Maylis de Kerangal - The Heart

* * *

The theater is ready. The surgical lamp projects a white light, vertical and shadowless, over the operating table, the beams from its circle of spots converging on Simon Limbres’s body, which has just been brought here and which still shows the same level of animation. It is still troubling, still moving to see him this way. He is placed in the center of the room — he is the heart of the world. A first circle around him delimits a sterile zone that cannot be crossed by anyone not involved in the operation: nothing must be touched, soiled, infected; the organs that are about to be harvested here are sacred objects.

In a corner of the room, Cordélia Owl takes it all in. She has changed into scrubs and left her cell phone in a changing-room locker. Being separated from it — no longer feeling that hard rectangular shape vibrating against her hip, insidious as a parasite — has sent her into another reality: yes, it’s here that it’s happening, she thinks, eyes riveted on the body stretched out before her, this is where I am. Having gone through her training in the OR, the place itself is not alien to her, but she has only ever seen intense mobilizations aimed at saving patients, at keeping them alive, and she is struggling to comprehend the coming operation, because the young man is already dead, isn’t he, and the objective of the surgery is to save other lives. She has prepared the equipment, arranged the tools, and now she is quietly repeating to herself the order in which the organs will be removed, lips barely moving behind her mask: (1) the kidneys; (2) the liver; (3) the lungs; (4) the heart. Then she starts over in reverse, reciting the order of the organs based on the duration of ischemia the organ will tolerate — in other words, how much time it will survive once vascularization has been stopped — (1) the heart; (2) the lungs; (3) the liver; (4) the kidneys.

* * *

The body is lying flat, naked, arms extended to the sides, leaving clear the thoracic cage and the abdomen. It has been prepared, shaved, painted, then covered in a fenestrated drape that marks out a window of skin on the body, a cutaneous perimeter covering the thorax and the abdomen.

All right, here we go. Let’s get started. The first team appears in the operating theater. The urologists will get the ball rolling — they will be the ones to open the body and they will close it again at the end. Two men get to work, a Laurel and Hardy — like odd couple, the tall, thin one being the surgeon, and the small, round one the intern. The tall, thin one bends over the body and makes an incision in the abdomen — a bilateral laparotomy below the ribs, tracing a sort of cross on the abdomen. In this way, the body is split in two distinct zones at the level of the diaphragm: the abdominal zone, where the liver and the kidneys are located, and the thoracic zone, home to the lungs and the heart. The men use self-retaining retractors on the incision, turning them by hand to widen the opening — this action requires physical force, allied to meticulous technique, and suddenly the manual dimension of the operation shows through the massed technology, the physical confrontation with reality that is necessary in this place. The body’s interior — the murky, oozing insides — glows red under the lamps.

* * *

The practitioners will prepare their organs in turn. Quick, meticulous blades move around the organs, freeing them from their attachments, their ligaments, their respective envelopes, but for the moment nothing is severed. The urologists, standing on either side of the table, talk to each other as this happens, the surgeon taking the opportunity to educate the intern: he leans over the kidneys, breaking down the movements he makes, describing the techniques he uses, while his pupil nods and sometimes asks questions.

One hour later, the Alsace team enters the room, both women, both the same height and build; the surgeon, a rising star in the relatively select world of hepatic surgery, does not utter a word, her gaze impassive behind her small, round, metal glasses, working at the liver with the determination of someone in a fight, fully committed to an action that seems to find fulfillment in its own execution. Her colleague stares unblinkingly at the surgeon’s unbelievably skillful hands.

Another thirty-five minutes pass and the thoracic team enters the theater. It’s Virgilio’s turn now; time for him to shine. He informs the Alsatians that he is ready to make the first incision, then immediately afterward makes the longitudinal section of the sternum. Unlike the others, he does not bend over the body, but remains upright, neck angled and arms held forward — a way of maintaining his distance from the body. The thorax is open and Virgilio can now see the heart — his heart — he can consider its volume, scrutinize the ventricles and auricles, observe its solid contractions. Alice sees the satisfaction in his face: it’s a magnificent heart.

He proceeds with stunning speed — the arm of a quarterback and the fingers of a lacemaker — first dissecting the aorta, then, one by one, the venae cavae: untangling the muscle. Alice, standing directly across from him on the other side of the operating table, is gripped by what is unfolding: by the parade around this body, by the sum of actions of which it is the object; she watches Virgilio’s face, wonders what it means to him to operate on a dead person, what he’s feeling, what he’s thinking, and the space around her seems to reel, as if the separation between the living and the dead no longer exists here.

