The Heart

24

The organ-removal teams begin arriving at 10:00 p.m. The Rouen team turns up in a car, only one hour on the roads separating them from the hospital in Le Havre, whereas the teams from Lyon, Strasbourg, and Paris are all arriving by airplane.

* * *

The teams have organized their transportation, calling an airline company that will accept this Sunday mission, and have verified the nocturnal opening of the little airport at Octeville-sur-Mer, formalizing all the logistical details. At the Pitié, Virgilio paced impatiently around the duty nurse who was frantically calling everyone, and did not even look at the young woman in a white overcoat who was also standing there, in silence, and who, when their eyes did finally meet, moved away from the wall and advanced toward him, hello, Alice Harfang, I’m the new intern in the department, I’ll be doing the removal with you. Virgilio eyeballed her: she didn’t have the giveaway white cowlick, but he could tell she was one of them — ugly, indeterminate age, yellow eyes and eagle-beak nose. He could almost see the strings that were pulled to get her here. His face darkened. He particularly disliked the beautiful white coat with the fur collar. Not exactly an appropriate outfit for traipsing around hospitals. She’s the kind of chick who just comes along for the ride and thinks money grows on trees, he thought irritably. Okay, I assume you’re not scared of flying, right? he questioned her curtly then turned away while she replied no, not at all. The duty nurse handed him a road map, hot off the printer: go ahead, the plane’s on the runway, you’ll be departing in forty minutes. Virgilio picked up his bag and headed toward the exit without even glancing at Alice, who was following him, then took the elevator, the taxi, the main roads to Bourget airport, where they passed jet-lagged businessmen in long cashmere overcoats, holding luxury briefcases, and soon the two of them were climbing into a Beechcraft 200 and fastening their seat belts, without having exchanged a single word.

The weather forecast is favorable: no snow yet, and not much wind. The pilot, a man in his late thirties with perfectly straight teeth, announces good flying conditions and an estimated journey time of forty-five minutes, then disappears into the cockpit. As soon as he’s sitting down, Virgilio has his nose in a financial magazine that someone had left on his seat, while Alice turns toward the window and watches Paris transformed into a sparkling tapestry as the little plane gains altitude — the almond shape, the river and its islands, the squares and the main roads, the bright zones full of exclusive stores, the dark zones full of tower blocks and forests, all of it shading into obscurity if you let your eyes move from the heart of the capital to its edges, beyond the luminous ring of the beltway; she follows the lines traced by those tiny red and yellow dots that run along invisible roads, the silent activity of the earth’s surface. After that, the Beechcraft climbs through the clouds and into the celestial night. And so, probably because they are disconnected from the ground in this way, propelled far beyond all social markers, Virgilio thinks differently about his companion — maybe he is beginning to find her less repugnant — asking her, is this your first removal? Surprised, the woman turns her face from the window and looks at him: Yes, first removal, and first transplant. Closing his magazine, Virgilio warns her: The first part of the night might be a little upsetting, it’s a multiorgan removal, the kid’s only nineteen, we’re probably going to take everything — organs, blood vessels, tissue — we’re just going to scrape everything out. His fist opens and closes very fast. Alice looks at him — her expression, enigmatic, might just as easily mean “I’m scared” as “So? I’m a Harfang, remember?”—then she sits up and reattaches her seat belt, while Virgilio, suddenly destabilized, does the same: they are making their descent toward Octeville.

The little airport has been opened specially for them: the runway is lined with lights, the top of the tower illuminated. The aircraft touches down, shaken by spasms. The door slides open and the gangway unfolds. Alice and Virgilio walk down to the runway, and from that moment on they are propelled in a single movement, as if they are standing on a moving walkway, a magically fluid and unbroken trajectory, crossing through a deserted exterior (that asphalt perimeter where they can hear the sea), a mobile, cozy interior (the taxi), a freezing cold exterior (the hospital parking lot), and an interior whose codes they recognize instantly (the surgery unit).

* * *

Thomas Rémige is waiting for them, like the master of the house. Handshakes, espressos, introductions made, connections created, and, as always, the Harfang name radiates its aura. He makes a head count: each team consists of two people, a senior surgeon and an intern, to which his own hospital has added the anesthesiologist and the nurse anesthetist, the OR nurse, the nurse’s aid, and himself — thirteen altogether. It will seem like a crowd in the operating theater, the impregnable citadel, the secret zone accessible only to holders of multiple entry codes. Christ, it’s going to be standing room only in there, Thomas thinks.

