Harvest

CHAPTER EIGHT

She had had the same dream two nights in a row. The nurses told her it was because of all the medications she'd been taking. The methylprednisolone and the cyclosporine and the pain pills. The chemicals were scrambling her brain. And after weeks of hospitalization, of course she'd be having bad dreams. Everyone did. It was nothing to worry about. The dreams would, eventually, fade away.

But that morning, as Nina Voss lay in her ICU bed, the tears fresh in her eyes, she knew the dream would not go away, would never go away. It was part of her now. Just as this heart was part of her.

Softly, she touched her hand to the bandages on her chest. It had been two days since the operation, and though the soreness was just starting to ease, it still awakened her at night, a reminder of the gift she'd received. It was a good, strong heart. She had known that within a day of the surgery. During the long months of her illness, she'd forgotten what it was like to have a strong heart. To walk without gasping for air. To feel the blood pump, warm and vital, to her muscles. To look down at her own fingers and marvel at the rosy flush of her capillaries. She had lived so long waiting for death, accepting death, that life itself had become foreign to her. But now she could see it in her own hands. Could feel it in her fingertips.

And in the beating of this new heart.

It did not yet feel as if it belonged to her. Perhaps it never would. As a child, she would often inherit her older sister's clothing, Caroline's good wool sweaters, her scarcely-worn party dresses. Although the garments had unquestionably passed to Nina's ownership, she had never stopped thinking of them as her sister's. In her mind, they would always be Caroline's dresses, Caroline's skirts.

And whose heart are you? she thought, her hand gently touching her chest.

At noon, Victor came to sit by her bed.

"I had the dream again," she told him. "The one about the boy. It was so clear to me this time! When I woke up, I couldn't stop crying."

"It's the steroids, darling," said Victor. "They warned you about that side effect."

"I think it means something. Don't you see? I have this part of him inside me. A part that's still alive. I can feel him…"

"That nurse should never have told you it was a boy's."

"I asked her."

"Still, she shouldn't have told you. It does no one any good to release that information. "Not you. Not the boy."

"No," she said softly. "Not the boy. But the family — if there's a family-'

"I'm sure they don't wish to be reminded. Think about it, Nina. It's a strictly confidential process. There's a reason for it."

"Would it be so bad? To send the family a thank-you letter? It would be completely anonymous. Just a simple-'

"No, Nina. Absolutely not."

Nina sank back quietly on the pillows. She was being foolish again. Victor was right. Victor was always right.

"You're looking wonderful today, darling," he said. "Have you been up in a chair yet?"

"Twice," said Nina. Suddenly the room seemed very, very cold to her. She looked away and shivered.

Pete was sitting in a chair by Abby's bed, looking at her. He wore his blue Cub Scout uniform, the one with all the little patches sewn on the sleeves and the plastic beads dangling from his breast pocket, one bead for each achievement. He was not wearing his cap. Where is his cap? she wondered. And then she remembered that it was lost, that she and her sisters had searched and searched the roadside but had not found it anywhere near the mangled remains of his bicycle.

He had not visited in a long time, not since the night she'd left for college. When he did visit, it was always the same. He would sit looking at her, not speaking.

She said, "Where have you been, Pete? Why did you come if you're not going to say anything?"

He just sat watching her, his eyes silent, his lips unmoving. The collar of his blue shirt was starched and stiff, just the way their mother had pressed it for the burial. He turned and looked towards another room. A musical note seemed to be calling to him; he was starting to shimmer, like water that has been stirred.

She said, "What did you come to tell me?"

The waters were churning now, beaten to a froth by all those musical notes. Another bell-like jangle led to total disintegration. There was only darkness.

And the ringing telephone.

Abby reached for the receiver. "DiMatteo," she said.

"This is the SICU. I think maybe you'd better come down."

"What's happening?"

"It's Mrs ross in Bed 15. The transplant. She's running a fever, 38.6?

"What about her other vitals?"

"BP's a hundred over seventy. Pulse is ninety-six."

