Harvest

CHAPTER THREE

In the night it came to her like the gentlest of whispers or the brush of fairy wings across her face: I am dying. That realization did not frighten Nina Voss. For weeks, through the changing shifts of three private duty nurses, through the daily visits of Dr. Morissey with his ever-higher doses of furosemide, Nina had maintained her serenity. And why should she not be serene? Her life had been rich with blessings. She had known love, and joy, and wonder. In her forty-six years she had seen sunrise over the temples of Karnak, had wandered the twilight ruins of Delphi and climbed the foothills of Nepal. And she had known the peace of mind that comes only with the acceptance of one's place in God's universe. She was left with only two regrets in her life. One was that she had never held a child of her own.

The other was that Victor would be alone.

All night her husband had maintained his vigil at her bedside, had held her hand through the long hours of laboured breaths and coughing, through the changing of the oxygen tanks and the visits of Dr. Morissey. even in her sleep she had felt Victor's presence. Sometime near dawn, through the haze of her dreams, she heard him say: She is so young. So very young. Couldn't something else, anything else, be done?

Something! Anything!That was Victor. He did not believe in the inevitable.

But Nina did.

She opened her eyes and saw that night had finally passed, and that sunlight was shining through her bedroom window. Beyond that window was a sweeping view of her beloved Rhode Island Sound. In the days before her illness, before the cardiomyopathy had drained her strength, dawn would usually find Nina awake and dressed. She would step out onto their bedroom balcony and watch the sun rise. Even on mornings when fog cloaked the Sound, when the water seemed little more than a silvery tremor in the mist, she would stand and feel the earth tilting, the day spilling towards her. As it did today.

So many dawns have I known. I thank you, Lord, for every one of them.

"Good morning, darling," whispered Victor.

Nina focused on her husband's face, smiling down at her. Some who looked at Victor Voss saw the face of authority. Some saw genius or ruthlessness. But this morning, as Nina gazed at her husband, she saw only the love. And the weariness.

She reached out for his hand. He took it and pressed it to his lips. "You must get some sleep, Victor," she said.

"I'm not tired."

"But I can see you are."

"No I'm not." He kissed her hand again, his lips warm against her chilled skin. They looked at each other for a moment. Oxygen hissed softly through the tubes in her nostrils. From the open window came the sound of ocean waves sluicing across the rocks.

She closed her eyes. "Remember the time…" Her voice faded as she paused to catch her breath.

"Which time?" he prompted gently.

"The day I… broke my leg…" She smiled.

It was the week they'd met, in Gstaad. He told her later that he'd first spotted her schussing down a double black diamond, had pursued her down the mountain, back up in the lift, and down the mountain again. That was twenty-five years ago.

Since then they had been together every day of their lives.

'! knew," she whispered. "In that hospital… when you stayed by my bed.! knew."

"Knew what, darling?"

"That you were the only one for me." She opened her eyes and smiled at him again. Only then did she see the tear trickle down his lined cheek. Oh, but Victor did not cry! She had never seen him cry, not once in their twenty-five years together. She had always thought of Victor as the strong one, the brave one. Now, as she looked at his face, she realized how very wrong she had been.

"Victor," she said and clasped his hand in hers. "You mustn't be afraid."

Quickly, almost angrily, he mopped his hand across his face. "I won't let this happen. I won't lose you."

"You never will."

"No. That's not enough! I want you here on this earth. With me. With me."

"Victor, if there's one thing… one thing I know…" She took a deep breath, a gasp for air. "It's that this time… we have here… is a very small part… of our existence."

She felt him stiffen with impatience, felt him withdraw. He rose from the chair and paced to the window where he stood gazing out at the Sound. She felt the warmth of his hand fade from her skin. Felt the chill return.

"I'll take care of this, Nina," he said.

"There are things… in this life… we cannot change."

"I've already taken steps."

"But Victor…"

He turned and looked at her. His shoulders, framed by the window, seemed to blot out the light of dawn. "It will all be taken care of, darling," he said. "Don't you worry about a thing."

It was one of those warm and perfect evenings, the sun just setting, ice cubes clinking in glasses, perfumed ladies floating past in silk and voile. It seemed to Abby, standing in the walled garden of Dr. Bill Archer, that the air itself was magical. Clematis and roses arched across a latticed pergola. Drifts of flowers swept broad strokes of colour across the expanse of lawn. The garden was the pride and joy of Marilee Archer, whose loud contralto could be heard booming out botanical names as she shepherded the other doctors' wives from flowerbed to flowerbed.

