Harvesting The Heart Part 4

I thought about the easy days, when he would bathe me as a child and wrap me in my long-john pajamas and comb the tangles from my hair. I thought about sitting on his lap and watching the bluest flames in the fireplace and wondering if there was any finer thing in the world.

"Paige?" he said into the silence. "Paige?"

I did not answer all the questions he was trying to ask. "I'm getting married, and I wanted you to know," I said, but I was certain he could hear the fear in my voice as loudly as I could hear it in his.

It built up in my stomach and my chest, the feeling, as if I were spiraling into myself. I could feel Nicholas holding back, tensed like a puma, until I was ready. I wrapped my arms and my legs around Nicholas, and, together, we came. I loved the way he arched his neck and exhaled and then opened his eyes as though he wasn't quite sure where he was and how he had got there. I loved knowing I had done that to him.

Nicholas cupped my face in his hands and told me he loved me. He kissed me, but instead of pa.s.sion I felt protection. He pulled us onto our sides, and I curled myself in the hollow of his chest and tasted his skin and his sweat. I tried to burrow closer. I did not close my eyes to sleep, because I was waiting, as I had the last time I'd been with a man, for G.o.d to strike me down.

Nicholas brought me violets, two huge bunches, still misted and swollen with the spray of a florist. "Violets," I said, smiling. "For faithfulness."

"Now, how do you know that?" Nicholas said.

"That's what Ophelia says, anyway, in Hamlet," Hamlet," I told him, taking the bunches and holding them in my left hand. I had a quick vision of the famous painting of Ophelia, where she floats faceup in a stream, dead, her hair swirled around her and tangled with flowers. Daisies, in fact. And violets. I told him, taking the bunches and holding them in my left hand. I had a quick vision of the famous painting of Ophelia, where she floats faceup in a stream, dead, her hair swirled around her and tangled with flowers. Daisies, in fact. And violets.

The justice of the peace and a woman whom he introduced only as a witness were standing in the center of a plain room when we walked in. I think Nicholas had told me the man was a retired judge. He asked us to spell and p.r.o.nounce our names, and then he said "Dearly beloved." The entire thing took less than ten minutes.

I did not have a ring for Nicholas and I started to panic, but Nicholas pulled from his suit pocket two bright gold bands and handed the larger one to me. He looked at me, and I could clearly read his eyes: 1 didn't forget. I won't forget anything. 1 didn't forget. I won't forget anything.

Within a few minutes I began to cry. It was not that I was hurt, which Nicholas thought, or that I was happy or disillusioned. It was because I had spent the past eight weeks with a hole in my heart. I had even started to hate myself a little. But in making love with Nicholas, I discovered that what had been missing was replaced. Patchwork, but still, it was better. Nicholas had the ability to fill me.

Nicholas kissed the tears off my cheeks and stroked my hair. He was so close that we were breathing the same square of air. And as he stirred beside me again, I began to erase my past until almost all I could remember was whatever I had told Nicholas, whatever he wanted to believe. "Paige," he said, "the second time is even better." And reading into this, I moved astride him and eased him inside me and started to heal.

chapter 5

Paige The best of the several memories I have of my mother involved the betrayal of my father. It was a Sunday, which had meant for as long as I'd been alive that we would be going to Ma.s.s. Every Sunday, my mother and my father and I would put on our best outfits and walk down the street to Saint Christopher's, where I would listen to the rhythmic hum of prayers and watch my mother and my father receive Communion. Afterward we'd stand in the sun on the worn stone steps of the church, and my father's hand would rest warm on my head while he talked to the Morenos and the Salvuccis about the fine Chicago weather. But this particular Sunday, my father had left for O'Hare before the sun came up. He was flying to Westchester, New York, to meet with an eccentric old millionaire in hopes of promoting his latest invention, a polypropylene pool float that hung suspended by wires in the middle of the two-car garages that were part of the new suburban tract houses. He called it the Sedan Saver, and it kept car doors from scratching each other's paint when they were opened.

I was supposed to be asleep, but I had been awakened by the dreams I'd been having. At four, almost five, I didn't have many friends. Part of the problem was that I was shy; part was that other kids were steered clear of the O'Toole house by their parents. The bosomy Italian mothers in the neighborhood said my mother was too sa.s.sy for her own good; the dark, sweating men worried that my father's bad luck in inventing could ooze uninvited over the thresholds of their own homes. Consequently, I had begun to dream up play-mates. I wasn't the type of kid who saw someone beside me when I took out my Tinkertoys and my dominoes; I knew very well when I was alone that I was truly alone. But at night, I had the same dream over and over: another girl called to me, and together we rolled mud-burgers in our hands and pumped on swings until we both grazed the sun with our toes. The dream always ended the same way: I would get up the courage to ask the girl's name so that I'd be able to find her and play together again, and just before she answered I'd wake up.

And so it was that on that Sunday I opened my eyes already disappointed, to hear my father tugging his suitcase down the hall and my mother whispering goodbye and reminding him to call us later, after we got home from Saint Christopher's, to tell us how it went.

