A Midsummer Tale ~ First Place
Sarah Evans
Photo Credit: Patrick B/Flickr (CC-by)
1. The heart beats 115,000 times a day
The sky darkens and my heart beats uncomfortably fast.
I put the phone down and try to absorb the information, letting it pass from ear to brain. This is it. A possible match. Please get here as soon as possible. Time is of the essence.
For weeks the heat has built; for months I have waited for this call. Now it is here, I’m not ready; I long to return to balmy warmth and postponement. I look down at my list of shakily scribbled instructions. Nil by mouth. Not a problem now nausea has taken hold. Bring all current medication.
My rapid pulse is not good; it is important to remain relaxed and calm, to steer clear of all strong emotion, avoiding undue stress on a damaged organ. The wind has picked up, setting the windows rattling. The rattling of my heart feels like terror; perhaps it is also something else.
I breathe in slowly and slowly out, inhaling the smell of dusty heat through the open window.
I think how this is my once in a lifetime chance to regain my life.
I think how the operation has risks.
I think how someone has died, someone who most likely got up this morning expecting a perfectly ordinary day.
A car accident. An operation gone awry.
A murder.
A suicide.
A bolt out of the blue.
I won’t be told the details, not now. It is morbid to speculate, impossible not to be curious about the stranger whose heart is still beating, the heart which will become mine. Afterwards I will be given the opportunity to write a letter to the grieving family. Thank you for my gift of a heart from someone you loved and lost.
Presupposing that I am still around.
2. The heart is the size of a fist
Lightning flashes across the sky. I don’t want to do this: the thought sparks up hard and fast and I fist my fingers, reason battling against instinct. I stare at the veins on the back of my hand, their bifurcating pattern.
Operative mortality—death within thirty days—is between five and ten percent. Toss a coin four times, all are heads, fail to wake up, or wake up only to succumb to septicaemia. Is the former any worse than the latter? Is dying from the operation worse than dying from this natural but unlucky defect? There are no satisfactory answers.
I have little time left, but am unlikely to die today, not if I stay here safely at home. This is not the way I should be thinking.
The decision is made, my consent given when I agreed to my name being put on the waiting list. No amount of prior discussion—calm and rational—with doctors and my daughter, settles the matter within this instant. But the call has created an obligation. I owe a debt to unknown people—the person who died, the family who have said yes, the one who was next after me on the waiting list—to seize this chance. Even though, right now, every ounce, every minute of here and now life seems so much more precious than my nine in ten chance of a future.
Thunder cracks. I relax my hand. I stand and drive myself forward through the procedures. I retrieve my already packed bag, essentials pared down, keeping things light. I sweep up my cornucopia of pills. I make the single call I need to, leaving a message when Amanda fails to pick up. ‘It’s Mum. They’ve found a match. I’m making my way to the hospital now.’
She knows the score. She has been waiting for this phone call too. I know what she would say if she was here, all the reassuring words she thinks are good for me to hear, reinforcing all that the doctors have already said.
I am doing this for you, I think. So my adult daughter will not be orphaned, so her future children will know their grandmother.
This is my final call for an added decade.
3. The heart beats to an electrically controlled rhythm.
Lightning again, electricity discharging chaotically, then thunder, the gap between them shorter, the storm moving closer, a scattering of rain across the windows. I ring a taxi and try to still the waver in my tone. The woman’s voice—laid back, indifferent—does not provide confidence that this booking is being taken sufficiently seriously, the details properly marked down. ‘It’s urgent,’ I say, and I repeat my address.
‘We’ll be there soon as.’ She sounds annoyed at my pushiness, at my inflection of doubt.
And now there is nothing to do but pull on comfortable shoes and check I have my keys for the umpteenth time. To wander round my flat and double-check all the windows are closed. I confirm the battery level on my mobile phone and go in search of my charger and list the possible ways this will go.
Option 1: I will be in hospital for four weeks. Option 2: I will be sent home immediately, the match not confirmed, or tests revealing an infection, or a deterioration in my health. Option 3: I am not going to think about that.