Archer, standing on the patio with highball in hand, laughed. "Marilee knows more goddamn Latin than I do."

'! took three years of it in college," said Mark. "All I remember is what I learned in medical school."

They were gathered next to the brick barbecue, Bill Archer, Mark, the General, and two surgical residents. Abby was the only woman in that circle. It was something she'd never grown accustomed to, being the lone female in a group. She might lose sight of it for a moment or two, but then she would glance around a room where surgeons were gathered, and she'd experience that familiar flash of discomfort with the realization that she was surrounded by men.

Tonight there were wives at Archer's house party, of course, but they seemed to move in a parallel universe, seldom intersecting with that of their husbands. Abby, standing with the surgeons, would occasionally hear far-off snippets from the wives' conversations. Talk of damask roses, of trips to Paris and meals savoured. She would feel pulled both ways, as though she stood straddling the divide between men and women, belonging to neither universe, yet drawn to both.

It was Mark who anchored her in this circle of men. He and Bill Archer, also a thoracic surgeon, were close colleagues. Archer, chief of the cardiac transplant team, had been one of the doctors who'd recruited Mark to Bayside seven years ago. It wasn't surprising the two men got along so well. Both of them were hard-driving, athletic, and fiercely competitive. In the OR they worked together as a team, but out of the hospital, their friendly rivalry extended from the ski slopes of Vermont to the waters of Massachusetts Bay. Both men kept their J-35 sailboats moored at Marblehead marina, and so far this season, the racing score stood at six to five, Archer's Red Eye versus Mark's Gimme Shelter. Mark planned to even the score this weekend. He'd already recruited Rob Lessing, the other second-year resident, as crew.

What was it about men and boats? wondered Abby. This was gizmo talk, men and their sailing machines, high-tech conversation fuelled by testosterone. In this circle, centre stage belonged to the men with greying hair. To Archer, with his silver-threaded mane. To Colin Wettig, already a distinguished grey. And to Mark who, at forty-one, was just starting to turn silver at the temples.

As the conversation veered towards hull maintenance and keel design and the outrageous price of spinnakers, Abby's attention drifted. That's when she noticed two late arrivals: Dr. Aaron Levi and his wife Elaine. Aaron, the transplant team cardiologist, was a painfully shy man. Already he had retreated with his drink to a far corner of the lawn, where he stood stoop-shouldered and silent. Elaine was glancing around in search of a conversational beachhead.

This was Abby's chance to flee the boat talk. She slipped away from Mark and went to join the Levis.

"Mrs Levi? It's so nice to see you again."

Elaine returned a smile of recognition. "It's… Abby, isn't it?" "Yes, Abby DiMatteo. I think we met at the residents' picnic."

"Oh yes, that's right. There are so many residents, I have trouble keeping you all straight. But I do remember you."

Abby laughed. "With only three women in the surgery programme, we do stick out."

"It's a lot better than the old days, when there were no women at all. Which rotation are you on now?"

"I start thoracic surgery tomorrow."

"Then you'll be working with Aaron."

"If I'm lucky enough to scrub on any transplants."

"You're bound to. The team's been so busy lately. They're even getting referrals from Massachusetts General, which tickles Aaron pink." Elaine leaned towards Abby. "They turned him down for a fellowship years ago. Now they're sending him patients."

"The only thing Mass Gen has over Bayside is their Harvard mystique," said Abby. "You know Vivian Chao, don't you? Our Chief Resident?"

"Of course."

"She graduated top ten at Harvard Med. But when it came time to apply for residency, Bayside was her number one choice." Elaine turned to her husband. "Aaron, did you hear that?" Reluctantly he looked up from his drink. "Hear what?"

"Vivian Chao picked Bayside over Mass Gen. Really, Aaron, you're already at the top here. Why would you want to leave?"

"Leave?" Abby looked at Aaron, but the cardiologist was glaring at his wife. Their sudden silence was what puzzled Abby most. From across the lawn came the sound of laughter, the echoing drifts of conversation, but in this corner of the garden, nothing was said.

Aaron cleared his throat. "It's just something I've toyed with," he said. "You know. Getting away from the city. Moving to a small town. Everyone daydreams about small towns, but no one really wants to move there."

"I don't," said Elaine.

"I grew up in a small town," said Abby. "Belfast, Maine. I couldn't wait to get out."

