The heart, p.17
The Heart, page 17
So, he chose the heart, and then cardiac surgery. People were surprised, thinking that he could have made a fortune examining suspicious moles, injecting hyaluronic acid into frown lines and Botox into cheeks, remodeling the floppy, stretch-marked stomachs of multiparous women, X-raying bodies, developing vaccines in Swiss laboratories, giving speeches in Israel and the United States on iatrogenic diseases, becoming a high-flying nutritionist. Or he could have covered himself in glory by opting for neurosurgery, or even hepatic surgery—specialties that dazzle with their complexity, their use of cutting-edge technology—instead of which he chose the heart. The good old heart. The human engine. A creaking pump that gets clogged up, goes on the blink. I’m basically a plumber, he liked to tell people: I tap on the surface, listen to the echo, identify what’s gone wrong, replace the faulty piece, repair the machine, it’s perfect for me—hamming it up as he says this, hopping from one foot to the other, minimizing the prestige of the discipline when the truth was that all of this flattered his megalomania.
In fact, Virgilio chose the heart so he could exist at the highest level, reckoning on the idea that the organ’s kingly aura would reflect on him, just as it reflected on the cardiac surgeons rushing through the corridors of the hospital, plumbers and demigods. Because the heart is more than the heart, as he knew perfectly well. Even deposed from its former throne—the muscle continuing to pump no longer being enough to separate the living from the dead—it was, for him, the central organ of the body, the place where the most crucial operations, those most essential for life, took place, and to Virgilio its symbolic stratification was unaltered. More than that, as both a cutting-edge mechanism and the operator of mankind’s supercharged imagination, Virgilio envisaged it as the keystone to representations ordering man’s relationship with his body, with other humans, with Creation, with gods, and the young surgeon was awestruck by the idea that he would be a part of this, a recurrent presence at this magical point in language, permanently situated at the exact intersection of the literal and the figurative, of muscle and emotion; he was thrilled by the metaphors and figures of speech that made it appear as the very analogy of life and never tired of repeating the fact that, having been the first to appear, the heart would also be the last to disappear. One night at the Pitié, sitting at a table with some others in the duty room, in front of the huge mural painted by the interns—a spectacular tangle of sexual scenes and surgical operations, a sort of gory orgy, jokey and morbid, where a few representations of hospital bigwigs appeared between all the asses, breasts, and enormous erections, among them a Harfang or two, generally portrayed on the job, in obscene postures, doggy-style or missionary, scalpel in hand—he told the story of the death of Joan of Arc, his delivery theatrical, eyes sparkling like obsidian balls, slowly recounting how the captive was taken by cart from her prison to the Vieux-Marché, where a crowd had gathered to watch, describing the slim figure in the tunic that had been treated with sulfur so she would burn more quickly, the pyre built too high, Thérage the executioner climbing up to tie her to the stake—Virgilio, encouraged by his listeners’ captivated faces, mimed the scene, tying solid knots in the invisible ropes—before setting fire to the bundles of sticks with an experienced hand, lowering the torch to the coals and the oil-soaked wood, the smoke rising, the screams, Joan’s last words before she suffocated, then the scaffold blazing like a flare, and the heart that they discovered intact after the body had been consumed, red and whole in the ashes, so they were forced to rekindle the fire to be rid of it.
* * *
An exceptional student, an extraordinary intern, Virgilio intrigued the hospital’s management but struggled to find a niche for himself among groups of fellow surgeons-to-be, professing with equal vehemence an orthodox anarchism and a hatred of “families,” those incestuous casts, those biological connivances—when, in truth, like so many others, he was fascinated by all the Harfangs in white coats, attracted by the heirs, mesmerized by their reign, their health, the power of their numbers, curious about their properties, their tastes, and their idioms, their sense of humor, their clay tennis courts, so much so that he became obsessed by the idea of being invited to their homes, sharing their culture, drinking their wine, complimenting their mother, sleeping with their sisters—a raw devouring—and he intrigued like crazy to make it happen, as concentrated as a snake-charmer, then hated himself when he woke up between their sheets, suddenly rude, unpleasantly insulting, a grumpy old bear kicking the bottle of Chivas under the bed, wrecking the Limoges porcelain and the chintz curtains, and he would always end up running away, a lost soul.
