Maylis de Kerangal - The Heart

She walks over to the window. Figures hurry down paths in the hospital grounds; cars move slowly between the buildings that, in the night, redraw the anatomical map of the human body, organ by organ, pathology by pathology, separate children from adults, bring together mothers, the aged, the dying. She hopes that she will be able to kiss her sons before she puts on this tissue-paper gown that flutters without covering her up, making her feel as if she is naked in a breeze. Her eyes remain dry, but she is struggling to get her head around the enormity of what she is about to go through. Placing her hand there, between her breasts, she feels her pulse, still slightly too fast in spite of the medication, still somewhat unpredictable too, and says its name out loud: heart.

* * *

All those hours being interviewed by doctors who were making a psychological assessment of her when she was first proposed as a transplant candidate — a summary of her emotional relationships, an evaluation of her social integration, an appraisal of her behavior when faced with fatigue and anxiety, of her likely willingness to deal with a postoperative treatment that would be long and tough — from none of that did she learn what will happen to her heart, afterward. Maybe there is a scrapyard for organs somewhere, she thinks, removing her jewelry and her watch, some sort of garbage heap where hers will be dumped along with others, evacuated from the hospital through a back door in large trash bags; she imagines a container for organic matter where it will be recycled, transformed into paste, a flesh compost served by unimaginably cruel heirs of Atreus to their rivals, who enter the palace dining room with hearty appetites — served as pancakes or steak tartare, or slop fed to dogs in huge dishes, or bait for bears and dolphins — and maybe those dolphins will be transformed, after eating the substance, their rubbery skin covered with blond hair like hers, maybe they will grow long velvety eyelashes.

A knock at the door and Emmanuel Harfang enters without waiting for a response. He stands in front of her, tells her the heart will be removed around eleven, that the organ is in excellent health, and then he stops talking, observes her: You wanted to speak to me. She sits on the bed, shoulders hunched, hands pressed flat to the mattress, ankles crossed — her feet are beautiful, the toenails painted bright red, sparkling in the chlorotic room like foxglove petals — yes, I have questions, about the donor. Harfang shakes his head, as if he thinks she is being silly, that she knows the answer already. We’ve already talked about this. But Claire does not give up. Her blond hair brushes her cheeks. I would like to be able to think about it. For example, she adds persuasively, where is this heart coming from? It’s not from Paris. Harfang stares at her, frowning; how does she know that? Then yields: Seine-Maritime. Claire closes her eyes, accelerates: Male or female? Harfang, instantly: Male. He reaches the door, open onto the corridor, she hears him leave and opens her eyes: Wait, tell me his age, please. But Harfang has gone.

* * *

Her three sons arrive just after this, looking unhappy. The eldest is terribly anxious and won’t let go of her hand, the middle son paces the room, repeating everything is going to be fine, while the youngest has brought her a packet of heart-shaped candy. Harfang’s a brilliant man, the best in his field, seventy heart transplants a year, and the best team too, you’re in good hands, he says in a small, trembling voice. She nods mechanically, watching his face without really listening to him: I know, don’t worry. It’s more difficult with her mother, who keeps sniveling that life is unfair, that she wants to take her place under the knife, implying that it would be more natural, more conceivable for her to die first, or at least risk her life first. Claire loses her patience: But I’m not going to die, I have no intention whatsoever of dying. The boys, incensed, abuse their grandmother: For God’s sake, just shut up, you’re not helping! Returning to the room, the nurse taps her watch face and curtails the discussion: All right, it’s time for you to get ready. Claire hugs her sons, stroking their cheeks, whispering to each one, see you tomorrow, my love.

* * *

Later, naked, she went into the shower cubicle and washed herself with Betadine for a long time, spraying the yellow liquid all over her body and vigorously rubbing it into her skin. When she was dry, she put on the sterile paper gown, then began to wait.

Around 10:00 p.m., the anesthesiologist comes into the room: Everything okay? She is a tall woman, narrow-shouldered and narrow-hipped, with a swan neck and pale smile and long-fingered cold hands that brush hers when handing her a first pill — to relax you. Claire lies back on the bed, suddenly exhausted, even though she is more excited than ever before. One hour later, the department orderlies enter the room, grab the handles of her bed — the operation will be performed on a table, but you’ll be returned to your bed afterward — then they transfer her without another word. She is wheeled through corridors, not knowing where to look, sees endless dull ceilings rush past, and coils of electric wire like water snakes. Her heartbeat accelerates as they draw closer to the surgical theater, going through doors requiring electronic pass codes that lead to sterile zones. The space divides again, and then she is taken to a small room where they make her wait. We’ll come and get you. Time is diluted: soon it is midnight.

Behind the door of the operating room, the anesthesiologist checks the placement of the equipment that will monitor the patient’s condition: electrodes to monitor the heart, catheters to provide a continual blood pressure reading, and that device that pinches the patient’s fingertip and tracks oxygen levels in the blood. She sets up the drip, suspending the bag of clear liquid, checking the flow speed — simple gestures, perfectly executed, as you would expect after thirty years of experience — all right, we can get going, is everyone here? But no one is completely ready yet: the team is in the changing rooms, putting on their sky-blue scrubs, short-sleeved shirts, and long-sleeved jackets; everyone wears at least two surgical caps to ensure their entire scalp is covered, and two masks over their mouth. Disposable slippers and overshoes, and multiple pairs of sterile gloves, changed on a regular basis. They wash thoroughly, lathering their hands and forearms up to their elbows with disinfectant soap, cleaning and recleaning their fingernails. Indistinct bodies move into place, check the equipment, but their faces have vanished, leaving only a general notion of appearance, height, shape, gait, mannerisms, and the expressiveness of eyes, which in this room forms the basis of another language. There is a perfusionist, the OR intern, two dressings nurses, and two anesthesiologists: Harfang has worked with these two women — old friends now — for thirty years; he performed his first transplant with them.

And so it begins, like the start of a race. He is wearing a sort of apron gown that covers almost his entire body; it goes on front first and knots in the back; one sleeve is tied to his thumb; with its mid-calf length, it is reminiscent of those straight, narrow aprons that butchers wear. He approaches Claire for one last word: The heart will be here in thirty minutes; it’s a wonderful heart, perfect for you, the two of you will get along splendidly. Claire smiles: But you will wait until it’s in the operating room before you take mine out, won’t you? Harfang stares at her, amazed — are you serious?

Claire is anesthetized. Soon, images appear under her eyelids, a gush of vague shapes and warm tones, an infinite metamorphosis of surfaces, a kaleidoscope of cells and fibers, while the nurses make her head and most of her body disappear under large yellow plastic sheets, which are in turn covered with surgical drapes: only a small area of skin remains visible, lit clearly by the lamps overhead; it is a moving sight, this zone where they will dig. Harfang begins; with a sterile pencil, he traces the lines of the incisions to come, marking out the precise spots where he will make small openings — they slide pipes into these holes, through which they will send a system of tiny cameras. Then the anesthesiologist, ear to the OR phone, announces: Okay, they’re here.