They smiled.
"Or second, it's that rose-scented geranium at your feet. I bought it at your hardware store a few weeks ago because I liked the smell."
Cindy rubbed the leaves to activate the scent and then smelled her fingers.
"Or third"-I pointed toward the open window of my secondstory bedroom-"bachelors don't always do their laundry on time. Please tell me it's one of the first two."
Cindy smelled again. "Mint. It's the mint."
"Pick some, and I'll make tea," I said.
Cindy picked a few shoots while Annie and I put on a kettle to boil.
While the tea steeped, I gave them a tour. Annie noticed the many charcoal sketches and oil paintings decorating most every square inch of wall space in my home and asked, "You like art?"
"Some."
"These are really good."
I nodded.
"Is this somebody in New York or L.A.?" Cindy asked.
"No." I shook my head. "My wife."
Cindy folded her arms, looking cold again, while Annie examined everything. I gave them a tour including every room in the house save one: my office. I keep it locked and seldom go in except when necessity requires.
Cindy noticed one of Emma's early sketches of the lake and said, "That early morning, swirling-tornado look that spins across the lake just after sunup is one of my favorite times of day out here." She studied the painting some more. "She was talented."
I grabbed three glasses and began filling them with ice, then pointed a glass toward the shop. "Would you like to see the workshop?"
Annie nodded while Cindy poured tea and gave everyone a sprig of mint. We walked to the workshop, I turned on all the lights and punched Play on the CD player-Mozart.
"This is where you work?" Cindy asked incredulously.
I nodded. "Pretty nice, huh?"
"I'll say so." Annie looked over the tools while I explained how Charlie and I worked.
"And Charlie really helps you?" Cindy asked.
"You ought to see his chain-saw carvings. He's really pretty good."
"You're kidding."
"I promise," I said, pointing to the beam and hoist in the ceiling. "Charlie has great hands. He'd have made a great surgeon except for the fact that he liked working with wood."
Cindy looked at me and stepped closer, letting out one of the questions that had first pricked her fancy in the hospital. "You know a thing or two about surgeons?"
I smiled. "Only what I've read."
Cindy looked around her at the tools, the organization, the cleanliness. "This looks more like an operating room than a woodshop."
Chapter 24
he human heart is remarkable in that it is designed to pump continuously for a hundred and twenty years without ever needing to be reminded what it was meant to do. It just does it. In all my reading and study, I have come to know one thing without any shadow of doubt: if anything in this universe reflects the fingerprint of God, it is the human heart.
While it pumps more than a hundred thousand times a day without stopping, funneling hundreds of gallons of fluid around the body, it derives no benefit from the blood it pumps, making it the most unselfish of organs. In order to feed itself, it siphons from its own flow then reroutes it through three main arteries that loop back around the outside of the muscle to feed itself. Two of these arteries feed approximately half the heart, and the third, largest artery-also known as "the widowmaker"-feeds the other half. If it becomes blocked with plaque, a condition known as coronary artery disease, the heart stops.
If caught early, this condition can be corrected with a stent or a bypass-taking an artery from another place in the body, like the leg or inside the chest wall, and rerouting the siphon.
If you've ever bought an old house with iron plumbing, you have some idea of how this works. Rather than remove all the old, you simply snake it to dislodge the clog-a temporary fix-or add new pipe to bypass it altogether-much more permanent. Following such surgery, it is not uncommon for an individual to leave the operating room with four or five bypasses and a rather expensive medical bill.
In the womb, a baby gains oxygen through its mother's lungs, which she sends, along with everything else the baby needs, via the umbilical cord. Baby's heart doesn't need to send blood out to the lungs to be reoxygenated; Mom has already taken care of that. To prevent the needless flow of blood through those tender, developing lungs, God created a small hole between the right and left atria-the top portions of the heart-that allows it, in utero, to bypass the lungs. At birth, a hormone called prostaglandin causes the hole to close and begins routing the blood into and out of the lungs. When that doesn't happen, and the hole doesn't close, it's called an atrial septal defect.