If sent home, would relief or disappointment gain the upper hand? Best not to ask unanswerable questions. The rain builds; it clatters and runs down the windows in all directions.
4. The heart pumps 2,000 gallons of blood every day
I operate on autopilot, heading out into the deluge of rain to the taxi, suppressing the instinct to make a quick dash for it. Raindrops bounce off the tarmac; they course down the windscreen and I watch the smear of colourful umbrellas, grey buildings, and greenery outside. The trees with their summer leaves, which I hope to see turn to autumn reds and gold. Roses on the turn. Scorched grass. The people I don’t know, all of them precious, I hope, to someone.
Water drips from the ends of my hair. Shivering, I place my hand over my damp clothing above my poorly functioning heart, which is giving out in the summer of my life. I have no reason to feel attached to this, yet it has been with me from the beginning and I feel reluctant to let it go. I picture how the donor—the person, the body—will be scalpelled and then sawed open, the lungs still inflating, the organ still beating as it is cut free. The same process will be enacted on me, and then the reversal. I will receive a secondhand heart, be sewn back up and brought round. The details provoke a swell of nausea, my brain dwelling on the blood and guts details I’d prefer not to know.
At the hospital I am taken though to a small room whose closed window looks out onto the expanse of low-lying cloud. Someone will be with you soon. I have forgotten to bring anything to read. Unlikely I’d be able to concentrate, but I miss the page turning distraction. Minutes pass slowly and I ought to appreciate every one; instead I feel a fidgety anxiousness, and I try to mute my emotions down while, beyond the glass, light continues to flash and thunder rumbles distantly. I long for the cool freshness of the outside air; I am trapped here amidst the suffocating stuffiness.
The nurse arrives, briskly cheerful and I wish she wouldn’t be. ‘How are we today?’
How would anyone feel before such a major operation?
She takes my pulse and blood pressure, and then a blood sample. I’ve had this done so many times and you’d imagine I’d be used to it by now. Still, I manage to dislike the whole procedure. The application of the tourniquet, the prod and prick as she tries to find a vein. I close my eyes tight and try not to think about the pumping red flow. I have always been squeamish and it’s an unfortunate thing to be, given how much time I spend in hospitals.
5. A disconnected heart continues beating
I stand under the warm downpour of the shower and close my eyes. I wash thoroughly using plenty of soap, mud-brown and smelling of iodine. Dried, I pull on the hospital gown and draw a sterile dressing gown round tight. The doctor turns up, the man who I have seen regularly for months now. He runs through the practical details which I already know. ‘Have you any questions?’
His smile is forced, yet not unkind. I wonder how he feels. Trepidation, knowing what is at stake? The excitement of imminent performance?
I ask if the other heart has arrived yet.
The surgeon looks me in the eye in that disconcerting way he has and I picture this being part of his training. Always make eye contact. Don’t avoid awkward answers. Be honest.
Honesty is not a well-defined thing.
‘Not yet, but it will be by the time we need it.’
‘You won’t remove the old one until the new one arrives though?’
He lets his silence speak.
I have become an expert in this operation. The maelstrom of medical activity involved in cutting me open and severing my heart cannot be done in a hurry. The longer the other heart is on ice, the poorer the chances of success. Timing is everything. The logistical chain is complex. The heart might be in a hospital far away and a team from here will need to travel there for the process of harvesting. Harvest. It’s an uncomfortable term. I don’t know what word I might prefer, but not this one, conjuring picturesque farms abundant with fruits and grains.
What ifs pound in my head. What if the storm means the plane cannot take off or the courier car crashes in the wet? What if the icepack fails? I picture myself lying prone and opened out, my defective organ set aside and still beating, and the finger tapping wait for the new one to arrive. At what point would they put the old one back and what sort of chance would it have?
‘Trust me,’ the doctor says. ‘We’re not going to leave you high and dry without a heart.’
Trust is the hardest of things.
