Buried Strangers

Sylvie shook her head. “Mostly not. Consent from their next of kin is what we usually get. And that consent has to be quick. If we don’t get a heart into refrigeration within three hours after death, my boss won’t use it. He won’t use it, either, if the person died from any one of a number of dis-eases, and he won’t use a heart from anyone over fifty, no matter what shape it appears to be in.”

“And lots of people do it?”

“Do what?”

“Agree to donate their next of kin’s hearts.”

“Not enough. It’s the biggest problem we have.”

“So how do you go about it?”

The waiter was back with their fish. Sylvie put down her wine glass, picked up a fork, cut off a small piece of snapper, popped it into her mouth, and savored it.

“Delicious,” she said. “You know something? I don’t like lobster anyway.”

“How do you go about it?” Gilda insisted. “The sourcing, I mean.”

“I don’t go about it,” Sylvie said. “I just implant them.”

“But you must have some idea.”

“Some idea, yes. Basically, it works like this: a good prospect comes into a public hospital; maybe some kid shot to death in a favela, maybe a young woman run over by a car. Anyway, somebody who didn’t die of a debilitating disease, someone who met a sudden, usually violent, end. If the upper torso doesn’t seem to have sustained any major dam-age, if the area around the heart seems to be in good shape, somebody at the hospital tips off my boss and-”

“Why would somebody at the hospital do that?” Gilda interrupted. “Tip off your boss?”

Sylvie took a sip of wine.

“Good stuff, this,” she said.

“Sylvie. .”

Sylvie glanced at the neighboring tables and lowered her voice.

“There’s this woman we have on staff,” she said. “Once he gets the tip, she goes over there, has a chat with the family, tells them how much good they can do by helping someone else, and gets them to release the heart to us.”

“Why don’t they release it to the hospital?”

“Get real, Gilda. You have any idea how much my boss charges for a heart transplant?”

“What’s that got to do with it?”

“It’s got everything to do with it. He pegs his fees to the American dollar, and he gets the whole sum in advance. There’s nothing unusual in that. All the private clinics do it. The current price is four hundred thousand dollars.”

“Dollars?” Gilda did a quick calculation. Four hundred thousand dollars was only a little less than eight hundred thousand reais.

“God,” she said. “I had no idea. Are you suggesting that he uses part of that to pay for tips from hospital staff and part to pay survivors? That he buys hearts?”

“I’m not suggesting anything,” Sylvie said.

But both of them knew she was. And both of them knew it was illegal. In Brazil, as in most countries, the law pro-scribes trafficking in human organs.

“Four hundred thousand dollars,” Gilda repeated, still try-ing to come to terms with the enormity of the sum. “How can he get away with charging so much?”

Sylvie continued to dissect her fish. “He not only gets away with it, he has patients standing in line to pay. If shelling out the money is the only thing that’s going to save your life, you shell out the money. And, if you don’t have it, you beg, borrow, or steal. You know where I worked before?”

“You worked in a number of places. You mean where you first started doing transplants? The Hospital das Clinicas?”

The Hospital das Clinicas was owned and run by the state of Sao Paulo. Most of the patients were people who received free treatment under the government health scheme.

“Uh-huh,” Silvie said. She put a morsel of fish into her mouth, chewed, and swallowed. “Any idea what their official charge is for a heart transplant?”

“Why ‘official?’ ”

“They have to put a number on it. Some people fall out-side the government health scheme, and that’s what they’d charge, if they charged, but they never do. Guess. Guess how much it is.”

“I haven’t the slightest idea.”

“Twenty thousand reais.”

“So why doesn’t everyone elect to do their procedure there?”

“Because, querida, the Clinicas, like every other public hospital, has a hell of a time getting healthy hearts. They source only one or two a month on average. And if you want one, there’s a waiting list as long as my ex- fiance’s penis- which is very long indeed, believe you me.”

“How does one-”

Sylvie anticipated her question. “Get to the top of the list?”

Gilda nodded.

“You make sure you’re young, suffering exclusively from heart failure, and just about to die. And you make sure you’ve been on that list for at least six months, because, all other considerations being equal, hearts are doled out on a first-come, first-served basis.”

While Gilda digested that, Sylvie ingested the rest of her snapper. She left the vegetables and potatoes on the plate and poured herself another glass of white wine.

“So,” Gilda said, “Many patients at the Clinicas die while they’re waiting for a heart?”

Sylvie nodded.

“If you’re over sixty, or if you suffer from a life-threatening disease in addition to your heart problem, your chances of getting an organ through the Clinicas are nil.”

“So that’s the patient profile at your boss’s clinic? The old? The people who suffer from other diseases?”

“Our patients aren’t all old, and they don’t all suffer from other diseases, but they’re all people that can scratch up four hundred thousand dollars. Mind you, even with us there’s no guarantee. We still have more patients than we can find hearts for. The money buys you a better chance, but it doesn’t give you a guarantee. If we could guarantee a heart to any-one who asked, we’d probably be able to charge twice as much. But one thing’s for sure: if you’re poor, you can’t afford us. You have to take your chances with a public hospital.”

“Where the likelihood of someone getting a heart is akin to one’s chances of winning the national lottery?”

“Exactly.”

“And you think that’s right?”

“I’m not a jurist, Gilda. I’m a surgeon. I don’t dictate how the system works. I’m just telling you how it is. Besides, rich people have as much right to life as poor people, wouldn’t you say?”

“But-”

“It’s all regulated, Gilda. The survivors can donate the heart to whomever they want.”

“But not for gain.”

“Not legally, no. But who’s to say it’s for gain?”

“You just implied that-”

Sylvie waved a finger in front of Gilda’s nose.

“No audit by health or tax authorities has ever detected an irregularity in my clinic’s paperwork. I made sure of that before I took the job. I want to earn money, that’s only nat-ural, but not if it involves a risk of losing my license to prac-tice medicine. What with my love life being the way it is, my profession might be the only thing I’ll have to sustain me in my old age.”

Gilda shook her head, more in condemnation of the prac-tice than denial at Sylvie’s prospects. Sylvie reached out and put a hand over one of hers. “Gilda, Gilda, you’re always painting things in black-and-white. The world doesn’t work that way. You have to see the other side of things.”