All epidermal exteriors are nothing, mean nothing, their purpose only to hide the forbidden cities within. The patient’s legs and torso were bound in transparent Mylar wrap—a surgical dressing coated with iodine—mummified and inert. Nothing drew my eyes to those exteriors, not even the curled penis, thighs, chest, or the articulation of toes or arch of feet, so unsexed was he. Legs splayed, belly protuberant—a convenient shelf for instruments tossed down—the body had no head, or appeared not to. Eyes, looks, conversation were only surface, the skin of personality. Whatever else came into my line of vision in that first instant was incidental. Nothing could train my eyes from the view.
I was a voyager. How did they get inside there? The room was cold. Steam rose from the opened cavity. I felt as if I had broken into a hidden cave and come upon rubies and sapphires. Looking past skin, red tissue, white bone, into a chest held open by a steel frame, I saw a beating heart.
The surgeon moved his gloved hand under the heart, lifting it carefully with a small wad of gauze. Only slightly bigger than my fist, it had a covering of yellow fat near the top, but below, it was red and gray with branching arteries. On either side, thick pink flaps veined with black, like Italian marble, swelled and flattened: those were the lungs.
Not a landscape but an organscape: so many moving parts and bright colors—blue, purple, yellow, red. They were marble-quarries, veined leaves, red pathways leading to dark recesses. Was this a clock whose works were made from precious stones?
Before the surgery Blaine and I had looked at the patient’s angiogram. A tight blockage in his right coronary artery and two tangent lesions in the left coronary descending artery were causing the problem. Blockage on the left side is more serious because those arteries feed all the organs as well as the limbs. The lesions occurred at the top of the artery where it branches off from the aorta, which made his a dangerous and urgent case. “What we call a widowmaker,” Blaine said. “These are the guys who get an obstruction and die before they make it to the hospital. But his ventricular function is great. See? It squeezes down hard, and his pumping action is good, so that cuts the risk factor of surgery to less than one percent, and that’s as good as it gets.”
The beating heart was both militant and gentle; whether rhythmical or arrhythmical, its movements were soft, even subtle, but its persistent redundancy sustained life.
Dr. Westerman separated the left mammary artery, which would be used as one of the bypass grafts, held up one end, cleaned if off, then laid it on a green towel that Charlie, the assistant surgeon, had prepared at the side of the patient’s chest. “We’re looking awfully Christmasy,” Charlie said. Everyone laughed except for the younger surgeon, who had just completed his residency. He was all concentration as he took from the man’s leg a vein that would be used to bypass one of the blockages. Held in the air, it looked like pasta—a long rubbery tube that was laid on the towel next to the mammary artery.
Then the arteries were suspended by blue guy wires above the beating heart. Or was I looking at the blue span of a bridge, or the skeleton of a modern structure built over a graceful ruin?
“We have to stop the heart now,” Westerman told me. “Because it would be too hard to do all this sewing with it moving up and down.” Such a procedure could only happen with the use of the heart-lung machine, also called a pump-oxygenator, which reroutes all but a small quantity of blood away from the heart while it is being worked on and delivers blood and oxygen to the rest of the body.
“Pump on?” Westerman asked.
“Pump on, sir,” the technician retorted crisply.
A tube emerging from the patient’s atrium pulsed with blood, bright and beautiful as neon.
“Watch this,” Charlie announced, smiling. He poured a pitcher of ice water into the chest cavity, right over the heart. “We’re cooling him down to a core temperature of about thirty so he won’t need as much oxygen.” Gary started an IV with ice water. A human’s normal core temperature is thirty-seven degrees centigrade. On the monitor—which recorded heart rate, blood pressure, and body temperatures-I saw the man’s T Core drop. At 30.6 he looked dead but his reflexes were working; as ice water poured in, goose bumps rose on his thighs.
As soon as Westerman was assured that the pump was working properly, the anesthesiologist stopped the ventilator, which did the breathing for the patient, and added a high dosage of potassium to the heart—what would be, without the aid of the heart-lung machine, a “lethal dose.”
“You may want to see this,” Westerman said coolly. I peered closer: the heart jiggled, bumped out of rhythm, then gently stopped. No violent cessation, only a small change. How simple death is.