For most of us, things work pretty well until genetics, what we've eaten, or how we've lived catches up with us. Usually, that "catching up" is called a heart attack, which is nothing more than plaque clogging an artery and stopping blood flow to a portion of the heart. Anyone who's ever run the quarter mile knows what I mean. The first three hundred yards can be relatively fun, but by the last turn and final straightaway, the human body is so oxygendeprived the muscles are beginning to lock up, making the runner feel as if rigor mortis has set in. Experienced runners call the last fifty yards "the bear" because it often feels as if one has jumped on your back.
In truth, the muscles in the runner's legs have burned far more oxygen than the heart and lungs can supply. Extremely fit sprinters can minimize this through aggressive training, as can rowers, cyclists, marathoners, and others, but training has its limits. It cannot overcome genetics. The physical limitations of aerobic exercise are established by the volume of oxygen and blood the heart and lungs can send throughout the body.
God gives most of us mortals normal hearts and lungs. To others, He gives a little more. A slightly larger heart and lungs. Studies of long-distance athletes confirm this. And yet to other people, like Emma, He gives a little less. One thing my education never taught me was the reason for this.
When the human heart has suffered an attack, often the area that's been shut off from blood flow will die. Amazingly, even halfdead, the human heart still pumps. People can survive and live somewhat normal lives with only part of their hearts functioning, though it changes their lifestyles substantially. The heart is not only the most unselfish of organs, it is also the most courageous and faithful.
Emma's problem was not the buildup of plaque, but that her embryonic hole had never closed, causing a continual partial bypass of blood to her lungs. Many people walking around the planet right now suffer from the same problem, have no idea of its existence, and will never suffer a day for it. It's almost as common as a mitral valve prolapse-a common heart condition in which the last valve of the heart doesn't close all the way, allowing something of a backwash into the heart. Emma would have continued to lead a completely normal life had one thing not occurred. Her hole enlarged, resulting in a continual flow of oxygendepleted blood coursing through her veins.
As the hole enlarged, it further crippled her heart, causing the onset of the disease that would further enlarge it-a natural result of a muscle working overtime. The enlarged muscle fills up the cavity in which it lives and works, creating more pressure against the walls that house it, thereby decreasing the space it has to work in and, once again, causing itself to work that much harder and that much less efficiently. It's called dilated cardiomyopathy and is often described as increased volume in the heart, causing the muscles to dilate like an overinflated balloon. It's a problem that worsens exponentially rather than incrementally. It's like gaining forty pounds at the waistline while trying to wear a belt with only one hole. You can buy a bigger belt, but you can't enlarge your chest.
From the moment we are born, every human on the planet is dying. Emma was just dying at about six times the rate as the rest of us. And if during that slow death she looked perpetually tired, she was. Emma lived her entire life feeling as if she were running the last hundred
yards of the quarter mile, always behind and never able to catch her breath.
My reading had taught me that Emma's heart was diseased, big and flabby, inefficient, and inherently weak. Nothing anyone could do to her present heart would do her any good. It was beyond repair and, after so much deterioration, had lost most of its elasticity. The very real danger that Emma faced was the popping of her balloon.
The heart, brittle, inelastic, and frail, will pop or tear, causing a hole in the side of the ventricle, through which blood will pour out into the pericardium, the nearly bulletproof sac surrounding the heart. The blood, now on the outside of the heart, fills up this sac, which is so tough it won't bust. This, in turn, places increased pressure on the heart, in effect suffocating it. In doing so, it places more pressure on the heart than it can pump, a condition known as pericardial tamponade.
In emergency situations, when there is no time to open the chest, the only way to alleviate the pressure is through pericardiocentesis- a doctor inserts a heavy-gauge needle through the sternum at about a thirty-degree angle to the patient, trying to avoid the lungs and pierce the pericardium to allow the blood to exit through the needle and decrease pressure on the heart. The problem now is that the patient has a hole in both the heart and the pericardium and is losing body fluids at a fantastic rate, which is dropping the blood pressure and further compounding the stress on the heart. It's a downward fall that can quickly spiral out of control.
