Chapter Sixteen

Madelaine reached for the doorknob. She gave a last sidelong look at Lina, who wouldn’t meet her gaze, then pushed the door open.

Sounds came at her, sounds she’d heard a million times in her life—the whoosh-wheeze of the ventilator, the steady electronic drone of the cardiac monitor. They should have meant nothing, those noises that were as familiar to her as the sound of her own breathing, but suddenly in the confines of this small, shadowy room, they were obscenely loud.

Taking a deep breath, she closed the door and went inside, circling around to the far side of the bed so that she wouldn’t have to disturb the curtain.

He lay in the narrow, metal-railed bed, the covers tucked up to his slack chin, his arms pressed protectively to his sides. Clear plastic tubing invaded his mouth and nose, one going to his lungs to keep him breathing, the other providing a steady drip of fluids. Bottles and bags hung from metal poles beside the bed, sending a tangle of clear tubing into his wrists, throat, and chest. A huge, discolored layer of gauze hid half his face.

The room was dark except for a triangle of weak light from the streetlamp outside. He looked completely calm and serene, as if he couldn’t have cared less that plastic tubing stormed his body and pumped air through his lungs.

She was so unsteady, she had to cling to the rails to keep from falling down. Finally she reached out, brushed a lock of hair from his eyes, tucking it beneath the white rim of the bandage. Beside her, the ventilator wheezed and dropped. His chest rose and fell, rose and fell.

She wanted to believe in a miracle right now, to believe that she could take his hand and lean close to his ear and help him find his way back to her, guide him back from the light so many patients spoke of.

But she’d been a doctor too long. His EEG was stone-flat. He’d had no reaction to the pain tests. Nothing. There was no life inside him anymore.

He would never smile at her, never call her his Maddy-girl.

At the thought, the grief she’d been holding at bay welled up inside her, spilling everywhere, streaking down her cheeks in hot, wet tears.

She remembered all the times they’d snuggled up on her couch to watch a movie together, all the times she’d held his hand in hers. She leaned over and pressed a kiss to his warm cheek.

And waited breathlessly for him to open his eyes and smile at her and say, Maddy-girl you didn’t think it was real, did you?

But he didn’t answer, didn’t move, just lay there breathing through a machine.

Without realizing what she was going to do, she lowered the bedrail and climbed into bed beside him, slipping an arm gently around his chest, staring at the side of his face that was unharmed.

He looked peaceful from this angle, and she prayed that he was, needed to believe that he was. She clung to him, pressing her face against his throat, crying. She wanted to beg him not to leave her, not to be dead, but she was crying too hard to speak, too hard even to think.

She had no idea how long she lay there, tangled up with him, breathing the last subtle reminder of his aftershave—the one she’d given him for Christmas. Thinking of all the moments they’d never have again, all the times she’d reach instinctively for the phone to call him, only to realize he wasn’t at home anymore.

She was roused at last by a knock on the door. She sniffed and wiped her eyes, intending to crawl out of the bed and stand by his side like the professional she’d always been. To buck up and be strong. But she couldn’t move, couldn’t leave him. So she lay there, holding him, and offered a harsh, raw “Come in.”

The door opened and Dr. Nusbaum came up beside her. “I’m sorry—”

“Don’t say it,” she snapped. The moment the words left her mouth, she was horrified by her loss of control. She tried to force her trembling mouth into a smile and failed. “I’m sorry. It’s just …” She couldn’t go on. The tears came back, spilled helplessly down her cheeks. She balled her hands into fists and struggled to sit up. Without meeting Nusbaum’s gaze, she climbed out of the bed.

“It’s okay,” he said in a quiet voice. After a long, silent moment, he added, “I’ve spoken to Dr. Allenford at St. Joseph’s.”

At first Madelaine was confused—what did Chris have to do with this?—then the explanation washed over her, rippling and icy cold. She sucked in a sharp, aching breath. Facts fell into place: Francis was brain-dead, but his organs were functioning. The organ procurement people had spoken with UNOS, who had referred them to Dr. Allenford.