"I'll be there." Abby hung up and switched on the lamp. It was 2 a.m. The chair by her bed was empty. No Pete. Groaning, she climbed out of bed and stumbled across the room to the sink, where she splashed cold water on her face. Its temperature didn't even register. She felt the water as though through anaesthesia. Wake up, wake up, she told herself. You have to know what the hell you're doing. A post-op fever. A three-day-old transplant. First step, check the wound. Examine the lungs, the abdomen. Order a chest x-ray and cultures.

And keep your cool She couldn't afford to make any mistakes. Not now, and certainly not with this patient.

Every morning for the past three days, she'd walked into Bayside not knowing if she still had a job. And every afternoon at five o'clock she'd heaved a sigh of relief that she'd survived another twenty-four hours. With each day that passed, the crisis seemed a little dimmer and Parr's threats more remote. She knew she had Wettig on her side, and Mark as well. With their help, maybe — just maybe — she'd keep her job. She didn't want to give Parr any reason to question her performance as a doctor, so she'd been especially meticulous at work, had checked and re-checked every lab result, every physical finding. And she'd been careful to steer clear of Nina Voss's hospital room. Another angry encounter with Victor Voss was the last thing she needed.

But now NinaVoss was running a fever andAbby was the resident on the spot. She couldn't avoid this: she had a job to do.

She pulled on her tennis shoes and left the on-call room.

Late at night, a hospital is a surreal place. Hallways stretch empty, the lights are too bright, and through tired eyes, all those white walls seem to curve and sway like moving tunnels. She was weaving through one of those tunnels now, her body still numb, her brain still struggling to function. Only her heart had fully responded to the crisis: it was pounding.

She turned a corner, into the SICU.

The lights were dimmed for the night — modern technology's concession to the diurnal needs of human patients. In the gloom of the nurses' station, the electrical patterns of sixteen patients' hearts traced across sixteen screens. A glance at Screen 15 confirmed that Mrs Voss's pulse was running fast. A rate of 100.

The monitor nurse picked up the ringing telephone, then said: "Dr. Levi's on the line. He wants to talk to the on-call resident."

"I'll take it," said Abby, reaching for the receiver. "Hello, Dr. Levi? This is Abby DiMatteo."

There was a silence. "You're on call tonight?" he said, and she heard a distinct note of dismay in his voice. She understood at once the reason for it. Abby was the last person he wanted to lay hands on Nina Voss. But tonight there was no alternative; she was the senior resident on call.

She said: "I was just about to examine MrsVoss. She's running a fever."

"Yes, they told me about it." Again there was a pause.

She plunged into that void, determined to keep their conversation purely professional. I'll do the usual fever workup," she said. "I'll examine her. Order a CBC and cultures, urine, and chest x-ray. As soon as I have the results I'll call you back."

"All right," he finally said. I'll be waiting for your call."

Abby donned an isolation gown and stepped into Nina Voss's cubicle. A single lamp had been left on, and it shone dimly above the bed. Under that soft cone of light, NinaVoss's hair was a silvery streak across the pillow. Her eyelids were shut, her hands crossed over her body in a strange semblance of holy repose. The princess in the sepulchre, thought Abby.

She moved to the side of the bed and said softly: "Mrs Voss?" Nina opened her eyes. Slowly her gaze focused on Abby. "Yes?" Tm Dr. DiMatteo," said Abby. "I'm one of the surgical residents." She saw the flicker of recognition in the other woman's eyes. She knows my name, thoughtAbby. She knows who I am. The graverobber. The body thief.

Nina Voss said nothing, merely looked at her with those fathomless eyes.

"You have a fever," explained Abby. "We need to find out why. How are you feeling, Mrs Voss?"

"I'm… tired. That's all," whispered Nina. "Just tired."

"I'll have to check your incision." Abby turned up the lights and gently peeled the bandages off the chest wound. The incision looked clean, no redness, no swelling. She pulled out her stethoscope and moved on to the rest of the fever workup. She heard the normal rush of air in and out of the lungs. Felt the abdomen. Peered into the ears, nose, and throat. She found nothing alarming, nothing that would cause a fever. Through it all, Nina remained silent, her gaze following Abby's every move.