The good news is that the heart is still able to pump. The bad news is that the heart is a lot like an old well pump; it works great as long as the prime is retained, but once that prime is lost, it's a devil to get going again. So, following the pericardiocentesis, the trick is getting the patient open and sewing up the holes while keeping the blood pumping and the body's fluid levels up.
And if I had known all this about the heart as a kid, I would have ripped open my chest, severed my own arteries, and given Emma mine.
Chapter 25
t was nearly dark when we made it back to the dock. I had probably kept them out too late. Annie had dozed again, so while Cindy tied off the boat, I lifted Annie into my arms and she wrapped hers around my neck-a familiar sensation. One I missed. I walked slowly up to the house. As we neared the cricket box, raucous with noise and nighttime chatter, Annie raised her head.
She looked down, and the crickets fell quiet, making a low, almost inaudible chatter, as if they obeyed or observed something I knew nothing about. It was like a song you could hear only if you weren't trying to listen, or a far-off star that you could see only when you weren't focusing, and then only out of the corner of your eye. She put her finger to her lips and whispered, "Shhhh."
I listened. "What are they doing?" I asked.
She looked at me as if I should already know. "Why ... they're crying."
I leaned in and tried to hear, but couldn't. I shrugged my shoulders.
She whispered in my ear, "Only if you listen closely, and you want to, can you hear when crickets cry."
I leaned in again and turned my head, almost pointing my ear downward.
She whispered again, "No, no, no. You don't hear them with your ears." She poked me in the chest gently with her finger. "You hear them with your heart."
I almost dropped her. Recovering, I tried to change the subject. "Why do they cry?"
Annie thought for a minute. "Because they know."
"They know what?" I asked.
She looked at me as if it were so simple. "They know that if Dr. Royer doesn't find a heart, and Aunt Cici doesn't find somebody who can put it in me, and I don't stay healthy until then, and we don't find the money to pay for it, then ... I won't be here next year to talk to them." She put her head back down on my shoulder and closed her eyes. "And ... because they know it's their life for mine."
In my arms, Annie weighed ten thousand pounds. "How do they know all that?"
She smiled like I was teasing her. "Because I tell them, dummy."
0! the world hath not a sweeter creature, she might lie by an emperor's side and command him tasks.
Cindy unlocked the door and showed me the way to their room. I placed Annie in her bed and stepped back as Cindy tucked her in. The concrete-block house was small and had only two rooms: a bedroom complete with one dresser and two single beds, and another room that served as the kitchen, living room, and den. Two pictures sat atop the mantel. Scattered across the kitchen table, which was a wobbly card table covered by a red plastic tablecloth, were all the finance books and loan applications I had seen at the hospital.
Cindy caught me looking at the pictures. "The one on the left is Annie with her mom and dad, almost three years ago. The other is last year's school picture."
Annie favored her dad, although her smile looked more like her mom's. They were suntanned and vibrant. I wanted to ask questions, but figured I'd stayed long enough and wasn't sure I wanted to get into that conversation. The school picture showed Annie in front of a blue canvas backdrop, holding the handlebars of a red bicycle and smiling. Printed on the front of the picture at the bottom, partially covered by the frame, was the word Proof
In the other room, Annie coughed again, evidence that the cough had sunk into her lungs.
"Has her doctor listened to that?"
"Yes." Cindy nodded. "Sal was here this morning. He said I should keep her away from other kids and out of Sunday school for a few weeks. It'll take a while."
"Sal's a good man. A good doctor."
"The best. He's never sent me a bill, and there's no telling how many thousands of dollars I owe him." She fumbled through some pots in the kitchen. "You want some coffee?'