“What did he say?” she asked quietly.

“He says he has a perfect match for your … friend’s heart. A patient in Seattle.”

Madelaine felt as if she were doing a free fall into a deep, dark hole. She couldn’t reach out, couldn’t catch her breath. Her own heart started hammering in her chest. She should have seen it instantly, known it. How had she missed the obvious?

Nusbaum looked a little uncomfortable. “I’ve never had this conversation with someone who knew more about transplants than I do.… Are you the patient’s legal next of kin?”

“He’s a priest, did you know that? A priest. He’s never done a mean thing in his life. And now, now …” Words failed her.

Dr. Nusbaum gave her a gentle smile. “Would you like me to send the organ transplant coordinator in here? The bereavement counselor handles these things a hell of a lot better than I do.”

“No. Yes. Let me think.” She brushed the hair from Francis’s face with a shaking hand.

He moved toward her, placed a hand on her shoulder. “It’s not a coma, Dr. Hillyard, and I know you know the difference. Mr. DeMarco is legally brain-dead. Now his next of kin has to decide what to do. You know there isn’t much time for the donation decision. Dr. Allenford said—”

She turned on him, balling the report in her fist. “Don’t you think I know that?” Her voice cracked. “Leave us alone now.”

“Certainly. Dr. Allenford said he could have the Lear down here in forty-five minutes.”

“Yes,” she said dully, stroking Francis’s soft, soft cheek. “I know the procedure.”

He left as quickly as he’d come, and when he was gone, she wished he hadn’t left. It was too quiet in here; the electronic noises were so soulless, so inhuman.

“Oh, Francis,” she whispered. Tears streamed down her cheeks.

She couldn’t make a decision like this alone, and yet there was no one to take the burden from her shoulders. Angel was Francis’s only living relative, and God knew he couldn’t help her. It would be inhuman to ask it of him.

The minutes ticked by, one after another, stitching into some endless quilt of time, minutes existing, then not existing, falling away.

It was so precious, time. Why was it you never realized that until it slipped through your fingers and lay forgotten at your feet?

“Why is that, Francis?” she asked, stroking his hair. She kept hoping against hope that he would hear her, blink his eyes, twitch one finger, something. But there was nothing except the droning hiss of the machines and the quiet strain of her own breathing.

“Oh, God,” she whispered, feeling as if her soul were being slowly ripped in half.

She understood at last how so many of her patients’ families had felt in this moment. She wanted to rail at the injustice of it all, but she’d learned long ago that life was unfair and unpredictable, that death stalked a family right up to the dinner table without once emitting a sound—she knew all this, had known it since she was six years old.

She knew, too, what Francis would have her do right now. He would want his death to mean something. And if he could save Angel’s life, Francis would do it in a second, without hesitation. She knew that Francis’s heart—his wonderful loving heart—could save his brother’s life.

But could she do it? Could she authorize the end of Francis’s life support? Could she live with herself if she did? If she didn’t?

Slowly she kneeled on the cold linoleum floor, and brought her hands together in prayer. “Please, God, help me make the right decision.”

She waited, breath held, for a sign of some kind.

There was nothing but the click of the cardiac monitor and the whoosh-thunk of the respirator. She squeezed her eyes shut. “What do I do?” she whispered. “Help me, God, please.…”

You know, Maddy-girl. You know.

She lurched to her feet and stared down at him, studying everything about him, looking for … something that meant he’d spoken.

But of course, she knew he hadn’t. His voice had been in her own mind. After a long minute, she straightened her shoulders and walked from the room.

Outside, Lina sat slumped on one of those uncomfortable chairs that hospitals set out for family members. At Madelaine’s arrival, she jumped to her feet.

Her eyes were puffy and red, her cheeks streaked with dried tears.

