Gone Before Goodbye

Chapter Twenty-Five

Before Maggie puts on her surgical gown, gloves, and goggles, Ivan Brovski enters the room and collapses into a chair.

“All okay?” Maggie asks.

“I need to deliver a message.”

Maggie waits.

“Oleg Ragoravich has given us clear instructions: If he doesn’t make it out of the surgery, neither do you.”

He looks up at her.

“Hell of an incentive,” Maggie says, because sometimes humor is the best defense mechanism.

Brovski stands. “I’ll see you in the OR.”

He leaves.

Half an hour later, Maggie is in the operating room and ready to go. Beads of sweat coat her forehead before she even starts.

“Doctor?”

It’s the nurse to her right.

Deep breaths, Maggie tells herself.

“Scalpel.”

Maggie begins by performing a median sternotomy to access the thoracic cavity. With the scalpel, she makes a vertical incision down the sternum and then, using the surgical saw, she divides the sternum to gain access. Maggie opens the pericardium, the membrane protecting the heart. They’ve already run the flexible tube down Oleg Ragoravich’s throat and into the esophagus and now, using sound waves from the transesophageal echocardiogram, Maggie can see the heart on his monitor.

It’s a mess.

The heart is gray and enlarged. She can see scars on the surface.

Man, this surgery is happening just in time.

The operating theater is, no question, fully stocked. The staff seems first-rate so far, even though Maggie did not meet any of them ahead of time. They, like Maggie, wear full-face masks and opaque goggles. Ivan Brovski, who, as promised/threatened, is also in the operating room, ominously explained that discretion is paramount in this strange hidden lair they vaguely call The Vineyard:

“They can’t know your identity — and you can’t know theirs.”

Oleg Ragoravich lies beneath a sea of blue drape. His rib cage is split wide open now, held in place by retractors. It’s gross to most, but Maggie finds it oddly beautiful, and yeah, she knows that’s weird. Right now, only one assistant surgeon is in the room with her. She — yes, the other surgeon is a woman too — clearly knows her stuff. The third surgeon, Maggie is told, is in the adjacent theater with the brain-dead heart donor. That surgeon has opened the chest and will extract the donor heart at the same time Maggie removes Ragoravich’s native heart and attaches the THUMPR7 in its place.

Beneath the glare from the surgical lights, Oleg’s heart pulses in a weak, spastic rhythm. The tubes from the cardiopulmonary bypass twist away from the venae cavae and aorta. Maggie nods to the perfusionist, and the bypass takes over.

Oleg’s heart sputters, slows, and then stops completely.

Time to move fast and disconnect the blood vessels.

Maggie uses scissors to part the aorta and pulmonary artery, their ends tattered by disease. She trims the right ventricle along the atrioventricular groove, preserving the tricuspid annulus. She does the same on the left side.

“Prepare the donor heart and THUMPR7,” Maggie says.

The Vineyard has the latest cardiac retraction glove and sling, which are designed to lift the heart out of the chest without damaging surrounding tissue. Maggie does that now, carefully yet quickly. The native heart is seriously diseased — thinned and stretched, weak and so fragile that Maggie worries the heart muscle might rip or crumble or even disintegrate upon extraction.

“Need another set of hands?” the assistant surgeon asks.

Her voice is high-pitched, with an exaggerated Southern twang, and Maggie wonders whether the voice is a put-on for further disguise.

Maggie is a photo of focus. “I got it.”

When the heart is clear of the chest, Maggie turns and drops it into a basin on the surgical back table. Normally a heart like this is sent to pathology for examination or disposal. What will they do with it down here in The Vineyard? Study it maybe. Use it for experimentation. Eat it. Who the hell knows?

Maggie lets herself smile at the thought.

In fact, she realizes, under her mask, she’s been smiling the whole time.

Because even though she’s scared out of her mind, even though she can almost feel the gun being readied if something goes wrong, Maggie loves this.

She loves being a surgeon. She loves operating.

“TAH,” she says.

One of the surgical nurses hands her the THUMPR7 artificial heart.

“Donor heart ready?” Maggie asks.

“Coming in the moment you need it.”

“Now,” she says.

Maggie takes hold of the THUMPR7. She looks down at Oleg’s vacant chest cavity. Where there should be a heart, there is nothing but a yawning, bloodless void. It is a sight to behold, this threshold between death and life, between an ending and a beginning, between emptiness and hope. This chest is the emptiest of vessels and a promise waiting to be fulfilled.

For the briefest of moments, Maggie considers ending that hope.

Her patient is a man with no heart, figuratively and, for the moment, literally. He is also, perhaps figuratively and literally, dead.

Only she can bring him back to life.

What would happen if she didn’t? What would happen if she just let Oleg die on the table?

She glances to her right, toward Ivan Brovski. He may be goggled and masked up too so that she cannot read his expression, but his little headshake says it all:

Don’t even think it. He dies, you die.

