She took the chart to the desk and began to write: Transfer to 5 East, Thoracic Surgery Service. Diagnosis: Post-op open lung biopsy for multiple pulmonary nodules. Condition: stable. She wrote steadily: orders for diet, meds, activity. She reached the line for code status. Automatically she wrote: Full code.
She looked across the desk at Mary Allen, lying motionless on the gurney. Thought about what it would be like to be eighty-four years old and fiddled with cancer, the days numbered, each one filled with pain. Would the patient choose a kinder, swifter death? Abby didn't know.
'Dr. DiMatteo?' It was a voice over the intercom.
'Yes?' said Abby.
'You had a call from 4 East about ten minutes ago. They want you to come by.'
'Neurosurg? Did they say why?'
'Something about a patient named Terrio. They want you to talk to the husband.'
'Karen Terrio's not my patient any longer.'
'I'm just passing the message along, Doctor.'
'OK, thanks.'
Sighing, Abby rose to her feet and went to Mary Allen's gurney for one last check of the cardiac monitor, the vital signs. The pulse was running a little fast, and the patient was moving, groaning again. Still in pain.
Abby looked at the nurse. 'Another two milligrammes of morphine,' she said.
The blip on the EKG monitor traced a slow and steady rhythm.
'Her heart's so strong,' murmured JoeTerrio. 'It doesn't want to give up. She doesn't want to give up.'
He sat at his wife's bedside, his hand clasping hers, his gaze fixed on that green line squiggling across the oscilloscope. He looked bewildered by all the gadgetty in the room. The tubes, the monitors, the suction pump. Bewildered and afraid. He focused every ounce of attention on the EKG monitor, as though, if he could somehow master the secrets of that mysterious box, he could master everything else. He could understand why and how he had come to be sitting at the bedside of the woman he loved, the woman whose heart refused to stop beating.
It was 3 p.m., sixty-two hours since a drunk driver had slammed into KarenTerrio's car. She was thirty-four years old, HIV negative, cancer free, infection free. She was also brain dead. In short, she was a living supermarket of healthy donor organs. Heart and lungs. Kidneys. Pancreas. Liver. Bone. Corneas. Skin. With one terrible harvest, half a dozen different lives could be saved or changed for the better.
Abby pulled up a stool and sat down across from him. She was the only doctor who'd actually spent much time talking with Joe, so she was the one the nurses had called to speak to him now. To convince him to sign the papers and allow his wife to die. She sat quietly with him for a moment. Karen Terrio's body stretched between them, her chest rising and falling at a preselected twenty breaths per minute.
'You're right, Joe,' said Abby. 'Her heart is strong. It could keep going for some time. But not forever. Eventually the body knows. The body understands.'
Joe looked across at her, his eyes red-rimmed with tears and sleeplessness. 'Understands?'
'That the brain is dead. That there's no reason for the heart to keep beating.'
'How would it know?'
'We need our brains. Not just to think and feel, but also to give the rest of our body a purpose. When that purpose is gone, the heart, the lungs, they start to fail.' Abby looked at the ventilator. 'The machine is breathing for her.'
'I know.' Joe rubbed his face with his hands. 'I know, I know. I know. .'
Abby said nothing, Joe was rocking back and forth in his chair now, his hands in his hair, his throat squeezing out little grunts and whimpers, the closest thing to sobs a man could allow himself. When he raised his head again, clumps of his hair stood up damp and stiff with tears.
He looked up at the monitor again. The one spot in the room he seemed to feel was safe to stare at. 'It all seems too soon.'
'It isn't. There's only a certain amount of time before the organs start to go bad. Then they can't be used. And no one is helped by that, Joe.'
He looked at her, across the body of his wife. 'Did you bring the papers?'
'I have them.'
He scarcely looked at the forms. He merely signed his name at the bottom and handed the papers back. An ICU nurse and Abby witnessed the signature. Copies of the form would go into Karen Terrio's record, to the New England Organ Bank, and Bayside's Transplant Coordinator files. Then the organs would be harvested.
Long after KarenTerrio was buried, bits and pieces of her would go on living. The heart that she'd once felt thudding in her chest when she'd played as a five-year-old, married as a twenty-year-old, and strained at childbirth as a twenty-one-year-old, would go on beating in the chest of a stranger. It was as close as one could come to immortality.
But it was scarcely much comfort to Joseph Terrio, who continued his silent vigil at the bedside of his wife.
Abby found Vivian Chao undressing in the OR locker room. Vivian had just emerged from four hours of emergency surgery, yet not a single blot of sweat stained the discarded scrub clothes lying on the bench beside her.
Abby said, 'We have consent for the harvest.'
'The papers are signed?' asked Vivian. 'Yes.'
'Good. I'll order the lymphocyte crossmatch.' Vivian reached for a fresh scrub top. She was dressed only in her bra and underwear, and every rib seemed to stand out on her frail, flat chest. Honorary manhood, thought Abby, is a state of mind, not body. 'How are her vitals?' asked Vivian.
'They're holding steady.'
'Have to keep her blood pressure up. Kidneys perfused. It's not every day a nice pair of AB positive kidneys comes along.' Vivian pulled on a pair of drawstring trousers and tucked in her shirt. Every movement she made was precise. Elegant.
'Will you be scrubbing in on the harvest?' asked Abby.
'If my patient gets the heart, I will. The harvest is the easy part. It's reattaching the plumbing that gets interesting.' Vivian closed the locker door and snapped the padlock shut. 'You have a minute?
I'll introduce you to Josh.'
'Josh?'
'My patient on the teaching service. He's up in MICU.'
They left the locker room and headed down the hall towards the elevator. Vivian made up for her short legs by her quick, almost fierce stride. 'You can't judge the success of a heart transplant until you've seen the before and the after,' said Vivian. 'So I'm going to show you the before. Maybe it'll make things easier for you.' 'what do you mean?'
'Your woman has a heart but no brain. My boy has a brain and practically no heart.'The elevator door opened. Vivian stepped in. 'Once you get past the tragedy, it all makes sense.'
They rode the elevator in silence.
Of course it makes sense, thoughtAbby. It makes perfect sense. Vivian sees it clearly. But I can't seem to get past the image of two little girls standing by their mother's bed. Afraid to touch her… Vivian led the way to the Medical ICU. Joshua O' Day was asleep in Bed 4.
'He's sleeping a lot these days,' whispered the nurse, a sweet faced blonde with Hannah Love, RN, on her nametag.
'Change in meds?' asked Vivian.
'I think it's depression.' Hannah shook her head and sighed. 'I've been his nurse for weeks. Ever since he was admitted. He's such a terrific kid, you know? Really nice. A little goofy. But lately, all he does is sleep. Or stare at his trophies.' She nodded at the bedside stand, where a display of various awards and ribbons had been lovingly arranged. One ribbon went all the way back to the third grade — an honourable mention for a Cub Scout Pinewood Derby. Abby knew about pinewood derbies. Like Joshua O' Day, her brother had been a Cub Scout.
Abby moved to the bedside. The boy looked much younger than she had expected. Seventeen, according to the birthdate on Hannah Love's clipboard. He could have passed for fourteen. A thicket of plastic tubes surrounded his bed, IV's and arterial and Swan-Ganz lines. The last was used to monitor pressures in the right atrium and