Madelaine touched Lina’s cheek in a gentle, intimate gesture that wasn’t enough, wasn’t nearly enough. “I need to talk to you about something.…”

Lina squeezed her eyes shut, shaking her head. “You think I don’t know what it is, Mom? I’ve been sitting out here for almost an hour. I heard the diagnosis and the prognosis.” She gave a laugh that was bitter. “I am a cardiologist’s kid, you know.”

Madelaine looked at her daughter in awe, and saw for the first time a hint of the woman that Lina would someday become—strong, focused, independent. “Yes,” she said softly, wanting to say more but unable to find the words.

Lina bit down on her lower lip and stared at the curtained window. “You know what he would want.”

“Yes.” To her horror, she felt herself starting to cry, right there in front of her daughter, in front of the one person on earth she was supposed to always be strong in front of. But the tears came anyway, flooding, burning.

Lina took a hesitant step forward. “Don’t cry, Mom. He … he wouldn’t want you to cry.”

Madelaine reached for her daughter, pulled her into a desperate hug. They stood that way for what felt like hours, holding each other, swaying in their grief, crying and stopping and crying again. Finally Madelaine drew back, gazed down at her daughter’s beautiful, tear-filled eyes, and gave her a trembling smile. “I love you, baby, and I’m so, so proud of you right now. You’re stronger than I ever was.”

“So what happens now?”

Madelaine sighed, feeling old. “They’ve got a few more tests to run, and I’ve got to call Chris.”

Madelaine went back into Francis’s room and picked up the phone, dialing Chris’s home number.

He picked up on the first ring. “Allenford here.”

“Hi, Chris, it’s Madelaine.”

There was a moment’s pause. “Madelaine?”

“I’m down at Claremont Hospital in Portland.”

“Oh, Jesus, Madelaine … what happened?”

Her voice trembled. “It’s Francis.” She tried to say more, go on, but she couldn’t.

“The donor is your priest? Angel’s brother?”

“Yes,” she whispered, trying desperately to keep her focus. “Third EEG was flat. No spontaneous activity off the ventilator, no response to pain tests. He’s … he’s gone. I’m the executor of his estate, Chris. I want to authorize the … donation.”

“Okay, Madelaine,” he said quietly. “I’ll take it from here. Maybe you should come home, get some sleep.”

“No,” she said more sharply than she intended. “I’m not leaving him. I don’t want anyone else near him.” She realized how stupid and childish she sounded—she knew the teams that would descend on this hospital within the hour. Surgeons from all over the country, taking bits and pieces from Francis’s body to save other lives. She tried to cling to that grain of hope—Francis’s beautiful blue eyes still seeing the world, his kidneys saving a child’s life, his bright loving heart still beating.…

She squeezed her eyes shut, trying to remember that this was a miracle. And yet all she felt was dead and hollow and hurting. “I’ve got his durable power of attorney, Chris. I’ll sign a waiver to donate Francis’s eyes, heart, kidney, pancreas, everything. It’s what he’d want.”

“NOPA and UNOS faxed me the stats—kidney and liver functions are good, dopamine level is acceptable, hydration okay. I knew he was a perfect match for Angel.” His voice fell to a whisper. “Now I know why.”

“Yes.” It was all she could say.

“Madelaine.” He said her name softly, and with an unusual intimacy. “He’s going to save his brother’s life.”

She choked back a tiny sob. “I know.”

“Will Angel accept—”

“I don’t want Angel to know. What if …” She hesitated. “What if he thinks I did the wrong thing? What if—”

“The policy is confidentiality, Madelaine. I’ll let you make the call. You can tell Angel or not—it’s up to you.”

The words were like tiny nicks from a razor blade, and she flinched at each one. “Thanks.”

“Nusbaum knows how we want the body—” At her gasp, he cut himself off immediately. “He knows how we want Mr. DeMarco taken care of?”

“Francis,” she corrected him softly. Then, “I’ll make sure they do it right, Chris. How long until you can be down here?”

