A Permanent Member of the Family

TRANSPLANT

The crushed gravel footpath wound uphill from the parking lot through a grove of poplar trees. From the passenger’s seat of the van, Howard spotted the monument at the top of the hill — a head-high granite pylon that marked the site of a Puritan massacre of a band of Narragansett Indians. He made out the slender figure of a woman standing next to the pylon. She wore jeans and a bright yellow nylon poncho with the hood up. He turned to the woman in the driver’s seat and said, “I don’t know, Betty. It’s farther than I usually walk, you know.”

“Can’t turn back now,” she said. She reached across him and opened his door and handed his cane to him. “It’s not so far. She’s waiting for you.”

“Maybe you could go up and bring her down here instead.”

“Maybe you could pretend she doesn’t exist and go sit on the porch at the house like an invalid and watch the sun set over the harbor. You need the exercise, Howard. Besides, you set this up. This is your deal.”

“No, it’s Dr. Horowitz’s deal,” he said. He grabbed his cane and eased himself from the van. The whole thing is crazy, he thought. I am an invalid. I need to be left alone. This woman shouldn’t bring her troubles to me, I’ve got enough of my own. He stood unsteadily for a few seconds, then squared his shoulders and slowly made his way up the path toward the woman in the yellow poncho.

THIS WAS NOT HOW he had expected the day to play out. Around ten that morning Betty had entered his bedroom without knocking, as usual, and had drawn back the curtains and let sunlight flood the room. From his bed Howard saw the sloping meadow below and then the harbor and the long, low peninsula on the far side, the white steeple of the church and the colonial-era waterside houses and docks of the fishing village, and his irritation, as usual, passed.

“Let’s check the vitals,” Betty said. “See if you’re ready for a walk in the park today. Doctor’s orders.” She pushed up his pajama sleeve and began taking his blood pressure. She was an abrupt, pink, square-faced woman with graying, straw-colored hair cut in a pageboy with Prince Valiant bangs. Her hair looked ridiculous to Howard. She was in her mid-forties, a few years younger than he. After some initial difficulty, they had become friends. Her short, athletic body was attractive, but in a masculine way that was not sexy to him, and he was glad of that. Relieved, is more like it.

Betty treated him as if he were an adolescent boy, but he felt like a very old man locked in an even older man’s body. He liked her crisp, no-nonsense personality and her bark of a laugh when he resisted her attempts to get him up and moving or make him follow his strict diet, drink eight glasses of water a day, walk in the house without a cane. A certain degree of irritation gave him pleasure. Her refusal to treat him the way he felt, along with the daily sight of the harbor and the marina and town on the other side of it, cheered him. Very little else cheered him, however.

“You got a phone call to make,” she said and stuck the thermometer under his tongue. “Dr. Anthea Horowitz wants to talk to you. What kind of name is that anyhow, Anthea? She’s Jewish, right?” She pulled out the thermometer, checked it and shook it down. “Ninety-seven point nine. BP is one thirty over seventy-eight. You’re still functional, Howard.”

“I don’t know, Scandinavian, maybe. Could be Jewish, I guess. How many times have you asked me about her name, anyhow? You got a problem with Jewish women doctors? Give me the damned phone,” he said.

She passed him the telephone. “Don’t forget your morning meds,” she said and pointed to the glass of water and plastic cup of pills on the bedside table. “Breakfast in fifteen, mister. More like brunch, actually,” she noted and headed for the kitchen.

SINCE HE’D LEFT THE HOSPITAL, every morning had been the same. He knew at once where he was and why, but couldn’t remember exactly how he had got there. It wasn’t the painkillers — he’d been off them for five weeks almost. It had to be the residue of the anesthesia. They say it takes a month for every hour you’re anesthetized before you’re normal, and he’d been knocked out for eight and a half hours. He did the math again: it was mid-May; the operation had been January sixth; he wouldn’t be clear of the effects of the anesthesia until September.

There were still large blank patches in his memory that shifted locale daily, unpredictably. Every morning when he woke, he remembered suddenly something that the day before he’d been unable to recall — his cell phone number or the name of his daily newspaper. Then an hour or two later he’d notice a batch of new blanks — he couldn’t remember the brand of car he owned, his social security number, the name of the mysterious, leafy green vegetable in the refrigerator. The patch over his move in March from the hospital to his ex-mother-in-law’s summer house had stayed, however, week after week, month after month. He had no memory of the actual event. That worried him.

