I RAN THE WATER, MAKING IT AS HOT AS I COULD PHYSICALLY stand it, and then soaked myself. The moon lit on the lake like a single headlight, and a light breeze ruffled the trees outside. I cracked the window, turned off the light above me, and sat in the dark, waiting.
Pretty soon they started. It didn't take me long to drift off. When I woke, the crickets had fallen silent, having finished their serenade. It was past midnight, the water was cold, and I stepped out, pruny and withered.
I don't know how many times Emma and I sat in that tub together. And the memory of her stepping out of that tub, hair pulled up, water dripping from her earlobes and fingertips and toes, is one of those images that I'd not sell to Termite for all the tea in China, or all the magazines in the world.
Chapter 29
ed school taught me many things, but one thing kept coming back over and over again: it is incredibly hard to kill the human body. People do all sorts of things to themselves; they smoke like chimneys until their lungs look like Winston's, drink like fish until their livers are pickled, eat like pigs until their hearts and kidneys are fatty and three chins hang off their faces, sit around like slugs until it hurts to walk ... and yet the human body takes all that punishment and keeps right on ticking. This gave me hope, because if people can voluntarily cause that much abuse to normal systems, and those same systems still give them seventy or eighty years of life, then I figured people like Emma who involuntarily live with a defective and abnormal system ought to at least get half that amount of time. This meant that while the clock was ticking, I had time to learn what I needed, and Emma had time to wait for me.
I finished Harvard Medical School in three years. Then, thanks to Dr. Trainer's recommendation, I was fortunate enough to be selected for a five-year general surgical residency at Mass General.
Mass General taught me a lot. On call seven out of every fourteen days, I learned that sleep is a weapon and we can do with much less than we get. I often worked three days and two entire nights without one second of sleep. After nearly seventy bloodsoaked and tissue-cutting hours, I'd drop into bed next to Emma, sleep four to six hours, then get up and do it again.
And I wasn't the only one. The twelve of us who made up the surgical residency team at Mass General had been handpicked from the best schools around the world. We were called "the best" because we were. Our record proved it. I justified the long hours away from Emma by telling myself that every hour spent in the hospital was one more hour in pursuit of perfecting my craft. One more hour credited toward her healing.
With my time completed at Mass General, I got a call from one of the best transplant surgeons in the world, asking me to spend eighteen months under his wing at Vanderbilt learning the art of transplantation. We accepted, moved to Nashville, and I fell in alongside this tall, lanky, mild-mannered country physician who, despite his humility, just happened to be the number one or two best transplant surgeon the world had ever known. Despite his credentials and the aura that surrounded him, he insisted that we call him "Billy." We did, but behind his back we called him "Sir."
Whereas Mass General had taught me to survive and think on my feet, Vanderbilt taught me to heal. Transplantation wasn't difficult; the mechanics of it have been around for years. Cut the old heart out, stitch the new heart in, sew the patient up. The hard part comes next, after surgery, when you literally force the human body, via powerful drugs, to accept a foreign organ. To do so, you selectively weaken parts of the immune system so that it can't attack itself due to the fact that John Doe's heart is now sitting center stage amid a body it was never meant to power. It's a delicate walk. To force acceptance and ward off rejection, transplant recipients take an average of fourteen pills a day at specific times.
Thus, being a transplant surgeon makes one by default an expert on infectious disease. You train yourself to recognize symptoms that others don't, tuning in to even the slightest variation in a person's blood count or chemical makeup. The way a cough sounds, the color of the eyes or the skin, the smell of the breath.
Unlike other surgeons, who often operate on someone they have never met and then see that same patient once in two weeks for a final checkup, transplant surgeons meet their patients months in advance, know their stories and family histories, and then endure along with them the agonizing process of waiting for a heart. Following surgery, they see their patients weekly, then monthly, for years afterward. They are linked by this indescribable act whereby one takes another person's heart and places it in a living person's chest, where it instinctively beats again. Few doctors share so close a bond with their patients.
