When Crickets Cry (19 page)

During my interview process, most panels, filled with whitejacketed and plaid-bow-tied doctors, stumbled through the answer or balked at the very idea that I would ask so insolent a question. I wasn't being prideful. I simply knew my purpose, and I didn't have time to wait for them to figure it out. I needed to hit the ground running.

Things changed when I interviewed at Harvard. As one of three finalists for an endowed fellowship, I sat in front of an eight person panel and was encouraged to ask questions of my own. I respectfully said, "I have one."

They raised their eyebrows and waited.

I asked, "If I join your program, could you tell me in one sentence what you will teach me about the human heart?"

Dr. Ezra Trainer-bow tie, tweed jacket, gray beard, laser pointer, and a handful of M&Ms, which he was popping one at a time into his mouth-raised his finger, lowered his glasses, and said, "Guard your heart, for it is the wellspring of life."

I nearly jumped out of my chair.

r. Trainer began the first day of anatomy class with three simple rules: "Drink unsweetened iced tea-the tannic acid is good for your heart, as is the absence of refined sugar; take an aspirin every day, as it causes your arteries and veins to become less sticky and less apt to catch plaque; and never take the elevator when there's a stairwell nearby." He patted the jar of M&Ms on his desk and said, "Oh, and take care to control your addictions."

Some things are so simple.

He ended class by saying, "Remember, ladies and gentlemen, you will learn many techniques and procedures, but the best tool you'll ever work with is the one that fits between the earpieces of your stethoscope." When the laughter quieted he held up a finger and said quietly, "Never forget, the best is the enemy of the good."

But I already knew this, because I had read Voltaire.

On our first day, we met our cadavers. My team and I were given three people, all blue, wrinkly, and very much dead, whom we would work on throughout the semester. While most teams labeled their cadavers with numbers or something technical like Alpha, Beta, and Delta, we named ours.

We knew we'd dissect everything from their big toes to their medulla oblongatas, but to keep us humble, Dr. Trainer insisted, "These folks were walking, talking people at one time. They loved, spoke, and dreamed. Dead or not, I think we ought to treat them that way."

The first was a seventy-something man who had apparently smoked himself onto that table. We named him Winston. And when they say that tar sticks to the lungs, they're not kidding. His looked like a road map of tiny tar highways.

The second was an Asian lady in her forties who, we would discover a month later, died from a heart attack. We named her Cathy, because she reminded one team member of his aunt.

The third was a man in his midsixties who'd suffered a massive stroke judging from the calluses on his hands, probably on the golf course. We named him Scotty because we thought he would have looked right in some sort of Scottish plaid. And when those same people say that plaque actually connects to the sides of the arteries like Velcro, they're not kidding. Two months later, we dissected Scotty's carotid artery-the one that allows blood flow from the heart to the brain-and found his 99 percent blocked.

That first night, I brought Emma into the morgue, a large, cold room filled with sixty tables and just as many bodies, and pulled back the sheets. Most folks saw blue bodies, contorted lips, and shriveled body parts, devoid of human fluid or function. Some sick trick out of a midnight horror movie. Not Emma. To Emma, the human form was a divine reflection. She walked between the tables and said, "That makes us pretty special."

While I filled our home with books, journals, diagrams, and set my face like flint toward learning everything known about the human heart, Emma poured her heart onto canvas and filled our lives with color and expression.

Except for Emma, who really did know everything about me, I had never told anyone of my future plans. I figured I could talk all I wanted, but talk mattered little. Actions spoke. Despite that silence, when we began cutting Winston's sternum, intent on dissecting his heart, everyone turned to me and said, "You should."

We split him from his sternum to the base of his esophagus with a cordless Stryker saw, inserted a stainless rib spreader, and gently cranked opened his chest. Beneath the pericardium-the sac that protects the heart sat his "wellspring"-diseased and long since affected by years of smoking. I looked around, the others nodded, so I reached my hand in and wrapped my fingers around it. It was cold and hard.

This is why you're here. This is the starting point. Learn this, Reese. Learn everything about it.

TOWARD THE END OF MY FIRST YEAR, DR. TRAINER BROUGHT me into his office and sat me down across from him. He pointed at me with an unlit pipe. "Reese, any fool can see that you're a bit different from most students." He pointed toward the wall behind me. "I'm your adviser, so you might as well choose early. Basically, you've got three options."

I knew this, and he knew I knew this, and he knew that I knew that he knew, but there was more going on here than a simple conversation between teacher and student. He pointed his laser at a diagram on the wall, which showed a tree with three branches.

"Electrophysiologists are the electricians of the heart. Primarily, they put in pacemakers and play gin at the club on Saturdays. They send their kids to private schools, drive foreign cars, and ski two weeks in Utah during the winter."

He moved his laser to the right side of the diagram. "Invasive cardiologists are plumbers. They put in stents and then play golf with the guys who don't play gin rummy. Their wives carpool with these guys' wives"-he flashed his laser back at the electrophysiol- ogists-"and they probably buy time-share condos in the Bahamas where they spend two weeks fly-fishing in the summer."

Slowly he moved his laser to the middle of the diagram, the trunk, and began running it in circles. "Cardiothoracic surgeons." He said it slowly, with reverence and emphasis. "We're the carpenters, the builders. We perform bypass surgeries and transplants and do things that the golfers, the guys playing gin rummy, and the fly fishermen only dream about. We work too much, seldom ski, get paid a lot less than we used to, and most of us are bastards. In truth, we're the end of the line, the last stop before either the pearly gates or the fiery pit."