* * *

The theater is ready. The surgical lamp projects a white light, vertical and shadowless, over the operating table, the beams from its circle of spots converging on Simon Limbres’s body, which has just been brought here and which still shows the same level of animation. It is still troubling, still moving to see him this way. He is placed in the center of the room — he is the heart of the world. A first circle around him delimits a sterile zone that cannot be crossed by anyone not involved in the operation: nothing must be touched, soiled, infected; the organs that are about to be harvested here are sacred objects.

In a corner of the room, Cordélia Owl takes it all in. She has changed into scrubs and left her cell phone in a changing-room locker. Being separated from it — no longer feeling that hard rectangular shape vibrating against her hip, insidious as a parasite — has sent her into another reality: yes, it’s here that it’s happening, she thinks, eyes riveted on the body stretched out before her, this is where I am. Having gone through her training in the OR, the place itself is not alien to her, but she has only ever seen intense mobilizations aimed at saving patients, at keeping them alive, and she is struggling to comprehend the coming operation, because the young man is already dead, isn’t he, and the objective of the surgery is to save other lives. She has prepared the equipment, arranged the tools, and now she is quietly repeating to herself the order in which the organs will be removed, lips barely moving behind her mask: (1) the kidneys; (2) the liver; (3) the lungs; (4) the heart. Then she starts over in reverse, reciting the order of the organs based on the duration of ischemia the organ will tolerate — in other words, how much time it will survive once vascularization has been stopped — (1) the heart; (2) the lungs; (3) the liver; (4) the kidneys.

* * *

The body is lying flat, naked, arms extended to the sides, leaving clear the thoracic cage and the abdomen. It has been prepared, shaved, painted, then covered in a fenestrated drape that marks out a window of skin on the body, a cutaneous perimeter covering the thorax and the abdomen.

All right, here we go. Let’s get started. The first team appears in the operating theater. The urologists will get the ball rolling — they will be the ones to open the body and they will close it again at the end. Two men get to work, a Laurel and Hardy — like odd couple, the tall, thin one being the surgeon, and the small, round one the intern. The tall, thin one bends over the body and makes an incision in the abdomen — a bilateral laparotomy below the ribs, tracing a sort of cross on the abdomen. In this way, the body is split in two distinct zones at the level of the diaphragm: the abdominal zone, where the liver and the kidneys are located, and the thoracic zone, home to the lungs and the heart. The men use self-retaining retractors on the incision, turning them by hand to widen the opening — this action requires physical force, allied to meticulous technique, and suddenly the manual dimension of the operation shows through the massed technology, the physical confrontation with reality that is necessary in this place. The body’s interior — the murky, oozing insides — glows red under the lamps.

* * *

The practitioners will prepare their organs in turn. Quick, meticulous blades move around the organs, freeing them from their attachments, their ligaments, their respective envelopes, but for the moment nothing is severed. The urologists, standing on either side of the table, talk to each other as this happens, the surgeon taking the opportunity to educate the intern: he leans over the kidneys, breaking down the movements he makes, describing the techniques he uses, while his pupil nods and sometimes asks questions.

One hour later, the Alsace team enters the room, both women, both the same height and build; the surgeon, a rising star in the relatively select world of hepatic surgery, does not utter a word, her gaze impassive behind her small, round, metal glasses, working at the liver with the determination of someone in a fight, fully committed to an action that seems to find fulfillment in its own execution. Her colleague stares unblinkingly at the surgeon’s unbelievably skillful hands.

Another thirty-five minutes pass and the thoracic team enters the theater. It’s Virgilio’s turn now; time for him to shine. He informs the Alsatians that he is ready to make the first incision, then immediately afterward makes the longitudinal section of the sternum. Unlike the others, he does not bend over the body, but remains upright, neck angled and arms held forward — a way of maintaining his distance from the body. The thorax is open and Virgilio can now see the heart — his heart — he can consider its volume, scrutinize the ventricles and auricles, observe its solid contractions. Alice sees the satisfaction in his face: it’s a magnificent heart.

He proceeds with stunning speed — the arm of a quarterback and the fingers of a lacemaker — first dissecting the aorta, then, one by one, the venae cavae: untangling the muscle. Alice, standing directly across from him on the other side of the operating table, is gripped by what is unfolding: by the parade around this body, by the sum of actions of which it is the object; she watches Virgilio’s face, wonders what it means to him to operate on a dead person, what he’s feeling, what he’s thinking, and the space around her seems to reel, as if the separation between the living and the dead no longer exists here.