The morning started the way it always did. My mother made me breakfast-my favorite today, apple pancakes in the shape of my initials. She laid my pink lace last-year Easter dress on the foot of my bed. But when the time came to leave for Ma.s.s, my mother and I stepped into one of those perfect April days. The sun was as filling as a kiss, and the air held the promise of freshly mowed gra.s.s. My mother smiled and took my hand and headed up the street, away from Saint Christopher's. "On a day like this," she said, "G.o.d didn't mean for us to rot away indoors."

It was the first time that I realized my mother had a second life, one that had nothing at all to do with my father. What I had always a.s.sumed was spirituality was really just the side effect of the energy that hovered around her like a magnetic field. I discovered that when my mother wasn't bending to someone else's whims, she could be a completely different person.

We walked for blocks and blocks, coming closer to the lake, I knew, by the way the wind hung in the air. It became unseasonably warm as we walked, reaching into the high seventies, maybe even eighty. She let go of my hand as we came to the white walls of the Lincoln Park Zoo, which prided itself on its natural habitats. Instead of keeping the animals locked in, they cleverly kept the people out. There were few fences or concrete barriers. What kept the giraffes penned was a wide-holed grate that their legs would have slipped through; what kept the zebras in were gulleys too wide to leap. My mother smiled at me. "You'll love it here," she said, making me wonder if she came often, and if so, whom she brought instead of me.

We were drawn to the polar bear exhibit simply because of the water. The free-form rocks and ledges were painted the cool blue of the Arctic, and the bears stretched in the sun, too warm in their winter fur. They slapped their paws at the water, which, my mother said, was just thirty-three degrees. There were two females and a cub. I wondered what the relations.h.i.+p was.

My mother waited until the cub couldn't take the heat anymore, and then she pulled me down a few shadowed steps to the underwater viewing lounge, where you could see into the underwater tank through a window of thick plexigla.s.s. The cub swam right toward us, sticking its nose against the plastic. "Look, Paige!" my mother said. "It's kissing you!" She held me up to the window so that I could get a closer look at the sad brown eyes and the slippery whiskers. "Don't you wish you could be in there?" my mother said, putting me down and dabbing at my forehead with the hem of her skirt. When I did not answer her, she began to walk back up into the heat, still talking quietly to herself. I followed her; what else could I do? "There are many places," I heard her whisper, "I'd like to be."

Then she got an inspiration. She found the nearest totem pole directional sign and dragged me toward the elephants. African and Indian, they were two different breeds but similar enough to live in the same zoo s.p.a.ce. They had wide bald foreheads and paper-thin ears, and their skin was folded and soft and spread with wrinkles, like the saggy, mapped neck of the old black woman who came to clean Saint Christopher's. The elephants shook their heads and swatted at gnats with their trunks. They followed each other from one end of their habitat to the other, stopping at, trees and examining them as if they'd never seen them before. I looked at them and wondered what it would be like to have one eye on each side of my body. I didn't know if I'd like not being able to see things head-on.

A moat separated us from the elephants. My mother sat down on the hot concrete and pulled off her high heels. She was not wearing stockings. She hiked up her dress and waded into the knee-high water. "It's lovely," she said, sighing. "But don't you come in, Paige. Really, I shouldn't be doing this. Really, I could get in trouble." She splashed me with the water, little bits of gra.s.s and dead flies sticking to the white lace collar of my dress. She sashayed and stomped and once almost lost her footing on the smooth bottom. She sang tunes from Broadway shows, but she made up her own lyrics, silly things about firm pachyderms and the wonder of Dumbo. When the zoo guard came up slowly, unsure of how to confront a grown woman in the elephant moat, my mother laughed and waved him away. She stepped out of the water with the grace of an angel and sat down on the concrete again. She pulled on her pumps, and when she stood, there was a dark oval on the ground where her damp bottom had been. She told me with the serious demeanor she'd used to tell me the Golden Rule that sometimes one had to take chances.

Several times that day I found myself looking at my mother with a strange tangle of feelings. I had no doubt that when my father called, she would tell him we'd been at Saint Christopher's and that it had been just as it always was. I loved being part of a conspiracy. At one point I even wondered if the girlfriend I'd been seeing night after night in my dreams was really just my own mother. I thought of how convenient and wonderful that might be.

We sat on a low bench beside a lady who was selling a cloud of banana balloons. My mother had been reading my thoughts. "Today," she said, "today let's say I'm not your mother. Today I'll just be May. Just your friend May." And of course I didn't argue, because this was what I had been hoping hoping anyway, and besides, she wasn't anyway, and besides, she wasn't acting acting like my mother, at least not the one I knew. We told the man cleaning out the ape cage our white lie, and although he did not look up from his work, one large, ruddy gorilla came forward and stared at us, a very human exhaustion in her eyes, which seemed to say, like my mother, at least not the one I knew. We told the man cleaning out the ape cage our white lie, and although he did not look up from his work, one large, ruddy gorilla came forward and stared at us, a very human exhaustion in her eyes, which seemed to say, Yes, I believe you. Yes, I believe you.

