struggling to stay awake. Think. A post-op fever. Where was the infection coming from? What had she overlooked?
'What about the organ?' said Sheila.
Abby looked up. 'The heart?'
'It was just something that occurred to me. But I guess it's not very likely…'
'What are you thinking, Sheila?'
The nurse hesitated. I've never seen it happen here. But before I came to Bayside, I used to work with a renal transplant service in Mayo. I remember we had this patient. A kidney recipient with post-op fevers. We didn't figure out what his infection was until after he died. It turned out to be fungal. Later they tracked down the donor record and found out the donor's blood cultures were positive, but the results didn't come back until a week after the kidney was harvested. By then it was too late for the recipient. Our patient.'
Abby thought it over for a moment. She looked at the bank of monitors, at the heart tracing of Bed 15 dancing across the screen. 'Where's the donor information kept?' asked Abby.
'It would be in the Transplant Coordinator's office downstairs. The Nursing Supervisor has the key.'
'Could you ask her to get the file for me?'
Abby reopened NinaVoss's chart. She turned to the New England Organ Bank donor form — the sheet that had accompanied the heart from Vermont. Recorded there was the ABO blood type, HIV status, syphilis antibody titres, and a long list of other lab screens for various viral infections. The donor was not identified.
Fifteen minutes later, the phone rang. It was the nursing supervisor, calling for Abby.
'I can't find the donor file,' she said.
'Isn't it under NinaVoss's name?'
'They're filed under the recipient's medical record number.
There's nothing here under Mrs Voss's number.'
'Could it be misfiled?'
'I've looked in all the kidney and liver transplant files too. And I double-checked that record number. Are you sure it isn't somewhere up in the SICU?'
'I'll ask them to look. Thanks.' Abby hung up and sighed. Missing paperwork. It was the last thing she felt like dealing with at this time of the morning. She looked at the SICU records shelf, where files from current patients' previous hospitalizations were kept. If the missing file was buried somewhere in that, she could be searching for an hour.
Or she could call the donor hospital directly. They could pull the record, tell her the donor's medical history and lab tests.
Directory assistance gave her the number for Wilcox Memorial. She dialled the number and asked for the nursing supervisor.
A moment later a woman answered: 'Gail DeLeon speaking.'
'This is Dr. DiMatteo calling from Bayside Hospital in Boston,' said Abby. 'We have a heart transplant recipient here who's running a post-op fever. We know the donor heart came from your OR. I need a little more information on the donor's medical history. I wonder if you might know the patient's name.'
'The organ harvest was done here?'
'Yes. Three days ago. The donor was a boy. An adolescent.'
'Let me check the OR log. I'll call you back.'
Ten minutes later, she did — not with an answer but with a question: 'Are you sure you have the right hospital, doctor?'
Abby glanced down at Nina's chart. 'It says right here. Donor hospital was Wilcox Memorial. Burlington, Vermont.'
'Well that's us. But I don't see a harvest on the log.'
'Can you check your OR schedule? The date would have been…' Abby looked at the form. 'September 24th. The harvest would've been done sometime around midnight.'
'Hold on.'
Over the receiver, Abby heard the sound of turning pages and the nurse's intermittent throat clearing. The voice came back. 'Hello?'
'I'm here,' said Abby.
'I've checked the schedule for September 23rd, 24th, and 25th. There are a couple of appendectomies, a cholecystectomy, and two Caesareans. But there's no organ harvest anywhere.'
'There has to be. We got the heart.'
'We're not the ones who sent it.'
Abby scanned the OR nurses' notes and saw the notation: O105: Dr. Leonard Mapes arrived from Wilcox Memorial. She said, 'One of the surgeons who scrubbed on the harvest was Dr. Leonard Mapes. That's the same guy who delivered it.'
'We don't have any Dr. Mapes on our staff.'
'He's a thoracic surgeon-'
'Look, there's no Dr. Mapes here. In fact, I don't know of any Dr. Mapes practising anywhere in Burlington. I don't know where you're getting your info, doctor, but it's obviously wrong. Maybe you should check again.'
'But-'
'Try another hospital.'
Slowly Abby hung up.
For a long time she sat staring at the phone. She thought about Victor Voss and his money, about all the things that money could buy. She thought about the amazing confluence of events that had granted Nina Voss a new heart. A matched heart.
She reached, once again, for the telephone.
CHAPTER NINE
'You're overreacting,' said Mark, flipping through NinaVoss's SICU
chart. 'There has to be a reasonable explanation for all of this.'
'I'd like to know what it is,' said Abby.
'It was a good excision. The heart came packed right, delivered right. And there were donor papers.'
'Which now seem to be missing.'
'The transplant coordinator will be in at nine. We can ask her about the papers then. I'm sure they're around somewhere.'
'Mark, there's one more thing. I called the donor hospital. There's no surgeon named Leonard Mapes practising there. In fact there's no such surgeon practising in Burlington.' She paused. Softly she said, 'Do we really know where that heart came from?'
Mark said nothing. He seemed too dazed, too tired to be thinking straight. It was four-fifteen. After Abby's phone call, he'd dragged himself out of bed and driven to Bayside. Post-op fevers required immediate attention, and although he trusted Abby's findings, he had wanted to see the patient for himself. Now Mark sat in the gloom of the SICU, struggling to make sense of the paperwork in Nina Voss's chart. A bank of heart monitors faced him on the countertop, and three bright green lines traced across the reflection in his glasses. In the semidarkness nurses moved like shadows and spoke in hushed voices.
Mark closed the chart. Sighing, he pulled off his glasses and rubbed his eyes. 'This fever. What the hell is causing the fever? That's what really concerns me.'
'Could it be an infection passed from the donor?'
'Unlikely. I've never seen it happen with a heart.'
'But we don't know anything about the donor. Or his medical history. We don't even know which hospital that heart came from.'
'Abby, you're going off the deep end here. I know Archer spoke on the phone to the harvesting surgeon. I