He tossed me the laser pointer. "Choose."

I had known my place on that poster since I made my promise to Emma's mom. I may not have known what to call it, but I knew my place. I sat back and pointed at the trunk. "Here. Always have been." I clicked off his pointer and quietly set it on the front of his desk.

He sat back and folded his hands, and the springs in his chair accentuated his nod. He hung his pipe over his lip, considered a moment, and said, "Good. That is good." He scratched his chin, and his eyes narrowed on me. "You need to know from the beginning ..."

"Yes sir?"

"It's an amazing organ, truly the emperor, but not all hearts start up again after they've been stopped." He looked out through a window and somewhere out into a now-foggy past. "Remember that."

DURING INTERNSHIP, DR. TRAINER INEVITABLY TURNED TO A few select individuals in the class and asked them to assist in an afternoon bypass. It was one of the perks of med school. The infamous question had long ago placed Dr. Trainer on a mythical pedestal. For weeks, the classroom chatter had been, How will you respond when he calls your name?

Toward the end of my second year, Dr. Trainer turned to me one day and said loudly before the class, "Doctor, are you busy this afternoon?"

I never even blinked. I had waited mywhole life for that moment.

I scrubbed, joined him in the OR, and watched him peel the mammary artery from beneath the rib cage of Jimbo, a fortysomething construction worker who was ninety pounds overweight and about three beats away from a flatline. I stood across from Dr. Trainer and next to Dan, his PA, who was cutting with a Bovie and pulling an artery from Jimbo's leg for the second and third bypasses.

Dr. Trainer inserted the artery, completing the first bypass, and then looked at me with a queer expression pasted across his face. His face turned red, his eyes rolled back, his knees buckled, and he passed out cold, hitting the tile floor with a thud. With Jimbo lying on the table, chest open, heart stopped, living off a pump, the OR went into a frenzy.

Dan dropped the Bovie and began hyperventilating, bumping into sterile tables and slinging stainless instruments all over the place. The head nurse removed her sterile table from Dan's reach and paged Dr. Trainer's partner, Jack Metzo, but he was thirty miles from the hospital and stuck in traffic. Problem was, Jimbo didn't have time for Dr. Metzo to navigate the interstate and the ensuing downtown Boston stoplights.

While a nurse started screaming at Dr. Trainer in high-pitched annoying shrieks, Dan started mumbling incoherent mumbo jumbo to the techs and nurses scattered about the room. I looked at the anesthesiologist, who held up his hands and looked at both me and the perfusionist and said, "I'm not scrubbed."

I looked at the perfusionist, who looked at me, held up her hands, and gave me a blank, unscrubbed stare.

I turned to the head nurse, held out my hand, and said, "Needle-driver."

She looked at the floor, at the patient, then at me, and placed the threaded needle into my palm. I had seen it done a hundred times, performed several dozen "successful" cadaver bypasses, read about it a thousand times, and dreamed about it every minute of every day for twenty years. In my mind, I had walked through every stitch and every second.

I asked the anesthesiologist to raise the table, because I'm about three inches taller than Dr. Trainer, reached my hands into Jimbo's chest, and then did what God had made me to do. I fixed his heart.

Several stitches into the second bypass, I looked down at Dr. Trainer who, evidently, was playing possum. I picked up on this because I caught him looking at me through one eye and watching the video monitor with the other. When he winked at me, I realized he had this whole thing planned, and everybody was in on it but me.

No matter. In twenty minutes, I had rerouted the circulation around Jimbo's heart with three new arteries, one from his chest and two from his leg, pulled him "off pump," and watched his heart fill with blood and turn deep red. With blood filling the cavities, I reached my hand in, wrapped my fingers around his heart, and squeezed.

It beat. And then it beat again. And Jimbo didn't die.

After I had sewn up the pericardium, run three drain tubes out the wall of his stomach, wired his chest shut, and stitched and stapled the skin above his sternum, I stepped back.

Dan shook his head and laughed. "Seventeen times we've done this, and you're the only one we've ever let finish. Usually Dr. Trainer's back up in two minutes, after the guy in your shoes soils his scrubs or screws up an already screwed-up heart." He pointed to Jimbo. "Good work too. Almost as good as him." And he pointed behind me.

I turned around, and Dr. Trainer was looking over my shoulder, taking M&Ms from a nurse who was feeding him one at a time.

Dr. Trainer nodded and said with a smile, "Maybe." When I pulled off my gloves and apron, he winked. `Just maybe."

he only original item of furniture that I kept from the fish camp was an oversized, lion-footed, iron bathtub. The thing was waist-deep and looked like something out of a brothel. Charlie said it weighed three hundred pounds, and Emma absolutely loved it. She'd get the water warm but not too hot and let the tub fill up while she plucked her eyebrows in the mirror above the sink. After she quit sneezing, she'd slide in, sit for a long time, run more warm water as needed, and read. She must have read a hundred books in that thing. Bubbles, wet towel behind her head, feet propped up.

Sometimes I'd poke my head in the bathroom and ask, "You want some company?"

And every once in a while, she'd look at me from around her book, move her bookmark, and nod. I'd climb in and lean back, and she'd read to me while I rubbed her feet. We'd step out looking like two raisins.