Between one beat and the next

Photo by Patricia Tser on Unsplash

My friend Bridie and I used to ride our bikes to school together. Every morning I rode the half mile or so to the corner near her house, and then we rode the remaining two or three miles side by side, giggling, ignoring her bossy older sister Jan who pedaled and puffed behind us. One morning Bridie wasn’t there so I rode to her house, leaned my bike against the wall, started to walk through the back door.

Someone – her mother? – grabbed my arms and stopped me. Told me Bridie wouldn’t be coming to school that day because her father had died. He and her mom had gone to bed the night before, but only her mom had woken up. His heart just stopped beating.

Some time later I stormed into her house, raging over the latest fight I’d had with my father. “You should be grateful you still have him,” Jan told me – so pompous! I snarled at her, “You have no idea how lucky you are!” and her face went white as her heart missed a beat. After that we didn’t speak for a long time.

By the time my father had his first heart attack, I think in 1997, which was the year before I married the Hubbit and moved to the US, he and I had achieved a truce of sorts. I was on my way to an interview when someone – my mother? – called me on my cell phone and I changed direction and sped to the hospital. The Egg and her husband were already there, huddled together on one of the long benches in the large, empty waiting area. They directed me to another waiting area next door, where I found Marmeee standing beside him, clutching his hand and looking scared. He was on one of those narrow, wheeled metal hospital beds, gasping for breath, his face the dull yellow of old fat that’s been exposed to air.

Not far from them was a counter, and behind it an empty reception area, and beyond that a room full of nurses engaged in loud conversation while they drank their tea. There was a bell, which I rang furiously with one hand while slapping the wood of the counter with my other hand. A nurse emerged and looked me up and down. “Yes?” she asked.

“My father needs attention!” I demanded.

She glanced dismissively at him. “We are waiting for his file,” she said.

“Where is his file?”

She flipped a languid finger back toward the room where the Egg and her husband were waiting. “The messenger will get it. But now he is on his break,” she said. I stormed through the door, rang a different bell, slapped a different counter. Demanded the file, which I carried back and slammed down in front of the nurse. She rolled her eyes, flicked the file open, froze. Called more nurses. Moments later they wheeled him away, Marmeee scurrying alongside as he clung to her hand.

There was nothing left for me to do, except … I could call for favors. I called Cass, a cardiologist I’d interviewed a few weeks previously. He was a hot shot, associated with a private hospital. My father, who didn’t have medical insurance, was in a state hospital. Cass had liked the story I wrote about him, and had asked me to write another story about organ transplants and the need for donors. I’d told him I would, but that it would be a better story if I could actually witness and write about a heart transplant. So at that point – the point I was at, sitting in the waiting room while my father clung to my mother’s hand in a different room full of machines beeping and nurses scurrying and doctors barking instructions – at that point, we were waiting for one of Cass’s patients to be matched with a donor heart.

Well, if your father has a heart attack and you happen to know the top cardiologist in town, maybe happen to have impressed him enough that he wants a favor, obviously you call him. And even if he can’t personally get involved in the case, he makes a few calls, lets it be known that he has an interest, and the awed cardiac team responsible for your father’s care snaps to attention and gets the job done. The Olde Buzzard had surgery and it went well and he got medical insurance and started seeing Cass regularly, and his heart kept up a steady thump for nearly twenty more years, until Marmeee’s stopped and his no longer had a reason to keep on beating.

It was late Friday afternoon, a hot day at the end of a too-long week. The voice on the phone was warm. Sexy. “Hey there – would you like to spend the night with me?”

My pulse quickened … but … I was in Johannesburg, and the only man at that time likely to make me such an offer was on the other side of the planet. “Who is this?” I squeaked.

He chuckled. “It’s Cass,” he said. We had a heart!

I met him at the hospital a couple hours later, and he took me to meet the patient’s wife. I had forgotten the wife until I read my notes today. At the time she was merely background, barely relevant to the story. It’s interesting how life has a way of teaching one empathy.

I had my laptop with me, and I made my notes in the form of a letter to the Hubbit. He wasn’t my Hubbit yet, of course; we were still at the internet romance stage of our relationship, he in the US and I in South Africa. We didn’t yet expect to meet, but we’d got into the habit of sharing the events of our lives.

Hiya, honeybun!

I’m sitting on the floor of a large passage in the hospital. Nothing much is happening … I need to write down what I’m experiencing, and – hope you don’t mind – it’ll be a lot easier just to tell it all to you. I guess it’s one way to spend the night with you … <smial>

Oh yeah – we got pretty steamy back then. Even with the full bulk of the planet between us he could make my heart flutter!

I told him about the family – Hindu, a large crowd, the women all dressed in saris. The mother, who sat lotus-legged and praying on a plastic chair, one eye covered by an eye patch held in place by masking tape – she’d had cataract surgery a few days previously. Three sons, the youngest 13. A brother who was a cardiologist, who later showed up in the operating theater.

The patient is only 47. He has had heart disease for about six years and they had been keeping it under control with medication, but early this year he went into heart arrest and Cass said it was time to plan for a transplant. He’s been incredibly lucky – he’s had to wait only five weeks. Some people wait years.

An orderly brought him his pre-med while I was there – a tiny plastic tot glass of water and a handful of pills. The orderly told him not to drink more of the water than he absolutely had to, but he must have been thirsty – he downed the whole lot almost compulsively. Then they had to give him an injection; wanted to give it into his shoulder, but he’s so thin there’s not enough flesh there. They had to inject him in the buttock.

Suddenly it was time to take him away. Orderlies pushed his hospital bed speedily toward the operating theater, and his family streamed behind, keeping pace with his bed until a nurse stopped them, gently told them to say goodbye, that they’d see him the next day. They stood in a small cluster, waving and smiling with determination, and kept waving even after he was out of sight, their fear surrounding them like a fog.