His acceptance into the cardiac surgery department of Pitié-Salpêtrière sent his emotions up a notch: aware of his value, he immediately despised the petty rivalries of the medical courtiers, ignored the docile heirs and heiresses apparent, and set to work on getting close to Harfang, getting so close to him that he could hear him think, doubt, tremble, so that he could sense his decision in the very instant it was made and see it in the movement of his gesture. From now on, he knows, he is going to learn with this man what he could never learn anywhere else.
* * *
Virgilio checks the Italian team’s roster on his cell phone—makes sure that Balotelli is playing, Motta too, yes, that’s good, and Pirlo, and we’ve got Buffon in goal—then exchanges predictions and insults with two other chief residents who will be eating dinner in front of a giant plasma screen tonight and drinking his good health, both of them French guys who hate the defensive Italian style and support a team that is physically underprepared. The taxi glides in parallel with the Seine, as flat and smooth as a runway, and as he approaches the entrance to the hospital opposite the Chevaleret metro station, he tries to calm himself down. Soon he is not responding to his colleagues’ messages, only smiling, dropping out of their gamblers’ stake-raising frenzy. Rose’s face reappears in his mind, and he is about to write her a gallant text—something along the lines of: the curve of your eyes encircles my heart—then changes his mind: that girl is a nutcase, a dangerous nutcase, and tonight, nothing must disturb his concentration, his control, nothing must deflect the success of his work.
The organ-removal teams begin arriving at 10:00 p.m. The Rouen team turns up in a car, only one hour on the roads separating them from the hospital in Le Havre, whereas the teams from Lyon, Strasbourg, and Paris are all arriving by airplane.
* * *
The teams have organized their transportation, calling an airline company that will accept this Sunday mission, and have verified the nocturnal opening of the little airport at Octeville-sur-Mer, formalizing all the logistical details. At the Pitié, Virgilio paced impatiently around the duty nurse who was frantically calling everyone, and did not even look at the young woman in a white overcoat who was also standing there, in silence, and who, when their eyes did finally meet, moved away from the wall and advanced toward him, hello, Alice Harfang, I’m the new intern in the department, I’ll be doing the removal with you. Virgilio eyeballed her: she didn’t have the giveaway white cowlick, but he could tell she was one of them—ugly, indeterminate age, yellow eyes and eagle-beak nose. He could almost see the strings that were pulled to get her here. His face darkened. He particularly disliked the beautiful white coat with the fur collar. Not exactly an appropriate outfit for traipsing around hospitals. She’s the kind of chick who just comes along for the ride and thinks money grows on trees, he thought irritably. Okay, I assume you’re not scared of flying, right? he questioned her curtly then turned away while she replied no, not at all. The duty nurse handed him a road map, hot off the printer: go ahead, the plane’s on the runway, you’ll be departing in forty minutes. Virgilio picked up his bag and headed toward the exit without even glancing at Alice, who was following him, then took the elevator, the taxi, the main roads to Bourget airport, where they passed jet-lagged businessmen in long cashmere overcoats, holding luxury briefcases, and soon the two of them were climbing into a Beechcraft 200 and fastening their seat belts, without having exchanged a single word.