The door opens. The other assisting surgeon, his gloved hands covered in blood — it’s a man — wheels an Organ Care System carrying the donor heart into the room. The OCS pumps an oxygenated blood base solution through the organ, keeping the heart viable.

The new surgeon stands on the other side of the table.

Maggie looks at him. He looks at her. But she can’t really see him, of course. She can’t see his eyes or his face. The shape of his body, too, looks pretty vague in the loose surgical gown. His hands are gloved.

He nods at her. For a moment, Maggie doesn’t move.

Ivan Brovski says, “Doctor?”

Maggie snaps out of it. With her gloved hand, she steadily lowers the THUMPR7 artificial heart — the one created by WorldCures but mostly by Marc, Marc’s brainchild, Marc’s work, Marc’s attempt to save lives on a massive scale — into the seemingly bottomless hole where Oleg Ragoravich’s heart once resided.

“Suture,” the assistant male surgeon barks.

His voice is gruff, muffled, and again she wonders whether this is his natural sound or if he is trying to mask his identity. With Maggie holding the THUMPR7 in place, her partner begins the delicate work of suturing the device’s inflow connectors to Oleg’s atrial cuffs.

Maggie joins in. Her adrenaline starts kicking into overdrive. She’s nervous. She has never done anything like this.

Gruff Voice stops for a moment. Maggie looks up into the goggled face.

“It’s okay,” he says to her. “You got this.”

Maggie is grateful for the encouragement. She swallows and nods.

The two surgeons — Maggie and Gruff Voice — work now in perfect tandem, threading the outflow connectors to the pulmonary artery and aorta, sizing the grafts with the precision of, well, cardiothoracic surgeons — too long and the lines will tangle; too short and blood won’t flow.

“Left ventricle first,” Maggie says, but Gruff Voice is one step ahead of her. He quick-connects — think “little snaps” — the heart to the Three A’s: artery, aorta, atria. Maggie does the same with the right. The THUMPR7 has four flaps. They are all open.

“Now,” Maggie says.

Gruff Voice opens the OCS or “heart box” and extracts a healthy, red, beating heart. He moves fast, guiding the donor heart into the THUMPR7. This, Maggie realizes, has never been done before. This, she realizes, would have been Marc and Trace’s dream moment — the THUMPR7 in tandem with a healthy beating-heart transplant donation. With a nod, Maggie takes over. She uses forceps to maneuver the heart into place. She attaches the donor heart’s pulmonary artery to the THUMPR7’s plastic valve in only one place. If this works, that should be the only attachment they need. The DNA sequencing machine is normally used after surgery to detect graft rejection. Maggie uses a specially designed one now, one that offers immediate feedback. She checks the readout.

So far, so good.

This is what their technology is trying to do: blend the robotic wonders of an artificial heart with the idea of cell regeneration and tissue compatibility. The best way of doing that is via a full organ — as in a beating-heart transplant like this — but the future hope is that stem cells, rather than full organs, will be enough.

Gruff Voice says, “No leaks. Blood flow is strong.”

Their goggled eyes meet again. They know this is the moment of truth. He gives her an encouraging nod. Maggie takes one more deep breath and turns to the perfusionist. “Turn it off.”

“Wait, shouldn’t we wean?”

“Not with the THUMPR7. It should kick in right away.”

The perfusionist hesitates.

“Do it,” Maggie snaps.

The perfusionist grudgingly switches off the bypass machine.

For a moment, nothing happens. Flat line.

Five seconds pass. Ten seconds.

The perfusionist says, “Doctor?”

“Wait,” Maggie says.

“It’s not working.”

“Then he’s dead either way,” Maggie says, while that sarcastic inner voice adds, And he ain’t the only one...

Ten more seconds pass, fifteen, twenty.

Ivan Brovski puts his large, gloved hands on both her shoulders as though to push her out of the way. “Doctor McCabe, what’s happening—?”

And then, with an audible grunt, the THUMPR7 starts beating.

BEAT... BEAT... BEAT...

Steadier now.

BEAT... BEAT... BEAT...

It’s working.

BEAT... BEAT... BEAT...

The room cheers.

BEAT... BEAT... BEAT...

Under the mask, Maggie’s face breaks into a wide smile. She looks up to lock celebratory goggle-eyes with Gruff Voice.

But he’s gone.

Maggie rips off her gloves, strips out of her gown, and steps into the shower.

The shower’s jet stream is powerful. Marc had always liked that in a shower, maybe more so because the showers during any kind of humanitarian mission were set on what Marc called “light urination.” When Maggie and Marc renovated the bathroom in their apartment, he offered the contractor no opinions on tiles, faucets, colors, toilets, design, only noting, “I want the water pressure to be so powerful I bleed.”

The pang again.

Weird when it comes back. She hadn’t felt him that much during surgery. Now, in the shower, with the powerful blast washing the blood and tissue of an evil man off her, once again grief makes its sneak attack.