* * *

Once the dissection is completed, it is time for cannulation. The blood vessels are pierced with a needle and little catheters inserted into them, through which will pass the liquid that cools the organs. The anesthesiologist surveys the donor’s hemodynamic status on the screens — perfectly stable — while Cordélia supplies the surgeons with implements as required, taking care to repeat the name of the compress, the number of the pliers or blade as she places them in the palm of the plastic-gloved hand held open in front of her, and the more she does this, the firmer her voice sounds, the more confident she feels of her place in this operation. It’s ready now: cannulation is completed, and we can clamp the aorta — and every practitioner in the room checks the anatomical map they have just been given, identifying the part intended for them.

* * *

Can we clamp? Virgilio’s voice, loud in the theater even though muffled by the mask, startles Thomas. No, wait! He shouted, and everyone turns to look at him now, hands immobilized over the open body, elbows frozen at right angles: the operation is suspended while the coordinator weaves between them to reach the table, moving his mouth close to Simon Limbres’s ear. What he whispers then, in his most humane voice, even though he knows that his words are falling into a deathly void, is the promised litany of names, the names of those who are escorting him; he whispers that Sean and Marianne are with him, and Lou, and Grandma, he whispers that Juliette is there by his side — Juliette who knows about Simon now: she got a call from Sean around 10:00 p.m. after leaving a succession of increasingly distraught messages on Marianne’s cell phone, though what Simon’s father said to her was incomprehensible, as his words seemed to wander beyond language; he seemed unable to formulate a sentence, only gasps, cracked syllables, stammered phonemes, sobs, till Juliette finally understood that there was nothing else to hear, that there were no words, that this was what she had to hear, and she replied I’m coming, in a breath, then rushed out into the night, running to join the Limbres family in their apartment, hurtling down the steep hill, not wearing a coat or even a scarf, an elf in sneakers, keys in one hand and cell phone in the other, and soon the glass-sharp cold started to burn, she was consumed on the slope, a figurine broken into pieces, almost falling several times as she struggled to coordinate her strides, breathing badly — not at all the way Simon had taught her to breathe, with no regularity, forgetting to exhale — her tibias aching and heels burning, ears popping like they did in a landing plane, and a stitch stabbing at her side; bent double, she continued to run on the too-narrow sidewalk, grazing her elbow against the high stone wall that bordered the curve, rushing down this slope that he had climbed for her on his bike five months earlier — the same bend but in the opposite direction, that day of the Ballade des pendus and the red plastic lovers’ shelter that they had raised together, that day, that first day — she was running so hard she couldn’t breathe now, and the cars were driving past her, up the hill, catching her in the white glare of their headlights, slowing down, the startled drivers continuing to watch her in their rearview mirrors for a long time afterward — a kid in a T-shirt, out in the street, at this hour, in this cold, and the look of panic on her face! — then she came into view of the unlit bay window of the living room and accelerated again, entering the grounds, crossing a clear space of flower beds and hedges that seemed to her like a hostile jungle, then sprinting up the steps, where she took a tumble, the carpet of leaves coagulated by the cold forming a layer of ice, and scraped her face, splashing mud on her temple and her chin, and then she was up again and climbing the stairs, three floors, and when she arrived on the landing, her face deformed like the others, unrecognizable, Sean opened the door to her before she even rang the bell and took her in his arms, holding her tight, while behind him, in the dark, Marianne was smoking a cigarette, wearing a coat, standing next to the sleeping Lou: Oh Juliette, and the tears began — then Thomas takes the earbuds from his pocket, the earbuds that he has sterilized, and inserts them into Simon’s ears, switches on the iPod, track 7, and the last wave forms on the horizon, in front of the cliffs, it rises and rises until it fills the whole sky, forming and unforming, deploying the chaos of the matter and the perfection of the spiral in its metamorphosis, scraping the seafloor, stirring up the layers of sediment and shaking the alluvium, uncovering fossils and overturning treasure chests, revealing those invertebrates sunk deep in the vastness of time, 150-million-year-old ammonites and bottles of beer, airplane wreckage and handguns, bleached bones like tree bark, the seabed as fascinating as a gigantic garbage dump and an ultrasensitive membrane, a pure biology, and the wave lifts up the earth’s skin, digging into memory and turning it over, regenerating the soil where Simon Limbres lived — the soft dune in whose hollow he shared a packet of french fries and mustard with Juliette, the pine forest where they sheltered during the squall, the 150-foot bamboo stalks just behind them, swaying like they do in Asia, and the warm raindrops hitting the gray sand that day, the odors mingling, bitter and salty, Juliette’s lips the color of grapefruit — and then finally it explodes and scatters, in an almighty splash, a conflagration and a shimmer, while around the operating table the silence thickens, they wait, eyes meeting over the body, toes twitching, fingers suspended, but they all accept that it is right to pause for a moment as they stop Simon Limbres’s heart. Once the rite has been performed, Thomas removes the earbuds and returns to his place. Again: Can we clamp?