After eighteen months at Vanderbilt, I got a call from St. Joseph's in Atlanta. They were trying to start a transplant program and wanted me to head it. Billy gave me his blessing and cut me loose. I shook his hand and said, "Thank you, sir," and Emma and I drove home to Atlanta.
By this time I carried two cell phones and two pagers and had been on call 24/7 for about seven years. I was thirty years old, and people were coming from all over to meet me. I'd never lost a patient who wasn't already dead, never been sued, and never not had a success, so word of my ability was spreading.
After my second year in practice, Charlie-who'd gone into the construction business north of Atlanta-called us to say he'd found some property for sale on the northern tip of Lake Burton. Two lots, one containing a one-room fish camp with a porch, faced each other across a narrow finger of the lake.
The three of us met the Realtor late on a Sunday afternoon when my surgery schedule was clear, and walked the property. The existing structure was sparse but clean and would work as a weekend getaway until we could build what we wanted. From the moment we set foot on that soil, Emma began imagining the kind of home she wanted. On the ride back, she began putting her ideas on paper. We made an offer from the phone driving south on 400 and signed the papers later that week.
ONE AFTERNOON, AFTER. FOUR SIMPLE BYPASS SURGERIES and one thoracotomy, I walked into my office to meet an elderly man from China. Doubled over and leaning on a cane, he raised his head and greeted me. I stooped to shake his hand and make eye contact. Even though we didn't speak the same language, I knew what he wanted. I want to live in any language means I want to live. The eyes say it as clearly as the lips.
I turned around, scheduled the OR, and that night, he began living again. When they saw I could work with small, frail tissue, that's when they started bringing the children to see me. The steadiness of my hands and my ability to sew fine stitching in small places with dangerously thin tissue was much sought after among parents whose children's small, frail hearts needed miracles wrapped in the disguise of modern medicine. And when I saved the eight-year-old who'd had three previous surgeries and was unable to come off the four machines that were keeping her alive, that's when they started calling me "the miracle maker."
Emma just smiled and continued to hope.
The life of a transplant patient is no painless ordeal. Following surgery, patients endure a long stay in the hospital during which they sleep little, are probed and pricked often, and endure several rather uncomfortable tubes poking into or out of different bodily orifices. Within a short period of time they suffer their first episode of inevitable rejection when the body's immune system attacks the alien threat, the thing in the center of the body that's not supposed to be there.
Then begins the time-consuming search for the right combination of drugs to regulate the body's immune system. Then the frequent biopsies, when a doctor runs a tiny pair of tweezers down a tube stuck into a vein of the neck and clips off five little pieces of heart muscle to study and analyze. Then follow weeks of physical therapy and weekly and then monthly checkups.
Finally, patients must accept and comply with a lifelong regimen of diet, take a dozen different medications daily at just the right times, and pay inordinate attention to every cough, sneeze, and sniffle, each cut or sore that appears on the body, and the most minuscule variation in temperature. But despite all that
hardship, and all that pain, people line up to endure it.
Then there are the doctors. The honest ones will tell you that few of us are immune to a bit of a God-complex. The system itself breeds the problem. Unlike CEOs, who receive feedback from their stockholders or boards of directors, doctors receive little to no correction. We feed off control. And in the operating room we are in total control; everyone is subservient to our smallest command. No argument. No negotiation. No question or protest. We prescribe, and people do. We extend a hand, and people jump. And with every saved life, we are affirmed. "Nice job, Doctor." "That was good work, Doctor." "Well done, Doctor."
Our mouths might say, "Oh, it was nothing, really," but in our minds we're saying, You bet it was good work. We feast on our own pride and are gluttons for our own self-promotion. And don't think we leave it inside the OR. Because most of us have an overdeveloped sense of self, we treat most relationships the same way, which explains why we work twenty hours a day and have no home life, leave a wake of failed marriages, and send Christmas cards to our kids.