I squinted one eye and considered. "You got any tea?"
"Sure." She pulled the kettle off the stove and began filling it under the sink faucet.
I turned my back and appeared to be looking out the window while my eyes continued scanning the house for any sign that a boyfriend was soon to come charging in the front door. In the background, I heard Cindy pull a knife from the drawer.
"You want lemon in your tea?"
"Yes, thanks."
Cindy cut the lemon one time and then screamed, "Oh! Ouch! "
I turned as Cindy dropped the knife and reached for a towel, dripping red blood across the kitchen floor. By the time I took eight steps and grabbed her hand, it was covered in red and splatter had painted the kitchen floor.
I held her hand and studied the cut while Cindy held her hand out, chest high, and covered her eyes with the other hand. Her face turned ashen, and I knew she was about to buckle. "The sight of blood make you queasy?"
"Only my own," she muttered as her knees crumpled. I caught her midfall and carried her to the couch. I wrapped her hand in the towel she'd been holding and then returned from the kitchen with some peroxide. I emptied my pockets onto the table beside Cindy, washed my hands, and then her cut, which was deep into the meat of her left palm. I had the feeling she wouldn't make a very compli ant patient when I started wielding a needle and that if I could get to work before she came to, I'd be a lot better off. I pulled the flashlight from my belt, turned it on, and held it over Cindy's hand using my teeth as a vise. I threaded a needle and, by the time she opened her eyes a minute later, I had already completed my fourth stitch. She looked at me and then grasped her cut hand with the good one, fighting the urge to yank it back to her chest.
"Oh, my!" she said closing her eyes and putting her head back down on the couch. She tried to control her short, deep breaths and then opened her eyes, studying me through one eye while I quietly tied the sixth stitch. "This is a good one," I muttered around a mouthful of flashlight. She didn't say a word but tried not to look at her hand. Cindy looked over my shoulder and appeared to see someone. I heard small footsteps, and Annie said, "Aunt Cricket, you okay?"
"Yeah, sweetheart. Fine." She nodded and tried to wave Annie off. "Go back to sleep." Annie walked up behind me and leaned over my shoulder. When she did, her thumb-worn sandal dangled aro
und my collarbone. It sparkled with each turn. Annie looked at my work and then at Cindy. "You cut yourself?" Apparently, Annie had no problem with either blood or needles.
Cindy's color had partially returned, but she wasn't about to move off that couch. Not only was she linked to me via eighteen inches of purple monofilament stitching, but there was still too much blood in sight. "Yeah, just a silly little cut. You go back to sleep." She closed her eyes and winced as I looped the needle through her skin.
I held the flashlight and whispered to Annie, "This cut here"-I pointed with the needle and shone the light so Annie could see"is almost to the bone, slicing a goodly sized vein here." I pointed closer with the needle. Annie studied it and then looked at her own hand for comparison. I continued, "Cricket did a doozey on this one. I think eight stitches should do, and judging by the looks of the nice rusty knife over there, she's going to need a tetanus shot."
"Oh, great!" Cindy closed her eyes and began forcefully breathing deep and slow.
Annie whispered in my ear, "She doesn't like shots."
I looked at Cindy's face, which had faded white again. "I gathered that."
I tied off the last stitch, turned to Annie, and nodded my head toward the small snips lying on the table beside me. "My hands are full. You mind cutting this for me?" Annie grabbed the snips, inserted her small fingers into the holes, and gently leaned forward. "Right up next to the knot," I said. I held out the stitching like an umbilical cord, and Annie cut it with all the care and concern of a first-time father. Annie snipped it and studied her handiwork. I nodded and said, "Can you get me a washrag?"
Annie returned with a faded and tattered green washrag and handed it to me. Cindy saw it and spoke up, "No, honey, not our good ones. Get those old white ones with the spots on 'em. Next to the washing machine." Annie fetched the washrag, and I doused it in hydrogen peroxide and gently padded Cindy's hand and stitching.
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