Then a nurse brought me a hideous green overall to wear. Needless to say the one-size-fits-all trousers didn’t, but she found me some bigger ones. I had the MOST frustrating time trying to persuade my hair to stay tucked inside a silly little cap. I’m wearing nothing but thin plastic overshoes on my feet, because I didn’t think to change into sneakers and the overshoes won’t work with the heels I was wearing. My feet are freezing! Now I’m sitting in a little room outside the theater, drinking tea and waiting for something to happen. In TV hospital programs hospital life looks like one adrenaline rush after another. Not so. This evening has been mainly waiting.

And now I’m in the theater! I rushed in and was promptly chased out – I’d forgotten my face mask! Put it on – how do doctors wear these things? After less than a minute I felt as though I was suffocating.

The operating theater was a small room crammed with equipment and crowded with people – several nurses, an anesthetist, two cardiologists, all chatting and joking as though they were at a party. The perfusionist – the person responsible for the heart-lung machine – sat next to the patient reading a Playboy magazine. The two cardiac surgeons had their own extra-high-sterility area, separated from everyone else by a low divider covered with hanging towels.

At the center of it all is the patient. He is very still, and is almost completely covered by green sheets; even his face is covered, except for a little slit where a tube goes in. On the cardiac monitor his heartbeat is erratic, frantic… They’ve started cutting and his heart is going crazy… They’ve sawed open his sternum. It looks like meat, but the smell is strange, nasty.

Okay … I went to stand above the patient’s head, and watched the surgeon cut open the pericardium. I saw inside his body. I saw his heart, laboring sluggishly to keep going. And now … we wait. The new heart is on its way. They are ready.

Time is of the essence in a heart transplant. The donor heart must be in and beating within four hours or tissues start to break down. In this case, the donor heart was flown up to Johannesburg from a town on the coast. To save time they opened up the patient and were ready to go, but they didn’t disconnect his old heart until the new one had actually arrived.

The heart is packed in ice, inside a plastic bag, the whole kaboodle inside the kind of polystyrene cooler box one uses for picnics. They’ve put it next to an identical box that’s full of ice and soft drinks. The packaged heart looks like someone’s groceries.

They have taken out the old heart. It fibrillated for about 15 minutes while they were connecting the heart-lung machine, before they removed it and the monitor finally fell silent. Now it’s lying off to one side in a kidney dish, still trying its best to beat. Cass says it wouldn’t have lasted longer than a few more weeks. It makes me sad to think of it being thrown away now, though, when it’s tried so hard.

The new heart looks more solid, meatier, than the old one. The surgeons agree that it’s a nice heart. It used to belong to a 43-year-old woman who lived in a small coastal town. Today she had a cerebral aneurysm – she had a massive bleed and died – just like that. Well, technically, she didn’t die until they took her heart out about two-and-a-half hours ago. I wonder what she’d planned to do today.

And right now, technically, this patient is also dead. A machine is doing his breathing and moving his blood, and his temperature’s right down at 28 Celsius. Every now and then a nurse takes some ice out of the picnic box and puts it into his heart cavity to keep it cold. I touched his head. It felt … horrible. Icy. Not alive.

The surgery I watched was something of a milestone. I’d forgotten that too, until reading my notes. It was the first time of using surgical superglue in a heart transplant in South Africa. They spent an hour stitching the heart and supplemented the stitches with glue. I’m sure by now surgeons use glue alone to connect the blood vessels to the heart tissue. According to my notes that was the goal, anyway.

They’re trying to start the heart by pumping blood into it, massaging it gently by hand, and shocking it. It doesn’t want to start. They massage, shock, look at the monitor. It fibrillates, then stops. They try again and again. They look like Sunday afternoon mechanics huddled around a car engine, coaxing it to life.

Ten minutes in the beat is strong and steady. There are a few little leaks, which the surgeons are stitching and gluing. There’s gore everywhere, and the surgeons are spattered with blood.

Everyone is tired, coming down off a high. The final stage of the process is mechanical. They disconnect the heart-lung machine and the perfusionist packs it and his magazines away. Release the clamps that have been holding his rib cage open, remove the swabs, finish cauterizing the wound – that disgusting smell again. Insert drains and sew him up.

I thanked the hot cardiologist for giving me one of the best nights of my life. “I learned a lot!” I told him, and went home.

The Hubbit’s new cardiologist isn’t especially hot. He’s a large, blustery man, a kind man, I believe a good doctor, but as hard to pin down as a picnic blanket on a windy day. I’m learning from him that the language of the heart is imprecise. Love … fear … loss … failure … What do these words actually mean? I tried to ask him: in the context of this husband, in this consulting room, at this moment, what exactly is heart failure?

I asked him question after question, and his words were like bits of dry grass swept up by a dust devil. They had no shape or pattern. He tried to answer. He opened a folder and showed me printouts – the results of many tests over the past few weeks. He used words like “ventricle”, “left”, “right”, “congestion”. I think he may have showed me a diagram. At last he gave up, ordered another test. It’s scheduled for the day after tomorrow.

Perhaps it’s not his answers that are imprecise, but my questions. I will rephrase them.

Will his heart keep going, or will it just stop between one beat and the next?

Will I wake up one night, hear the soft snores of the dogs snuggled between us, raise my head and strain my failing ears, hear silence from his side of the bed, reach out and touch him and find him cold as ice?

Can you fix it?

In the context of right here, right now, how best should I cherish him?

Usually I end with questions for you, dear reader. An invitation to engage. This time, my questions are all directed elsewhere … but please engage anyway.