"She told me she had a dream where she saw my surgery and the doctor putting a new, strong heart in me. In her dream it was raining outside, and the clock on the wall read 11:11 and the doctor had a Band-Aid on the inside of his elbow."
"She tell you how it turned out?" I asked.
Annie smiled. "Nope. Said she woke up before we got to that part. "
Royer walked in, sat down across from me, and took Annie's other hand. "Okay, big girl, here's the deal." He held up a syringe and eyed the line running out of her IV bag. "I'm going to shoot this sleepy stuff through that valve called the piggyback. Then, once you're good and snoring, we'll roll you down that hall while your aunt and your kind chauffeur sit and wait on you."
Annie liked him calling me her chauffeur. She also liked the part about her snoring.
"Then I'm gonna take a look at your heart. When I'm done, I'll roll you back in here and let you wake up at your leisure." From his pocket he pulled a small silver bell that looked like the kind the Salvation Army rings at Christmastime, and laid it in her lap. "If you need me before, after, or during, you ring this. You got it?"
Annie picked up the bell and rang it a few times. Royer stood and walked around my side of the bed, so I walked to the corner of the room and held up the wall. Royer emptied the syringe into Annie's IV and said, "Okay, waiting on you."
Royer was walking out when Annie said, "Dr. Royer?"
He turned.
"You're forgetting something."
"Oh, yes, yes." Royer walked back over, knelt next to Annie's bed, and grabbed her hand. He closed his eyes, she closed hers, and Cindy sat on the end of the bed and held Annie's feet that were cozy beneath the sheets.
After a second of silence, Annie looked up at Royer and said, "You want to ring and I hang up?"
Royer shook his head. "You ring."
"God?" Annie said, as if He were sitting on the edge of the bed. "Please help Dr. Royer to see what he needs to do. Help Aunt Cici not to be scared and let her know that I'll be right back ... and ..." She paused, and her voice told me she had cracked into a large smile. "Thank You for my own personal chauffeur."
The single light above painted her in white, the monitors next to her flashed red and blue, and Royer looked huge kneeling next to the bed.
She looked to Royer and whispered, "Your turn."
Royer cradled Annie's tiny hand between his huge paws. He kissed her hand, pressed it against his forehead, and said, "Lord, You're the only one here who really knows what He's doing, so we're planning on You taking charge. You promised Annie something, and we're holding You to it. Forgive us if that's too bold, but we don't have time to be timid. I got a feeling You're not finished with this one, not hardly-You're just barely getting started, so ... bottom line, You're needed. It's time to clock in. Let me see what I need to and ..." Royer paused, and his voice grew low and more steady. "Give this girl sweet dreams in the process."
I whispered "Amen" and watched as Royer kissed Annie on the forehead.
"See you in an hour or so."
Annie nodded; her eyelids had grown heavy, and she tried to speak, but her words were all connected and run together. Another minute, and she was asleep.
The nurses pushed the bed down the hall, leaving Cindy and me sitting in the room wondering where to start.
I took a stab. "How 'bout that chocolate cake?"
Cindy nodded, tucked her hands tighter under her armpits, and we walked out into the hall. When I pulled my hat down and put my sunglasses on, she raised an eyebrow but said nothing. She and Annie had warmed to my eccentricities, partly from kindness and partly just from having too much going on with themselves to figure someone else out. We walked to the cafe, and I kept my eyes to myself.
During the day, a hospital is an intense place. It's a cauldron of emotions, struggles, and people with short fuses facing few options. Peopled with nurses, doctors, patients, social workers, administrators, and family members, everybody is bouncing off one another like atoms in a centrifuge rapidly transiting between somewhere and somewhere else.
But at night, while most of that remains true, a serene quiet falls along the halls that seems more in touch with not the gravity of life and death but the immediacy of it. No less critical but somehow more manageable. I always preferred working at night.