* * *

Once the dissection is completed, it is time for cannulation. The blood vessels are pierced with a needle and little catheters inserted into them, through which will pass the liquid that cools the organs. The anesthesiologist surveys the donor’s hemodynamic status on the screens — perfectly stable — while Cordélia supplies the surgeons with implements as required, taking care to repeat the name of the compress, the number of the pliers or blade as she places them in the palm of the plastic-gloved hand held open in front of her, and the more she does this, the firmer her voice sounds, the more confident she feels of her place in this operation. It’s ready now: cannulation is completed, and we can clamp the aorta — and every practitioner in the room checks the anatomical map they have just been given, identifying the part intended for them.

* * *

Can we clamp? Virgilio’s voice, loud in the theater even though muffled by the mask, startles Thomas. No, wait! He shouted, and everyone turns to look at him now, hands immobilized over the open body, elbows frozen at right angles: the operation is suspended while the coordinator weaves between them to reach the table, moving his mouth close to Simon Limbres’s ear. What he whispers then, in his most humane voice, even though he knows that his words are falling into a deathly void, is the promised litany of names, the names of those who are escorting him; he whispers that Sean and Marianne are with him, and Lou, and Grandma, he whispers that Juliette is there by his side — Juliette who knows about Simon now: she got a call from Sean around 10:00 p.m. after leaving a succession of increasingly distraught messages on Marianne’s cell phone, though what Simon’s father said to her was incomprehensible, as his words seemed to wander beyond language; he seemed unable to formulate a sentence, only gasps, cracked syllables, stammered phonemes, sobs, till Juliette finally understood that there was nothing else to hear, that there were no words, that this was what she had to hear, and she replied I’m coming, in a breath, then rushed out into the night, running to join the Limbres family in their apartment, hurtling down the steep hill, not wearing a coat or even a scarf, an elf in sneakers, keys in one hand and cell phone in the other, and soon the glass-sharp cold started to burn, she was consumed on the slope, a figurine broken into pieces, almost falling several times as she struggled to coordinate her strides, breathing badly — not at all the way Simon had taught her to breathe, with no regularity, forgetting to exhale — her tibias aching and heels burning, ears popping like they did in a landing plane, and a stitch stabbing at her side; bent double, she continued to run on the too-narrow sidewalk, grazing her elbow against the high stone wall that bordered the curve, rushing down this slope that he had climbed for her on his bike five months earlier — the same bend but in the opposite direction, that day of the Ballade des pendus and the red plastic lovers’ shelter that they had raised together, that day, that first day — she was running so hard she couldn’t breathe now, and the cars were driving past her, up the hill, catching her in the white glare of their headlights, slowing down, the startled drivers continuing to watch her in their rearview mirrors for a long time afterward — a kid in a T-shirt, out in the street, at this hour, in this cold, and the look of panic on her face! — then she came into view of the unlit bay window of the living room and accelerated again, entering the grounds, crossing a clear space of flower beds and hedges that seemed to her like a hostile jungle, then sprinting up the steps, where she took a tumble, the carpet of leaves coagulated by the cold forming a layer of ice, and scraped her face, splashing mud on her temple and her chin, and then she was up again and climbing the stairs, three floors, and when she arrived on the landing, her face deformed like the others, unrecognizable, Sean opened the door to her before she even rang the bell and took her in his arms, holding her tight, while behind him, in the dark, Marianne was smoking a cigarette, wearing a coat, standing next to the sleeping Lou: Oh Juliette, and the tears began — then Thomas takes the earbuds from his pocket, the earbuds that he has sterilized, and inserts them into Simon’s ears, switches on the iPod, track 7, and the last wave forms on the horizon, in front of the cliffs, it rises and rises until it fills the whole sky, forming and unforming, deploying the chaos of the matter and the perfection of the spiral in its metamorphosis, scraping the seafloor, stirring up the layers of sediment and shaking the alluvium, uncovering fossils and overturning treasure chests, revealing those invertebrates sunk deep in the vastness of time, 150-million-year-old ammonites and bottles of beer, airplane wreckage and handguns, bleached bones like tree bark, the seabed as fascinating as a gigantic garbage dump and an ultrasensitive membrane, a pure biology, and the wave lifts up the earth’s skin, digging into memory and turning it over, regenerating the soil where Simon Limbres lived — the soft dune in whose hollow he shared a packet of french fries and mustard with Juliette, the pine forest where they sheltered during the squall, the 150-foot bamboo stalks just behind them, swaying like they do in Asia, and the warm raindrops hitting the gray sand that day, the odors mingling, bitter and salty, Juliette’s lips the color of grapefruit — and then finally it explodes and scatters, in an almighty splash, a conflagration and a shimmer, while around the operating table the silence thickens, they wait, eyes meeting over the body, toes twitching, fingers suspended, but they all accept that it is right to pause for a moment as they stop Simon Limbres’s heart. Once the rite has been performed, Thomas removes the earbuds and returns to his place. Again: Can we clamp?