6. Laughter is good for your heart.
Time ticks by and I try to exist outside these moments, to rest suspended, in a state beyond thought. My last moments may thus be unarticulated ones.
The rain against the window starts to ease. My phone rumbles, interrupting my quasi-meditative state. I jolt alert in a wholly unpleasant way, heart beating fast. I pick up.
‘Mum.’
I feel reluctant to take this call, lacking the energy to adopt my usual role of not wanting to worry her. Nurturing, that’s how a mother should be; not needy. Yet now that her voice speaks in my ear, I discover how desperately I need to hear it. Neither of us will refer to the possibility of this being our last ever call, but we are unusually tender with one another. She makes a joke about my heart-age becoming younger than hers and we both laugh and I feel the tension ease. Rays of sun peak out from the leaden sky, the rain reducing to a few heavy drips.
‘I’m sure it will all be fine,’ she says, though very obviously she cannot be sure, not beyond the ninety-percent-plus success rate of at least getting through the first thirty days.
‘It had better be,’ I say.
She tells me that she is going to get a train later this evening and should be here for when I wake in the morning. I try to picture opening my eyes, feeling groggy and crap, yet alive, knowing this thing is over. I picture placing my hand on my bandaged chest and feeling a heart beating inside me, one which is not mine, one which has the capability to keep on going. I focus on the image of my daughter being there and the sun shining once more through the window. I am doing this for her.
We are out of things to say and we spend a moment listening to the imagined sound of the other’s breathing, and of their heartbeat. ‘I love you,’ I say and wait for the returning echo.
The door opens. ‘The nurse is here,’ I say. ‘I have to go.’
7. The beating sound is caused by the valves of the heart opening and closing.
The room is windowless, cocooning me from the outside world. I have always hated submitting to anaesthetic, that feeling of drifting away. As a child in the dentist chair, gas mask placed over my mouth, I kicked out, tried to fight the dentist off, before consciousness was switched off and I woke in an eye-blink to a painful, bloody mouth. In bed, sometimes, I catch myself on the very verge of sleep and the thought jerks me awake. The terror of the void. Of not emerging from it. Even though, once I am there, it will not be terrifying at all.
The anaesthetist has a carefully practised manner. She chats about everyday things, things which have no importance within the scheme of facing death. She wouldn’t talk about tomorrow’s weather—the calm after the storm—unless she thought I’d survive, would she?
What would she talk about?
The odds of my coming round are better than nine in ten. The odds will shortly turn binary: life or death.
A person has died; I ought to get my shot at living as cosmic compensation. But there is no ought to this.
The prick of the needle hurts. The woman apologises. Just my luck that she’s less than competent, or having a bad day. I dislike the thought of the cannula, of this opening into my vein. I cannot bear to think of what will happen once I go under. I long to rip the needle out, to shout and scream, to claw and fight my way out of here, to run carefree through the rain-washed world, inhaling the scent of green, to flee my only hope of living.
I don’t. I breathe in the scent of hospital and try to relax. ‘Count down from ten,’ the woman says. And dutifully I do.
Ten…
— I feel the steady beating of my heart —
…nine…
— I fist and relax my free hand —
…eight…
— I imagine the lightning jolt which will kick-start my new heart —
…seven…
— blood courses through my veins, carrying the drip feed of drugs to my brain and adding a mugginess to my thoughts —
…six…
— I picture my heart, disconnected, still beating —
…five…
— I hear the rumble of children’s laughter, my daughter long ago, the grandchildren who might one day come —
…four…
— I feel myself sinking, can hear nothing but the opening and closing of valves, the closing of one chapter, the opening of another —
…three…
…two…
…one…
Sarah Evans has had many short stories published in anthologies, magazines and online. Prizes have been awarded by, amongst others: Words and Women, Winston Fletcher Prize, Stratford Literary Festival, Glass Woman and Rubery. Other publishing outlets include: the Bridport Prize, Unthank Books, Riptide, Best New Writing, and Shooter. She has also had work performed in London, Hong Kong and New York. Twitter: @sarah_mm_evans