As Cindy and I walked the halls, the hospital was alive, pulsing with the smell of disinfectant, the sound of hushed tones and unguarded laughter, and the feel of unending possibilities. I loved this, the feeling of absolute and eternal optimism, the feeling that no matter how bad or no matter how dire the circumstances or predictions, that until death has been declared and the sheet rolled up over the patient's eyes, that even beyond the flat line, anything is possible. Beneath the undercurrent of even the direst predictions, hope lives here. It creeps along the corridors, hangs from every corner of every room, and speeds down every gurney in search of a soul in need.
I ran my finger along the seam of the wallpaper and remembered one afternoon after Emma had undergone a round of tests and lay in her bed, recovering. I'd stop in and check on her every ten minutes or so, and about two in the morning, I asked her how she felt.
She opened heavy eyes, tilted her head, and said, "Reese, hope lives here, and death can't kill it."
CINDY BUMPED INTO ME AS A NURSE PASSED BY. I TOOK A deep breath, as deep a breath as I'd taken in a long time, and filled every inch of me with the smell of what was so good and so familiar. It filled me, and I knew in part what I had not known in a long, long time-the doctor's high. The surge of all that I had missed, all that I had come to know and love, jolted through me like a thunderbolt at dawn. Then the image of Emma, cold, still, and unbreathing on the floor of the kitchen, passed across my eyes, flooded through my heart, and my mind only had one thought: Annie.
Cindy grabbed my arm and attempted to steady me as I swayed and banged my shoulder against the wall that led to the nearest nurses' station. "You okay?"
I didn't answer.
She placed her hand on my face, forcing my eyes to find hers. "Reese? You okay?"
The intercom overhead paged a doctor. I heard his name, I heard that he was needed in the OR, and I heard, "Stat!" When all that registered in my mind, and the pieces fell into place like a giant game of Tetris, something deep within me stirred. "Yeah." I nodded. `Just hungry, I guess."
We small-talked en route to the cafe, but our minds were elsewhere. Cindy, I knew, was trying not to think about Annie lying on that table with instruments probing her heart. I could think of nothing else.
I knew what Royer would be looking for, I knew how and where he'd look, and I knew how long it would take. And if I knew Royer, he'd make a video of the entire procedure under the guise of showing Cindy what he had done while I just happened to look on.
The cafe was brimming with people. I pulled the collar up on my unbuttoned flannel shirt, pulled my hat down, and we sat in a corner. If Cindy thought me curious, she didn't let on. We ordered chocolate cake and both nibbled.
On Emma's last visit to the hospital for some routine blood work, we had come here, sat two tables over, and ordered a milk shake. She had sipped, I had not, and we talked about life after the transplant. She had laughed easily, held my hand across the table, looked skinny beneath clothes that were once not so baggy, and tried to hide the eyes that were set so deep and so dark.
Every few minutes, doctors and nurses who knew us both would come to the table and wish her well. They'd pat her on the shoulder, shake my hand. Everyone just knew that we'd be having fun and laughter-filled conversations in the months to come. Nothing was more right, more deserving, more ordered out of a Norman Rockwell painting-Emma would live, and we would too, together, as it should be.
"Reese?" Cindy shook me. "You there?"
"Huh?"
"I've been talking for ten minutes, and I don't think you've heard a word I've said."
The cake was gone; somehow we'd eaten it all.
"I'm sorry. What were you saying?
"
"I was saying that if Dr. Royer can't locate his old partner, or find another surgeon he thinks can do the job, it won't matter what he learns today."
"So where is this ex-partner? What happened to him?"
"Pulled a Houdini. All Royer would say was that he suffered a personal tragedy and left medicine. Royer thinks that if Jonathan Mitchell can recover from whatever took him out of medicine, he'll make one of the finest heart surgeons the world has ever known."
The sound of my own name shook me like a cold shower.
"Annie's prayed for over a year that we'd just run into him in the street. That he'd walk up and buy a cup of lemonade from her. She's sure that he'd know what she needed just as soon as he saw her and would want to help her."
We stood up and pushed in our chairs.
"I keep telling her that sometimes adults have reasons for doing things or not doing things that most kids just don't understand. But you know Annie. She's hardheaded."