She dries off and slips back into sweats. There is a full-size mask and goggles for her to wear on the way out. Forget it. If they recognize her, who cares? She enters that main tunnel again and heads to the makeshift ICU. She looks in the window. Ragoravich is still unconscious. There are monitors and six overly masked staff present. Maggie wonders whether any of these people had been on her team.

Through the glass, she hears it again.

BEAT... BEAT... BEAT...

From behind her, she hears Ivan Brovski’s voice. “A tremendous success.”

Maggie frowns. He sees it in the window’s reflection.

“You don’t agree?”

BEAT... BEAT... BEAT...

“I warned Oleg. I warned you. I don’t think it’s ready for human usage.” She turns to him. “Who were the other surgeons with me?”

“I can’t tell you that.”

“To keep confidentiality?”

“Yes. You know now how we hire people. You know how we pay them. It’s like you, in Russia.”

“Speaking of Russia,” Maggie says. “You almost killed me.”

“Not really, no. You ran onto the roof. My men, they reacted. Aleksander was running away too at the time. It created something of a panic. We wanted to close it all down. We needed you alive, but the men didn’t know the mission. And then, of course, there was Nadia.”

BEAT... BEAT... BEAT...

“What about Nadia?”

He shrugs. “She was in many ways the lady of the house.”

“Are you saying she wanted—”

“I don’t know,” Brovski says. “It doesn’t matter anymore, does it?”

BEAT... BEAT... BEAT...

“Nadia led me here,” Maggie says.

“What do you mean?”

“Can I see your phone?”

“Excuse me?”

She lifts her hand and beckons for him to give it to her. He looks as though he’s about to protest but then, thinking better of it, he opens it with his face and hands it over. Maggie takes it and starts searching for the appropriate app. Brovski watches over her shoulder. Maggie doesn’t care. When she opens the app, she scrolls down.

“Good timing,” she says. “My being here.”

Hmm. The dropped pin is there. Nadia had been telling the truth.

“What’s that?” he asks.

“It’s nothing.”

Maggie hands his phone back to him. “It was good timing, I guess — my coming to France just when you needed me to do the surgery.”

Brovski shrugs. “We could have grabbed you and brought you here anytime.”

“So why didn’t you?”

He shrugs again. “No need. You showed up.”

BEAT... BEAT... BEAT...

“Yeah, I’m not really buying that, Ivan.”

“And I’m not really selling it either.”

“Do you know who killed my husband?”

Just like that. She holds his gaze.

“I can tell you what Oleg and I believed.”

She waits.

“You are adrenaline junkies. You always took too many risks with your humanitarian missions, and while your medical care benefited some, it wasn’t worth it. Many you saved ended up living short, miserable lives in squalor or getting killed in the next battle. You didn’t have to take such risks. You could have played it safer. Instead, you chose to keep rolling the dice. Eventually the dice came up snake eyes.”

BEAT... BEAT... BEAT...

“So it was just a matter of time,” she says.

“I know you want there to be more. And maybe there is. Your husband died a hero. But he also died a fool.”

Ivan Brovski starts to walk away.

“And Trace Packer?”

He says nothing.

“Do you know where he is?”

BEAT... BEAT... BEAT...

“You must be exhausted, Doctor McCabe.”

“That’s not an answer.”

“It’s the only one I’m giving you today.” He nods toward the exit. “You know the way out.”

She starts toward him, but he slips into a room and locks the door behind him. Maybe that’s for the best. She’s far too exhausted right now to come up with a new strategy to get the truth out of him. She turns left and moves down that massive white artery back to the stairwell. At the top of the stairs, she pushes the barrels out of the way. She’s back up in the musty old cellar. She looks to the right, to the door, and she sees a man wearing a baseball cap exiting.

“Hold up!” she shouts.

He doesn’t. The door closes behind him. Maggie hurries after him.

Of course, he could be anyone. He doesn’t have to be the surgeon who stood across from her. But he’s wearing a baseball cap. That might be meaningless, but you don’t see a lot of men in France wearing them. In the United States, it’s almost a staple, especially when someone doesn’t want to be recognized.

But in France?

She opens the door and bursts out into the overgrown vineyard. It feels good to be back out of the bunker with its piped-in staleness. The air outside is both sweet and acrid, earthy and ethereal.

She looks left. Nothing. She looks right. Nothing. The only way out, as far as she knows, is to the right, to the gate where she has come and gone both times she’s been here. She sprints toward it. When she makes the final turn she can see the gate, and through the gate, the man in the baseball cap is getting into the back of a car.

“Stop!”

He doesn’t. He slips inside and shuts the car door. Maggie runs toward him, but it’s too late. The car starts moving. The gate slides closed. Maggie bangs on the chain-link as the vehicle vanishes into the woods.

He’s gone.