“Is he really alive?” I asked. The surgeons smiled and nodded yes.
Westerman slid his hand under the stilled heart and lifted it. He cut a tiny hole in the right coronary artery, inserted a vein that had been removed from the leg and sewed it in place. Five minutes later he started on the left side, wedging the heart into position with another wad of gauze. For an organ that pumps 100,000 times a day, 700,000 times a week, it looked rather meek nestled in the surgeon’s hand. As Westerman prepared to sew, Charlie poured more ice water over the heart, cooling it and cleaning it at the same time.
Suction tubes pulled the water back out of the cavity. Sewing was performed with a half-moon hook and a tiny filament of blue thread that glinted under the lights. Westerman looked up at me: “Now don’t go telling people this is easy.... They’ll start having their neighborhood seamstress doing it.”
How odd that sewing is thought to be “woman’s work” when surgeons, sailors, and cowboys sew too. Yet how many female thoracic surgeons are there? And if precision motor activities are thought to be performed better by women, why wouldn’t they make better surgeons too?
At 9:25 A.M. the bypass grafts were attached. “Let’s get him going,” Charlie said. The line on the heart monitor was still flat. I peered over the curtain. What if the heart didn’t start? How can they be so sure it will?
Ice water was stopped, the heat in the room was turned up, calcium was added to the IV to excite the cardiac muscle into contracting. At 9:25 the patient’s T Core was 34.5; and nine minutes later it was 35.7, almost normal. The heart moved, but erratically, almost vibrating. “He’s in ventricular fibrillation,” Charlie said, which is what happens to a heart when struck by lightning.
The EKG showed an unmetered scrawl across the monitor. Ventricular fib, as it’s called, is a heart in chaos, a heart whose twitchings are so uncoordinated, it cannot pump blood. Death follows. The patient had to die before he came back to life—like anyone on the hero’s journey.
“It’s nothing unusual,” Gary assured me. “When the electrical activity of the heart is stopped and started again it gets confused. That’s what’s going on now.” Westerman asked for the defibrillator paddles. These were much smaller than the ones used to resuscitate a human with skin intact. Touching the paddles lightly to the ventricle caused the heart to stop for a fraction of a second; it started again when the body’s natural pacemaker, the SA node, initiated an electrical stimulus in a synchronized manner, so that a normal rhythm could take over again.
The flat line on the monitor reshaped itself, rising into steep peaks and ever-narrowing valleys as if a cartographer was at work behind the screen refiguring a piece of land never seen before, or a composer disciplining wild notes into a serial order. Tibetan medicine gives us a body that is wholly circulatory. There are four groups of veins and arteries: “thog mar chags pa’ rsta” means “first appearing vein,” as if it came into the body like an evening star. “Sriid pa’i rata” is “vein of the world,” reminding us how intimately we are connected to the entire cosmos. “Hbrel ba’ i rsta,” “the vein of union,” and the last, “t’se gnas pa’y rsta,” or “life-sustaining vein,” remind us that the body is a self-regulating universe. About these arterial pathways the Tibetans say: “They all meet in the heart and the mental activities and emotions go t
hrough the chamber of the heart which causes the heart to beat.”
Near the end of the operation Blaine stepped up behind me. “The will to survive isn’t purely psychological. You’ve just seen that. It’s built into our cellular structure; it’s intrinsic. The heart is completely motivated to maintain life. The muscle cells may survive four or five hours after a blockage, but brain cells die in four minutes. That’s what I like about hearts. It’s what saved your life. It wasn’t me.”
At 9:34 A.M. the slow, sure accordian of the breathing machine started moving up and down in a quiet rhythm, and blood was allowed to enter the heart again. I watched the pink marble of the lungs inflate-deflate-inflate and the heart move quietly. “Pump is off, sir,” the technician said to Westerman. “Is the calcium in?” Westerman asked. “Yes sir, calcium in.”
The rookie surgeon finished sewing up the leg where the vein had been extracted and Westerman cauterized the needle holes and oozing spots along the grafts. He looked up at me: “What makes this go so smoothly is the people I have around me. It’s the whole team.”
