Harvest

by Tess Gerritsen

  “As usual,” said Vivian. She gestured to the others standing at the table. “Dr. Lim will do the kidneys. Dr. DiMatteo and I will assist as needed.”

  “History on this patient?”

  “Head injury. Brain-dead, donor forms all signed. She’s thirty-four, previously healthy, and her blood’s been screened.”

  He picked up a scalpel and paused over the chest. “Anything else I should know?”

  “Not a thing. NEOB confirms it’s a perfect match. Trust me.”

  “I hate it when people tell me that,” muttered Frobisher. “Okay, let’s take a quick look at our heart, make sure it’s in good shape. Then we’ll move aside and let Dr. Lim do his thing first.” He touched the scalpel blade to Karen Terrio’s chest. In one swift slice, he cut straight down the center, exposing the breast bone. “Sternal saw.”

  The scrub nurse handed him the electric saw. Abby took hold of the retractor. As Frobisher cut through the sternum, Abby couldn’t help turning away. She felt vaguely nauseated by the whine of the blade, the smell of bone dust, neither of which seemed to bother Frobisher, whose hands moved with swift skill. In moments he was in the chest cavity, his scalpel poised over the pericardial sac.

  Cutting through the sternum had seemed an act of brute force. What lay ahead was a far more delicate task. He slit open the membrane.

  At his first glance at the beating heart, he gave a soft murmur of satisfaction. Glancing across at Vivian, he asked: “Opinion, Dr. Chao?”

  With almost reverential silence, Vivian reached deep into the chest cavity. She seemed to caress the heart, her fingers stroking the walls, tracing the course of each coronary artery. The organ pulsed vigorously in her hands. “It’s beautiful,” she said softly. Eyes shining, she looked across at Abby. “It’s just the heart for Josh.”

  The intercom buzzed. A nurse’s voice said: “Dr. Tarasoff’s on the line.”

  “Tell him the heart looks fine,” said Frobisher. “We’re just starting the kidney harvest.”

  “He wants to talk to one of the doctors. He says it’s extremely urgent.”

  Vivian glanced at Abby. “Go ahead and break scrub. Take the call.”

  Abby peeled off her gloves and went to pick up the wall phone. “Hello, Dr. Tarasoff? This is Abby DiMatteo, one of the residents. The heart looks great. We should be at your doorstep in an hour and a half.”

  “That may not be soon enough,” answered Tarasoff. Over the line, Abby could hear a lot of background noise: a rapid-fire exchange of voices, the clank of metal instruments. Tarasoff himself sounded tense, distracted. She heard him turn away, talk to someone else. Then he was back on the line. “The boy’s coded twice in the last ten minutes. Right now we’ve got him back in sinus rhythm. But we can’t wait any longer. Either we get him on the bypass machine now or we lose him. We may lose him in any event.” Again he turned from the receiver, this time to listen to someone. When he came back on line, it was only to say: “We’re going to cut. Just get here, okay?”

  Abby hung up and said to Vivian: “They’re putting Josh on bypass. He’s coded twice. They need that heart now.”

  “It’ll take me an hour to free up the kidneys,” said Dr. Lim.

  “Screw the kidneys,” snapped Vivian. “We go straight for the heart.”

  “But—”

  “She’s right,” said Frobisher. He called to the nurse: “Iced saline! Get the Igloo ready. And someone better call an ambulance for transport.”

  “Shall I scrub in again?” asked Abby.

  “No.” Vivian reached for the retractor. “We’ll be done in a few minutes. We need you for a delivery.”

  “What about my patients?”

  “I’ll cover for you. Leave your beeper at the OR desk.”

  One nurse began to pack an Igloo cooler with ice. Another was arranging buckets of cold saline next to the operating table. Frobisher didn’t need to issue any more orders; these were cardiac nurses. They knew exactly what to do.

  Already, Frobisher’s scalpel was moving swiftly, freeing up the heart in preparatory dissection. The organ was still pumping, each beat squeezing oxygen-rich blood into the arteries. Now it was time to stop it, time to shut down the last vestiges of life in Karen Terrio.

  Frobisher injected five hundred cc’s of a high-potassium solution into the aortic root. The heart beat once. Twice.