“I’m on my way. I’ll contact UNOS and they can alert the rest of the teams across the country.”

He didn’t say good-bye, and neither did she. They both knew there were no words for a time like this, nothing but cold practicality and pain that would never go away.

Angel felt like he was in the middle of Safeway—the produce aisle with its glaring lights and gleaming silver metal bins and bland white ceiling. Here, in OR 9, the walls were colorless. Stainless steel tables were draped in surgical green fabric, their flat surfaces covered with precisely placed metal instruments. A television set hung from the ceiling, its screen a gaping black square. Computers and machines were everywhere, ticking, buzzing, whooshing. There were people all around him, none of whom he could see, of course, because they were masked and draped and gloved.

Not that any of them seemed to care about him—he was just the patient. Plain old Mark Jones. They didn’t care that he was here, in this sterile room, stretched out on a steel table, naked, his body invaded by needles and tubes, his blood infected with medications. In the hour he’d lain here, no one had even spoken to him. Instead, they talked around him, checking their gauges, monitoring his vital signs, looking at the clock. Every few minutes some new masked person would rush in with flight information, and some nurse would recheck the surgical instruments on the table beside him. All the while the big clock on the wall kept ticking.

He was shaved—again—from chin to foot and had been bathed in a stinging red-brown solution that made him look as if he’d been dipped in caramel sauce. More blue-green fabric draped his naked body.

This is it. This is when they cut your heart out.

He squeezed his eyes shut at the thought, fighting panic. He tried not to think about the surgeon’s first cut, or his second, or the instruments that would crack his chest open, or the gloved hands that would take a few snip-snip-snips with the scissors and then reach deep, deep inside his chest.

His eyes snapped open and he lay there, breathing hard. “Oh, Christ,” he whispered, wishing it were a prayer, wishing he knew what to say, what to beg for in this moment. But his whole life had been a headlong rush to death, and he had no hope, no real hope, that he would ever wake up again, that this stranger’s heart would be his redemption.

A masked woman came over to him, peering down at him through eyes that were crinkled in the corners. It was pathetic how pleased he was to have her beside him, even if it was for a second, even if she didn’t know or care who he was. At least he wasn’t so alone.

“The heart has just landed at SeaTac, Mr. Jones,” she said in a hushed voice. “We’ll be ready to begin soon.”

He pictured a huge, beating heart splatting on runway twelve, spraying blood everywhere. He winced, swallowed hard.

He reached out, grabbed the nurse’s gloved hand. Don’t leave me. The humiliating plea ached for release. Instead, he sucked in a sharp, shaking breath and whispered, “Where’s Mad?”

Above the mask, he saw her frown. “You’re mad?”

He shook her hand impatiently. “Dr. Hillyard, where is she?”

The frown faded. “She was on Lifeflight One with your new heart. Now they’re on a helicopter. They should be here any second.”

“Don’t let them anesthetize me until she gets here, okay?”

She glanced at the clock. “It’s not my decision, Mr. Jones.”

He clung to her hand. “Please.” He heard the pathetic shake in his voice, but he couldn’t change it, didn’t really care anymore. “Don’t let anyone touch me until Madelaine gets here.”

There was so much he needed to say to her before they did this abominable thing to his body.…

And to Francis.

Francis. Jesus, he had so many things to say to his big brother. So many things … and yet, only one. I love you, bro.

He winced at the memory of their last meeting, and closed his eyes. He’d make it up to Franco, if only God would give him a second chance. Just a second—a moment of consciousness before death, when Angel could say he was sorry. So damned sorry.

At exactly 3:15 a masked man came over to Angel, looked at the machines one by one, then finally said, “Hello, Mr. Jones. I’m Dr. Arche.” He reached for one of the clear plastic bags hanging above Angel’s head. “It’s easy to remember—Dr. A. for anesthesia.”

“Oh, good. Mnemonics.” Angel sighed. “Just don’t put me to sleep until Madelaine gets here.”