The weather forecast is favorable: no snow yet, and not much wind. The pilot, a man in his late thirties with perfectly straight teeth, announces good flying conditions and an estimated journey time of forty-five minutes, then disappears into the cockpit. As soon as he’s sitting down, Virgilio has his nose in a financial magazine that someone had left on his seat, while Alice turns toward the window and watches Paris transformed into a sparkling tapestry as the little plane gains altitude—the almond shape, the river and its islands, the squares and the main roads, the bright zones full of exclusive stores, the dark zones full of tower blocks and forests, all of it shading into obscurity if you let your eyes move from the heart of the capital to its edges, beyond the luminous ring of the beltway; she follows the lines traced by those tiny red and yellow dots that run along invisible roads, the silent activity of the earth’s surface. After that, the Beechcraft climbs through the clouds and into the celestial night. And so, probably because they are disconnected from the ground in this way, propelled far beyond all social markers, Virgilio thinks differently about his companion—maybe he is beginning to find her less repugnant—asking her, is this your first removal? Surprised, the woman turns her face from the window and looks at him: Yes, first removal, and first transplant. Closing his magazine, Virgilio warns her: The first part of the night might be a little upsetting, it’s a multiorgan removal, the kid’s only nineteen, we’re probably going to take everything—organs, blood vessels, tissue—we’re just going to scrape everything out. His fist opens and closes very fast. Alice looks at him—her expression, enigmatic, might just as easily mean “I’m scared” as “So? I’m a Harfang, remember?”—then she sits up and reattaches her seat belt, while Virgilio, suddenly destabilized, does the same: they are making their descent toward Octeville.
The little airport has been opened specially for them: the runway is lined with lights, the top of the tower illuminated. The aircraft touches down, shaken by spasms. The door slides open and the gangway unfolds. Alice and Virgilio walk down to the runway, and from that moment on they are propelled in a single movement, as if they are standing on a moving walkway, a magically fluid and unbroken trajectory, crossing through a deserted exterior (that asphalt perimeter where they can hear the sea), a mobile, cozy interior (the taxi), a freezing cold exterior (the hospital parking lot), and an interior whose codes they recognize instantly (the surgery unit).
* * *
Thomas Rémige is waiting for them, like the master of the house. Handshakes, espressos, introductions made, connections created, and, as always, the Harfang name radiates its aura. He makes a head count: each team consists of two people, a senior surgeon and an intern, to which his own hospital has added the anesthesiologist and the nurse anesthetist, the OR nurse, the nurse’s aid, and himself—thirteen altogether. It will seem like a crowd in the operating theater, the impregnable citadel, the secret zone accessible only to holders of multiple entry codes. Christ, it’s going to be standing room only in there, Thomas thinks.
* * *
The theater is ready. The surgical lamp projects a white light, vertical and shadowless, over the operating table, the beams from its circle of spots converging on Simon Limbres’s body, which has just been brought here and which still shows the same level of animation. It is still troubling, still moving to see him this way. He is placed in the center of the room—he is the heart of the world. A first circle around him delimits a sterile zone that cannot be crossed by anyone not involved in the operation: nothing must be touched, soiled, infected; the organs that are about to be harvested here are sacred objects.
In a corner of the room, Cordélia Owl takes it all in. She has changed into scrubs and left her cell phone in a changing-room locker. Being separated from it—no longer feeling that hard rectangular shape vibrating against her hip, insidious as a parasite—has sent her into another reality: yes, it’s here that it’s happening, she thinks, eyes riveted on the body stretched out before her, this is where I am. Having gone through her training in the OR, the place itself is not alien to her, but she has only ever seen intense mobilizations aimed at saving patients, at keeping them alive, and she is struggling to comprehend the coming operation, because the young man is already dead, isn’t he, and the objective of the surgery is to save other lives. She has prepared the equipment, arranged the tools, and now she is quietly repeating to herself the order in which the organs will be removed, lips barely moving behind her mask: (1) the kidneys; (2) the liver; (3) the lungs; (4) the heart. Then she starts over in reverse, reciting the order of the organs based on the duration of ischemia the organ will tolerate—in other words, how much time it will survive once vascularization has been stopped—(1) the heart; (2) the lungs; (3) the liver; (4) the kidneys.
