Harvest

team won't do it, then Tarasoffwill.'

'Even if Josh survives the transfer,' said Abby, 'he still needs a donor heart.'

'Then we'll have to get him one.' Vivian looked straight at Abby. 'Karen Terrio's.'

That's when Abby understood exactly what she had to do. She nodded. 'I'll talk to Joe Terrio now.'

'It has to be in writing. Make sure he signs it.'

'What about the harvest? We can't use the Bayside team.'

'Tarasoft likes to send his own man for the harvest. We'll assist. We'll even deliver to his doorstep. There can't be any delay. We have to do it fast, before anyone here can stop us.'

'Wait a minute,' said the other nurse. 'You can't authorize a transfer to Mass Gen.'

'Yes I can,' saidVivian. 'Josh O' Day is on teaching service. Which means the Chief Residents are in charge. I'll take full responsibility. Just follow my orders and get him ready for ambulance transfer.'

'Absolutely, Dr. Chao,' said Hannah. 'In fact, I'll ride with him.'

'You do that.' Vivian looked at Abby. 'OK, DiMatteo,' she snapped. 'Go get us a heart.'

Ninety minutes later, Abby was scrubbing in. She completed her final rinse and, elbows bent, backed through the swinging door into OR 3.

The donor lay on the table, her pale body washed in fluorescent light. A nurse-anaesthetist was changing IV bottles. No need for anaesthesia on this patient; Karen Terrio could feel no pain.

Vivian, gowned and gloved, stood at one side of the table. Dr. Lima kidney surgeon, stood on the other. Abby had worked with Lim on previous cases. A man of few words, he was known for his swift, silent work.

'Signed and sealed?' asked Vivian.

'In triplicate. It's in the chart.' She herself had typed up the directed-donation consent, a statement specifying that Karen Terrio's heart be given to Josh O' Day, age seventeen.

It was the boy's age that had swayed JoeTerrio. He'd been sitting at his wife's bedside, holding her hand, and had listened to silence as Abby told him about a seventeen-year-old boy who loved baseball. Without saying a word, Joe had signed the paper.

And then he'd kissed his wife goodbye.

Abby was helped into a sterile gown and size six and a half gloves. 'Who's doing the harvest?' she asked.

'Dr. Frobisher, from Tarasoff's team. I've worked with him before,'

said Vivian. 'He's on his way now.'

'Any word about Josh?'

'Tarasoft called ten minutes ago. They've got his blood typed and crossed and an OR cleared. They're standing by.' She looked down impatiently at KarenTerrio. 'Jesus, I could do the heart myself. Where the hell's Frobisher?'

They waited. Ten minutes, fifteen. The intercom buzzed with a call from Tarasoft at Mass Gert. Was the harvest proceeding? 'Not yet,' said Vivian. 'Any minute now.'

Again the intercom buzzed. 'Dr. Frobisher's arrived,' said the nurse. 'He's scrubbing now.'

Five minutes later, the OR door swung open and Frobisher pushed in, his hefty arms dripping water. 'Size nine gloves,' he snapped.

At once the atmosphere in the room stretched taut. No one except Vivian had ever worked with Frobisher before, and his fierce expression did not invite any conversation. With silent efficiency, the nurses helped him gown and glove.

He stepped to the table and critically eyed the prepped operative site. 'Causing trouble again, Dr. Chao?' he said.

'As usual,' saidVivian. She gestured to the others standing at the table. 'Dr. Lim will do the kidneys. Dr. DiMatteo and I will assist as needed.'

'History on this patient?'

'Head injury. Brain dead, donor forms all signed. She's thirty-four, previously healthy, and her blood's been screened.'

He picked up a scalpel and paused over the chest. 'Anything else I should know?'

'Not a thing. NEOB confirms it's a perfect match. Trust me.'

'I hate it when people tell me that,' muttered Frobisher. 'OK, let's take a quick look at our heart, make sure it's in good shape. Then we'll move aside and let Dr. Lira do his thing first.' He touched the scalpel blade to KarenTerrio's chest. In one swift slice, he cut straight down the centre, exposing the breastbone. 'Sternal saw.'

The scrub nurse handed him the electric saw. Abby took hold of the retractor. As Frobisher cut through the sternum, Abby couldn't help turning away. She felt vaguely nauseated by the whine of the blade, the smell of bone dust, neither of which seemed to bother Frobisher, whose hands moved with swift skill. In moments he was in the chest cavity, his scalpel poised over the pericardial sac.

Cutting through the sternum had seemed an act of brute force. What lay ahead was a far more delicate task. He slit open the membrane.

At his first glance at the beating heart, he gave a soft murmur of satisfaction. Glancing across at Vivian, he asked: 'Opinion, Dr. Chao?'

With almost reverential silence, Vivian reached deep into the chest cavity. She seemed to caress the heart, her fingers stroking the walls, tracing the course of each coronary artery. The organ pulsed vigorously in her hands. 'It's beautiful,' she said softly. Eyes shining, she looked across at Abby. 'It's just the heart for Josh.'

The intercom buzzed. A nurse's voice said: 'DrTarasoff's on the line.'

'Tell him the heart looks free,' said Frobisher. 'We're just starting the kidney harvest.'

'He wants to talk to one of the doctors. He says it's extremely urgent.'

Vivian glanced at Abby. 'Go ahead and break scrub. Take the call.'

Abby peeled off her gloves and went to pick up the wall phone. 'Hello, Dr. Tarasoft? This is Abby DiMatteo, one of the residents. The heart looks great. We should be at your doorstep in an hour and a half.'

'That may not be soon enough,' answered Tarasoft. Over the line, Abby could hear a lot of background noise: a rapid-fire exchange of voices, the clank of metal instruments. Tarasofthimself sounded tense, distracted. She heard him turn away, talk to someone else. Then he was back on the line. 'The boy's coded twice in the last ten minutes. Right now we've got him back in sinus rhythm. But we can't wait any longer. Either we get him on the bypass machine now or we lose him. We may lose him in any event.' Again he turned from the receiver, this time to listen to someone. When he came back on line, it was only to say: 'We're going to cut. Just get here, OK?'

Abby hung up and said to Vivian: 'They're putting Josh on bypass. He's coded twice. They need that heart now.'

'It'll take me an hour to free up the kidneys,' said Dr. Lim. 'Screw the kidneys,' snapped Vivian. 'We go straight for the heart.'

'But-'

'She's right,' said Frobisher. He called to the nurse: 'Iced saline! Get the Igloo ready. And someone better call an ambulance for transport.'

'Shall I scrub in again?' asked Abby.

'No.' Vivian reached for the retractor. 'We'll be done in a few minutes. We need you for delivery.'

'What about my patients?'

'I'll cover for you. Leave your beeper at the OR desk.'

One nurse began to pack an Igloo cooler with ice. Another was arranging buckets of cold saline next to the operating table. Frobisher didn't need to issue any more orders; these were cardiac nurses. They knew exactly what to do.

Already, Frobisher's scalpel was moving swiftly, freeing up the heart in preparatory dissection. The organ was still pumping, each beat squeezing oxygen-rich blood into the arteries. Now it was time to stop it, time to shut down the last vestiges of life in Karen Terrio.

Frobisher injected five hundred cc's of a high-potassium solution into the aortic root. The heart beat once. Twice.

And it stopped. It was now flaccid, its muscles paralysed by the sudden infusion of potassium. Abby couldn't help glancing at the monitor. There was no EKG activity. KarenTerrio was finally, and clinically, dead.