We crossed the cafeteria, and I held the door for her.
"So every night," Cindy continued, starting down the hall, "she prays for Jonathan Mitchell. And even though I haven't met the guy, I already love him, because he's given Annie something that no other doctor except Royer has ever given her."
I looked confused. "What's that?" I said.
Cindy looked at me and raised her eyebrows matter-of-factly. "He's given her hope."
"And what if he doesn't show up?" I asked.
She shrugged and looped her backpack purse over her shoulder. "It's not up to me, but this much I know-if anybody's got a direct line to God, it's Annie. If I've seen it once, I've seen it a dozen times. But-" She put one finger in the air and gave a knowing shake of her head. "If He's going to answer this one, He'd better hurry up, because His hourglass is running low on sand."
Chapter 46
e didn't have to wait long before nurses wheeled Annie's bed back into the room. She was quiet, and when they reattached her to all the machines at the end of her bed, she continued sleeping beneath the whitish glow of the fluorescent lights.
Royer followed a few minutes later. He checked the face numbers on the machines over Annie's head, and the connection to and tape around her IV, and then placed his hand on her cheek and forehead. One of the things I admired most about Royer was the way he so seamlessly switched between father figure and doctor. Seldom since meeting him had I not sat beside a patient's bed and asked myself, either consciously or unconsciously, How would Royer do this?
Finally he turned to Cindy. "She's fine. Other than one small hiccup, the test went great." He brushed the hair out of Annie's face and tucked it behind her ear. "She'll wake tip in a couple of hours. I'm not opposed to keeping her overnight just as a precaution, so-"
Cindy raised her hand, and I could tell that the economic side of her brain had just clued in to what he was saying. The term overnight translated into higher bills, and she was trying desperately to keep those within lifetime-reachable limits. "But, Doc-"
"Nope," Royer cut her off and shook his head. He sipped his coffee and continued, "Here's what I saw ..."
I stood in the shadows, pressed against the wall, listening to the echoes of remembrance that reverberate off a hollow heart. I was stuck in that horrible place, one I knew all too well-that narrow and slippery ridge of hope that rises above the pits of despair that live on each side.
It's a fast track to circling the drain.
"First, ASD. Atrial septal defect. Long story short ... because the heart has had to work so hard for so long, it's grown bigger. It's a muscle. It'll respond that way. Even since her last surgery. That causes a couple of things to happen. It puts more pressure on itself, causing it to work less efficiently." Royer began to talk with his hands.
"While the heart can grow bigger in response to the exercise, the chest cavity is only so large. So it's compounding its own problem. The right atrium enlarges and sends multiple signals to the ventricle. Normally, the sinoatrial node sends a one-for-one signal from the top of the heart to the bottom. It's what creates the beat, the lub-dub. It's like a drill sergeant that determines the cadence for the march.
"When the atrium gets this big, all those different cells can't hear the signal, and it becomes like a radio with static on every channel. So to compensate, the atrium sends multiple signals. The ventricle hears all of them, so it naturally beats with each signal." Royer held up his right index finger. "But when the heart gets this big and flabby, the entire muscle doesn't know what the rest of the muscle is doing. The heart can't hear itself." He smiled. "When we say Annie has a big heart, we're not kidding."
Cindy faked a responsive smile and wrapped her arms tighter about herself while she braced for the bad news.
Royer continued, "So just to make sure, various portions of the muscle send their own signals. The ventricle receives all of them, and we get a confused heart. For every pump of the atrium, we might get two or three pumps of the ventricle. It's like two people dancing, arm in arm, but one is listening to Dean Martin"-he looked at me-"while the other is listening to Elvis."
Royer loves Elvis.
"They're just not in tune. And to make matters more complicated, she's also got what's called VSD, or ventricular septal defect. The ventricle gets big and floppy, and then becomes an ineffective pump. Bottom line, it's just worn out and needs a break. Once the ventricle gets like this, the atrium dilates, sends out several signals per heartbeat rather than just one, and we get what Annie feels every second of every day, multifocal atrial tachycardia. Meaning, whereas your resting heart rate is 60 beats a minute, hers is more like 130."
