Harvesting the Heart

Nicholas jumped, hitting his head on the low roof of the helicopter, and reached for the Playmate cooler. He shook the image of his father from his mind and waited for a surgeon’s reserve of energy to come from his gut, pulse into his arms and his legs, and spring to the balls of his feet.

Fogerty was waiting in the operating suite. As Nicholas came through the double doors, scrubbed and gowned, Fogerty began to open Alamonto’s chest. Nicholas listened to the whir of the saw slicing through bone as he prepared the heart for its new placement. He turned to face the patient, and that was when he stopped.

Nicholas had done more than enough surgeries in his seven years as a resident to know the procedure cold. Incisions, opening the chest, dissecting and suturing arteries-all these had become second nature. But Nicholas was used to seeing a patient with wrinkled skin, with age spots. Under the orange antiseptic, Paul Alamonto’s chest was smooth, firm, and resilient. “Unnatural,” Nicholas whispered.

Fogerty’s eyes slid to him above the blue mask. “Did you say something, Dr. Prescott?”

Nicholas swallowed and shook his head. “No,” he said. “Nothing.” He clamped an artery and followed Fogerty’s instructions.

When the heart had been dissected, Fogerty lifted it out and nodded to Nicholas, who placed the heart of the thirty-two-year-old woman in Paul Alamonto’s chest. It was a good fit, a near match, according to the tissue analyses done by computer. It remained to be seen what Paul Alamonto’s body would do with it. Nicholas felt the muscle, still cold, slipping from his fingers. He mopped as Fogerty attached the new heart just where the old one had been.

Nicholas held his breath when Fogerty took the new heart in his hand, kneading it warm and willing it to beat. And when it did, a four-chamber rhythm, Nicholas found himself blinking in time with the blood. In, up, over, out. In, up, over, out. He looked across the patient at Fogerty, who he knew was smiling beneath his mask. “Close, please, Doctor,” Fogerty said, and he left the operating room.

Nicholas threaded the ribs with wire, sutured the skin with tiny stitches. He had a fleeting thought of Paige, who made him sew loose buttons on his own shirts, saying he was better at it by trade. He exhaled slowly and thanked the rghtAhanked thesidents and the operating room nurses.

When he moved into the scrub room and peeled off his gloves, Fogerty was standing with his back to him at the far side of the room. He did not turn as Nicholas jerked off his paper cap and turned on the faucet. “You’re right about cases like that, Nicholas,” Fogerty said quietly. “We are playing God.” He tossed a paper towel into a receptacle, still facing away from Nicholas. “At any rate, when they’re that young, we’re fixing what God did wrong.”

Nicholas wanted to ask Alistair Fogerty many things: how he’d known what Nicholas was thinking, how come he’d sutured a certain artery when it would have been easier to cauterize it, why after so many years he still believed in God. But Fogerty turned around to face him, his eyes sharp and blue, as splintered as crystal. “Seven o’clock, then, at your place?”

Nicholas stared for a moment, dumbfounded, and then remembered that he was giving his first dinner party for his “associates”-Alistair Fogerty, as well as the heads of pediatrics, cardiology, and urology. “Seven,” he said. He wondered what time it was now; how long it would take him to change gears. “Of course.”

Nicholas had been having nightmares again. They weren’t the same ones he’d had when he was in medical school, but they were every bit as disturbing, and Nicholas believed they stemmed from the same source, that old fear of failure.

He was being chased through a heavy, wet rain forest whose ivy vines dripped blood. He could feel his lungs near bursting; he pulled his legs high from the spongy ground. He did not have time to look back, could only brush the branches from his face as they lacerated his forehead and his cheeks. In the background was the banshee howl of a jackal.