The last place we visited in the Lincoln Park Zoo was the penguin and seabird house. It was dark and smelled of herring and was fully enclosed. It sat partially under the ground to maintain its cool temperature. The viewing area was a twisty hallway with windows exposing penguins behind thick gla.s.s. They were striking in their formal wear, and they tap-danced like society men on floes of white ice. "Your father," May said, "looked no different than that at our wedding." She leaned in close to the gla.s.s. "In fact, I'd be hard-pressed to pick one groom from the next. They're all the same, you know." And I said I did, even though I had no idea what she was talking about.

I left her staring at a penguin that had slipped into the water belly-up to do rolling, slow-motion calisthenics. I disappeared around a bend, pulled toward the other half of the house, where the puffins were. I didn't know what a puffin was, but I liked the way the word sounded: soft and squashed and a little bit bruised, the way your lips looked after you'd eaten wild blackberries. It was a long, narrow walkway, and my eyes had not adjusted to the lack of light. I took very tiny steps, because I did not know where I was going, and I held my hands in front of me like a blind man. I walked for what felt like hours, but I could not find those puffins, or the sliver of silver daylight near the door, or even the places where I had already been. My heart swelled up into my throat. I knew the way you know these things that I was going to scream or to cry or to sink to my knees and become invisible forever. For some reason I was not surprised when, in total darkness, my fingers found the comforting shape of May, who turned back into my mother, and she wrapped her arms around me. I never understood how she wound up in front of me, since I'd left her with the penguins and I hadn't seen her pa.s.s. My mother's hair fell like a dark curtain over my eyes and tickled my nose. Her breath echoed against my cheek. Black shadows wrapped around us like an artificial night, but my mother's voice seemed solid, like something I could grab for support. "I thought I'd never find you," my mother said, words I held on to and breathed like a litany for the rest of my life.

chapter 6

Nicholas Nicholas was having a h.e.l.l of a week. One of his patients had died on the table during a gallbladder removal. He'd had to tell a thirty-six-year-old woman that the tumor in her breast was malignant. Today his surgical rotation had changed; he was back in cardiothoracic, which meant a whole new list of patients and treatments. He'd been at the hospital since five in the morning and had missed lunch because of afternoon conferences; he still hadn't written up notes on his rounds; and if all that wasn't enough of a b.i.t.c.h, he was the resident on call and would be for thirty-six hours.

He'd been summoned to the emergency room with one of his interns-a third-year Harvard student named Gary who was green around the gills and reminded Nicholas nothing of himself. Gary had cleaned and quickly prepped the patient, a forty-year-old woman with superficial head and face wounds that were bleeding profusely. She had been a.s.saulted, most likely by her husband. Nicholas let Gary continue, supervising his actions, his touches. As Gary sewed up the lacerations on her face, the patient began to scream. "f.u.c.k you," she yelled. "Don't you touch my face." Gary's hands began to shake, and finally Nicholas swore under his breath and told Gary to get the h.e.l.l out. He finished the job himself, as the woman cursed him out from beneath the sterile drapes. "G.o.dd.a.m.ned f.u.c.king pig a.s.shole," she shouted. "Get the f.u.c.k away from me."

Nicholas found Gary sitting on a stained cube sofa in one of Ma.s.s General's emergency room lounges. He'd drawn his knees up and was doubled over like a fetus. When he saw Nicholas coming toward him, he jumped to his feet, and Nicholas sighed. Gary was terrified of Nicholas; of doing anything wrong; of, really, being the surgeon he hoped to be. "I'm sorry," he murmured. "I shouldn't have let her get to me."

"No," Nicholas said evenly, "you shouldn't have." He thought of telling Gary everything that had gone wrong for himself today. See, he'd say, all that, that, and I'm still standing up, doing my job. Sometimes you just have to keep pus.h.i.+ng, he'd say. But in the end he did not say anything to his intern. Gary would figure it out eventually, and Nicholas didn't really want to recount his own failures to a subordinate. He turned away from Gary, a dismissal, feeling every bit the arrogant son of a b.i.t.c.h that he was reputed to be. and I'm still standing up, doing my job. Sometimes you just have to keep pus.h.i.+ng, he'd say. But in the end he did not say anything to his intern. Gary would figure it out eventually, and Nicholas didn't really want to recount his own failures to a subordinate. He turned away from Gary, a dismissal, feeling every bit the arrogant son of a b.i.t.c.h that he was reputed to be.

For years now, Nicholas had not gauged time by its usual measures. Months and days meant little; hours were things you logged onto a patient's fact sheet. He saw his life pa.s.sing in blocks, in places where he spent his days and in medical specialties where he filled his mind with details. At first, at Harvard, he'd counted off the semesters by their courses: histology, neurophysiology, anatomy, pathology. His last two years of rotations had run together, experiences blending at the edges. Sometimes he'd be remembering an orthopedic patient at the Brigham, but he'd picture the decor of the orthopedic floor at Ma.s.sachusetts General. He'd started his rotations with internal medicine; then came a month of psychiatry, eight weeks of general surgery, a month of radiology, twelve weeks of obstetrics/gynecology and pediatrics, and so on. He had forgotten about seasons for a while, shuttling from discipline to discipline and hospital to hospital like a foster child.