"That's how I imagine it would be," said Elaine. "Everyone clawing to get to civilization."

"Well, it wasn't that bad."

"But you're not going back. Are you?"

Abby hesitated. "My parents are dead. And both my sisters have moved out of state. So I don't have any reason to go back. But I have a lot of reasons to stay here."

"It was just a fantasy," said Aaron, and he took a deep gulp of his drink. "I wasn't really thinking about it."

In the odd silence that followed, Abby heard her name called. She turned and saw Mark waving to her.

"Excuse me," she said, and crossed the lawn to join him. "Archer's giving the tour of his inner sanctum," said Mark. "What inner sanctum?"

"Come on. You'll see." He took her hand and led her across the terrace and into the house. They climbed the staircase to the second floor. Only once before had Abby been upstairs in the Archer house, and that was to view the oil paintings hung in the gallery.

Tonight was the first time she'd been invited into the room at the end of the hall.

Archer was already waiting inside. In a grouping of leather chairs were seated Drs Frank Zwick and Raj Mohandas. But Abby scarcely noticed the people: it was the room itself that commanded her attention.

She was standing in a museum of antique medical instruments. In display cases were exhibited a variety of tools both fascinating and frightening. Scalpels and bloodletting basins. Leech jars. Obstetrical forceps with jaws that could crush an infant's skull. Over the fireplace hung an oil painting: the battle between Death and the Physician over the life of a young woman. A Brandenburg Concerto was playing on the stereo.

Archer turned down the volume, and the room suddenly seemed very quiet, with only the whisper of music in the background. "Isn't Aaron coming?" asked Archer.

"He knows about it. He'll be on his way up," said Mark.

"Good." Archer smiled at Abby. "What do you think of my little collection?"

She studied the contents of a display case. "This is fascinating. I can't even tell you what some of these things are."

Archer pointed to an odd contraption of gears and pulleys. "That device over there is interesting. It was meant to generate a weak electrical current, which was applied to various parts of the body. Said to be helpful for anything from female troubles to diabetes. Funny, isn't it?The nonsense medical science would have us believe."

Abby stopped before the oil painting and gazed at the black-robed image of Death. Doctor as hero, Doctor as conqueror, she thought. And of course the object of rescue is a woman. A beautiful woman.

The door opened.

"Here he is," said Mark. "We wondered if you'd forgotten about it, Aaron."

Aaron came into the room. He said nothing, only nodded as he sat down in a chair.

"Can I refill your drink, Abby?" said Archer, gesturing to her glass. "I'm fine."

"Just a splash of brandy? Mark's driving, right?"

Abby smiled. "All right. Thanks."

Archer touched up Abby's drink and handed it back to her. The room had fallen strangely quiet, as though everyone was waiting for this formality to be completed. It struck her then: she was the only resident in the room. Bill Archer threw this sort of party every few months, to welcome another batch of house staff to the thoracic and trauma rotations. At this moment, there were six other surgical residents circulating downstairs in the garden. But here, in Archer's private retreat, there was only the transplant team.

And Abby.

She sat down on the couch next to Mark and sipped her drink. Already she was feeling the brandy's heat, and the warmth of this special attention. As an intern, she'd viewed these five men with awe, had felt privileged just to assist in the same OR with Archer and Mohandas. Though her relationship with Mark had brought her into their social circle, she never forgot who these men were. Nor did she forget the power they held over her career.

Archer sat down across from her. "I've been hearing some good things about you, Abby. From the General. Before he left tonight, he paid you some wonderful compliments."

"Dr. Wettig did?" Abby couldn't help a surprised laugh. "To be honest, I'm never quite sure what he thinks about my performance."

"Well, that's just the General's way. Spreading a little insecurity around in the world."

The other men laughed. Abby did too.

"I do respect Colin's judgment," said Archer. "And I know he thinks you're one of the best Level-Two residents in the programme. I've worked with you, so I know he's right."

Abby shifted uneasily on the couch. Mark reached for her hand and gave it a squeeze. That gesture was not missed by Archer, who smiled.

"Obviously, Mark thinks you're pretty special. And that's part of the reason we thought we should have this discussion. I know it may seem a little premature. But we're long-range planners, Abby.

We think it never hurts to scout out the territory in advance."

"I'm afraid I don't quite follow you," said Abby.

