Maylis de Kerangal - The Heart

* * *

First they have to deal with the veins and arteries that carry blood into and out of the organ. One by one, the veins are severed and clamped — Harfang and Virgilio move quickly, but it’s as if this rapidity drives their action, as if by slowing down they would risk trembling — and then, this is impressive, the heart is extracted from the body and an extracorporeal circulation takes over: for two hours, a machine replaces Claire’s heart, a machine that will reproduce the blood flow in her body. At that moment, Harfang asks for silence. He chimes a blade against a metal tube, then through his mask pronounces the phrase that is ritual at this stage of the operation: Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus —an homage to William Harvey, who in 1628 became the first doctor to describe the entire blood circulation system of the human body, with the heart named as a sort of hydraulic pump, a muscle that — through its movements and beats — ensured the continuity of blood flow. In the theater, without stopping what they are doing, everyone replies: Amen!

The perfusionist is disconcerted by this strange ritual. He does not understand Latin and wonders what the hell is going on. He is a young nurse, twenty-five, twenty-six, with curled-up eyelashes, the only person in the room who has never worked with Harfang before. He is sitting on a high stool positioned in front of his machine, like a DJ with his turntables, and no one here would be more at home than him in the tangle of wires coming out of the large black boxes. Filtered and oxygenated, the blood runs through a jumble of thin transparent pipes, color-coded stickers specifying their direction. On the screen, the electrocardiogram is flat and the body temperature is 90 degrees, but Claire is perfectly alive. The anesthesiologists take turns checking her vital signs, to confirm she is receiving the necessary substances. They can continue.

So Virgilio leans down and picks up the cup containing the heart. The ties of the various bags that protect the organ are sprayed with disinfectant, then undone; after that, he extracts the heart from the jar, holding it in both hands, and places it at the edge of the thoracic cage. Alice, still perched on the metal step, now stands on tiptoes, staring, fascinated, and almost loses her balance when she moves her chin forward to get a better view of what’s happening, there, inside the body. She is not the only one to crane her neck in this way: the department intern, who is standing next to Harfang, also moves forward, his face so covered in sweat that his glasses slide down his nose and he nearly loses them, drawing back at the last minute to push them up, knocking a drip with his elbow. Please be careful, the anesthesiologist says coldly, before handing him a compress.

* * *

Now the surgeons begin the long process of sewing: they labor to connect the new heart, going from bottom to top so that it is anchored at four points — the recipient’s left auricle is stitched to the complementary part of the left auricle of the donor’s heart, same thing for the right auricle, then the recipient’s pulmonary artery is attached to the end of the donor’s right ventricle, and the aorta to the end of the left ventricle. At regular intervals, Virgilio massages the heart, using two hands to press down hard, so his wrists disappear inside Claire’s body.

An almost routine atmosphere descends now, and there are snatches of conversation, sometimes a hubbub of voices, department in-jokes. Harfang asks Virgilio about the game, with that mixture of condescension and fake complicity that annoys the Italian: So what do you think of the Italians’ tactics, Virgilio? Do you think it makes for an entertaining game? And the young man replies, tersely, that Pirlo is a truly great player. The body is kept in a state of hypothermia, but the air in the room is hot now, and the practitioners’ foreheads, temples, and upper lips are regularly sponged, they are helped to change their clothes and their gloves — the nurse opens the bags then holds up the protective outfits horizontally and inside out. The human energy being spent here, the physical tension and the meaning of each action — nothing less than a transfer of life — seems bound to produce this humidity, which starts to grow, to hover like a cloud in the room.

* * *

The suture is completed at last. The transplant organ is purged, the air evacuated so that no bubbles rise into Claire’s brain: now the heart is ready to receive blood.

The tension around the table skyrockets. Harfang announces: Okay, we can fill it up now. This filling is measured to the nearest milliliter, requiring a carefully calibrated flow: if they go too fast, the organ might be permanently deformed. The nurses hold their breath, the anesthesiologists watch vigilantly, the perfusionist sweats — while Alice remains composed. Nobody in the theater moves a muscle; a dense silence covers the surgical bed while the heart is slowly irrigated. And now, at last, we reach the electric moment. Virgilio grabs the paddles and hands them to Harfang; the devices remain suspended in the air for a moment; their eyes meet, then Harfang motions with his chin to Virgilio, go ahead, you do it — and in that moment, maybe Virgilio gathers every prayer and superstition he knows, maybe he begs God, or maybe, on the contrary, he thinks back through everything they have achieved up to now, the sum of their actions and the sum of their words, the sum of spaces and feelings — and he carefully places the electric paddles on either side of the heart, glancing at the screen of the electrocardiogram. Ready? Clear! The heart receives the electric shock, and the world stands still above what is now Claire’s heart. The organ stirs weakly: two, three little jolts, and then it stops. Virgilio swallows, Harfang rests his hands on the edge of the bed, and Alice is so pale that the anesthesiologist, afraid she might collapse, takes her arm and helps her off the step. Second time. Ready?

Clear!

* * *

The heart contracts — a shudder — and then there are tremors, so tiny they are barely perceptible, but you can see them if you look closely, those feeble beats, and slowly the organ begins to pump blood into the body, as it used to. The beats, strangely fast but regular, soon form a rhythm, like an embryo’s pulse, that jerky percussion heard during the first ultrasound, and what we are hearing is indeed embryonic — the first heartbeat, a new dawn.

* * *

Did Claire hear Thomas Rémige’s voice during her anesthetic dreams, as he sang his song of a good death? Did she hear him at four in the morning as she received Simon Limbres’s heart? She is placed under extracorporeal assistance for another thirty minutes, and then, like Simon, she is sewn up, the retractors releasing the tissue for a delicate ladylike suture. She remains in the theater under surveillance, surrounded by black screens that trace the luminous waves of her heart, while her body recuperates, while the bedlam of the room is tidied, while the implements and compresses are tallied, while the blood is wiped away, while the team breaks up, while everyone discards their surgical scrubs and dresses in their own clothes, while they splash water on their faces and wash their hands, then leave the hospital to catch the first metro, while Alice recovers and risks a smile as Harfang whispers into her ear, so, little Harfang girl, what did you think of all that? while Virgilio takes off his surgical cap and lowers his mask and decides to ask her to join him for a beer somewhere in Montparnasse, for a plate of fries and a bloody steak, to prolong the atmosphere of this night, while she puts on her white overcoat and he strokes the fur collar, while the first rays of daylight touch the undergrowth and the moss turns bluish, while the goldfinch sings and the big surf comes to an end in the digital night: it is 5:49 a.m.