“Don’t worry, she’ll be right beside you.” Dr. Arche swept past Angel in a blur of blue-green and settled with a whining squeak onto a stool. The wheels grated across the linoleum and took the anesthesiologist to his station.

Angel tried to lift his head off the hard table and couldn’t. Instead, he turned, stared at the closed door. An image shimmered in front of bland steel.

Francis, he realized suddenly. It was his brother come to hold his hand.

Heya, Angel.

Angel started to say something and realized he didn’t know what it was. Dizziness rolled through him. He blinked hard, and when he opened his eyes, Francis was gone.

Angel’s cheek seemed to hit the table with a loud thunk.

They’d done it. The assholes had started the anesthesia.

He could feel the drugs oozing into his veins, crawling through his body in a swaying, intoxicating rhythm. He tried to concentrate … on the bag hanging above his head … the prick of the needle in his wrist.… It was dripping, dripping into his blood, seeping, seeping.…

He swallowed thickly; it felt as if cotton were wadded in his mouth and throat.

Dr. Arche wheeled back toward him. “Just relax, Mr. Jones. Go with the flow … the flow … the flow …”

Angel tried to lift his chin and couldn’t. “Fu … fuck you … mother … fucker …”

Dr. Arche laughed quietly and wheeled back to his station.

Angel wanted to rip the IV needle from his arm, but he couldn’t lift his hand. The lights overhead bled together and became the sun.

Panic pressed down on him, made his ragged heartbeat speed up.

“Whoa, Mr. Jones,” Dr. Arche said in his ear, “calm down, fella, calm down. Go with the flow.”

Angel’s eyes fluttered shut. He forced them open again, tried to focus on the hot, hot sun.

Something was different. Noise, he realized groggily.

And then she was there, peering over him, filling his world like a Madonna. “Angel? Can you hear me?”

“Mad …” He sighed with relief, wanting—aching—to feel her hand in his; it wasn’t enough to know she was touching him, he wanted to feel it. One last time. He wanted to rip that damned mask from her face and see her smile again. There was so much to say, so much, and the drugs were taking it all away from him. “Loved … you …”

She stroked his cheek, and it felt good, so good, he felt tears sting his eyes. He fought his way through the layers of fog that separated them.

She gave him a smile—he could see it above the mask, the way it crinkled her eyes. He remembered that smile, had always remembered it. Christ, so beautiful …

“Francis,” he wheezed. “Sorry … tell him … loved him … too.”

Suddenly he saw Francis standing beside her, smiling that cockeyed smile of his, whispering that it was okay, that it had always been okay.…

But Angel knew it wasn’t real.

Tears glazed Madelaine’s eyes, and he wanted to say, Don’t cry for me, but he couldn’t speak.

His eyelids fluttered again. He heard Dr. Arche’s lilting voice, talking, talking, talking …

Then he was out.

Madelaine stood off to the side, watching the surgery.

Surgeons and residents and nurses were clustered around the table, working on Angel, poking, prodding, tubing, monitoring every breath he took, every pulse of blood through his heart and veins. He was intubated and catheterized and his body had been washed again with iodine, then he’d been redraped in sterile sheets. His hair was covered by a blue paper cap, and tiny strips of white adhesive tape kept his eyelids shut. The only part of his naked body that was exposed was a narrow strip of chest and upper abdomen, an orange belt of skin covered in taut, clear plastic and surrounded by blue-green sheets. A dehumanizing patch of color that seemed light years away from Angel’s ready smile or swaggering personality or towering temper.

The patient.

Madelaine tried to think of him that way, tried to be cold and distant and professional. But when Chris reached for the scalpel, touched its razor-sharp point to the skin at the base of Angel’s throat, she flinched.

Instinctively she closed her eyes, and when she did, she found herself traveling back in time to another place. A Ferris wheel at a tawdry little carnival, a rocking ride with the boy of her dreams. She felt his arm slip around her, slide down the bare skin of her arm. I love you, Mad.

