When Crickets Cry (34 page)

"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."

Cindy looked at the floor, at Annie, at me, then back at Royer. "Who?"

Royer shrugged. "Don't know. They didn't say." He smiled. "That's why it's called anonymous. Atlanta's a pretty good town. People hear about needs, and it's not uncommon to wake up one morning and find that. . ."

"Yeah, but . . . " Cindy worked her fingers across the keys to the calculator in her mind. "All this? And an entire transplant? That's close to $150,000."

Royer smiled and patted Annie's toes. "Actually the account balance is closer to $200,000. Whoever did it knew that she'd have follow-up care for years to come. Chances are good that you won't see another bill for close to a decade."

Cindy rested her head on the bed and placed her hand beneath Annie's.

Royer walked around the bed and put his hand on her shoulder, his back to me. "Hey, right now, Annie needs you to sit here quietly, paint her toenails, treat her like a kid with her whole life ahead of her. Just spend the day with her. Hold her hand when she wakes up. I'll probably keep her here, just to be safe. Matter of fact, I think I will." He glanced over his shoulder at me. "It's looking like I'll be here tonight, and there's really nothing quite like a hospital at night. While the rest of the world is sleeping, it's a rather busy place. Besides, the more rest we can give her here, the more energy we can put back in her muscle banks. I'll check back in a little while."

When the sound of Royer's heels had faded down the hall, I walked over next to Annie, dug the chain from my pocket, clasped it around her neck, and laid the sandal flat across her chest as it rose beneath one more breath.

Cindy spent much of the day sitting quietly next to Annie's bed, stroking her hair and whispering to her. At 3:47 p.m., Annie opened her eyes lazily and looked around the room. Before she ever said a word, her right hand came up from under the sheet and unconsciously felt for the sandal. Then her eyes found Cindy, who had fallen asleep on the edge of the bed. Annie searched the remainder of the room, and when her eyes found me, she closed them again and slept until 4:32, when she woke again and whispered, "I didn't wake up."

Cindy tried to smile and said, "I know, baby. I know."

Cindy held a water cup with a straw to Annie's mouth.

When Annie swallowed, which was painful and would be for a few days, she said with a half smile, "Hey, I was just wondering if, while I was asleep, you guys went ahead and found a heart and put it inside me without telling me. That way, we could just skip the whole waiting thing that comes next."

She and Cindy spent the evening watching movies, sending their personal chauffeur for non-hospital food and napping while I watched them.

About midnight, I stepped from the corner of the room and walked out into the hall. Cindy was asleep on the pullout sofa, and Annie had dozed off some time ago. The shift change had come and gone an hour ago, but that wasn't what brought me out of the room.

About eight minutes earlier, a helicopter had landed atop the hospital on the helipad. Given the chatter on the intercom and the excitement among the nurses, I knew Royer would be in the thick of things about now.

I climbed the service stairs-the "back way" that doctors used when they didn't want to be delayed-punched the numbers of Emma's birthday into the keypad, and waited to see if the light would turn green. When it did, I realized that Royer still had hope. I pushed on the door I had sworn I would never walk through again. The air was cold, the hallway clear, and at the far end stood the nurses' station and a half-sleeping security guard I didn't know.

OR2 sat at the other end of the hall, where the corridors crawled with nurses and ICU personnel. The cameras would catch my every move, but they'd go back to them only in the event that I slipped up. If no one knew I was here, they'd have no need to go back and look.

I slipped through a few side doors, crossed a hall, grabbed a white doctor's coat from the back of a supply closet, and tied a surgeon's cap over my head. I slipped into the doctors' locker room and into a pair of blue scrubs and covers for my shoes, and grabbed a stainless clipboard. I walked through a back door, down a small hallway traveled only by doctors, and once again punched Emma's birth date into the keypad. The light turned green, I climbed the single flight of stairs, and walked into the observation post above OR2. The far wall was constructed of tinted one-way glass. I crept up to the glass, looked down upon the ninemember team, and started looking over Royer's shoulder.

He had just removed the old, diseased heart and placed it into a stainless bowl held by another doctor, who immediately left the room to go study that heart for several days, maybe even weeks, because dead hearts tell us much. Another doctor, whom I didn't know, stood next to the red-and-white Igloo. Upon Royer's silent command-an open palm and accompanying nod-the doctor reached in, grabbed the cold, lifeless heart, removed it from the plastic bag, and put it in Royer's hand.

Royer placed it in the patient's chest and began his work. Twenty-seven minutes later, he brought the patient "off pump" to test a series of stitches; then, satisfied with what he saw, requested that the patient be placed back "on pump" while he stitched another artery. After fifty-one minutes, Royer looked to the doctor across from him, who nodded, and the two requested the patient once again be taken off pump. Royer released one final clamp, blood filled the heart, turning it a bright, vibrant red, and then the true miracle occurred.

It beat on its own.

In all my years fixing hearts, it never ceased to amaze me how a lifeless, unbeating, and cold heart that had not been inside a human chest for almost four hours could be removed from ice water, placed inside another's chest, and, when filled with blood, beat as though it had never quit.

Life is where the blood flows.

A minute later, the heart pumping perfectly and the patient once again alive, Royer stepped back, broke scrub, and nodded to the other doctor, who began closing the patient. For the patient, a new life. For Royer, it was simply another day at the office.

