Jodi Picoult - Harvesting the Heart

Nicholas likes to look at the portraits in his drawer just before he goes down to surgery-which, thank God, is the only place Paige hasn’t been allowed into yet. The pictures clear his head, and he likes to have that kind of directed focus before doing an operation. He pulls out the latest drawing: his hands poised in midair as if they are going to cast a spell. Every line is deeply etched; his fingernails are blunt and larger than life. In the shadow of the thumb is Paige’s face. The drawing reminds him of the photo his mother developed years before to save her marriage, the one of her own hands folded beneath his father’s. Paige couldn’t have known, and it strikes Nicholas as uncanny.

He v› t‡leaves the portrait on the desk, on top of the scrawled sheets of assets he is supposed to be preparing for Oakie Peterborough. He has added nothing since the day he met the lawyer for lunch, a week ago. He keeps thinking that he must call to set up a consultation, but he forgets to mention it to his secretary and he is too busy to do it himself.

The operation this morning is a routine bypass, which Nicholas thinks he could do with his eyes closed. He walks briskly to the locker room, although he is not in a hurry; he changes into the soft laundered blue scrubs. He pulls on paper booties and a paper cap and winds a mask around his neck. Then he takes a deep breath and goes to scrub, thinking about the business of fixing hearts.

It’s strange being the chief of cardiac surgery. When he enters the operating suite the patient is already prepped and the easy conversation between the residents and the nurses and the anesthesiologist comes to a dead halt. “Good morning, Dr. Prescott,” someone says finally, and Nicholas can’t even tell who it is because of the stupid masks. He wishes he knew what to do to put them all at ease, but he hasn’t had enough experience at it. As a surgical fellow, he spent so much time clawing his way to the top, he never bothered to consider whom he was crawling over to get there. Patients are one thing: Nicholas believes that if someone is going to trust you with his life and shell out $31,000 for five hours’ work, he or she deserves to be listened to and laughed with. He has even sat on the edges of beds and held his patients’ hands while they prayed. But doctors are a different breed. They are so busy looking behind them for an encroaching Brutus that everyone becomes a potential threat. Especially a superior like Nicholas: with one written criticism, he has the power to end a career. Nicholas wishes he could look over the blue edge of a mask just once and see a pair of smiling eyes. He wishes Marie, the stout, serious OR nurse, would put a whoopee cushion under the patient, or set rubber vomit on the instrument tray, or play some other practical joke. He wonders what would happen if he walked in and said, “Have you heard the one about the rabbi, the priest, and the call girl?”

Nicholas speaks softly as the patient is intubated, and then he directs a resident, a man his own age, to harvest the leg vein. His hands move by themselves, making the incision and opening the ribs, dissecting out the aorta and the vena cava for the bypass machine, sewing up and cauterizing blood vessels that are accidentally cut.

When the heart has been stopped-an action that never loses its effect for Nicholas, who holds his breath as if his own body has been affected-Nicholas peers through magnifying spectacles and begins to cut away the diseased coronary arteries. He sews on the leg vein, turned backward, to bypass the obstructions. At one point, when a blood vessel begins spurting blood all over Nicholas and his first assistant, Nicholas curses. The anesthesiologist looks up, because he’s never seen Dr. Prescott-the famous Dr. Prescott-lose his cool. But even as he does so, Nicholas’s hands are flying quickly, clamping the vessel as the other doctor sews it up.

When it is all over and Nicholas steps back to let his assistant close, he does not feel as if five hours have passed. He never does. He is not a religious man, but he leans against the tiled wall and beneath his blue mask he whispers a prayer of thanks to God. In spite of the fact that he knows he is skilled, that his expertise comes from years of training and practice, Nicholas cent€†annot help but believe a little bit of luck has been thrown in, that someone is looking out for him.

That’s when he sees the angel. In the observation gallery is the figure of a woman, her hands pressed to the window, her cheek flush against the glass. She is wearing something loose that falls to her calves and that glows in the reflected fluorescent light of the operating suite. Nicholas cannot help himself; he takes a step forward and lifts his hand a fraction of an inch as if he might touch her. He cannot see her eyes, but somehow he knows this is only an apparition. The angel glides away and disappears into the dark background of the gallery. Nicholas knows that even if he has never seen her before, she has always been with him, watching over his surgeries. He wishes, harder than he has ever wished for anything in his life, that he could see her face.

After such a spiritual morning, it is a letdown for Nicholas to find Paige in all his patients’ rooms when he is doing afternoon rounds. Today she has pulled her hair away from her face in a braid that hangs down to her shoulder blades and moves like a thick switch when she leans over to refill a water pitcher or to plump pillows. She’s not wearing makeup, she rarely does, and she looks about as old as a candy striper.

Nicholas flips over the metal cover of Mrs. McCrory’s chart. The patient is a woman in her late fifties who had a valve replacement done three days ago and is almost ready to go home. He skims a finger across the vitals recorded by one of the interns. “I think we’re getting ready to kick you out of here,” he says, grinning down at her.

Mrs. McCrory beams and grabs Paige’s hand, which is the nearest one. Paige, startled, gasps and almost overturns a vase of peonies. “Take it easy,” Nicholas says dryly. “I don’t have room in my agenda for an unscheduled heart attack.”

At this unexpected attention, Paige turns. Mrs. McCrory eyes her critically. “He doesn’t bite, dear,” she says.

“I know,” Paige murmurs. “He’s my husband.”

Mrs. McCrory claps her hands together, thrilled by this news. Nicholas mutters something unintelligible, amazed at how easily Paige can ruin his good mood. “Don’t you have somewhere else to be?” he says.

“No,” Paige says. “I’m supposed to go wherever you go. It’s my job.”

Nicholas tosses the chart down on Mrs. McCrory’s bed. “That is not a volunteer’s assignment. I’ve been here long enough to know the standard rounds, Paige. Ambulatory, patient transport, admitting. Volunteers are never assigned to doctors.”

Paige shrugs, but it looks more like a shiver. “They made an exception.”

For the first time in minutes, Nicholas remembers Mrs. McCrory. “Excuse us,” he says, grabbing Paige’s upper arm and dragging her out of the room.

“Oh, stay!” Mrs. McCrory exclaims after them. “You’re better trtu€†han Burns and Allen.”

Reaching the hallway, Nicholas leans against the wall and releases Paige. He wanted to yell and to complain, but suddenly he can’t remember what he was going to say. He wonders if the whole hospital is laughing at him. “Thank God they don’t let you in surgery,” he says.

“They did. I watched you today.” Paige touches his sleeve gently. “Dr. Saget arranged it for me, and I was in the observation room. Oh, Nicholas, it’s incredible to be able to do that.”