Archer reached for the brandy decanter and poured himself a scant refill. "Our transplant team's interested in only the best. The best credentials, the best performance. We're always looking over the residents for fellowship material. Oh, we have a selfish motive, of course. We're grooming people for the team." He paused. "And we were wondering if you might have an interest in transplant surgery."

Abby flashed Mark a startled look. He nodded.

"It's not something you have to decide anytime soon," said Archer. "But we want you to think about it. We have the next few years to get to know each other. By then, you may not even want a fellowship. It may turn out transplant surgery's not something you're even vaguely interested in."

"But it is." She leaned forward, her face flushing with enthusiasm. "I guess I'm just… surprised by this. And flattered. There are so many good residents in the programme. Vivian Chao, for instance."

"Yes, Vivian is good."

"I think she'll be looking for a fellowship next year."

Mohandas said, "There's no question that Dr. Chao's surgical technique is outstanding. I can think of several residents with excellent technique. But you have heard the saying? One can teach a monkey how to operate.The trick is teaching him when to operate."

"I think what Raj is trying to say is, we're looking for good clinical judgment," said Archer. "And a sense of teamwork. We see you as someone who works well with a team. Not at cross-purposes. That's something we insist on, Abby, teamwork. When you're sweating it out in the OR, all sorts of things can go wrong. Equipment fails. Scalpels slip. The heart gets lost in transit. We have to be able to pull together, come hell or high water. And we do."

"We help each other out, too," said Frank Zwick. "Both in the OR and outside of it."

"Absolutely," said Archer. He glanced at Aaron. "Wouldn't you agree?"

Aaron cleared his throat. "Yes, we help each other out. It's one of the benefits of joining this team."

"One of the many benefits," added Mohandas.

For a moment no one spoke. The Brandenburg Concerto played softly in the background. Archer said, "I like this part," and turned up the volume. As the sound of violins spilled from the speakers, Abby found herself gazing, once again, at Death versus the Physician. The battle for a patient's life, a patient's soul.

"You mentioned there were… other benefits," said Abby.

"For example," offered Mohandas, 'when I completed my surgery residency, I had a number of student loans to pay off. So that was part of my recruitment package. Bayside helped me pay off my loans."

"Now that's something we can talk about, Abby," said Archer. "Ways we can make this attractive to you.Young surgeons nowadays, they come out of residency at thirty years old. Most of them are already married with maybe a kid or two. And they owe — what? A hundred thousand dollars in loans. They don't even own a house yet! It'll take 'em ten years just to get out of debt. By then they're forty, and worried about college for their kids!" He shook his head. "I don't know why anyone goes into medicine these days. Certainly not to make money."

"If anything," agreed Abby, 'it's a hardship."

"It doesn't have to be. That's where Bayside can help. Mark mentioned to us that you were on financial aid all the way through medical school."

"A combination of scholarships and loans. Mostly loans."

"Ouch. That sounds painful."

Abby nodded ruefully. "I'm just beginning to feel the pain."

"College loans as well?"

"Yes. My family had… financial problems," Abby admitted. "You make it sound like something to be ashamed of."

"It was more a case of… bad luck. My younger brother was hospitalized for a number of months and we weren't insured. But then, in the town where I grew up, a lot of people weren't insured."

"Which only confirms how hard you must have worked to beat the odds. Everyone here knows what that's like. Raj here was an immigrant, didn't speak English until he was ten. Me, I'm the first in my family to go to college. Believe me, there are no goddamn Boston Brahmins in this room. No rich daddies or handy little trust funds. We know about beating the odds because we've all done it. That's the kind of drive we're looking for in this team."

The music swelled to its finale. The last chord of trumpets and strings faded away. Archer shut off the stereo and looked at Abby.

"Anyway. It's something for you to think about," he said. "We're not making any firm offers, of course. It's more like talking about a, uh…" Archer grinned at Mark. "First date."

"I understand," said Abby.

"One thing you should know. You're the only resident we've approached. The only one we're really considering. It would be wise if you didn't mention this to the rest of the house staff. We don't want to stir up any jealousy."

"Of course not."

"Good." Archer looked around the room. "I think we're all in agreement about this. Right, gentlemen?"

There was a general nodding of heads.

"We have consensus," said Archer. And, smiling, he reached once again for the brandy decanter. "This is what I call a real team."

"So what do you think?" Mark asked as they drove home.

Abby threw back her head and shouted deliriously. "I'm floating! God, what a night!"

"You're happy about it, huh?"

"Are you kidding? I'm terrified."

"Terrified? Of what?"

"That I'll screw up. And blow it all."

