Jodi Picoult - Harvesting the Heart

After Kim had disappeared, Nicholas went upstairs to round his new cardiac patients. That was the hardest part about being a resident in general surgery-the constant changes from department to department. Nicholas had swung through urology, neurosurgery, emergency room, anesthesia. He’d done a stint in transplants, and one in orthopedics, and one in plastic surgery and burns. Still, coming back to cardiac was better than the others; cardiac surgery felt like home. And indeed Nicholas had been rotated through cardiothoracic more than was normal for a third-year, because he had made it clear to Alistair Fogerty that one day he was going to have his job.

Fogerty was exactly what Nicholas had pictured a cardiac surgeon to be like: tall, fit, in his late fifties, with piercing blue eyes and a handshake that could cripple. He was a hospital “untouchable,” his reputation having evolved into a surgical gold standard. There had once been a scandal about him-something involving a candy striper-but the rumors were squelched and there had been no divorce and that was that.

Fogerty had been Nicholas’s attending physician during his internship, and one day last year Nicholas had gone to him in his office and told him his plans. “Listen,” he’d said, even though his throat had been dry and his palms had been quivering. “I want to cut through the bullshit, Alistair. You know and I know I’m the best surgical resident you’ve got here, and I want to specialize in cardiothoracic. I know what I can do for you and for the hospital. I want to know what you can do for me.”

For a long moment, Alistair Fogerty had sat on the edge of his mahogany desk, riffling through a patient’s file. When he finally lifted his head, his eyes were dark and angry, but in no way surprised. “You, Doctor Prescott,” he said, “have got bigger balls than even me.”

Alistair Fogerty had got to be director of cardiac surgery by sticking his neck out, taking chances, and courting Fate so that it seemed to stay on his side. When he’d begun doing transplants, the newspapers dubbed him “The Miracle Maker.” He was calculating, stubborn, and usually right. He liked Nicholas Prescott a hell of a lot.

And so even when Nicholas was rounding his regular patients in general surgery, and working under other attendings in other disciplines, he still found time to meet with Fogerty. When he had the chance, he rounded Fogerty’s patients, did the quick daily pre- and postoperative exams, moved patients in and out of surgical ICU-in short, acted like a cardiothoracic fellow, a seventh-year resident. And in return, Fogerty had him in cardiac surgery more often than not and was grooming him to be the best there was-after Fogerty himself.

Nicholas moved quietly into the recovery room, where Fogerty’s latest patient was resting. He read the vitals: here was a sixty-two-year-old man who had had aortic stenosis-the valve leading from the end of his ventricle to the aorta had been scarred down. Nicholas could have easily diagnosed this case from the symptoms: congestive heart failure, syncope, angina. He surveyed the clean white gauze over the patient’s chest, the gelatinous orange antiseptic that still coated the skin. Fogerty’s work, as always, would be perfect: the native valve removed and a pig valve sewn into its place. Nicholas checked the patient’s pulse, tugged the sheet up, and sat down beside him for a moment.

It was cold in recovery. Nicholas crossed his arms and rubbed his hands up and down, wondering how the patient, naked, could be faring. But there, the pink circles at his fingertips and his toes proved that the heart, marvelous muscle, was still working.

It was merely fortuitous that he saw it then, the heart breaking down. He had been watching the steady rise and fall, the classic heartbeat pattern of the monitor, when everything went wrong. The steady blip-blip-blip of the machines accelerated, and Nicholas checked to see a sinusoidal pattern, the heart racing at nearly one hundred beats per minute. For a quick second, Nicholas held his hands over the patient like a faith healer. It was an arrhythmia-ventricular fibrillation. Nicholas had seen cases of it before, when a heart was exposed in the chest: beating like a bag of worms, swollen and writhing, not pumping blood at all. “Code!” he yelled over his shoulder, seeing the nurses at the nearby station spring into motion. The patient’s heart had been traumatized, operated on, but Nicholas had little choeck‘d little ice. In a matter of minutes, the man would be dead. Where was Fogerty?

Almost immediately, recovery was filled with at least twenty people-anesthesiologists, surgeons, interns, and nurses. Nicholas applied wet gel pads to the patient’s raw chest, then put the defibrillator paddles to the skin. The body jumped with the shock, but the heart did not correct itself. Nicholas nodded to a nurse, who adjusted the charge. He ran his hand across his forehead, pushing back his hair. His mind was filled with the god-awful sound of the monitor, irregular and screeching, and the rustle of the nurses’ starched dresses as they moved around him. He was not certain, but he thought he could smell death.

Nicholas cleared the defibrillators and replaced the paddles on the patient’s chest. This time the shock was so violent that Nicholas took a step away, artificial life kicking back like a rifle’s recoil. You will live, he willed silently. He raised his eyes to the monitor screen, seeing the thin green line dip and peak and dip and peak, the craggy crests of a normal heartbeat. Alistair Fogerty entered the recovery room as Nicholas pushed past him, deafened by the muted touches and calls of congratulation, suddenly a hero.

Late at night on the patient floors, Nicholas learned to listen. He could tell by the flat beat of soles on the tiles when the nurses were making the midnight rounds. He saw old men recovering from surgery meet in the patient kitchens at 3:00 A.M. to steal the red jello. He waited for the slosh and whistle of the heavy industrial rag mops, shuffled up and down the halls by half-blind old Hispanic janitors. He noticed every patient call sounded at the nurses’ desk, the tear of sterile paper that revealed virgin gauze, the sucked-in breath of a syringe. When he was on call and things were quiet, Nicholas liked to wander around the floors, his hands deep in the pockets of his white lab coat. He did not stop into patient rooms, not even when he was on a general surgery rotation and the patients were more than just names and charts posted on the door. Instead he moved like an insomniac, roaming, interrupting the night with his own shrouded footsteps.

Nicholas did not wake Serena LeBeauf when he entered her room in the AIDS ward. It was well after two in the morning by the time he could spare a minute. He sat down in the stark black plastic chair beside her bed, amazed by her deterioration. Her vitals indicated that she weighed less than seventy pounds now; that she had pancreatitis, respiratory failure. An oxygen mask covered her face, and morphine dripped into her continuously.

Nicholas had done something very wrong the first time he met Serena-he let her get under his skin. It was something he had hardened himself to, seeing death every day the way he did. But Serena had a wide smile, with shocking white teeth; eyes light like a tiger’s. She had come in with her three children, three boys, all of different fathers. The youngest, Joshua, was six back then, a skinny kid-Nicholas could see the bumps of his backbone under his thin green T-shirt. Serena did not tell them she had AIDS; she wanted to spare them the stigma. Nicholas remembered sitting in the consultation room with the attending physician when she learned she was HIV positive. She had straightened her spine and had gripped the chair so tight that her fingers whitened. “Well,” she had said, her voice soft like a child’s. “That’s not what I expected.” She did not cry, and she asked her roo‘e asked hdoctor for all the information she could get, and then, almost shyly, she asked him not to mention this to her boys. She told them, and her neighbors and distant relatives, that it was leukemia.