She heard the whining buzz of an electric saw and kept her eyes shut. She didn’t want to see them cut open his chest, see his blood spill over the sterile little patch of green, splash on the linoleum floor.

“Chest spreader,” Allenford barked.

Madelaine winced and tried to keep thinking about the carnival. That had been their last time together as lovers, and what a magical time it had been. Stars everywhere, the smell of popcorn, the faraway squeal of people on the midway. She remembered the earrings he’d won for her, the solemn way they’d buried the gaudy jewelry as a reminder of their love.

She thought of Francis, gentle, loving Francis, and the gift he was giving to his brother, the miracle that was unfolding just a few feet away.

“Get the bypass ready.”

Madelaine opened her eyes. Reluctant to move and yet unable to remain where she was, she took a few steps toward the table. She saw instantly where they were in the operation—Angel’s chest was a red, gaping hole in the surgical fabric. Cannulas had been inserted and sutured in the heart, and they were busily connecting Angel to the heart-lung bypass machine.

Everyone drew in a sharp breath as the bypass machine was started. The squat machine started whirring and pounding and pumping. A technician monitored the machine’s function and said, “Everything looks good, Dr. Allenford.”

“Okay,” Chris said, reaching for his instruments, “let’s go.”

Madelaine moved toward the table, her gaze riveted on the surgery. She inched forward, mesmerized, watching Chris’s bloody, gloved hands work. He removed Angel’s damaged heart and handed it, still beating, to the pathologist, who put it in a metal bowl and disappeared.

Then Chris reached over and lifted Francis’s heart in his capable hands. It looked so ordinary, she thought, a pale pink lump that had once held Francis’s soul.

Chris studied the inert organ, then lowered it deep into Angel’s chest.

It took almost an hour and a half to secure the new heart in place. Finally Chris looked over to the perfusionist monitoring the bypass machine. “Okay, let’s warm him up.”

Chris placed the final sutures in the pulmonary artery, and rich, warm blood began pouring into the heart, feeding it, warming it.

He glanced up suddenly, made eye contact with Madelaine. A single thought leapt between them: This is it.

Everyone in the room seemed to draw in a sudden, anticipatory breath. Madelaine stepped closer, until she was almost touching the table. She peered past the blue-green-clad bodies on either side of her, staring at the hole in Angel’s chest, at the mass of pinkish tissue that lay there, motionless.

Beat, she pleaded silently. Don’t make it all for nothing.…

The big old wall clock ticked past a minute, then another.

“Increase Isuprel,” Allenford said evenly. “Go to four mics.”

“Come on,” Madelaine whispered, her hands curling into fists at her sides. Come on, Francis.

“You want the defibrillator?” someone said.

“Hush,” Chris said.

The room fell utterly silent, all eyes trained on the new heart. After what felt like hours, it quivered.

Madelaine felt her own heart lurch in expectation.

“Come on,” Chris urged the organ. “Come on.”

Inside Angel’s chest, Francis’s heart jumped. Once, twice, three times, then it began a slow, steady thumping.

“Houston, we have a heartbeat,” Chris said.

“Heart rate’s going up,” someone said. “Fifty-four. Sixty-three …”

A cheer went through the room. Madelaine tried to join in, but she couldn’t move, couldn’t speak, couldn’t even smile. Her whole body was trembling and her eyes were stinging. She felt as if the spirit of God were inside her, filling her to overflowing, making her know—know—that what had just happened in this room was a miracle.

God had taken a life, and then He’d given one back.

She watched, mesmerized, as the healthy heart kept up its slow, rhythmic dance. Grinning, crying, she covered her masked mouth with her hands and looked up at the ceiling, as if, in that magical instant, she could see God.

Love him, Maddy-girl. She jumped at the sound and spun around, half expecting to see Francis standing beside her.

But there was no one there at all.