He laughed and gave her knee a squeeze. "Hey, we've worked with all the other residents, OIL> We know we're recruiting the best."

"And just how much of this was your influence, Dr. Hodell?"

"Oh, I put in my two cents' worth. The others just happened to be in complete agreement."

"Right."

"It's true. Believe me, Abby, you're our number one choice. And I think you'd find it a terrific arrangement, too."

She sat back, smiling. Imagining. Until tonight, she'd had only a fuzzy notion of where she'd be working in three and a half years. Toiling in an HMO, most likely. Private practice was in its dying days; she saw no future in it, at least, not in the city of Boston. And Boston was where she wanted to stay. Where Mark was.

"I want this so badly," she said. "I just hope I don't disappoint you all."

"Not a chance. The team knows what it wants. We're all together on this."

She fell silent for a moment. "Even Aaron Levi?" she asked. "Aaron? Why wouldn't he be?"

"I don't know. I was talking to his wife tonight. Elaine. I got the feeling Aaron isn't very happy. Did you know he was thinking of leaving?"

"What?" Mark glanced at her in surprise.

"Something about moving to a small town."

He laughed. "It'll never happen. Elaine's a Boston girl."

"It wasn't Elaine. It was Aaron who was thinking about it."

For a while Mark drove without saying a word. "You must have misunderstood," he said at last.

She shrugged. "Maybe I did."

"Light, please," said Abby.

A nurse reached up and adjusted the overhead lamp, focusing the beam on the patient's chest. The operative site had been drawn on the skin in black marker, two tiny x's connected by a line tracing along the top of the fifth rib. It was a small chest, a small woman. Mary Allen, eighty-four years old and a widow, had been admitted to Bayside a week ago complaining of weight loss and severe headaches. A routine chest x-ray had turned up an alarming find: multiple nodules in both lungs. For six days she'd been probed, scanned, and x-rayed. She'd had a bronchoscope down her throat, needles punched through her chest wall, and still the diagnosis was unclear.

Today they'd know the answer.

Dr. Wetfig picked up the scalpel and stood with blade poised over the incision site. Abby waited for him to make the cut. He didn't. Instead he looked at Abby, his eyes a hard, metallic blue over the mask.

"How many open lung biopsies have you assisted on, DiMatteo?" he asked.

"Five, I think."

"You're familiar with this patient's history? Her chest films?"

"Yes, sir."

Wetfig held out the scalpel. "This one's yours, Doctor."

Abby looked in surprise at the scalpel, glittering in his hand. The General seldom relinquished the blade, even to his upper level residents.

She took the scalpel, felt the weight of stainless steel settle comfortably in her grasp. With steady hands, she made her incision, stretching the skin taut as she sliced a line along the rib's upper edge. The patient was thin, almost wasted; there was scant subcutaneous fat to obscure the landmarks. Another, slightly deeper incision parted the intercostal muscles.

She was now in the pleural cavity.

She slipped a finger through the incision and could feel the surface of the lung. Soft, spongy. "Everything all right?" she asked the anaesthesiologist.

"Doing fine."

"OK, retract," said Abby.

The ribs were spread apart, widening the incision. The ventilator pumped another burst of air, and a small segment of lung tissue ballooned out of the incision. Abby clamped it, still inflated. Again she glanced at the anaesthesiologist. "OK?"

"No problem."

Abby focused her attention on the exposed segment of lung tissue. It took only a glance to locate one of the nodules. She ran her fingers across it. "Feels pretty solid," she said. "Not good."

"No surprise," said Wettig. "She looked like a chemotherapy special on x-ray. We're just confirming cell type."

"The headache? Brain metastases?"

Wetfig nodded. "This one's aggressive. Eight months ago she had a normal chest x-ray. Now she's a cancer farm."

"She's eighty-four," said one of the nurses. "At least she had a long life."

But what kind of life? wondered Abby as she resected the wedge of lung containing the nodule. Yesterday, she had met Mary Allen for the first time. She had found the woman sitting very quiet and still in her hospital room. The shades had been drawn, the bed cast in semidarkness. It was the headaches, Mary said. The sun hurts my eyes. Only when I sleep does the pain go away. So many different kinds of pain…

Please, doctor, couldn't I have a stronger sleeping pill?

Abby completed the resection and sutured the cut edge of lung. Wetfig offered no comment. He merely watched her work, his gaze as chilly as ever. The silence was compliment enough; she'd learned long ago that just to escape the General's criticism was a triumph.