I escaped this complex not because I was a better man than those around me, but because I couldn't afford to fall victim to it. I came home every night and climbed into bed with a woman whose breathing had me running scared. I began working twenty hours a day not because I fed off the affirmation, though I wasn't immune to it, but because I hoped that God would remember all my good deeds and spare Emma.
Often I'd walk in the door after two nights and three complete days at the hospital and lie down in bed, my eyelids heavier than I could hold up. But sleep was the enemy, and I did whatever I could to hold it off because all I wanted to do was listen to my wife breathe. Doing so held my doubts at bay.
Many nights she'd turn over, see my open eyes, and brush my cheek with her thumb. "Hey, you."
I'd smile.
"You're not sleepy?"
I'd shake my head.
She'd smile and touch my lips. "You're lying."
I'd nod.
She'd tuck herself under my arm, find my feet with the tips of her toes, close her eyes, and drift off. Each time I wanted to say, "Wait, no, don't go. Stay. Just a few minutes longer." But before I could get the words out, she'd be asleep.
So I'd lie there, my heart racing, and inside my arms her weak chest would fill and then empty itself. The urge to sleep was powerful, but I stood amid the storm, the waves crashing over my bow as I fought to command the rudder. But I had no more control over this ship than I'd had over the boats we built and floated down the creek as kids. We might glide across the surface, row in perfect, clean strokes, or swim discreetly in the shallows, but in the end, the water carried us. It was the best of times, it was the worst of times ... it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us.
When I was sure she was asleep, I'd place my stethoscope against her frail back and listen. Hours later, the storm raging in my ears, the waves crashing down on my mind, my hands weary on the tiller, I'd still be listening. Finally, when I was weakened and unable to stand any longer, a final wave would break, shatter my hull, and tumble me to shore. An hour later I'd wake to the sting of sunlight and the pang of uncertainty. A castaway.
I UNDERSTOOD THAT EMMA'S CASE WAS MORE COMPLICATED than anything I'd ever faced. While the transplant surgery itself would be delicate and complex, it was the postsurgery that had me guessing. With so many years on powerful drugs to slow the degeneration of her heart, her immune system was already weakened. The trick would be to continue to selectively weaken her immune system so that it accepted the new heart, while also strengthening the rest of her immunity so that we could grow old together. While I was hopeful, her time was running out. Emma had told me that she didn't want me to perform her surgery because if something went wrong, she didn't want me walking around with that albatross draped around my shoulders the rest of my life.
While Emma's ejection fraction continued to fall and close in on 15 percent, I began thinking about the team I'd need to operate. I needed a good pair of hands. I wanted someone who was as good as I was. Dr. Lloyd Royer Morgan was a fifty-something surgeon who had performed his fair share of transplants, making him one of the top surgeons in the eastern half of the U.S. Royer often operated out of St. Joseph's, so we frequently rubbed shoulders.
Royer was a teddy bear. Six-foot-eight and with hands like bear paws, he was a gentle giant. Due to the sheer size of his hands, he was limited in what he could do with children, but he was everybody's all-American when it came to adults. If my heart failed and I needed a heart surgeon, I'd want Royer's hands in my chest.
Emma and I took him to dinner at Chops in downtown Buckhead, where he drank red wine, nibbled at a steak, and listened to our story. At the end of dinner, I asked him to be my hands. He looked at Emma, she nodded, and he said yes.
We began the multitude of tests that certified her ready for surgery. We also listed her. About midnight on a Tuesday, I entered Emma's information into the national transplant data computer, also known as the UNOS database, and formally registered her as a waiting recipient. I called her, and she began to cry. She didn't like having to wait for someone else to die so she could live.
Chapter 30
ednesday would be a warm summer day; the breeze off the lake told me that. I was up early because my dreams wouldn't let me sleep late. Actually, they didn't let me sleep much at all. I wore a flannel shirt with a collar that I could pull up if needed, put on my sunglasses, and pulled down my baseball cap. To make myself look even worse, I had not trimmed my beard. In my faded gray Suburban covered with Georgia red clay, which looked nothing like the Lexus I once drove, I felt I could escape detection at St. Joseph's.