  And it stopped. It was now flaccid, its muscles paralyzed by the sudden infusion of potassium. Abby couldn’t help glancing at the monitor. There was no EKG activity. Karen Terrio was finally, and clinically, dead.

  A nurse poured a bucket of the iced solution into the chest cavity, quickly chilling the heart. Then Frobisher got to work, ligating, cutting.

  Moments later, he lifted the heart out of the chest and slid it gently into a basin. Blood swirled in the cold saline. A nurse stepped forward, holding open a plastic bag. Frobisher gave the heart a few more swishes in the liquid, then eased the rinsed organ into the bag. More iced saline was poured in. The heart was double-bagged and placed in the Igloo.

  “It’s yours, DiMatteo,” said Frobisher. “You ride in the ambulance. I’ll follow in my car.”

  Abby picked up the Igloo. She was already pushing out the OR doors when she heard Vivian’s voice calling after her:

  “Don’t drop it.”

  5

  I’m holding Josh O’Day’s life in my hands, thought Abby as she clutched the Igloo in her lap. Boston traffic, heavy as always at the noon hour, parted like magic before the flashing ambulance lights. Abby had never before ridden in an ambulance. Under other circumstances, she might have enjoyed this ride, the exhilarating experience of watching Boston drivers— the rudest in the world—finally yield the right of way. But at the moment, she was too focused on the cargo she held in her lap, too aware that every second that ticked by was another second drained from the life of Josh O’Day.

  “Got yourself a live one in there, huh Doc?” said the ambulance driver. G. Furillo, according to his name tag.

  “A heart,” said Abby. “A nice one.”

  “So who’s it going to?”

  “Seventeen-year-old boy.”

  Furillo maneuvered the ambulance around a row of stalled traffic, his loose-jointed arms steering with almost casual grace. “I’ve done kidney runs, from the airport. But I have to tell you, this is my first heart.”

  “Mine too,” said Abby.

  “It stays good—what, five hours?”

  “About that.”

  Furillo glanced at her and grinned. “Relax. I’ll get you there with four and a half hours to spare.”

  “It’s not the heart I’m worried about. It’s the kid. Last I heard, he wasn’t doing so well.”

  Furillo focused his gaze more intently on the traffic. “We’re almost there. Five minutes, tops.”

  A voice crackled over the radio. “Unit Twenty-three, this is Bayside. Unit Twenty-three, this is Bayside.”

  Furillo picked up the microphone. “Twenty-three, Furillo.”

  “Twenty-three, please return to Bayside ER.”

  “Impossible. I’m transporting live organ to Mass Gen. Do you copy? I’m en route to Mass Gen.”

  “Twenty-three, your instructions are to return to Bayside immediately.”

  “Bayside, try another unit, okay? We have live organ on board—”

  “This order is specific for Unit Twenty-three. Return immediately.”

  “Who’s ordering this?”

  “Comes direct from Dr. Aaron Levi. Do not proceed to Mass Gen. Do you copy?”

  Furillo glanced at Abby. “What the hell’s this all about?”

  They found out, thought Abby. Oh God, they found out. And they’re trying to stop us . . .

  She looked down at the Igloo containing Karen Terrio’s heart. She thought about all the months and years of living that should lie ahead for a boy of seventeen.

  She said, “Don’t turn around. Keep going.”

  “What?”

  “I sa
id, keep going.”

  “But they’re ordering me—”

  “Unit Twenty-three, this is Bayside,” the radio cut in. “Please respond.”

  “Just get me to Mass Gen!” said Abby. “Do it.”

  Furillo glanced at the radio. “Jesus H.,” he said. “I don’t know—”

  “Okay, then let me off!” ordered Abby. “I’ll walk the rest of the way!”

  The radio said: “Unit Twenty-three, this is Bayside. Please respond immediately.”

  “Oh, fuck you,” Furillo muttered to the radio.

  And he stepped on the gas.

  A nurse in green scrubs was waiting at the ambulance dock. As Abby stepped out carrying the Igloo, the nurse snapped: “From Bayside?”

  “I have the heart.”

  “Follow me.”

  Abby had time for only a last wave of thanks to Furillo, then she was following the nurse through the ER. Moving at a near-jog, Abby caught a fast-forward view of corridors and busy hallways. They stepped into an elevator, and the nurse inserted the emergency key.