At last, the chest closed, the drain tube in place, Abby stripped off her bloodied gloves and deposited them in the bin labelled: contaminated.

"Now comes the hard part," she said, as the nurses wheeled the patient out of the OR. "Telling her the bad news."

"She knows," said Wettig. "They always do."

They followed the squeak of the gurney wheels to Recovery. Four post-op patients in various states of consciousness occupied the currained stalls. Mary Allen, in the last stall, was just beginning to stir. She moved her foot. Moaned. Tried to pull her hand free of the restraint.

With her stethoscope, Abby took a quick listen to the patient's lungs, then said: "Give her five milligrammes of morphine, IV."

The nurse injected an IV bolus of morphine sulphate. Just enough to dull the pain, yet allow a gentle return to consciousness. Mary's groaning ceased. The tracing on the heart monitor remained steady and regular.

"Post-op orders, Dr. Wettig?" the nurse asked.

There was a moment's silence. Abby glanced at Wetfig, who said, "Dr. DiMatteo's in charge here." And he left the room.

The nurses looked at each other. Wetfig always wrote his own post-op orders. This was another vote of confidence for Abby.

She took the chart to the desk and began to write: Transfer to 5 East, Thoracic Surgery Service. Diagnosis: Post-op open lung biopsy for multiple pulmonary nodules. Condition: stable. She wrote steadily: orders for diet, meds, activity. She reached the line for code status. Automatically she wrote: Full code.

She looked across the desk at Mary Allen, lying motionless on the gurney. Thought about what it would be like to be eighty-four years old and fiddled with cancer, the days numbered, each one filled with pain. Would the patient choose a kinder, swifter death? Abby didn't know.

"Dr. DiMatteo?" It was a voice over the intercom.

"Yes?" said Abby.

"You had a call from 4 East about ten minutes ago. They want you to come by."

"Neurosurg? Did they say why?"

"Something about a patient named Terrio. They want you to talk to the husband."

"Karen Terrio's not my patient any longer."

"I'm just passing the message along, Doctor."

"OK, thanks."

Sighing, Abby rose to her feet and went to Mary Allen's gurney for one last check of the cardiac monitor, the vital signs. The pulse was running a little fast, and the patient was moving, groaning again. Still in pain.

Abby looked at the nurse. "Another two milligrammes of morphine," she said.

The blip on the EKG monitor traced a slow and steady rhythm.

"Her heart's so strong," murmured JoeTerrio. "It doesn't want to give up. She doesn't want to give up."

He sat at his wife's bedside, his hand clasping hers, his gaze fixed on that green line squiggling across the oscilloscope. He looked bewildered by all the gadgetty in the room. The tubes, the monitors, the suction pump. Bewildered and afraid. He focused every ounce of attention on the EKG monitor, as though, if he could somehow master the secrets of that mysterious box, he could master everything else. He could understand why and how he had come to be sitting at the bedside of the woman he loved, the woman whose heart refused to stop beating.

It was 3 p.m., sixty-two hours since a drunk driver had slammed into KarenTerrio's car. She was thirty-four years old, HIV negative, cancer free, infection free. She was also brain dead. In short, she was a living supermarket of healthy donor organs. Heart and lungs. Kidneys. Pancreas. Liver. Bone. Corneas. Skin. With one terrible harvest, half a dozen different lives could be saved or changed for the better.

Abby pulled up a stool and sat down across from him. She was the only doctor who'd actually spent much time talking with Joe, so she was the one the nurses had called to speak to him now. To convince him to sign the papers and allow his wife to die. She sat quietly with him for a moment. Karen Terrio's body stretched between them, her chest rising and falling at a preselected twenty breaths per minute.

"You're right, Joe," said Abby. "Her heart is strong. It could keep going for some time. But not forever. Eventually the body knows. The body understands."

Joe looked across at her, his eyes red-rimmed with tears and sleeplessness. "Understands?"

"That the brain is dead. That there's no reason for the heart to keep beating."

"How would it know?"

"We need our brains. Not just to think and feel, but also to give the rest of our body a purpose. When that purpose is gone, the heart, the lungs, they start to fail." Abby looked at the ventilator. "The machine is breathing for her."

"I know." Joe rubbed his face with his hands. "I know, I know. I know. ."

Abby said nothing, Joe was rocking back and forth in his chair now, his hands in his hair, his throat squeezing out little grunts and whimpers, the closest thing to sobs a man could allow himself. When he raised his head again, clumps of his hair stood up damp and stiff with tears.