Charlie threaded heavy-gauge wire through the chest wall on his side, then Westerman did the same on his. Facing each other over the man’s chest they each took handfuls of wires and in one fluid movement, pulled up: as their hands moved together the chest closed, the jewelworks hidden from view, and this stranger’s body was made whole again.
chapter 27
“Love is a wildness that has been falsely domesticated,” my friend Pico Iyer said. I thought of the bypass patient’s chest being closed, the message being: You can’t see this wild place again, you can’t witness this beauty. But the moon was hidden in there, and the sun, and neither of these would rise or set, and the birds that flew up out of it were planets and constellations because the chest was really an aviary, too full of fluttering, and when it was closed no avian life would be seen again.
The thoracic cavity must have been the place where human music began, the first rhythm was the beat of the heart, and after that initial thump, waltzes and nocturnes, preludes and tangos rang out, straight up through flesh and capillary, nerve ganglion and epidermal layer, resonating in sternum bone: it wasn’t light that created the world but sound. And the sewing up of the man’s chest was like the closing in of a house with roof and walls: Where would passion erupt? How could the spirit fly free?
It was spring: light, sound, and smell were making the world anew. Light brought bare hills into being, but orange blossom perfume and coats of pale grass clothed them. A mile below my house, highway traffic droned, the occasional downshifting truck, the hydraulic rupture of “jake-brakes,” a bleating siren; perhaps those sounds were here before the world was made, and out of its steady hiss, birdsong and human talking came into being, and from the friction of song and words on air, more earth was created.
Was it the sonic boom of a missle being shot off at Vandenburg AFB that gathered waves in tight around El Capitan Point, or was it light trying to teach the old lessons about clarity, with its green transparencies serving up impermanence, then breaking like glass on shore?
Night came. A shadowy vapor disassembled the new world. Do we have to make it up fresh every morning? I wondered. All day a distant foghorn pushed against heat until it was night and the full moon in apogee—the closest it would be to earth for fifty years—could not be seen. Across an avocado orchard a single reading lamp was switched on—its globe stood for the moon—but fog completely obscured the house. Along the whole coast, only that one light shone.
Fog lapped new shorelines halfway up the mountains, then receded, exposing the human mess below—a car wreck, a bombing, a wedding, a birth, a heart attack. Fog moved out like a pale eyelid being pulled back, but was the patient dead? In the middle of the night the sky cleared: then I saw the moon, and it did seem close, all its mottled brightness puckered down to its south pole. Heavy-ended above me, my shoulders hunched. I thought if the moon fell toward earth, my head would rise up through it like a spike.
Spring. A gray swell became a green swell: voluptuous, vibrant hills appeared, the green slopes of a woman lying on her side, her hip sprouting with wild oats, her thigh smooth with redtop grass bent over by canyon winds and tufts of bear grass and beach rye sticking out from her head. “I cannot be weaned off the earth’s long contours,” Seamus Heaney wrote. Nor can I.
Sam and I walked a four-mile stretch from east to west between Dos Pueblos and El Capitan Beach. Dos Pueblos had once been the site of two large Chumash villages and El Capitan had been a small rancheria called Ahwawilashmu. Up the coast a few miles was the village of Qasil, now Refugio Beach; then came Point Conception, where dead souls began their journey to the afterworld.
The Chumash said: “All those who die follow the sun. Sun sees everything.... The sun rises in the east and goes to the west and all the spirits follow him. They leave their bodies. The sun reaches the door and enters and the souls enter too. When it is time for the sun to fulfill his duty he emerges and he lights abysses with his eye and all who are in the dusk are resurrected.”
As fog moved to the mainland I heard a flock of birds fly over: They sounded like a dress rustling, a dress being unfastened and dropping to the floor. Fog came unpinned like hair. On the beach cliffs, great colonies of datura—jimson weed—with their white trumpet flowers, looked like brass bands. Their hallucinogenic liquid was one imbibed by the Chumash, burning away reason and false domestication the way sun burns fog, and once again I watched the world remake itself and squinted my eyes to read the text of the blaze.