He'd decided on cardiac surgery-a long haul. The match had placed him at his first-choice hospital, Ma.s.s General. It was a large place, impersonal and disorganized and unfriendly. In cardiothoracic surgery, the attendings were a brilliant group of men and women. They were opinionated and impulsive; they wore pristine white lab coats over their cool, efficient demeanors. Nicholas loved it. Even during his postgraduate year one, he'd observe the easy motions of general surgery, waiting to be rotated back to the cardiac unit, where he'd marvel at Alistair Fogerty performing open-heart operations. Nicholas would stand for six hours at a time, listening to the thin ring of metal instruments on trays and the rustle of his own breath against his blue mask, watching life being put on hold and then recalled.

"Nicholas." At the sound of his name, he turned to see Kim Westin, a pretty woman who'd been in his graduating cla.s.s and was now in her third year of residency in internal medicine. "How's it going?" She came closer and squeezed his arm, propelling him down the hall in the direction he'd been walking.

"Hey," Nicholas said. "You don't have anything to eat, do you?"

Kim shook her head. "No, and I've got to run up to five, but I wanted to see you. Serena's back."

Serena was a patient they'd shared during their final year of rotations at Harvard. She was thirty-nine and she was black and she had AIDS-which, four years earlier, had still been rare. She'd come and gone in the hospital over the years, but Kim, in internal medicine, had more contact with her than Nicholas. Nicholas did not ask Kim what Serena's status was. "I'll go by," he said. "What's the room?"

After Kim had disappeared, Nicholas went upstairs to round his new cardiac patients. That was the hardest part about being a resident in general surgery-the constant changes from department to department. Nicholas had swung through urology, neurosurgery, emergency room, anesthesia. He'd done a stint in transplants, and one in orthopedics, and one in plastic surgery and burns. Still, coming back to cardiac was better than the others; cardiac surgery felt like home. And indeed Nicholas had been rotated through cardiothoracic more than was normal for a third-year, because he had made it clear to Alistair Fogerty that one day he was going to have his job.

Fogerty was exactly what Nicholas had pictured a cardiac surgeon to be like: tall, fit, in his late fifties, with piercing blue eyes and a handshake that could cripple. He was a hospital "untouchable," his reputation having evolved into a surgical gold standard. There had once been a scandal about him-something involving a candy striper-but the rumors were squelched and there had been no divorce and that was that.

Fogerty had been Nicholas's attending physician during his interns.h.i.+p, and one day last year Nicholas had gone to him in his office and told him his plans. "Listen," he'd said, even though his throat had been dry and his palms had been quivering. "I want to cut through the bulls.h.i.+t, Alistair. You know and I know I'm the best surgical resident you've got here, and I want to specialize in cardiothoracic. I know what I can do for you and for the hospital. I want to know what you can do for me." me."

For a long moment, Alistair Fogerty had sat on the edge of his mahogany desk, riffling through a patient's file. When he finally lifted his head, his eyes were dark and angry, but in no way surprised. "You, Doctor Doctor Prescott," he said, "have got bigger b.a.l.l.s than even me." Prescott," he said, "have got bigger b.a.l.l.s than even me."

Alistair Fogerty had got to be director of cardiac surgery by sticking his neck out, taking chances, and courting Fate so that it seemed to stay on his side. When he'd begun doing transplants, the newspapers dubbed him "The Miracle Maker." He was calculating, stubborn, and usually right. He liked Nicholas Prescott a h.e.l.l of a lot.

And so even when Nicholas was rounding his regular patients in general surgery, and working under other attendings in other disciplines, he still found time to meet with Fogerty. When he had the chance, he rounded Fogerty's patients, did the quick daily pre- and postoperative exams, moved patients in and out of surgical ICU-in short, acted like a cardiothoracic fellow, a seventh-year resident. And in return, Fogerty had him in cardiac surgery more often than not and was grooming him to be the best there was-after Fogerty himself.

Nicholas moved quietly into the recovery room, where Fogerty's latest patient was resting. He read the vitals: here was a sixty-two-year-old man who had had aortic stenosis-the valve leading from the end of his ventricle to the aorta had been scarred down. Nicholas could have easily diagnosed this case from the symptoms: congestive heart failure, syncope, angina. He surveyed the clean white gauze over the patient's chest, the gelatinous orange antiseptic that still coated the skin. Fogerty's work, as always, would be perfect: the native valve removed and a pig valve sewn into its place. Nicholas checked the patient's pulse, tugged the sheet up, and sat down beside him for a moment.

It was cold in recovery. Nicholas crossed his arms and rubbed his hands up and down, wondering how the patient, naked, could be faring. But there, the pink circles at his fingertips and his toes proved that the heart, marvelous muscle, was still working.