He looked up at the monitor again. The one spot in the room he seemed to feel was safe to stare at. "It all seems too soon."

"It isn't. There's only a certain amount of time before the organs start to go bad. Then they can't be used. And no one is helped by that, Joe."

He looked at her, across the body of his wife. "Did you bring the papers?"

"I have them."

He scarcely looked at the forms. He merely signed his name at the bottom and handed the papers back. An ICU nurse and Abby witnessed the signature. Copies of the form would go into Karen Terrio's record, to the New England Organ Bank, and Bayside's Transplant Coordinator files. Then the organs would be harvested.

Long after KarenTerrio was buried, bits and pieces of her would go on living. The heart that she'd once felt thudding in her chest when she'd played as a five-year-old, married as a twenty-year-old, and strained at childbirth as a twenty-one-year-old, would go on beating in the chest of a stranger. It was as close as one could come to immortality.

But it was scarcely much comfort to Joseph Terrio, who continued his silent vigil at the bedside of his wife.

Abby found Vivian Chao undressing in the OR locker room. Vivian had just emerged from four hours of emergency surgery, yet not a single blot of sweat stained the discarded scrub clothes lying on the bench beside her.

Abby said, "We have consent for the harvest."

"The papers are signed?" asked Vivian. "Yes."

"Good. I'll order the lymphocyte crossmatch." Vivian reached for a fresh scrub top. She was dressed only in her bra and underwear, and every rib seemed to stand out on her frail, flat chest. Honorary manhood, thought Abby, is a state of mind, not body. "How are her vitals?" asked Vivian.

"They're holding steady."

"Have to keep her blood pressure up. Kidneys perfused. It's not every day a nice pair of AB positive kidneys comes along." Vivian pulled on a pair of drawstring trousers and tucked in her shirt. Every movement she made was precise. Elegant.

"Will you be scrubbing in on the harvest?" asked Abby.

"If my patient gets the heart, I will. The harvest is the easy part. It's reattaching the plumbing that gets interesting." Vivian closed the locker door and snapped the padlock shut. "You have a minute?

I'll introduce you to Josh."

"Josh?"

"My patient on the teaching service. He's up in MICU."

They left the locker room and headed down the hall towards the elevator. Vivian made up for her short legs by her quick, almost fierce stride. "You can't judge the success of a heart transplant until you've seen the before and the after," said Vivian. "So I'm going to show you the before. Maybe it'll make things easier for you." 'what do you mean?"

"Your woman has a heart but no brain. My boy has a brain and practically no heart."The elevator door opened. Vivian stepped in. "Once you get past the tragedy, it all makes sense."

They rode the elevator in silence.

Of course it makes sense, thoughtAbby. It makes perfect sense. Vivian sees it clearly. But I can't seem to get past the image of two little girls standing by their mother's bed. Afraid to touch her… Vivian led the way to the Medical ICU. Joshua O" Day was asleep in Bed 4.

"He's sleeping a lot these days," whispered the nurse, a sweet faced blonde with Hannah Love, RN, on her nametag.

"Change in meds?" asked Vivian.

"I think it's depression." Hannah shook her head and sighed. "I've been his nurse for weeks. Ever since he was admitted. He's such a terrific kid, you know? Really nice. A little goofy. But lately, all he does is sleep. Or stare at his trophies." She nodded at the bedside stand, where a display of various awards and ribbons had been lovingly arranged. One ribbon went all the way back to the third grade — an honourable mention for a Cub Scout Pinewood Derby. Abby knew about pinewood derbies. Like Joshua O" Day, her brother had been a Cub Scout.

Abby moved to the bedside. The boy looked much younger than she had expected. Seventeen, according to the birthdate on Hannah Love's clipboard. He could have passed for fourteen. A thicket of plastic tubes surrounded his bed, IV's and arterial and Swan-Ganz lines. The last was used to monitor pressures in the right atrium and pulmonary artery. On the screen overhead, Abby could read the right atrial pressure. It was high. The boy's heart was too weak to pump effectively, and blood had backed up in his venous system. Even without the monitor, she could have reached that conclusion by a glance at his neck veins. They were bulging.

"You're looking at Redding High School's baseball star from two years ago," said Vivian. "I'm not into the game so I don't really know how to judge his batting average. But his dad seems pretty proud of it."