Clamp!

* * *

The heart stops beating. The body is slowly purged of its blood, which is replaced by a refrigerated liquid that, injected in a fast flow, will rinse the internal organs, while in that instant ice packs are placed around them — and it is probably at this point that Virgilio will glance at Alice Harfang to make sure she’s not about to faint, because the blood that flows from the body is pouring into a plastic tray that amplifies the sounds like an echo chamber, and it is this noise, more than the sight of the open body, that tends to upset people. But no, the young woman is still standing, perfectly stoical, even if her forehead looks rather pale and beaded with sweat, and he goes back to work as the countdown begins.

And so the thorax becomes, once again, a ritual battleground where cardiac surgeons and thoracic surgeons fight over who will get what length of that stump of vein, where they scrap over a few extra millimeters of pulmonary arteries. Virgilio is a good and generous colleague, but he’s tense, and he ends up snapping at the man opposite him: Leave me something, will you? I don’t think a centimeter or two is too much to ask!

* * *

Thomas Rémige has slipped out of the operating theater to phone the several hospital departments where the transplants will take place: he has to inform them of the time when the aorta was clamped—11:50 p.m. — a figure that instantly sharpens the timeline for the coming operation: prepping the recipient, transporting the organ, transplanting the organ. On his return, the first organ is being removed, in absolute silence. Virgilio now begins the ablation of the heart: the two venae cavae, the four pulmonary veins, the aorta, and the pulmonary artery are severed — perfect caesurae. The heart is explanted from Simon Limbres’s body. It’s crazy, you can see it — there, in the air — for a brief moment you can apprehend its mass and its volume, attempt to grasp its symmetrical form, its dual bulge, its beautiful color (crimson or vermilion), seek to match it to the universal pictogram of love, the playing-card emblem, the T-shirt logo — I ♥ NY — the bas-relief carved on tombs and royal reliquaries, the symbol of Eros the charlatan, the figurative representation of the sacred heart of Jesus in pious imagery — the organ held in the hand and exhibited to the world, streaming with tears of blood but haloed with radiant light — or any text icon indicating the infinite variety of sentimental emotions. Virgilio picks it up and immediately plunges it in a jar filled with clear liquid, a cardioplegic solution that guarantees a temperature of 39 degrees — the organ has to be cooled down very quickly in order to conserve it — after which the whole thing is protected inside a sterile safety bag and then in another bag, which is buried in crushed ice within an isothermic box.

When the box has been sealed, Virgilio waves goodbye to everyone, but none of the people surrounding Simon Limbres’s body looks up, no one reacts at all apart from the thoracic surgeon angled over the lungs, who barks out you didn’t leave me much to work with, you bastard, with a jerky laugh, while the surgeon from Strasbourg prepares to cut out the liver, such a fragile organ, by concentrating like a gymnast about to leap onto the beam — for a second, you half-expect her to thrust her hands into a bowl of chalk and rub her palms — while the urologists wait patiently to appropriate the kidneys.