It was merely fortuitous that he saw it then, the heart breaking down. He had been watching the steady rise and fall, the cla.s.sic heartbeat pattern of the monitor, when everything went wrong. The steady blip-blip-blip blip-blip-blip of the machines accelerated, and Nicholas checked to see a sinusoidal pattern, the heart racing at nearly one hundred beats per minute. For a quick second, Nicholas held his hands over the patient like a faith healer. It was an arrhythmia-ventricular fibrillation. Nicholas had seen cases of it before, when a heart was exposed in the chest: beating like a bag of worms, swollen and writhing, not pumping blood at all. "Code!" he yelled over his shoulder, seeing the nurses at the nearby station spring into motion. The patient's heart had been traumatized, operated on, but Nicholas had little choice. In a matter of minutes, the man would be dead. Where was Fogerty? of the machines accelerated, and Nicholas checked to see a sinusoidal pattern, the heart racing at nearly one hundred beats per minute. For a quick second, Nicholas held his hands over the patient like a faith healer. It was an arrhythmia-ventricular fibrillation. Nicholas had seen cases of it before, when a heart was exposed in the chest: beating like a bag of worms, swollen and writhing, not pumping blood at all. "Code!" he yelled over his shoulder, seeing the nurses at the nearby station spring into motion. The patient's heart had been traumatized, operated on, but Nicholas had little choice. In a matter of minutes, the man would be dead. Where was Fogerty?

Almost immediately, recovery was filled with at least twenty people-anesthesiologists, surgeons, interns, and nurses. Nicholas applied wet gel pads to the patient's raw chest, then put the defibrillator paddles to the skin. The body jumped with the shock, but the heart did not correct itself. Nicholas nodded to a nurse, who adjusted the charge. He ran his hand across his forehead, pus.h.i.+ng back his hair. His mind was filled with the G.o.d-awful sound of the monitor, irregular and screeching, and the rustle of the nurses' starched dresses as they moved around him. He was not certain, but he thought he could smell death.

Nicholas cleared the defibrillators and replaced the paddles on the patient's chest. This time the shock was so violent that Nicholas took a step away, artificial life kicking back like a rifle's recoil. You will You will live, he willed silently. He raised his eyes to the monitor screen, seeing the thin green line dip and peak and dip and peak, the craggy crests of a normal heartbeat. Alistair Fogerty entered the recovery room as Nicholas pushed past him, deafened by the muted touches and calls of congratulation, suddenly a hero. live, he willed silently. He raised his eyes to the monitor screen, seeing the thin green line dip and peak and dip and peak, the craggy crests of a normal heartbeat. Alistair Fogerty entered the recovery room as Nicholas pushed past him, deafened by the muted touches and calls of congratulation, suddenly a hero.

Late at night on the patient floors, Nicholas learned to listen. He could tell by the flat beat of soles on the tiles when the nurses were making the midnight rounds. He saw old men recovering from surgery meet in the patient kitchens at 3:00 A.M. to steal the red jello. He waited for the slosh and whistle of the heavy industrial rag mops, shuffled up and down the halls by half-blind old Hispanic janitors. He noticed every patient call sounded at the nurses' desk, the tear of sterile paper that revealed virgin gauze, the sucked-in breath of a syringe. When he was on call and things were quiet, Nicholas liked to wander around the floors, his hands deep in the pockets of his white lab coat. He did not stop into patient rooms, not even when he was on a general surgery rotation and the patients were more than just names and charts posted on the door. Instead he moved like an insomniac, roaming, interrupting the night with his own shrouded footsteps.

Nicholas did not wake Serena LeBeauf when he entered her room in the AIDS ward. It was well after two in the morning by the time he could spare a minute. He sat down in the stark black plastic chair beside her bed, amazed by her deterioration. Her vitals indicated that she weighed less than seventy pounds now; that she had pancreat.i.tis, respiratory failure. An oxygen mask covered her face, and morphine dripped into her continuously.

Nicholas had done something very wrong the first time he met Serena-he let her get under his skin. It was something he had hardened himself to, seeing death every day the way he did. But Serena had a wide smile, with shocking white teeth; eyes light like a tiger's. She had come in with her three children, three boys, all of different fathers. The youngest, Joshua, was six back then, a skinny kid-Nicholas could see the b.u.mps of his backbone under his thin green T-s.h.i.+rt. Serena did not tell them she had AIDS; she wanted to spare them the stigma. Nicholas remembered sitting in the consultation room with the attending physician when she learned she was HIV positive. She had straightened her spine and had gripped the chair so tight that her fingers whitened. "Well," she had said, her voice soft like a child's. "That's not what I expected." She did not cry, and she asked her doctor for all the information she could get, and then, almost shyly, she asked him not to mention this to her boys. She told them, and her neighbors and distant relatives, that it was leukemia.

Serena stirred, and Nicholas pulled the chair closer. He reached for her wrist, telling himself it was to check her pulse, but he knew it was just to hold her hand. Her skin was dry and hot. He waited for her to open her eyes or to say something, but in the end he held his palm soft against her cheek, wis.h.i.+ng he could take away the gray haze of her pain.