  “How’s the boy doing?” asked Abby.

  “He’s on bypass. We couldn’t wait.”

  “He coded again?”

  “He doesn’t stop coding.” The nurse glanced at the Igloo. “That’s his last chance you’ve got there.”

  They stepped off the elevator, made another quick jog through a set of automatic doors, into the surgery wing.

  “Here. I’ll take the heart,” said the nurse.

  Through the suite window, Abby saw a dozen masked faces turn to look as the container was passed through the door to a circulating nurse. The Igloo was immediately opened, the heart lifted from its bed of ice.

  “If you put on fresh scrubs, you can go in,” said a nurse. “Women’s locker room’s down the hall.”

  “Thanks. I think I will.”

  By the time Abby had donned new greens, cap, and shoe covers, the team in the OR had already removed Josh O’Day’s diseased heart. Abby slipped in among the throng of personnel, but found she couldn’t see a thing over all those shoulders. She could hear the surgeons’ conversation, though. It was relaxed, even congenial. All ORs looked alike, the same stainless steel, the same blue-green drapes and bright lights. What varied was the atmosphere for the people working in that room, and the atmosphere was determined by the senior surgeon’s personality.

  Judging by the easy conversation, Ivan Tarasoff was a comfortable surgeon to work with.

  Abby eased around to the head of the table and stood beside the anesthesiologist. Overhead, the cardiac monitor showed a flat line. There was no heart beating in Josh’s chest; the bypass machine was doing all the work. His eyelids had been taped shut to protect the corneas from drying, and his hair was covered by a paper cap. One dark tendril had escaped, curling over his forehead. Still alive, she thought. You can make it, kid.

  The anesthesiologist glanced at Abby. “You from Bayside?” he whispered.

  “I’m the courier. How’s it going so far?”

  “Touch and go for a while. But we’re over the worst of it. Tarasoff’s fast. He’s already on the aorta.” He nodded toward the chief surgeon.

  Ivan Tarasoff, with his snowy eyebrows and mild gaze, was the image of everyone’s favorite grandfather. His requests for a fresh suture needle, for more suction, were spoken in the same gentle tone with which one might ask for another cup of tea, please. No showmanship, no high-flying ego, just a quiet technician laboring at his job.

  Abby looked up again at the monitor. Still a flat line.

  Still no sign of life.

  Josh O’Day’s parents were crying in the waiting room, sobs mingled with laughter. Smiles all around. It was six P.M., and their ordeal was finally over.

  “The new heart’s working just fine,” said Dr. Tarasoff. “In fact, it started beating before we expected it to. It’s a good strong heart. It should last Josh for a lifetime.”

  “We didn’t expect this,” said Mr. O’Day. “All we heard was that they moved him here. That there was some kind of emergency. We thought—we thought—” He turned away, wrapped his arms around his wife. They clung together, not speaking. Not able to speak.

  A nurse said, gently, “Mr. and Mrs. O’Day? If you’d like to see Josh, he’s starting to wake up.”

  A smiling Tarasoff watched as the O’Days were led toward the Recovery Room. Then he turned and looked at Abby, his blue eyes glistening behind the wire-rim glasses. “That’s why we do it,” he said softly. “For moments like that.”

  “It was close,” said Abby.

  “Too damn close.” He shook his head. “And I’m getting too damn old for this excitement.”

  They went into the surgeons’ lounge, where he poured them both cups of coffee. With his cap off, his gray hair in disarray, he looked more the part of the rumpled professor than the renowned thoracic surgeon. He handed Abby a cup. “Tell Vivian to give me a little more warning next time,” he said. “I get one phone call from her, and suddenly this kid’s on our doorstep. I’m the one who almost coded.”

  “Vivian knew what she was doing. Sending the kid to you.”

  He laughed. “Vivian Chao always knows what she’s doing. She was like that as a medical student.”

  “She’s a great chief resident.”

  “You’re in the Bayside surgery program?”

  Abby nodded and sipped the hot coffee. “Second year.”

  “Good. Not enough women in the field. Too many macho blades. All they want to do is cut.”

  “That doesn’t sound like a surgeon talking.”

