Tuesday, September 18, 2012

A Heartbeat Away

A Heartbeat Away
David C. Cook (September 1, 2012)
Harry Kraus

Chapter 1

Between the gods and men. Are surgeons.

That’s the way Victoria “Tori” Anne Taylor, MD, always explained it to the sea of gaping medical-student faces as they prepared to begin their clinical rotations. She would pause for effect after the word men, turning one sentence into two and solidifying her own near-godlike status among the students who may have been book smart but didn’t know a normal S-2 heart sound from the bass rhythms throbbing through their iPod earbuds.

Tori looked around the busy anesthetia holding area and reviewed the operation, going over every step, imagining each movement as a choreographed symphony of dissection. She’d once heard that the best professional baseball hitters did the same thing as they stood on deck, just before entering the batter’s box. They saw the windup, the delivery, and the anticipated trajectory of the fastball, knee-high, just painting the inside corner of the plate. They saw their swing and the bat impacting the ball. Imagination led to success. Hitters who could see what would happen before it happened were the ones the fans adored.

And so it was with oncology surgeon Tori Taylor. Her operations were a thing of beauty, her even rows of sutures lining up like little soldiers on a Civil War battlefield. Predictably, home runs for Dr. Taylor were the norm. And behind her mask, she enjoyed the students’ worship.

But today was different.

Today the operation she imagined was not going to be performed by her; it was going to be performed on her. The mental review of her surgery was her way of coping, a vain attempt, a desperate grasping at something she was loath to give up: control.

Illness had changed everything. No longer was she wearing the stethoscope; it was being gently laid over her sternum. And the eyes that couldn’t hide concern were not hers but the eyes of her surgeon. The blade of the scalpel pointed toward her, not away. Up was down. In was out. Black was white, and control was a mirage, a wavering image floating above the minds of lost desert nomads or surgeons who thought they could predict outcomes because of their obsessive grip around everything manageable.

She’d lost control. And that terrified her.

The face of a nurse appeared over her. Tori had seen this par-ticular nurse a thousand times during her own tenure as a cancer surgeon, but, like all of the others, he was a background person, a nameless helper in orbit around her.

But today was different. She wanted—no, she needed to know the nurse’s name. She strained to lean forward, gripping the railings of the stretcher, and grunted. She attempted to focus on his name tag. Her voice was as weak as she felt, barely a whisper. “Jeff.”

“Don’t try to talk now, Dr. Taylor. They should be coming to get you soon. Dr. Parrish is closing on the case in front of you.”

That “case” has a name, she thought. Tori closed her eyes, annoyed but understanding. The nurse wasn’t allowed to mention a name.

“Don’t be afraid,” the nurse continued. “Dr. Parrish is the best.”

Do I look afraid? I’m not afraid!

Fear, Tori thought, was another needless emotion. She prided herself on operating on a higher plane than those mortals who struggled with the baggage of feelings. Emotions interfered with her ability to make tough decisions. When your enemy was cancer, being touchy-feely paralyzed your ability to cure. My enemy has no feelings. Cancer attacks without respect to beauty, form, or function. In order to win, a surgeon must match her foe.

She watched the staff scurry about, activities that Tori would have participated in just a few months ago without thinking. Hanging an IV, walking from bed to bed checking vital signs, pushing a stretcher. These were the mundane and unappreciated acts made possible by a functioning and efficient heart—something she no longer had.

As the staff cast furtive glances in her direction, Tori recognized contempt in some, pity in others. Their eyes sent the message: Oh, how the mighty have fallen. She may have stepped on them, reprimanding inefficiency, ineptitude—or worse, laziness—in this field where the stakes were health or illness, life or death. But now the tables were turned. She lay dying, her heart whimpering with each beat.

She heard low murmurings from beyond the curtain. The staff didn’t seem to know what to do. It’s neither professional nor personally satisfying to gloat over the dying.

Her heart had been ravaged by an evil lover of sorts, a virus that followed a cold-like illness, something Tori had pushed through, taking Tylenol and Sudafed until she just became so weak. At first, she’d just thought she had been pushing too hard, working late, performing too many operations in spite of the flu.

Later, she had awakened one night breathless and sat up gasping for air that suddenly seemed too thin to satisfy. She coughed frothy sputum into a Kleenex and stared down at her bare feet. Where did my ankles go? Extra fluid had taken up residence in her lungs and formerly shapely legs. Tori picked up her phone and dialed 911, explaining to the rescue squad that she was in acute heart failure. She demanded and received morphine, oxygen, and Lasix. Control.

Her heart-lover had a name: coxsackievirus B. It embraced the muscle layer of her heart with a savage jealousy, inflaming the muscle into submission and weakness. Regular medications improved things a little, chasing bully symptoms off the playground for a few hours, but then they would return and remind her to take the tablets that made life’s menial tasks possible.

But medicine could not provide a cure. Only surgery could do that. Only the transplantation of a new heart could cure.

Ironic, Tori thought, that a surgeon can only be cured with the knife. Finally, the woman who had not had so much as a childhood tonsillectomy would be submitted to the same controlled violence that she had inflicted on thousands of others.

Another face appeared above her, a female of about fifty-five with short, cropped gray hair and a no-nonsense demeanor. She turned to face a mobile computer monitor. “I’ll need you to verify your identification,” she said. She lifted Tori’s arm and studied her wristband.

“Victoria Anne Taylor,” she whispered, rolling her eyes. Protocol. “And what operation are you having today?”

“Heart transplant.”

The nurse entered the data, clicking boxes on the computer screen. A moment later, her face appeared again. This time she was holding a small electric hair trimmer. “I have to prepare the operative field.”

Tori shook her head. “I don’t have any hair on my chest.”

“Just routine,” the nurse responded, lifting and pushing Tori’s gown up under her chin.

The nurse studied Tori’s chest for a moment before lowering the gown again, but not before Tori’s eyes met those of a passing orderly who seemed to be enjoying a quick peek at Tori’s ample anatomy.

Tori shook her head. “You should have pulled the curtain.” “Dr. Taylor,” the nurse responded, “you’ve never cared much

about that before.” She offered a plastic smile. “It’s only business.” Tori winced. She must have slighted this nurse a time or two in

the past. Or maybe a hundred times or two. How petty. A taste of my own medicine.

The nurse studied Tori’s face. “You’ll need to be aware of the pain scale,” she said. “In recovery, the nurses will want you to rate your pain on a scale of one to ten. One is a slight annoyance. Ten is the worst agony you’ve ever felt.”

“I understand.”

“Who will be waiting for word from Dr. Parrish when the operation is over? Parents?”

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