Harvesting the Heart Read online

  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 pancreatitis, 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 bumps of his backbone under his thin green T-shirt. 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, wishing 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.

  It was a three-hour drive from Phoenix. There was no town of Winslow. Black houses, abandoned shops and apartments, stood impassively 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 nobody 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 hell 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 God 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, massaging 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 breasts 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 P