Deep inside, I smiled. Royer was still the best. I missed his bedside explanations, the care with which he gave his delivery. I took a deep breath and relaxed.
"Now, there's one more thing."
Cindy perked up as if she already knew all that he'd just told her.
"That hole I was telling you about, that's open when we're in the womb and closes when we're born?"
Cindy nodded.
"Well, Annie's is still open, and while it's probably not going to get any larger, it's not going to get any smaller either. This causes greater pressure at the exit holes of the heart than at the entrance, and reverses the flow. It's rare, and it's called Eisenmenger's syndrome."
Cindy's face faded to a shade of white as pale as the sheet next to her. I knew Royer wasn't telling her everything. I could read his body language and knew he was deliberating as to whether or not to give her all the results or all but one. I think my presence there shifted the balance.
Royer placed his fingers to his lips, paused, and lowered his voice. "I also found one other thing." He punched the intercom button to the nurses' station and said, `Jan? Can you patch in the last fifteen seconds of Annie's TEE?"
A lady quickly responded, "It'll be on channel 3."
Royer changed the channel, and pretty soon something that looked like a baby ultrasound appeared on the screen. Royer took a pen from his pocket and tapped the screen, but I had already seen it.
He circled the screen with the end of his pen and said, "There, right there is an area along the stitch line of her previous surgery that has weakened. The tissue has thinned, become more brittle. If, and I do say `if,' Annie undergoes any violent stress or impact to her body, it could rupture."
Cindy held her hands to her mouth, looked at Annie, and said, "What's that mean?"
Royer took a deep breath. "Annie's condition is worsening on an exponential scale. She's not growing worse daily, she's getting worse by the minute."
Cindy sat down in a chair next to the bed and hid her hands in her face, sobbing quietly.
Royer continued, "This means we've still got some time, but ... not much. With the right medicine, right care, right everything, Annie might have ..." Royer pressed his lips together and thought hard. "Three months on the outside. Two is more like it."
Cindy shook under the quiet sobs, and tears fell out from between her fingers
and off the insides of her palms.
I took a step closer, then stopped and took two steps back. Royer watched me, considered, and then returned to Cindy.
"We need to list her, find a donor, and get her transplanted." He pointed toward Annie's chest. "If that tissue ruptures before Annie gets a new heart, she'll have about two minutes before the pericardium fills up with her own blood and ... she'll never make it to the hospital. I'm not even sure my old partner could help her then." He didn't look at me, but kept his eyes trained on Cindy, who sat hunched quietly next to Annie. She was wiping her eyes with the sheet and smearing mascara across the word Hospital stamped along the hem.
"Cindy." Royer's tone changed from father figure to doctor. "I need you to listen to me. I told you two years ago, this is a marathon, not a sprint. Take a deep breath, because it's going to get worse before it gets better."
Cindy looked up.
"I know a doctor in Macon. Admittedly he's my second choice, but I've worked with him, he's a good man, and he's had great success with kids. I've already talked with him."
Cindy smeared what remained of her mascara across her face and said, "It's not me. It's Annie. She's had a dream and she's convinced-"
"I believe Annie's hope could move mountains, but I'm not sure it'll bring Jonny Mitchell out of retirement. Given our options and what I saw this morning, we better go with option B. We no longer have the luxury of time."
Cindy looked at Annie and nodded. "Dr. Royer, I, urn ... we got turned down from the last bank, and ..."
Royer cut her off, and his fatherly tone returned. "It's no longer an issue."
Cindy looked up, smearing her running nose along her sleeve. "What do you mean?"
"I mean," Royer said with a smile, "an anonymous donor ... or donors"-Royer knew better, but he threw that in anyway-"cre- ated a benevolence fund in Annie's name. Accounting called me just before you arrived. I meant to tell you this morning, but I was thinking about the surgery. Currently, the balance is enough to pay for your hospital bills for the next several years. Including the transplant."
(2006) When Crickets Cry Page 23