At last Abby straightened and said: "Everything seems to be fine, But there must be a reason for the fever. We'll be getting a chest x-ray and collecting three different blood samples for cultures." She smiled apologetically. "I'm afraid you're not going to get much sleep tonight."

Nina shook her head. "I don't sleep much, anyway. All the dreams.

So many dreams…"

"Bad dreams?"

Nina took in a breath, slowly let it out. "About the boy."

"Which boy, Mrs Voss?"

"This boy." Softly she touched her hand to her chest. "They told me it was a boy's. I don't even know his name. Or how he died. All I know is, this was a boy's." She looked at Abby. "It was. Wasn't it?" Abby nodded. "That's what I heard in the operating room."

"You were there?"

"I assisted Dr. Hodell."

A small smile formed on Nina's lips. "Strange. That you should be there, after…" Her voice faded.

Neither one of them spoke for a moment, Abby silenced by guilt, Nina Voss by… what? The irony of this meeting? Abby dimmed the lights. Once again the cubicle took on its sepulchral gloom.

"MrsVoss," said Abby. "What happened a few days ago. The other heart, the first heart…" She looked away, unable to meet the other woman's gaze. "There was a boy. Seventeen. Boys that age, they want cars or girlfriends. But this boy, all he wanted was to go home. Nothing else, just to go home." She sighed. "In the end, I couldn't let it happen.! didn't know you, MrsVoss. You weren't the one lying in that bed. He was. And I had to make a choice." She blinked, felt tears wet her lashes. "He lived?"

"Yes. He lived."

Nina nodded. Again she touched her own chest. She seemed to be conferring with her heart. Listening, communicating. She said, "This boy. This boy's alive, too. I'm so aware of his heart. Every beat. Some people believe that the heart is where the soul lives. Maybe that's what his parents believe. I think about them, too. And how hard it must be. I never had a son. I never had a child." She closed her hand into a fist, pressed it against the bandages. "Don't you think it would be a comfort, to know that some part of him is still alive? If it was my son, I'd want to know. I'd want to know." She was crying now, the tears a sparkling trickle down her temple.

Abby reached for the woman's hand and was startled by the force of Nina's grasp, the skin feverish, the fingers tight with need. Nina was looking up at her, a gaze that seemed to shine with its own strange fire. If I had known you then, thought Abby, if I had watched you dying in one bed, and Josh O" Day in another, which one of you would I have chosen?

I don't know.

Above the bed, a line skipped across the green glow of the oscilloscope. The heart of an unknown boy, beating a hundred times a minute, pumping fevered blood through a stranger's veins.

Abby, holding Nina's hand, could feel the throb of a pulse. A slow, steady pulse.

Not Nina's, but her own.

It took twenty minutes for the x-ray tech to arrive and shoot the portable chest film, and another fifteen minutes before Abby had the developed x-ray in hand. She clipped it to the SICU viewing box and examined it for signs of pneumonia. She saw none.

It was 3 a.m. She called Aaron Levi's house.

Aaron's wife answered, her voice husky with sleep. "Hello?"

"Elaine, this is Abby DiMatteo. I'm sorry to bother you at this hour. May I speak with Aaron?"

"He left for the hospital."

"How long ago?"

"Uh… it was just after the second phone call. Isn't he there?"

"I haven't seen him," said Abby.

There was a silence on the other end of the line. "He left home an hour ago," said Elaine. "He should be there."

"I'll page his beeper. Don't worry about it, Elaine." Abby hung up, then dialled Aaron's beeper and waited for the phone to ring.

By three-fifteen, he still hadn't answered.

"Dr. D.?" said Sheila, NinaVoss's nurse. "The last blood culture's been drawn. Is there anything else you want to order?"

What have I missed? thought Abby. She leaned forward against the desk and massaged her temples, 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.