Harvest (8 page)

"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.

A nurse poured a bucket of the iced solution into the chest cavity, quickly chilling the heart. Then Frobisher got to work, ligating, cutting.

Moments later, he lifted the heart out of the chest and slid it gently into a basin. Blood swirled in the cold saline. A nurse stepped forward, holding open a plastic bag. Frobisher gave the heart a few more swishes in the liquid, then eased the rinsed organ into the bag. More iced saline was poured in. The heart was double-bagged and placed in the Igloo.

"It's yours, DiMatteo," said Frobisher. "You ride in the ambulance. I'll follow in my car."

Abby picked up the Igloo. She was already pushing out the OR doors when she heard Vivian's voice calling after her:

"Don't drop it."

CHAPTER FIVE

I'm holding Josh O"Day's life in my hands, thought Abby as she clutched the Igloo in her lap. Boston traffic, heavy as always at the noon hour, parted like magic before the flashing ambulance lights. Abby had never before ridden in an ambulance. Under other circumstances, she might have enjoyed this ride, the exhilarating experience of watching Boston drivers - the rudest in the world -finally yield the right of way. But at the moment, she was too focused on the cargo she held in her lap, too aware that every second that ticked by was another second drained from the life of Josh O"Day.

"Got yourself a live one in there, huh Doc?" said the ambulance driver. "G. Furillo' according to his nametag. "A heart," said Abby. "A nice one."

"So who's it going to?"

"Seventeen-year-old boy."

Furillo manoeuvred the ambulance around a row of stalled traffic, his loose-jointed arms steering with almost casual grace. "I've done kidney runs, from the airport. But I have to tell you, this is my first heart."

"Mine too," said Abby.

"It stays good - what, five hours?"

"About that."

Furillo glanced at her and grinned. "Relax. I'll get you there with four and a half hours to spare."

"It's not the heart I'm worried about. It's the kid. Last I heard, he wasn't doing so well."

Furillo focused his gaze more intently on the traffic. "We're almost there. Five minutes, tops."

A voice crackled over the radio. "Unit twenty-three, this is Bayside. Unit twenty-three, this is Bayside."

Furillo picked up the microphone. "Twenty-three, Furillo." "Twenty-three, please return to Bayside ER."

"Impossible. I'm transporting live organ to Mass Gen. Do you copy? I'm enroute to Mass Gen."

"Twenty-three, your instructions are to return to Bayside immediately."

"Bayside, try another unit, OK?" We have live organ on board--'

"This order is specific for Unit twenty-three. Return immediately."

"Who' s ordering this?"

"Comes direct from Dr. Aaron Levi. Do not proceed to Mass Gen. Do you copy?"

Furillo glanced at Abby. "What the hell's this all about?"

They found out, thought Abby. Oh God, they found out. And they're trying to stop us...

She looked down at the Igloo containing Karen Terrio's heart. She thought about all the months and years of living that should lie ahead for a boy of seventeen.

She said, "Don't turn around. Keep going."

"What?"

"I said, keep going."

"But they're ordering me--'

"Unit twenty three, this is Bayside," the radio cut in. "Please respond."

"Just get me to Mass Gert!" said Abby. "Do it."

Furillo glanced at the radio. "Jesus H.," he said. "I don't know--'

"OK, then let me off!." ordered Abby. "I'll walk the rest of the way!"

The radio said: "Unit twenty-three, this is Bayside. Please respond immediately."

"Oh, fuck you," Furillo muttered to the radio.

And he stepped on the gas.

A nurse in green scrubs was waiting at the ambulance dock. As Abby stepped out carrying the Igloo, the nurse snapped: "From Bayside?"

"I have the heart."

"Follow me."

Abby had time for only a last wave of thanks to Furillo, then she was following the nurse through the ER. Moving at a near-jog, Abby caught a fast-forward view of corridors and busy hallways. They stepped into an elevator, and the nurse inserted the emergency key.

"How's the boy doing?" asked Abby. "He's on bypass. We couldn't wait." "He coded again?"

"He doesn't stop coding?The nurse glanced at the Igloo. "That's his last chance you've got there."

They stepped off the elevator, made another quick jog through a set of automatic doors, into the surgery wing.

"Here. I'll take the heart," said the nurse.

Through the suite window, Abby saw a dozen masked faces turn to look as the container was passed through the door to a circulating nurse. The Igloo was immediately opened, the heart lifted from its bed of ice.

"If you put on fresh scrubs, you can go in," said a nurse. "Women's locker room's down the hall."

"Thanks. I think I will."

By the time Abby had donned new greens, cap, and shoe covers, the team in the OR had already removed Josh O"Day's diseased heart. Abby slipped in among the throng of personnel, but found she couldn't see a thing over all those shoulders. She could hear the surgeons' conversation, though. It was relaxed, even congenial. All OR's looked alike, the same stainless steel, the same blue-green drapes and bright lights. What varied was the atmosphere for the people working in that room, and the atmosphere was determined by the senior surgeon's personality.

Judging by the easy conversation, evan Tarasoff was a comfortable surgeon to work with.

Abby eased around to the head of the table and stood beside the anaesthesiologist. Overhead, the cardiac monitor showed a flat line. There was no heart beating in Josh's chest; the bypass machine was doing all the work. His eyelids had been taped shut to protect the corneas from drying, and his hair was covered by a paper cap. One dark tendril had escaped, curling over his forehead. Still alive, she thought. You can make it, kid.

The anaesthesiologist glanced at Abby. "You from Bayside?" he whispered.

"I'm the courier. How's it going so far?"

"Touch and go for a while. But we're over the worst of it. Tarasoff's fast. He's already on the aorta." He nodded towards the chief surgeon.

Ivan Tarasoft, with his snowy eyebrows and mild gaze, was the image of everyone's favourite grandfather. His request for a fresh suture needle, for more suction, were spoken in the same gentle tone with which one might ask for another cup of tea, please. No showmanship, no high-flying ego, just a quiet technician labouring at his job.

Abby looked up again at the monitor. Still a flat line. Still no sign of life.

Josh O"Day's parents were crying in the waiting room, sobs mingled with laughter. Smiles all around. It was 6 p.m., and their ordeal was finally over.

"The new heart's working just fine," said DrTarasoff. "In fact, it started beating before we expected it to. It's a good strong heart. It should last Josh for a lifetime."

"We didn't expect this," said Mr O"Day. "All we heard was that they moved him here. That there was some kind of emergency. We thought- we thought--' He turned away, wrapped his arms around his wife. They clung together, not speaking. Not able to speak.