I sat down in the chair behind me and took it all in. Another man will see his children grow up, get to know his grandchildren, make love with his wife, go fishing, watch a movie, or drive the outskirts of Burton in an old wooden boat.

The amazing thing about transplantation, aside from the fact that it worked, was that it allowed people to feel again. The thing I liked best about my previous life was the first smile when a patient woke up. Because with that smile, I knew that I hadn't simply given that person a new pump, I had given him or her a new pump that allowed that person to live, to express emotion. It was the smile, even more than the first beat of the heart, that told me it had worked.

The heart doesn't just pump blood, it is our source of emotion. Out of it and because of it, people laugh, cry, get angry, grow sad, know joy, empathize, live with a full range of emotions.

Yes, the road after transplantation is not without its challenges. They are multiple and complex. The patient will forever maintain a regimen of some dozen medications a day, designed to force the body to accept the alien organ. And the doctor has to specifically and proactively target and weaken the immune system so that it will not reject the new heart. But given the choice, the pain of surgery, the agony of recovery, the long road back to health, and the constant maintenance of it, we still meet people who would give anything for the chance to lie down on our table and let us cut their hearts out.

When I turned to leave, I saw the yellow sticky note taped to the glass. Just three words, in Royer's handwriting, characteristically visible due to the all-caps: ABOVE ALL ELSE ...

I crept back to Annie's room to find Royer bent over the bed checking her vitals. Cindy lay sleeping quietly on the pullout against the wall. In stocking feet, I slipped into the shadows and watched him. Royer was meticulous. He recorded some notes in her chart slipped into the foot of her bed.

As he stood to go, Cindy jerked, sat upright, and said quickly, "She okay?"

"Fine," Royer whispered. `Just checking before I head home. Go back to sleep."

She put her head down, tucked both her hands under the pillow, and drifted off.

Royer stood, his starched white jacket draped with stethoscope and the day's notes, his blue scrubs wrinkled and splattered. Married to his job, he had sacrificed his love life at the altar of this hospital. He still dated, but at fifty-four, he lived mostly at the hospital and seldom went home, which was nothing more than a condo a few blocks away stuffed with some never-used furniture.

His bedside manner, his professionalism, his huge hands, kind smile, and tender voice-he was everything good in a doctor. In all my time here, in all my time across the table from him, we'd never had a cross word, never even close. Royer and I worked the way Charlie and I rowed. In perfect unison. And for the first time since Emma's death, I missed that.

He walked out, and I slipped from behind the door, sat in a chair opposite Annie, and wished I had Emma's letter.

I dozed fitfully, because my dream wouldn't let me sleep. No matter how hard I tried to pour that water, I just couldn't hold it on my own. It just got too heavy.

When streaks of the morning broke through the glass and lit my face with a white glow, I finally realized the one thought that had kept me awake all night. Something I had known and yet forgotten, something so simple yet so profound, something I promised Emma I'd never forget.

While the heart is an amazing organ, transplantation doesn't allow you to choose the emotions you want. It's not a Mr. Potato Head. You elect to go ahead with transplantation, and you get the whole package. That means with great joy, you also get immense sadness. It's not like a rib eye, where you can trim the fat before you eat it.

Transplant patients are lucky in one regard. They are guaranteed they will never physically feel heart pain again. When you transplant a heart, you sever all the nerve endings leading to it. Given current medical techniques and knowledge, it is impossible to reattach those nerve endings. Arteries yes, nerves no. So, while the patient gets the benefit of emotions, they do not get the burden of pain associated with them.

If they have another heart attack, they don't feel it. They could have a complete and total blockage of the entire heart, the most massive attack to ever hit a human being, and they wouldn't know something had happened until they quit breathing and passed out. About like an engine running out of gas. No signal other than a last sputter, and then silence. That's why transplanting children is so delicate-because if they don't recognize the signs, and if their communication skills aren't fully developed enough, they'll never know anything is wrong, and you, as their doctor, probably won't either, because they can't tell you.

It struck me as I sat not sleeping, letting the sunlight warm my face, that I had taken the last five years and attempted to sever the nerve endings in my own heart. I had taken a scalpel and carefully carved a swath around my own heart, cutting the nerves, while allowing the arteries to stay intact.

Self-diagnosis is painful at best. Or, to quote Dr. Trainer, "The doctor who treats himself has a fool for a patient, and a fool for a doctor."

And while medicine is helpless to regenerate the nerves, the heart can self-generate them, regrowing those tied to emotions in literally a matter of milliseconds. All they needed to take root, sprout, and begin the path back around my hardened and diseased heart was to talk with Royer at the bedside of a patient, watch Annie bravely undergo anesthesia and then simply breathe beneath a labored heart, and listen to Cindy care for everybody but herself.

And there, not far from the surface, floated the memories of Emma and Charlie. After more than thirty years of studying the heart, more than a hundred transplants and countless other surgeries, I could not cut out my own heart. I looked down, saw the tears that were now soaking my shirt, and realized that I hadn't even come close.

reakfast came early, and Annie ate as if she hadn't seen food in a week. Nurses from all around the hospital had heard she was in and awake, and began dropping in unannounced. That proved too risky for me, so I told Cindy I was going to get a paper, and stayed gone until she called me on my cell phone and asked me to bring the Suburban around.