* * *
The body is lying flat, naked, arms extended to the sides, leaving clear the thoracic cage and the abdomen. It has been prepared, shaved, painted, then covered in a fenestrated drape that marks out a window of skin on the body, a cutaneous perimeter covering the thorax and the abdomen.
All right, here we go. Let’s get started. The first team appears in the operating theater. The urologists will get the ball rolling—they will be the ones to open the body and they will close it again at the end. Two men get to work, a Laurel and Hardy–like odd couple, the tall, thin one being the surgeon, and the small, round one the intern. The tall, thin one bends over the body and makes an incision in the abdomen—a bilateral laparotomy below the ribs, tracing a sort of cross on the abdomen. In this way, the body is split in two distinct zones at the level of the diaphragm: the abdominal zone, where the liver and the kidneys are located, and the thoracic zone, home to the lungs and the heart. The men use self-retaining retractors on the incision, turning them by hand to widen the opening—this action requires physical force, allied to meticulous technique, and suddenly the manual dimension of the operation shows through the massed technology, the physical confrontation with reality that is necessary in this place. The body’s interior—the murky, oozing insides—glows red under the lamps.
* * *
The practitioners will prepare their organs in turn. Quick, meticulous blades move around the organs, freeing them from their attachments, their ligaments, their respective envelopes, but for the moment nothing is severed. The urologists, standing on either side of the table, talk to each other as this happens, the surgeon taking the opportunity to educate the intern: he leans over the kidneys, breaking down the movements he makes, describing the techniques he uses, while his pupil nods and sometimes asks questions.
One hour later, the Alsace team enters the room, both women, both the same height and build; the surgeon, a rising star in the relatively select world of hepatic surgery, does not utter a word, her gaze impassive behind her small, round, metal glasses, working at the liver with the determination of someone in a fight, fully committed to an action that seems to find fulfillment in its own execution. Her colleague stares unblinkingly at the surgeon’s unbelievably skillful hands.
Another thirty-five minutes pass and the thoracic team enters the theater. It’s Virgilio’s turn now; time for him to shine. He informs the Alsatians that he is ready to make the first incision, then immediately afterward makes the longitudinal section of the sternum. Unlike the others, he does not bend over the body, but remains upright, neck angled and arms held forward—a way of maintaining his distance from the body. The thorax is open and Virgilio can now see the heart—his heart—he can consider its volume, scrutinize the ventricles and auricles, observe its solid contractions. Alice sees the satisfaction in his face: it’s a magnificent heart.
He proceeds with stunning speed—the arm of a quarterback and the fingers of a lacemaker—first dissecting the aorta, then, one by one, the venae cavae: untangling the muscle. Alice, standing directly across from him on the other side of the operating table, is gripped by what is unfolding: by the parade around this body, by the sum of actions of which it is the object; she watches Virgilio’s face, wonders what it means to him to operate on a dead person, what he’s feeling, what he’s thinking, and the space around her seems to reel, as if the separation between the living and the dead no longer exists here.
* * *
Once the dissection is completed, it is time for cannulation. The blood vessels are pierced with a needle and little catheters inserted into them, through which will pass the liquid that cools the organs. The anesthesiologist surveys the donor’s hemodynamic status on the screens—perfectly stable—while Cordélia supplies the surgeons with implements as required, taking care to repeat the name of the compress, the number of the pliers or blade as she places them in the palm of the plastic-gloved hand held open in front of her, and the more she does this, the firmer her voice sounds, the more confident she feels of her place in this operation. It’s ready now: cannulation is completed, and we can clamp the aorta—and every practitioner in the room checks the anatomical map they have just been given, identifying the part intended for them.