Howard knew the facts. He had been told them by his ex-wife, Janice, and her mother, and by his surgeon, Dr. Horowitz, and his nurse, Betty O’Hara, and could pass that information on to anyone who wanted to know why he was living alone in a seaside summer cottage on Cohasset Harbor. The explanation was simple. He couldn’t return to his own house in Troy, New York, because he had undergone the transplant in Boston and had to stay nearby, monitored by Dr. Horowitz and her staff, while recovering from the surgery. Betty tested his blood daily and drove him to Boston weekly to be examined for telltale signs of rejection or infection. His insurance, although it covered Betty’s salary, wouldn’t pay for an apartment or house in the area. And he was currently unemployed — he had been a publisher’s representative, basically a traveling salesman for the northeast region, a job he was no longer capable of holding. He had fallen on hard times, as he liked to say. Luckily, drawing from some half-filled well of residual affection, his ex-wife had talked her mother into giving him the use of her summer house. He knew all that, although he couldn’t remember actually moving in, taking up residence.

He had no problem remembering Dr. Horowitz’s office number, however. In the last year, while waiting for an available heart, he had called her office hundreds of times, and dozens of times since the surgery. He sat up in bed and dialed and told the receptionist that he was returning a call from Dr. Horowitz. A few seconds later, she came on the line.

“Howard?”

“Yes. Hello.”

“How are you feeling this week, Howard?” She sounded tentative to him, less assured than usual. Not a good sign.

“Okay, I guess. No complaints. Why, anything wrong with my tests?”

“No, no, no. Everything’s hunky-dory. I’m sorry to bother you. I’m not bothering you, am I? Can you talk?”

“Yeah, sure. What’s up, Doc?” If she could say everything was hunky-dory, he could call her Doc.

“Howard, I’m passing on a request. Not a usual request, but one I have to honor. You understand.”

“Yeah. Sort of.”

“The wife… the widow of the man who donated your heart…?”

“My heart.”

“Yes. She wants to meet you.”

They were both silent for a moment. “Christ. She wants to meet me?”

“Yes.”

“Why?”

“I haven’t given her your contact information. I can’t do that without your permission. I only agreed to convey her request. That’s all.”

“Why, though? Why does she want to meet me? I don’t think… I’m not sure I can handle that.”

“I understand, Howard. I know you’ve been depressed. That’s not unusual. I can prescribe something for it, you know.”

“It’s not like the heart’s adopted and she’s the birth mother.”

“It’s up to you. It’s not all that uncommon, you know.”

“What, being depressed after a heart transplant?”

“That, too. But, no, the donor wanting to meet the recipient.”

“She’s not the donor,” he said. All he knew about his heart before it became his was that it had belonged to a twenty-six-year-old man who had died of head injuries suffered in a motorcycle accident. The man, a roofer in New Bedford, had been married, the father of a very young child. And a nonsmoker, Dr. Horowitz had assured him. Howard placed his right hand onto his heart and felt its sturdy beat. It’s my heart, damn it! It belongs to Howard Blume, not some poor kid who fell off his motorcycle, hit his head on a curb and died.

He said, “I’ve got to think about it.”

“Of course. She says she’ll meet you anywhere you want. She’s young, barely twenty-two, and I take it she’s alone in the world. Except for her baby boy. My guess is she still hasn’t accepted the death of her husband, hasn’t found closure. It’s not unusual.”

“Closure. I don’t know the meaning of the word,” he said. He was thinking of his divorce from Janice seven years ago, the end of a brief but perfect marriage — a marriage ruined by the affairs and dalliances that had resulted from his refusal to come in off the road and live and work close to home, maybe run a bookstore, turn himself into a domesticated man, a faithful husband because watched, a secure husband because watchful. But he’d spent twenty years on the road before falling in love with Janice, and after marrying her continued sleeping five nights a week away from home. Howard believed that he had married too late, when he was too old to change his ways. He was attractive to women, in spite of being a cold and selfish man, and he had betrayed Janice frequently, and finally Janice had betrayed him back and had fallen in love with one of her lovers, and now she was married to him and had two children with him, and that was that.

When a terrible thing happens, and it’s your own damn fault, there’s no closure, he thought. Whatever happened, you live with it. Alone, he had endured his three heart attacks and open-heart bypass surgery and a year later the steady deterioration of the organ itself. And now the transplant. All of it somehow the result of his having ruined his marriage to Janice, the one truly good thing that had befallen him. He believed that none of it, the heart attacks, the surgery, the transplant, would have happened if it hadn’t been for the divorce. It was a superstition, he knew, but he couldn’t let it go.

This young woman, though, had not caused her husband’s accident, the terrible thing that had happened to her. It was her husband’s fault. Maybe, for her, closure — whatever that meant—was possible. “I guess I owe her a lot, right? I mean, she’s the one who made the decision to donate his organs.”