Nicholas began believing in miracles his fourth year of medical school. He had been married just months when he decided to do a rotation in Winslow, Arizona, for the Indian Health Service. It was only four weeks, he'd said to Paige. He was tired of doing the scut work of interns at Boston-based hospitals: patient histories and physical exams, clerking for residents and attendings and anyone ranked above you. He'd heard about the rotation on the reservation. They were so short-staffed that you did everything. Everything. Everything.

It was a three-hour drive from Phoenix. There was no town of Winslow. Black houses, abandoned shops and apartments, stood impa.s.sively around Nicholas, their empty windows blinking back at him like the eyes of the blind. As he waited for his ride, tumbleweed edged across the road, just like in the movies, skittering over his shoes.

Fine dust covered everything. The clinic was just a concrete building set into a cloud of earth. He'd taken a red-eye flight, and the doctor who'd met him in Winslow had been there by 6:00 A.M. The clinic wasn't open yet, not officially, but there were several parked pickup trucks, waiting in the cold, their exhaust hanging in the air like the breath of dragons.

The Navajo were quiet people, stoic and reserved. Even in December, the children had played outside. Nicholas remembered that -the brown-skinned babies in short sleeves, making snow angels in the frosted sand, and n.o.body bothering to dress them more warmly. He remembered the heavy silver jewelry of the women: headbands and belt buckles, brooches that glittered against purple and deep-turquoise calico dresses. Nicholas also could remember the things that had shocked him when he first arrived: the endless alcoholism; the toddler who bit her lip, determined not to cry as Nicholas probed a painful skin infection; the thirteen-year-old girls in the prenatal clinic, their bellies grotesquely swollen, like the neck of a snake that has swallowed an egg.

On Nicholas's first morning at the clinic, he was called into the emergency room. A severely diabetic elderly man had consulted a shaman, a tribal medicine man, who had poured hot tar on his legs as part of the treatment. Horrible sores blistered up, and two physicians were trying to hold down his legs while a third examined the extent of the damage. Nicholas had hung back, not certain what he was needed to do, and then the second patient was brought in. Another diabetic, a sixty-year-old woman with heart disease, who had gone into cardiopulmonary arrest. One of the staff doctors had been jamming a plastic tube down the woman's throat to manage the airway and to breathe for her. He did not look up as he shouted at Nicholas. "What the h.e.l.l are you waiting for?" he said, and Nicholas stepped up to the patient and began CPR. Together they had tried to get the heart moving again, forty minutes of CPR, defibrillation, and drugs, but in the end the woman died.

During the month that Nicholas spent in Winslow, he had more autonomy than he'd ever had as a student at Harvard. He was given his own patients. He wrote up his own notes and plans and ran them by the eight staff physicians. He rode with public health nurses in four-wheel-drive vehicles to find those Navajos with no true addresses, who lived off the paths of roads, in huts with doors that faced the east. "I live eight miles west of Black Rock," they wrote on their face sheets, "just down the hill from the red tree whose trunk is cleaved in two."

At night Nicholas would write to Paige. He mentioned the dirty hands and feet of the toddlers, the cramped huts of the reservation, the glowing eyes of an elder who knew he was going to die. More often than not, the letters came out sounding like a list of his heroic medical feats, and when this happened Nicholas burned them. He kept seeing the unwritten line that ran through the back of his mind: Thank G.o.d this isn't the kind of doctor that I'm going to be Thank G.o.d this isn't the kind of doctor that I'm going to be-words never committed to paper that were still, he knew, indelible.

On his last day at the Indian Health Service, a young woman was brought in, writhing in the throes of labor. Her baby was breech. Nicholas had tried palpating the uterus, but it was clear a C-section was going to be necessary. He mentioned this to the Navajo nurse who was acting as translator, and the woman in labor shook her head, her hair spilling over the table like a sea. A Hand Trembler was called in, and Nicholas respectfully stepped back. The medicine woman put her hands over the swollen belly, singing incantations in the language of the People, ma.s.saging and circling the knotted womb. Nicholas told the story when he returned to Boston the next day, still thinking of the dark gnarled hands of the medicine woman, suspended above his patient, the red earth flurrying outside and hazing the window. "You can laugh," he said to his fellow interns, "but that baby was born headfirst."

"Nicholas," Paige said, her voice thick with sleep. "Hi."

Nicholas curled the metal cord of the pay phone around his wrist. He should not have awakened Paige, but he hadn't spoken to her all day. Sometimes he did this, called at three or four in the morning. He knew she'd be asleep, and he could imagine her there with her hair sticking up funny on the side she'd been sleeping on, her nightgown tangled around her waist. He liked to picture the soft down comforter, sunken in spots where her body had been before she had reached to answer the phone. He liked to imagine that he was sleeping next to her, his arms crossed under her b.r.e.a.s.t.s and his face pressed into her neck, but this was unrealistic. They slept at opposite sides of the bed, both fitful sleepers, unwilling to be tied by someone else's movements or smothered by someone else's heated skin.