Denuded of most sand by winter storms, beach rocks were encyclopedias of design: etched in white quartz I saw a spiral within a spiral and a circle within a circle that fell over the pointed end of gray stone, designs that looked like fast-spinning propellers, and Saturn’s rings, tree branches swept by a river, and the branching forks of lightning, and pushed up against them like bumpers were piles of rubbery kelp that had rolled in at high tide.
Up the hill from the beach, green slopes turned to hair: wild mustard—whose seed was originally scattered by Spaniards as they rode north—rose up on stalks like stilts, growing two inches a day until the flowering tops reached far above my head, and Irish green gave way to yellow. Hundreds of acres of avocados blossomed and the oak trees in the hills behind my house tassled out. In the fall the acorn harvest would be good. On the ground was buckeye, poppy, owl clover, paintbrush, but after thirty inches of rain the grass came in so thick the wildflowers wouldn’t find enough space to grow.
Along the road, yuccas sent up their long-stalked flowers—creamy white candles, and on my walks at night, if there was no moon they brightened my trail. But when the full moon came around again it shone a tapering path on seawater that led from El Capitan to Point Conception: a candle lit in the land of the dead.
chapter 28
The mustard held sway on the hills. At the beach, Sam lay in elliptical slices of shade cut out of dark air by returning swallows. In the curve of the coastline, a mother whale and her calf—California grays-fed and rested thirty yards from shore. After they left I walked up the hill through yellow alleys, under monumental bouquets that opened out into green parks, then tightened into black sage jungles with pom-poms of purple flowers skewered on long stalks, which, farther up, gave way to scattered oak trees.
Back on the beach, fourteen vultures were pecking holes in the side of a dead seal and they flew up as I approached, welding together in the sky like a single black cape. Was this the hood that would flop over my head and send me down underwater? A vulture’s sense of smell, not sight, directs it to prey. I hoped I was not giving off a wrong signal.
It wasn’t death that came to my door that afternoon but Sam in great distress. I had heard an odd noise in the house but ignored it. Then he appeared, jerking in convulsions. I flew to him as his eyes rolled back and he fell over on his side.
On ranches I’d helped resuscitate calves with mouth-to-mouth respiration; I clamped my hand acros
s Sam’s muzzle and leaned down to breathe into his mouth when his eyes opened and he gave me a puzzled look, that said: “What the hell are you doing now?”
Gathering him in my arms, I laid him on the seat of the pickup and careened down the winding road to the vet. By the time we arrived he was looking quite well. Subdued but bright-eyed, he must have wondered what the rush was all about. The vet checked him for poison, bowel obstruction, fever, and infection but he passed all those tests. I told her we’d both been struck by lightning and that many lightning survivors later suffered from epileptic seizures. She concurred. “That’s how he’s behaving. He’ll be tired now but he won’t remember the incident. He’ll be fine.”
That night he lay with his head on my lap during dinner at a friend’s beach house. A cool breeze lapped the front porch as we drank wine and ate steak. Sam didn’t want any steak, he only wanted to sleep. The sound of the ocean and the flat-handed leaves of a sycamore tree lulled him, would heal him. Since being struck by lightning he had become hypervigilant: even the sound of popcorn popping in the microwave sent him cowering to another room. I thought of the woman on the beach who thought he looked like a god.... He wasn’t a god that night, only a mortal whose body had been ravished by Zeus. The seizure was eidetic—a physiological reenactment of electricity’s chant echoing in cranial chambers. Later, a friend called and said, “I was just thumbing through a Japanese dictionary and saw that the radical for god is the same as the one for lightning.”
In one last storm, the moon was overtaken by clouds, as if its filaments had been crushed, and lightning’s stun gun brought the sea into view—momentary, spasmodic bursts of white. The wall that stood in front of a hotel was torn away and the unfinished living room of a house being built filled with breaking waves.
A friend who had gone surfing said, “It started raining and the sky and water turned white and I saw someone stand up on his board in the lightning and there was white light all around him. He looked like an X-ray riding the last wave.” The Chumash, many of whom lived at the water’s edge and paddled their thirty-foot canoes across the channel, said of lightning: “Beware, that is an element from the hand of a power that caused us to see the world.”
A Match to the Heart Page 14