The narrow graveled road winding down to their house was carved from gullywashers and a chronic lack of maintenance. I pulled into the drive and saw Cindy and Annie sitting on a bench, reading. Annie was wrapped in a blanket and wearing a purple fleece beret; Cindy wore a knee-length skirt that was not new and a sleeveless cotton sweater that had worn thin in spots.
There is a look, a hollow, thinning, wasting look shared by people who are chronically ill. The eyes are sunken; skin color is pale, glued over a blue translucent base; veins are exposed and appear brittle; hair is not something you'd see on a Revlon commercial; and movements are slow, as if the body were walking through water or the feet blistered from the sun. The medical term is cachexia. The more common expression is "death warmed over." Whichever you prefer, Annie was beginning to have the look. And beneath it was the faint suggestion that more and more vibrancy, more and more life, was slipping away.
She hopped off the bench, walked up to the passenger-side window, and said, "Hey, you, guess what we've been reading?"
I got out, walked around, and opened the door for her. "Oh, do tell," I said.
"Madeline. "
"You don't say."
Cindy spoke up. "Yeah, we thought about Dr. Seuss, but figured you'd get tired of three-letter words."
Highway 400 south was uneventful, and we pulled into St. Joseph's twenty minutes early.
Cindy shook her head. "You must have been here before. It always takes me an hour just to find the right entrance."
I smiled and said, "The Internet is a wonderful thing."
"Yeah, but they charge you twenty bucks an hour to use it at the Internet cafe."
"Come to my house. You can use my connection anytime." As I said it, I made a mental note to move my laptop out of my office.
I parked around back in patient parking that few patients know about.
"Wow! We can park here?"
I tried to look curious. "I think so. That sign says we can."
Cindy shook her head and opened Annie's door. "You coming up?" she asked.
"No, I think I'll stay put. I try not to go to doctors' offices unless absolutely necessary."
She smiled and held Annie's hand as they entered through the electronic door. I sat in the car, staring at th
e cover of Madeline and remembering how Emma's mom had read it to her.
Thirty minutes later, a tap on the window woke me up. A security guard motioned to me with an imposing-looking black stick. "Excuse me, sir, can I see some ID?"
Mike Ramirez had been the nighttime security five years ago. His parents were natives of Old Mexico, which explained his dark, tanned skin and dark hair. I can't say how many times Mike met me at the door after midnight and made sure my car would start and that nobody jumped out of the bushes and took my wallet, watch, or life.
Mike and Sofia had two kids and were hoping for more. He always carried pictures and said his goal was to send them to private school. As soon as he made Director of Security.
He knew Emma because of all her trips to the hospital and had followed her progress religiously. At her funeral he sat two rows back, crying like a baby.
In the five years since I'd last seen him, Mike had rounded a bit more in the middle and his hairline had receded. I had always liked Mike, always liked talking with him and always looked forward to seeing him when I finally clocked out of the OR and began the short trek to my car. But the last thing I wanted to do was show him my ID.
When I looked up, he tapped the glass again and said, "Sir, I'm sorry to bother you, really am, but security is pretty tight around here, and if you'd be kind enough ..."
I rolled the window down and reached for my back pocket. My wallet was there, but I didn't let him know that.
"Ummm . . . " I stalled, hoping Cindy and Annie would miraculously appear. I pointed toward the electronic door without looking at him. "I gave it to my sister and niece so they could get a bite. They're just inside. A checkup at Dr. Morgan's office."
He paused. "Oh ... so you're waiting on a patient?"
"Yeah, little girl, 'bout this tall, wearing a purple thing on her head. You know how little girls are. All trying to be the Cover Girl model." I tried to sound as backward and country as I could, but I wasn't sure he was buying it.
When Crickets Cry Page 14