A. Yehoshua - Open Heart

Maybe I was only projecting my own feverish excitement onto my surroundings, but as the day of the operation neared — it was set for ten days after my return from England — I sensed that the whole hospital was in a state of suspense. But perhaps I was simply not yet acclimated to the Israeli tension and tempo after a year of long nights in the relative peace and quiet of the ancient English hospital. After all, the kind of operation that Lazar was to undergo had become a routine matter in the hospital, and every week there were bypass operations and valve replacements in at least ten patients, as well the correction of congenital heart malformations in babies and premature infants. Nevertheless, I could feel the suspense in the air. It seemed that the clerical staff, who were closer in their daily work to the administrative director and his secretaries than the medical staff, and who were the true guardians of the spirit of the hospital, were the ones responsible for spreading rumors and drumming up suspense. The fact that the operation had been “stolen” from cardiac surgery and transferred to general surgery also added to the drama, and eventually Professor Hishin decided to schedule the operation for the quieter afternoon and evening hours, so that when it was over he and Levine would be available for the long hours of their friend’s recovery in intensive care. On the eve of the day of the operation I decided to drop in to the administrative wing and say hello to Lazar’s secretary, whom I found sitting in her office next to Lazar’s, all alone in the dark, deserted wing. When she saw me standing in the door, she uttered a joyful cry and immediately rose to her feet, offering me her rather ravaged face for a kiss. I embraced her, kissed her warmly on the cheek, and sat down to chat. First of all, she asked to see a picture of the baby and to hear about England, but I soon turned the subject to Lazar, who to my surprise was sitting in his office with his two chief assistants, clearing his desk before his hospitalization, which was scheduled to begin that evening. She too was in a fever of excitement and anxiety about her boss’s surgery, and her agitation pleased me and made me feel that I was not alone in my feelings. Suddenly she said, “Come and say hello to him, at least.” I felt myself trembling, and blurted out, “Why bother him now?” But she insisted, knocked lightly on the dividing door, and opened, it saying, “Dr. Rubin’s back from England — he wants to say hello to you before the operation.”

Lazar was sitting with his two assistants next to his big desk. He didn’t seem to have lost any weight in the interim, but he did look rather pale. With a quick, friendly gesture, he immediately beckoned me to come closer and said in surprise, “But you were supposed to come back on the fifteenth of the month. What made you change your plans?” I was so astonished to see that there was room in his bureaucratic brain for something as minor as the date of my return from England, a resident of uncertain status at the hospital like me, that I was unable to make up a lie on the spot, and blushing furiously, in front of everybody, I blurted out the truth, which burst out of me with uncontrollable force: “I just wanted to be here for your operation. And tomorrow I’m going to help Dr. Nakash with the anesthesia.” With this I succeeded in surprising even the unsurprisable Lazar. “You came back especially for my operation?” He turned in amazement to his assistants, who were also suitably surprised at my generous concern. After he recovered he said, “I see that the entire medical staff of the hospital wants to be in on the show. It’s a pity they’re not operating on me on the stage of the big auditorium.” He burst into loud laughter, in which he was joined by me and the two assistants, while his secretary only smiled quietly and somewhat mysteriously. But Lazar soon cut the entertainment short with a wave of his hand in my direction, and I left the room.

Before leaving Lazar’s secretary, I asked her how Dori was taking it. As I had expected, she was tense and even more confused than her husband. And soon she would be arriving to spend the night with him in a special room which had been put at their disposal for the first night of his hospitalization. The thought that she couldn’t spend even one night alone in her own home and her own bed sent a wave of pleasurable pity surging through me. I was so moved that for a moment I even thought of waiting for her right there in the office, but I was afraid that if she heard the reason for my return from England she would ask Professor Hishin to take me off the operating team, so I removed myself from the scene — but not entirely. In the depths of a side corridor I sat hidden in the growing darkness, waiting for the sound of her brisk, confident steps.

During the six hours of the operation she and her son sat in her husband’s office, with his faithful secretary pressing food and drink on them all the time. The granny came from the old-age home to be with the family and give them the support of her natural optimism and experience of life. Hishin and Levine themselves took Lazar down from the ward to the surgical wing at two o’clock in the afternoon, apparently relishing the role of simple stretcher-bearers.

Although Lazar was already dazed and sedated, he had to smile weakly at the constant stream of jokes and witticisms showered on him by Hishin. Professor Levine, in contrast, looked grave and solemn. Perhaps he was silently brewing up the next psychotic outburst, which would save him from his anger. Because of the number of instruments crowding the room for heart operations, the initial “takeoff” was performed in a small induction room where Dr. Nakash and Dr. Yarden were already waiting for the hospital director, and I too was standing in a corner. Yes, it was already clear to me that this would be my place throughout the operation, standing in a remote corner, for apart from the two technicians in charge of the cardiopulmonary bypass machine, and the three nurses, and Professor Adler himself, who was still standing at the basin and washing his hands with compulsive thoroughness, Hishin and Levine would be watching every move with gimlet eyes. In an operation of this nature it was necessary to maintain close communication between the surgeon and the anesthetists, and after the “takeoff” they had been instructed to maintain the “flight” by using a Fentanyl drip, a short-action anesthetic that could be precisely controlled, as opposed to anesthetic gases, whose action was more general and erratic. Nakash just had time to explain this change of plan to me before Lazar was brought in, but the moment his bed was rolled into the room, I noticed something about Nakash that I had never seen before: his hands were trembling slightly. After he had begun to inject the cocktails he had prepared into the two intravenous lines in the wrist, when it was time to insert the tube into the lungs, I saw that he, the most skillful and precise of anesthetists, suddenly missed the exact spot where the tube should have been inserted, and the dazed but not yet unconscious Lazar jerked under Nakash’s dark hand as if he wanted to bite it. Nakash went pale, and was obliged to apply force to Lazar’s face in order to regain control. It then transpired that the tube had been inserted too deeply so that only one lung was being respirated, and it had to be brought up to above the bifurcation point so that both lungs would be respirated equally. In contrast to Nakash’s uncharacteristic agitation, which heightened my anxiety, the second anesthetist, Dr. Yarden, experienced in cardiac surgery, behaved with calm and impeccable professionalism. He immediately bent over Lazar’s right leg to insert an extra intravenous line in case there was an urgent need for blood or fluids if something went wrong. All of a sudden Lazar’s genitals were exposed to everyone standing in the room. I bowed my head in a sorrowful gesture of respect, but I went on looking out of the corner of my eye at the administrative director’s large penis lying there calmly and full of dignity, with no idea that one of the people present had dared to contend with him in the name of an impossible love. After first cleaning the area with Betadine, Dr. Yarden inserted the long, thin catheter into the penis; then he spread a blue, sterile towel over the entire area in order to protect it from the large syringe being inserted into the femoral vein to provide the extra intravenous line.