Dr. Horowitz asked where he would like to meet the woman. Her name was Penny McDonough, she said, from New Bedford, less than an hour’s drive from his cottage on Cohasset Harbor.

“I don’t want her to come here,” he said. “I’ll ask Betty where’s a good place nearby, someplace she can drive me to. I’ll get back to you and set a time,” he said. “Tell her that I’m only good for a short visit.”

HE NEARED THE MONUMENT at the top of the hill, breathing hard, leaning heavily on his cane, his heart pounding: Whose heart was it, anyhow? Dear God, whose heart is inside me? It was not his own, but it was not someone else’s, either. Until this moment Howard had managed not to ask that question. Now, since agreeing to meet this woman, he couldn’t stop asking it, and he knew why he had avoided it for so long. There was no answer to the question. None. He was afraid that for the rest of his life he would not be able to say whose heart was keeping him alive.

He walked to the side of the monument where the woman in the yellow poncho stood waiting. She was very slender — fragile-seeming, almost childlike, with small hands and thin, bony wrists. Young enough to be his daughter, he thought. Instead of a woman’s purse, she held a green cloth book bag. She had pale skin and large blue eyes and wore no makeup or jewelry that he could see. Short wisps of coppery hair crossed her forehead, and he remembered her name, Penny, and wondered what her real name was. Not Penelope. Probably something Irish, he thought.

“I’m Howard Blume,” he said. “I guess you’re Penny? Mrs. McDonough, I mean.” He extended his right hand, and she gave him hers, cold and half the size of his.

“Yes. Thank you, Mr. Blume, for agreeing to meet with me.” She had a flattened South Shore accent. She looked directly at his eyes, but not into them, as if she had met him once long ago and was trying to remember where. “I’m sorry you had to walk all the way up here from the car,” she said. “I wasn’t sure it was you, or I’d have come down.”

“That’s okay. I needed the exercise.”

She made a tight-lipped smile. “Because of the surgery, yes. Are you all right? I mean…”

“Yes, I’m fine,” he said, cutting her off. “Listen, this is kind of uncomfortable for me. But I did want to be able to tell you how grateful I am for what you did. I don’t know why you wanted to meet me, but that’s why I wanted to meet you. To tell you… to thank you.”

“You don’t have to thank me. It’s what Steve, my husband, it’s what he would have wanted.”

“Yeah, well, I guess I should thank him, too.” He paused for a moment. “He must’ve been a good guy. Thoughtful. Right?”

She drew her bag in front of her, as if about to open it. “Yes. I have a favor I’d like to ask you,” she said. “May I?”

“Yeah, sure. Why not?”

“I want to listen to your heart. Steve’s heart.”

“Jesus! Listen to my heart? That’s… I mean, isn’t that a little… weird?”

“It would mean a lot to me. More than you can know. Please. Just once, just this one time.” She opened the bag and withdrew a black and silver stethoscope and extended it, as if it were an offering.

“I don’t know. It feels a little creepy to me. You can understand that, can’t you?” Howard looked down the hill toward the car. He didn’t want Betty to see this. He didn’t want anyone to see this. A few yards beyond the parking lot the narrow road followed the rock-strewn shore. A thickening bank of clouds had blotted out the sun, and an offshore wind had raised a chop in the blue-gray water.

“Please,” she said in a low voice. “Please let me do this.” She pushed back her hood and laid the curved, rubber-tipped ends of the stethoscope over her shoulders and around her neck.

Howard said nothing. He merely nodded, and she placed the tips into her ears and stepped toward him.

“Will you undo your shirt?”

He pulled his flannel shirt loose of his trousers and unbuttoned it all the way down. Why the hell am I letting her do this? I could just refuse and walk away, he thought. “What about my T-shirt?” he asked. “Want me to lift it up?”

“No,” she said firmly. “I don’t want to see it.”

The chest piece at the end of the stethoscope was the size and shape of a small biscuit, and swiftly, as if she’d rehearsed, the young woman placed it directly over the incision in Howard’s chest. Then she closed her eyes and listened. Tears ran down her cheeks. Howard put his arms around her shoulders and drew her closer to him and felt himself shudder and knew that he was weeping, too. Several moments passed, and then the woman removed the tips of the stethoscope from her ears and pressed the left side of her head against Howard’s chest. They stood together for a long time, buffeted by the wind off the harbor, holding each other, listening to Howard’s heart.

A light rain had started falling. In the parking lot below, Betty walked around the front of the van, checked her watch, and gazed up at the couple. After a few seconds, she walked back to the driver’s side, got into the vehicle and continued to wait.