* * *
Can we clamp? Virgilio’s voice, loud in the theater even though muffled by the mask, startles Thomas. No, wait! He shouted, and everyone turns to look at him now, hands immobilized over the open body, elbows frozen at right angles: the operation is suspended while the coordinator weaves between them to reach the table, moving his mouth close to Simon Limbres’s ear. What he whispers then, in his most humane voice, even though he knows that his words are falling into a deathly void, is the promised litany of names, the names of those who are escorting him; he whispers that Sean and Marianne are with him, and Lou, and Grandma, he whispers that Juliette is there by his side—Juliette who knows about Simon now: she got a call from Sean around 10:00 p.m. after leaving a succession of increasingly distraught messages on Marianne’s cell phone, though what Simon’s father said to her was incomprehensible, as his words seemed to wander beyond language; he seemed unable to formulate a sentence, only gasps, cracked syllables, stammered phonemes, sobs, till Juliette finally understood that there was nothing else to hear, that there were no words, that this was what she had to hear, and she replied I’m coming, in a breath, then rushed out into the night, running to join the Limbres family in their apartment, hurtling down the steep hill, not wearing a coat or even a scarf, an elf in sneakers, keys in one hand and cell phone in the other, and soon the glass-sharp cold started to burn, she was consumed on the slope, a figurine broken into pieces, almost falling several times as she struggled to coordinate her strides, breathing badly—not at all the way Simon had taught her to breathe, with no regularity, forgetting to exhale—her tibias aching and heels burning, ears popping like they did in a landing plane, and a stitch stabbing at her side; bent double, she continued to run on the too-narrow sidewalk, grazing her elbow against the high stone wall that bordered the curve, rushing down this slope that he had climbed for her on his bike five months earlier—the same bend but in the opposite direction, that day of the Ballade des pendus and the red plastic lovers’ shelter that they had raised together, that day, that first day—she was running so hard she couldn’t breathe now, and the cars were driving past her, up the hill, catching her in the white glare of their headlights, slowing down, the startled drivers continuing to watch her in their rearview mirrors for a long time afterward—a kid in a T-shirt, out in the street, at this hour, in this cold, and the look of panic on her face!—then she came into view of the unlit bay window of the living room and accelerated again, entering the grounds, crossing a clear space of flower beds and hedges that seemed to her like a hostile jungle, then sprinting up the steps, where she took a tumble, the carpet of leaves coagulated by the cold forming a layer of ice, and scraped her face, splashing mud on her temple and her chin, and then she was up again and climbing the stairs, three floors, and when she arrived on the landing, her face deformed like the others, unrecognizable, Sean opened the door to her before she even rang the bell and took her in his arms, holding her tight, while behind him, in the dark, Marianne was smoking a cigarette, wearing a coat, standing next to the sleeping Lou: Oh Juliette, and the tears began—then Thomas takes the earbuds from his pocket, the earbuds that he has sterilized, and inserts them into Simon’s ears, switches on the iPod, track 7, and the last wave forms on the horizon, in front of the cliffs, it rises and rises until it fills the whole sky, forming and unforming, deploying the chaos of the matter and the perfection of the spiral in its metamorphosis, scraping the seafloor, stirring up the layers of sediment and shaking the alluvium, uncovering fossils and overturning treasure chests, revealing those invertebrates sunk deep in the vastness of time, 150-million-year-old ammonites and bottles of beer, airplane wreckage and handguns, bleached bones like tree bark, the seabed as fascinating as a gigantic garbage dump and an ultrasensitive membrane, a pure biology, and the wave lifts up the earth’s skin, digging into memory and turning it over, regenerating the soil where Simon Limbres lived—the soft dune in whose hollow he shared a packet of french fries and mustard with Juliette, the pine forest where they sheltered during the squall, the 150-foot bamboo stalks just behind them, swaying like they do in Asia, and the warm raindrops hitting the gray sand that day, the odors mingling, bitter and salty, Juliette’s lips the color of grapefruit—and then finally it explodes and scatters, in an almighty splash, a conflagration and a shimmer, while around the operating table the silence thickens, they wait, eyes meeting over the body, toes twitching, fingers suspended, but they all accept that it is right to pause for a moment as they stop Simon Limbres’s heart. Once the rite has been performed, Thomas removes the earbuds and returns to his place. Again: Can we clamp?