Alice hangs back. She is focused on the scene in front of her, staring at the people, one after another, gathered around the table and the inanimate body that is its dazzling center — Rembrandt’s Anatomy Lesson flashes through her mind and she remembers how her father, an oncologist with long, twisted fingernails, like claws, hung a reproduction of the painting in the entrance hall of the family apartment and would often exclaim, tapping it with an index finger: That is a man, that’s what we are! But, being a daydreamer as a child, she preferred to see in it a council of wizards rather than the doctors who made up her kin. She would stand for long moments in front of those strange figures, admirably arranged around the cadaver, dressed in deep-black tunics, their wise heads posed on immaculate ruffs, the abundance of folds as delicate as wafer-paper origami, the lace trimmings and precise beards, and in the middle of all this, that pale body, that mysterious mask, and the slit in the arm through which could be seen the bones and the ligaments, the blade held by the man in the black hat plunged into the flesh. More than admiring it, however, she listened to the canvas, fascinated by the discussion represented there, and ended up learning that piercing the peritoneal wall was for a long time considered an affront to the sacredness of the body of man, that divinely created being, and she understood that all forms of knowledge contain an element of transgression. So it was that she decided to “do medicine,” supposing that she actually had a choice in the matter, because she was, after all, the eldest of four daughters, the one her father took to the hospital on Wednesdays, the one he gave a professional stethoscope to on her thirteenth birthday, whispering into her ear: Harfangs are jerks, little Harfang girl, and you’re going to crush them all.

Alice withdraws gradually, and everything in her field of view becomes still and illuminated, like a diorama. Suddenly, what she sees in place of the stretched-out body is simply matter, a substance to be used and shared; no longer a stopped mechanism peeled open to have its best parts removed, but a material of infinite potential: a human body, its power and its end, its human end — and it is the emotion she feels at this, rather than any fountain of blood splashing into a plastic bucket, that might make her pass out. Virgilio’s voice, already far off, behind her back: Are you coming? What the hell are you doing? Get your ass in gear! She turns around and runs the length of the corridor to catch up.

* * *

A specialized medical transport takes them back to the airport. The vehicle speeds through darkness while they watch the movement of figures on the dashboard clock, following the dance of the luminescent hands that point down and then up again, while they are mesmerized by the digital numbers on their cell-phone screens. And then Virgilio’s phone lights up. It’s Harfang. How is it?

Perfect.

* * *

They bypass the city by the north and take the Fontaine-la-Mallet road, passing the compact, indeterminate shapes of suburban buildings, tower blocks planted in fields behind the city, swarms of apartment towers around an asphalt loop; they drive through a forest, still not a star in the sky, no flashing airplane lights or flying saucers, nothing at all. The driver speeds along this secondary road, well above the limit; he’s an experienced driver, accustomed to this type of mission; he stares straight ahead, forearms rigid and immobile, muttering into a tiny microphone attached to a high-tech earpiece, I’m on my way, don’t fall asleep, I’ll be there soon. The box is wedged in the compartment behind them, and Alice visualizes the several hermetic walls surrounding the heart, those membranes that protect it; she imagines that it is a rocket engine propelling them through space. Turning around and lifting herself up on one side, she is able to see past the headrest; squinting through the dimness, she deciphers the words on the label affixed to the side of the box and notices, among the information necessary for the traceability of the organ, a strange phrase: “element or product of human body for therapeutic use.” And, just below this, the donor’s Cristal number.

Virgilio leans back in his seat and breathes out. His eyes linger on Alice’s profile, a shadow puppet against the window, and, suddenly stirred by her presence, asks in a soft voice: Are you okay? The question is unexpected — this guy has been so unpleasant up to now — and Macy Gray’s voice on the radio sings shake your booty, boys and girls, there is beauty in the world, and out of nowhere Alice feels like crying — an emotion that grabs her from within and lifts her up, quivering — but she holds back her tears, grits her teeth as she turns her face away: Yup, I’m fine. So he takes his cell phone out of his pocket for the thousandth time, but instead of checking the time he taps at it, gradually becoming annoyed: It’s not loading, he hisses, fuck it, fuck it. Feeling bolder, Alice asks, something wrong? Virgilio answers her without looking up, it’s the game, I wanted to see the result of the game, and without turning around the driver announces coldly that Italy won, 1–0. Virgilio lets out a yell, raises a fist, then demands: Who scored? The driver signals and brakes: the whitish space of an illuminated intersection looms ahead. It was Pirlo. Alice, stupefied, watches as Virgilio rapidly types a couple of victory texts, muttering to himself yes, yes, yes, then he looks over at her, one eyebrow raised: Pirlo, eh? What a player! His smile overwhelms his face, and then they are at the airport, hearing the roar of the sea close by, at the foot of the cliffs, and rolling the box across the runway and up the gangway, hauling it into the plane, this Russian doll of a box which contains the transparent plastic safety bag which contains the receptacle which contains the special jar which contains Simon Limbres’s heart, which contains nothing less than life itself, the possibility of life, and which five minutes later is airborne.