Maylis de Kerangal - The Heart

She had first made her appearance at the start of the university year, during one of the classes taken by medical interns at the Pitié. The instruction given during the day-school years took the form of tutorial classes of one particular type: the study of clinical cases. The students attended long sessions, where real situations experienced by the departments or scenarios invented on the basis of particular questions that required study were “replayed,” so that they could learn to listen to the patient, become acquainted with the methods of auscultation, practice diagnoses, identify a pathology, and decide on a treatment protocol. This practical work, developed around the patient/doctor duo, took place in public and sometimes required the setting up of bigger groups, in order to encourage an aptitude for working together, for dialogues between the different disciplines. It was intended to resist the compartmentalization of medical specialties, which divided the human body into a collection of rules and practices, with no flow of knowledge between them, making it impossible to see the patient as a whole person. Because it was based on simulation, however, this new teaching method provoked a degree of mistrust: the use of fiction in the process of acquiring scientific knowledge, the very idea of “play-acting” a situation — you be the doctor and you be the patient — was enough to make the faculty skeptical. They did agree to it, though, acknowledging that this teaching technique brought together some very interesting material, including subjectivity and emotion, and emphasizing the importance, in the patient/doctor dialogue, of understanding and deciphering that fragile, often distorted communication. In this role-playing game, it was decided that the students, carrying out their future function, would take on the part of the doctor, which meant that the hospital had to hire actors to play the patients.

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They turned up to the audition after a small ad appeared in a weekly paper for performing-arts professionals. Most of them were theater actors, highly promising newcomers or eternal bit-part players from television shows, commercial veterans, understudies, walk-ons, extras, doing the rounds of casting sessions in order to pick up hours, to earn enough money to pay their rent — generally a shared apartment in an arrondissement in the northeast of Paris or a nearby suburb — or reinventing themselves as coaches for training days on sales techniques (at home or elsewhere), and perhaps ending up as human guinea pigs, tasting new yogurts, testing moisturizers or lice-repellent shampoos, experimenting with diuretic pills.

There were too many, so there was a selection process. The jury was made up of medical professors and practitioners, some of them theater aficionados. When Rose entered the audition room and walked past the workbenches, wearing platform sneakers, burgundy Adidas sweatpants, and a sunshine-colored Lurex top, the men in the room were stirred into murmurs, their interest sparked by her face and her body. She was given a list of actions and words to help her improvise the part of a patient rushed to the gynecology department after the discovery of a suspicious lump in her left breast, and, during the fifteen minutes that followed, her commitment to the role elicited widespread admiration: she lay on her back, topless on the cold tile floor, and guided the student’s hand — here, here, that’s where it is, yes, there — and then, as the scene dragged on, a disturbance arose: the student, it was true, palpated her chest rather longer than was strictly necessary, moving from one breast to the other and then starting over, ignoring the dialogue guidelines, not listening to the essential information that she provided him with — including the intense pain she felt at the end of her menstrual cycle — so that she finally stood up, purple-faced, and slapped him. Bravo, mademoiselle! She was congratulated, and hired on the spot.

From the very beginning, Rose secretly disregarded the terms of the contract, believing that this job as a “patient,” which she had landed for the entire academic year, would be a learning opportunity for her, the chance to increase her range, the power of her art. Foolishly, she scorned ordinary pathologies — or what she considered ordinary pathologies — preferring to monopolize madness, hysteria, and melancholy, a register in which she excelled — romantic and mysterious heroines — sometimes allowing herself diversions not mentioned in the prescribed scenario (an effrontery that shocked the psychiatrists and neurologists who were running the classes and created confusion among the students, forcing them to ask her to take it down a notch or two); she played drowned women, attempted suicides, bulimics, erotomaniacs, diabetics, taking particular pleasure in mimicking people with limps, people in pain (a case of coxalgia in Brittany providing the opportunity for a very nice dialogue about inbreeding in Finistère Nord), people with hunchbacks (she succeeded in imitating the rotation of the vertebrae in the thoracic cage), and anything that required her to twist or unhinge her body; she liked interpreting a pregnant woman with premature contractions, but was less convincing in her incarnation of a young mother describing the symptoms of a three-month-old baby, which brought the pediatric intern out in a cold sweat; superstitious, she refused to play cancer patients.

However, she was never better than on that December day when she had to simulate angina. The renowned cardiologist who was leading the course had described the pain to her in these terms: A bear is sitting on your chest. Rose’s almond-shaped eyes had widened in awe: A bear? She had to gather her childhood memories — the vast, foul-smelling cage with its crudely modeled, cream-colored plastic rocks, and the huge animal, half a ton, with its triangular muzzle and its close-set eyes that gave a false impression of nearsightedness, the rust-brown fur dusted with sand, and the yells of the children when it stood up on its hind legs, six and a half feet tall; she recalled the scenes of Ceauşescu hunting in the Carpathian Mountains — the bears subdued by peasants and lured with buckets of food, emerging from the back of the clearing close to a log cabin mounted on pilings, moving forward until it was perfectly framed by the open window where a Securitate agent prepared a rifle before handing it to the dictator as soon as the bear was close enough that he couldn’t miss; lastly, she remembered a scene from Grizzly Man . Rose began at the back of the room, walked toward the student who was going to partner her in the scene, and then stood still. Could she make out the beast at the edge of the undergrowth, its head poking between bamboo shoots, or nonchalantly swaying its rump on four feet, cashew-colored fur, lazily scratching a stump with its nonretractable claws, before turning toward her and standing up like a man? Did she see the monster emerging from its cave after months of hibernation, stretching its muscles, reheating the stalled fluids in its body, reactivating the taste for blood in its heart? Could she discern it at dusk, rummaging through supermarket trash cans, growling happily under a huge moon? Or was she thinking about a different weight altogether — a man’s? She fell back onto the floor — the noise her body made when it hit the floor provoked a murmur in the room — and, stiffening convulsively, let out a cry of pain, soon muffled into a silent groan, and afterward stopped breathing, completely immobile. Her thoracic cage seemed to flatten and hollow out in a basin while her face swelled up, slowly reddening, her lips, held tight, soon turning colorless, eyes rolling back in her head, and her limbs began to fibrillate, as if electrocuted; such realism was not expected of these actors, and some of the students in the room stood up to get a better view, alarmed by her crimson face and concave abdomen, and a figure hurtled down the steps of the amphitheater and knelt next to Rose — knocking over the student who had begun imperturbably to read through the first lines of his questionnaire in a droning voice — and leaned over her to resuscitate her while the eminent cardiologist also rushed over, shining a penlight at her irises. Rose frowned with one eyebrow, opened one eye, then the other, sat up with a jolt, looked questioningly at the crowd gathered around her, and, for the first time in her life, felt the pleasure of being applauded. She lay flat on her back in front of the students as they stood and clapped in the bleachers.