"Sorry I didn't call this afternoon," Nicholas said. "I was busy in ICU." He did not tell Paige about the patient he'd had to code. She always wanted details, playing him for a superstar, and he wasn't in the mood to go into it all over again.

"That's okay," Paige said, and then she said something m.u.f.fled into the pillow.

Nicholas did not ask her to repeat herself. "Mmm," he said. "Well, I guess I don't have anything else to say." When Paige did not respond, he hit the # b.u.t.ton on the phone.

"Oh," Paige said. "Okay."

Nicholas scanned the hall for signs of activity. A nurse stood at the far end, dropping little red pills into cups that were lined up on a table. "I'll see you tomorrow," Nicholas said.

Paige rolled onto her back; Nicholas knew by the crinkling of the pillows and the fluff of her hair when it settled. "I love you," Paige said.

Nicholas watched the nurse, counting the pills. Eighteen, nineteen, twenty. The nurse stopped, pressed her hands into the small of her back as if she was suddenly weary. "Yes," Nicholas said.

The next morning Nicholas did prerounds at five-thirty and then began regular rounds with Fogerty and an intern. The patient Nicholas had coded yesterday was doing fine, comfortably settled in surgical ICU. By seven-thirty they were ready for their first surgery of the day, a simple bypa.s.s. As they scrubbed, Fogerty turned to Nicholas. "You did well with McLean," he said, "considering you'd just come onto the rotation minutes before."

Nicholas shrugged. "I did what anyone would have done," he said. He scrubbed at invisible germs under his nails, around his wrists.

Fogerty nodded to an OR nurse and shrugged into his sterile gown. "You make decisions well, Dr. Prescott. I'd like you to act as chief surgeon today."

Nicholas looked up but did not let the surprise he felt show in his eyes. Fogerty knew he'd been on call all night, knew he'd need a second wind to measure up. Fogerty also knew it was virtually unheard of for a third-year resident to lead a bypa.s.s operation. Nicholas nodded. "You got it," he said.

Nicholas spoke quietly to the patient as the anesthesiologist put him under. He stood beside Fogerty as the second a.s.sistant, a resident more senior than Nicholas who was obviously angry, shaved the legs, the groin, the belly, and covered the body with Betadine solution. The patient lay motionless, stark naked, stained orange, like a sacrifice for a pagan G.o.d.

Nicholas supervised the harvest of the leg vein, watching as blood vessels were clamped off and sewn, or were cauterized, filling the operating suite with the smell of burning human tissue. He waited until the vein was settled in solution for its later use. Then, stepping up to the patient, Nicholas took a deep breath. "Scalpel," he said, waiting for the nurse to pick the instrument off a tray. He made a clean incision in the patient's chest and then took the saw to cut through the sternum. He held the ribs spread apart with a rib spreader, and then he exhaled slowly, watching the heart beating inside the man's chest.

It never failed to amaze Nicholas how much power was in the human heart. It was phenomenal to watch, the dark-red muscle pumping quickly, turning hard and small with each contraction. Nicholas cut the pericardium and separated out the aorta and the vena cava, connected them to the bypa.s.s machine, which would oxygenate the blood for the patient once his heart was stopped by Nicholas.

The first a.s.sistant poured the cardioplegia liquid onto the heart, which stopped its beating, and Nicholas, along with everyone else in the room, turned his eyes to the bypa.s.s machine, to make sure it was doing its job. He bent closer toward the heart, snipping at the two coronary arteries that were blocked. Nicholas retrieved the leg vein, delicate, and turned it so that the valves did not hold blood back but let it through. With careful sutures he sewed the vein onto the first coronary artery before the point of blockage, and then attached the other end after the point of blockage. His hands moved with a will of their own, precise and steady, fingers blunt and strong beneath the translucent gloves. The next steps streamed through his mind, but the procedure and his role in it had become so natural to him, like breathing or batting right-handed, that Nicholas began to smile. I can do this, I can do this, he thought. he thought. I can really do this on my own. I can really do this on my own.

Nicholas finished the bypa.s.s five hours and ten minutes after he'd begun. He let the first a.s.sistant close for him, and it was only after he'd left the operating suite to scrub that he remembered Fogerty and the fact that he hadn't slept in twenty-four hours. "What did you think?" Nicholas said to Fogerty, who was coming up beside him.

Fogerty peeled off his own gloves and ran his hands under the hot water. "I think," he said, "you should go home and get some sleep now."

Nicholas had been untying his mask, and in his shock he let it drop to the floor. He had just done his first bypa.s.s, bypa.s.s, for G.o.d's sake. Even an a.s.shole like Fogerty should have some constructive criticism, maybe a word of praise. He'd done a terrific job, not one glitch, and even if it took an hour longer than Fogerty's usually did, well, it was to be expected because it was his first. for G.o.d's sake. Even an a.s.shole like Fogerty should have some constructive criticism, maybe a word of praise. He'd done a terrific job, not one glitch, and even if it took an hour longer than Fogerty's usually did, well, it was to be expected because it was his first.

"Nicholas," Fogerty said, "I'll see you at evening rounds."