"Oh, his dad/s proud," said Hannah. "He was in here the other day with a ball and mitt. I had to kick him out when they started a game of catch." Hannah laughed. "The dad's as crazy as the kid!"

"How long has he been sick?" asked Abby.

"He hasn't been to school in a year," said Vivian. "The virus hit him about two years ago. CoxsackieVirus B. Within six months, he was in congestive heart failure. He's been in the ICU for a month now, just waiting for a heart." Vivian paused. And smiled. "Right, Josh?"

The boy's eyes were open. He seemed to be looking at them as though through layers of gauze. He blinked a few times, then smiled at Vivian. "Hey, Dr. Chao."

"I see some new ribbons on display," said Vivian.

"Oh. Those." Josh rolled his eyes. "I don't know where my Mom digs those up. She keeps everything, you know. She even has this plastic bag with all my baby teeth. I think it's pretty gross."

"Josh, I brought someone along to meet you. This is Dr. DiMatteo, one of our surgical residents."

"Hello, Josh," said Abby.

It seemed to take the boy a moment to fully refocus his gaze. He didn't say anything.

"Is it OK for Dr. DiMatteo to examine you?" asked Vivian. "Why?"

"When you get your new heart, you'll be like that crazy Road Runner on TV. We won't be able to tie you down long enough for an exam."

Josh smiled. "You're so full of it."

Abby moved to the bedside. Already, Josh had pulled up his gown and bared his chest. It was white and haitiess, not a teenager's chest but a boy's. She lay her hand over his heart and felt it fluttering like bird's wings against the cage of ribs. She lay her stethoscope against it and listened to the heartbeat, the whole time aware of the boy's gaze, wary and untrusting. She had seen such looks from children who have been too long in paediatric wards, children who've learned that every new pair of hands brings a new variety of pain. When she finally straightened and slipped her stethoscope back in her pocket, she saw the look of relief in the boy's face. "Is that all?" he said.

"That's all." Abby smoothed down his hospital gown. "So. Who's your favourite team, Josh?"

"Who else?"

"Ah. Red Sox."

"My dad taped all their games for me. We used to go to the park together, my dad and me. When I get home, I'm going to watch 'era all. All those tapes. Three straight days of baseball…" He took a deep breath of oxygen-infused air and looked up at the ceiling.

Softly he said, "I want to go home, Dr. Chao."

"I know," said Vivian.

"I want to see my room again. I miss my room." He swallowed, but he couldn't hold back the sob. "I want to see my room. That's all. I just want to see my room."

At once Hannah moved to his side. She gathered the boy into her arms and held him, rocked him. He was fighting not to cry, his fists clenched, his face buried in her hair. "It's OK," murmured Hannah. "Baby, you just go ahead and cry. I'm right here with you. I'm going to stay right here, Josh. As long as you need me. It's OK." Hannah's gaze met Abby's over the boy's shoulder. The tears on the nurse's face weren't Josh's, but her own.

In silence, Abby and Vivian left the room.

At the MICU nurses' station, Abby watched as Vivian signed in duplicate the order for the lymphocyte crossmatch between Josh O" Day's and Karen Terrio's blood.

"How soon can he go to surgery?" asked Abby.

"We could be scrubbed and ready to cut by tomorrow morning. The sooner the better. The kid's had three episodes of V. tach in just the last day. With a heart rhythm that unstable, he doesn't have much time." Vivian swivelled around to face Abby. "I'd really like that boy to see another Red Sox game. Wouldn't you?"

Vivian's expression was as calm and unreadable as ever. She might be soft as slush inside, thought Abby, but Vivian would never show it.

"Dr. Chao?" said the ward clerk.

"Yes?"

"I just called SICU about that lymphocyte crossmatch. They said they're already running a match against Karen Terrio."

"Great. For once my intern's on the ball."

"But Dr. Chao, the crossmatch isn't with Josh O" Day."

Vivian turned and looked at the clerk. "What?"

"SICU says they're running it on someone else. Some private patient named Nina Voss."

"But Josh is critical! He's at the top of the list."

"All they said was the heart's going to that other patient." Vivian shot to her feet. In three quick steps she was at the telephone, punching in a number. A moment later, Abby heard her say:

"This is Dr. Chao. I want to know who ordered that lymphocyte crossmatch on Karen Terrio." She listened. Then, frowning, she hung up.

"Did you get the name?" asked Abby.

"Yes."

"Who ordered it?"

"Mark Hodell."