  Tarasoff glanced at the other doctors gathered near the coffee pot. “A little blasphemy,” he whispered, “is a healthy thing.”

  Abby drained her coffee and glanced at the time. “I’ve got to get back to Bayside. I probably shouldn’t have stayed for the surgery. But I’m glad I did.” She smiled at him. “Thanks, Dr. Tarasoff. For saving the boy’s life.”

  He shook her hand. “I’m just the plumber, Dr. DiMatteo,” he said. “You brought the vital part.”

  It was after seven when the taxi delivered Abby to Bayside’s lobby entrance. As she walked in the door, the first thing she heard was her name being paged on the overhead. She picked up the in-house phone.

  “This is DiMatteo,” she said.

  “Doctor, we’ve been paging you for hours,” said the operator.

  “Vivian Chao was supposed to cover for me. She’s carrying my beeper.”

  “We have your beeper here at the operator’s desk. Mr. Parr’s the one who’s been paging you.”

  “Jeremiah Parr?”

  “His extension is five-six-six. Administration.”

  “It’s seven o’clock. Is he still there?”

  “He was there five minutes ago.”

  Abby hung up, her stomach fluttering with a sense of alarm. Jeremiah Parr, the hospital president, was an administrator, not a physician. She’d spoken to him only once before, at the annual welcoming picnic for new house staff. They’d shaken hands, exchanged a few pleasantries, and then Parr had moved on to greet the other residents. That brief encounter had left her with a vivid impression of a man who was unflappable. And he wore great suits.

  She’d seen him since the picnic, of course. They’d smile and nod in recognition whenever they met in elevators or passed in hallways, but she doubted he remembered her name. Now he was paging her at seven o’clock in the evening.

  This can’t be good, she thought. This can’t be good at all.

  She picked up the phone and dialed Vivian’s house. Before she spoke to Parr, she had to know what was going on. Vivian would know.

  There was no answer.

  Abby hung up, her sense of alarm more acute than ever. Time to face the consequences. We made a decision; we saved a boy’s life. How can they fault us for that?

  Heart thudding, she rode the elevator to the second floor.

  The Administration wing was only dimly lit by a single row of fluorescent ce
iling panels. Abby walked beneath the strip of light, her footsteps noiseless on the carpet. The offices on either side of her were dark, the secretaries’ desks deserted. But at the far end of the hall, light was shining under a closed door. Someone was inside the conference room.

  She went to the door and knocked.

  It swung open. Jeremiah Parr stood gazing at her, his backlit face unreadable. Behind him, seated at the conference table, were half a dozen men. She glimpsed Bill Archer, Mark, and Mohandas. The transplant team.

  “Dr. DiMatteo,” said Parr.

  “I’m sorry, I didn’t know you were trying to reach me,” said Abby. “I was out of the hospital.”

  “We know where you were.” Parr stepped out of the room. Mark came out right behind him, both men confronting Abby in the dim hallway. They’d left the door ajar and she saw Archer rise from his chair and shut the door against her gaze.

  “Come into my office,” said Parr. The instant they stepped inside, he slammed the door and said, “Do you understand the damage you’ve done? Do you have any idea?”

  Abby looked at Mark, but his face told her nothing. That’s what scared her most: that she could not see past the mask, to the man she loved.

  “Josh O’Day’s alive,” she said. “The transplant saved his life. I can’t consider that any kind of mistake.”

  “The mistake lies in how it was done,” said Parr.

  “We were standing over his bed. Watching him die. A boy that young shouldn’t have to—”

  “Abby,” said Mark. “We’re not questioning your instincts. They were good, of course they were good.”

  “What’s this crap about instincts, Hodell?” snapped Parr. “They stole a goddamn heart! They knew what they were doing, and they didn’t care who they dragged into it! Nurses. Ambulance drivers. Even Dr. Lim got suckered in!”

  “Following the orders of her chief resident is exactly what Abby was supposed to do. And that’s all she did. Obey orders.”

  “There have to be repercussions. Firing the chief resident isn’t enough.”

  Fired? Vivian? Abby looked at Mark for confirmation.

  “Vivian admitted everything,” Mark said. “She admits that she coerced you and the nurses to go along with her.”