There were many things about Paige that Nicholas did not know when they had been married. He celebrated her birthday two weeks late because she had never told him when it was. He couldn't have guessed her favorite color until their first anniversary, when she picked emerald stud earrings over sapphires because of their sea-green glow. He certainly couldn't have predicted her disastrous cooking experiments, like Miracle Whip Stew and Turkey-Marshmallow Kabobs. He didn't know she'd sing car-commercial jingles when she dusted or that she'd have the skill of stretching a paycheck to cover the interest on a graduate student loan, groceries, condoms, and two tickets to the discount movie theater.

In Nicholas's defense, he did not have much time to discover his new wife. His rotations kept him at the hospital more often than he was at home, and after he graduated from Harvard, he was even more pressured for time. When he did stumble into the apartment, starved and blind with fatigue, Paige so seamlessly fed him, disrobed him, and loved him to sleep that he began to expect the treatment and sometimes forgot that Paige was connected to it.

When he came home from performing his first solo bypa.s.s, he did not turn the lights on in the apartment. Paige was at work. She was still waiting tables at Mercy, but only in the mornings. Afternoons, she worked at an OB/GYN office as a receptionist. She had taken on the second job after some night courses in architecture and literature at Harvard Extension didn't work out. She hadn't been able to keep up with the reading and the housework and told Nicholas that two incomes meant more money and that more money meant they'd move out of debt more quickly so she could go to college full time. Back then, Nicholas had wondered if it was just an excuse to drop out of her cla.s.ses. He'd seen her attempts at writing papers, after all, which were really no more than high-school caliber; and he'd almost said something to Paige, until he remembered that it was just what they would would be. be.

Nicholas never voiced his doubts to Paige. For one thing, he didn't want her to take it the wrong way. And also, Nicholas had hated seeing her surrounded by yellowed used textbooks, her hair springing free of its braid as she wound her fingers through it in concentration. Truthfully, Nicholas liked having Paige all to himself.

She was at the gynecologists' office, since it was well after two, but she'd left him a meal to heat up in the oven. He didn't eat it, although he was very hungry. He wanted Paige to be there, although he knew it wasn't possible. He wanted to close his eyes and, for once, become the patient, soothed by the cool ministrations of her tiny, fine hands.

Nicholas fell onto the bed, neatly made, amazed by the darkness and the cold of the late day. He fell asleep listening to the beat of his own heart, thinking of the directions patients gave at the Indian reservation. My home is west of Ma.s.s General, he would say, light-years beneath the brittle winter sun.

Serena LeBeauf was dying. Her sons were heaped like huge puppies on the edges of the hospital bed, holding her hand, her arm, her ankle-whatever pieces of her they could hold. They had brought things they thought would comfort her. There on her frail chest was the cut-out travel-brochure picture of San Francisco, where she'd lived when she was younger. Tucked under her arm were the stubby remains of a threadbare stuffed monkey. Curled across the hollow of her belly was her diploma, the college degree she'd worked so d.a.m.ned hard for and received just a week before her AIDS was diagnosed. Nicholas stood in the doorway, not wanting to intrude. He watched the liquid brown eyes of Serena's sons as they stared at their mother, and he wondered where they would all go, especially the little one, when she died.

He was paged, and he raced down three flights of stairs to surgical ICU, where his bypa.s.s patient was lying. The room was a rush of activity, physicians and nurses jockeying into place as the heart went into failure. As if he were watching a replay of the day before, Nicholas stripped the gown from his patient and gave an external shock. And another. Sweat ran down his back and into his eyes, searing. "G.o.ddammit," he muttered.

Fogerty was there. Within minutes he had moved the patient to an operating suite. Fogerty cracked the chest open again and slid his hands into the b.l.o.o.d.y cavity, ma.s.saging the heart. "Let's go," he said softly. His gloved fingers slipped over the tissue, the still-new sutures, rubbing and warming the muscle, kneading life. The heart did not pulse, did not beat. Blood welled around Fogerty's fingers. "Take over," he said.

Nicholas slipped his own hand around the muscle, forgetting for a second that there was a patient, that there was a past attached to this heart. All that mattered was getting the thing going again. He caressed the tissue, willing it to start. He pumped oxygen through his patient's system manually for forty-five minutes, until Fogerty told him to stop and signed the death certificate.

Minutes before Nicholas left the hospital for the night, Fogerty called him to his office. He was sitting behind the mahogany desk, his face shadowed by the slatted vertical blinds. He did not motion for Nicholas to enter, did not even lift his head from the paper he was writing upon. "You couldn't have done a thing," he said.

Nicholas pulled on his jacket and wandered toward his car in the parking garage, wondering if he'd ever be given a bypa.s.s to do again. He searched his memory to find something he'd overlooked, a torn capillary or an additional blockage, something Fogerty smugly hadn't mentioned after the operation that day, something that might have saved the guy. He pictured the still amber eyes of Serena LeBeauf's youngest son, mirrors of what her own used to be like. He thought about the Navajo Hand Trembler and wondered what potions and blessings and magic decrees might fall between the cracks of common knowledge.