The dream always started with Nicholas running; he never knew what it was he was running from. But sometime during the sheer physical concentration of sprinting, of balancing and dodging thick trees, he’d realize that he was no longer being chased. All of a sudden he was running toward something, just as faceless and forbidding as his pursuer had been. He gasped; he grabbed at a stitch in his side, but he couldn’t move quickly enough. Hot butterflies slapped against his neck and leaves striped his shoulders as he tried to move faster. Finally, he hurled himself against a sandstone altar, carved with the leers of naked pagan gods. Panting, Nicholas slid to his knees in front of the altar, and beneath his fingers it turned into a man, a person made of warm skin and twisted bone. He looked up and saw his own face, older and broken and blind.

He always woke up screaming; he always woke up in Paige’s arms. Last night when he had become fully conscious of his surroundings, she had been hovering over him with a damp washcloth, wiping his sweaty neck and chest. “Sssh,” she said. “It’s me.”

Nicholas let a choked sound escape from his throat and pulled Paige to him. “Was it the same?” she asked, her words muffled against his shoulder.

Nicholas nodded. “I couldn’t see,” he said. “I don’t know what I was running from.”

Paige ran her cool fingers up and down his arm. It was in these moments, when his defenses were down, that he would cling to her and think of her as the one constant in his life and let himself give in completely. Sometimes when he reached for her after the nightmares, he would grasp her arms so tightly he left bruises. But he never told her the end of the dream. He couldn’t. Whenever he had tried, he’d started shaking so badly he couldn’t finish.

Paige wrapped her arms around him, and he leaned into her, still warm and soft with sleep. “Tell me what I can do for you,” she whispered.

“Hold me,” Nicholas said, knowing she would; knowing, with the unswerving faith of a child at Christmastime, that she would never let go.

Paige hadn’t wanted to tell anyone she was pregnant. In fact, if Nicholas hadn’t known better, he would have thought she was avoiding the inevitable. She didn’t run out to buy maternity clothes; they really didn’t have the extra money, she said. In spite of Nicholas’s urging, when she called her father she did not tell him the news. “Nicholas,” she had told him, “one out of every three pregnancies ends in miscarriage. Let’s just wait and see.”

“That’s only true through the first trimester,” Nicholas had said. “You’re almost five months along.”

And Paige had turned on him. “I know that,” she said. “I’m not stupid. ”

“I didn’t say you were stupid,” Nicholas said gently. “I said you were pregnant.”

He drove home quickly, hoping Paige had remembered this dinner party even if he hadn’t. She’d have to, after the way they’d fought over it. Paige insisted the house was too small, that she couldn’t cook anything worthy of a dinner party, that they didn’t have fine china and crystal. “Who cares?” Nicholas had said. “Maybe they’ll feel bad and give me more money.”

He opened the back door and found his wife sitting on the kitchen floor. She wore an old shirt of his and a pair of his pants rolled to the knee. She held a bottle of Drano in one hand and a glass in the other, ringed brown. “Don’t do it,” Nicholas said, grinning. “Or if you do, wouldn’t sleeping pills be more pleasant?”

Paige sighed and put the glass down on the floor. “Very funny,” she said. “Do you know what this means?”

Nicholas pulled open his tie. “That you don’t want to have a dinner party?”

Paige held up her hand and let Nicholas pull her to her feet. “That it’s a boy.”

Nicholas shrugged. The ultrasound had said the same thing; the waitresses at Mercy said she was carrying out in front, the way you carry a boy. Even the old wives’ tale had confirmed it-the wedding ring dangling from a string had moved back and forth. “Drano probably isn’t the definitive test,” he said.

Paige went to the refrigerator and began pulling out trays of food covered by aluminum foil. “You pee into a cup, and then you add two tablespoons of Drano,” she said. “It’s like ninety percent foolproof. The Drano people have even written to OB/GYNS, asking them to tell their patients this is not a recommended use for their product.” She closed the door and leaned against it, her hands pressed against her forehead. “I’m having a boy,” she said.

Nicholas knew that Paige did not want a boy. Well, she wouldn’t admit it, at least not to him, but it was as if she just assumed that being the kind of person she was, it was impossible for her to be carrying anything other than a tiny replica of herself. “Now, really,” Nicholas said, putting his hands on her shoulders, “would a boy really be so awful?”