudt, ñ€†s the window. Nicholas looks up and sees me. I smile hesitantly, wondering at the power he must feel to spend every morning giving life.

N icholas remembers having heard once that the person who has started a relationship finds it easier to end it. Obviously, he thinks, that person did not know Paige.

He can’t get rid of her. He has to give her credit-he never thought she’d take it this far. But it is distracting. Everywhere he turns, there she is. Arranging flowers for his patients, wheeling them out of surgical ICU, eating lunch across the cafeteria. It has reached the point where he actually misses her when she isn’t around.

The drawings have got out of control. At first he ignored them, tacked crudely to his office door like kindergarten paintings on a refrigerator. But as people started to notice Paige’s talent, he couldn’t help but look at them. He brings the ones she does of his patients to their rooms, since it seems to brighten them up a little-some of his incoming patients have even heard of the portraits and ask for them at the pre-op exam. He pretends to throw out the ones she does of him, but in fact he has been saving them in the locked bottom drawer of the desk. When he has a minute, he pulls them out and looks at them. Because he knows Paige, he knows what to look for. And sure enough, in every single picture of him-even the ridiculous one of him singing in a bowling shirt-there is something else. Someone, actually. In the background of each drawing is a slight, barely noticeable portrait of Paige herself. Nicholas finds the same face over and over, and every time she is crying.

And now her pictures are all over the entrance hall of Mass General. The whole staff treats her like some kind of Picasso. Fans flock to his office door to see the latest ones, and he actually has to push through them to get into the room. The chief of staff-the goddamned chief of staff!-ran into Nicholas in the hall and complimented him on Paige’s talent.

Nicholas does not know how she has managed to win so many people to her side in a matter of days. Now, that’s Paige’s real talent-diplomacy. Every time he turns around, someone is mentioning her name or, worse, she is standing there herself. It reminds him of the ad agencies’ “block” strategy, where they run the same exact commercial at the same exact time on all three network stations, so that even if you flip channels you see their product. He can’t get her out of his mind.