(2006) When Crickets Cry (22 page)

I was keeping her alive with almost daily intravenous injections of dopamine-sort of an adrenaline kick for the heart. It forced her heart to artificially beat stronger and with more regularity, but it also decreased the life of it. Since Emma was near the top of the transplant list, Royer and I agreed that the increased strength caused by the drugs would help her, so we fitted her with a PICC. The "peripherally inserted central catheter" looked like an IV in Emma's left arm, but in truth it was attached to a tube that traveled up her arm and extended all the way to her right atrium, allowing the drugs to dump directly into her heart where they could mix with the optimum amount of blood. It kept us one step ahead of the dark night that was nipping at her heels.

Emma was thin, looked deathly pale, spoke little, mostly at a whisper, and blinked slowly. Her hair was thin, nails brittle, and mouth often filled with cotton balls. She had neared the top of the list, but with other names still taking precedence, I knew we had the weekend to ourselves. So I packed the car with enough Plasmalite and IV fluids to continue her daily dopamine injections and three bottles of liquid oxygen, which I had been using nightly to help her sleep. The increased 02 count eased the workload on her body, allowing her to rest. It was like putting energy in the bank. After a transplant, the body made huge withdrawals. The oxygen brought back some of the color to her face, and she enjoyed moments of relative excitement. Just in case a heart became available, I called the guys at Life Flight, gave them the exact GPS coordinates of the house, and told them there was a parking area a hundred yards away that could accommodate the helicopter.

Emma, the nasal cannula hooked over her ears and pumping oxygen up into her nose, put her head on my shoulder, and we drove to the lake. We were excited. After waiting so long, after so much study, so much hoping, we knew we were within weeks of a totally different life.

I had cleared my surgery schedule for two days, something I'd not done since I'd been in practice, and spent the day on the phone receiving updates from nurses and consulting with other doctors about past and future patients. After lunch, I even went for a row-something that for years had been confined to a daily 5:00 a.m. explosion on a stationary machine in the doctors' fitness center at the hospital. From her perch above the lake, Emma sketched, slept next to a cup of tea, and watched the wakes from the boats crash along the bulkhead.

That night a twenty-year-old on a motorcycle in Daytona, hyped on a cocktail of beer and amphetamines, revved his cafestyle racing bike to somewhere north of eighty miles an hour and tried to jump an entire intersection before the adoring eyes of a few dozen fellow thrill-seeking kids. He hit the ramp, had the distance, the speed, and, unfortunately, the height-because at the pinnacle of his jump, the power line he had failed to allow for nearly decapitated him. His bike landed without him, the power company pulled him down, and he was declared brain-dead upon arrival. He was only kept alive while the attending physician talked with the parents about organ donation. The hospital in Daytona listed the heart, and the national computer declared it a perfect match with two patients.

The great thing about the UNOS database is that it removes from the equation any situation in which a doctor is asked to play God. The only possible exception to the no-assign rule is when your transplant program has grown rather large, and your network of listed patients has grown. Even then, the chances of a perfect match for more than one of your patients is about like your odds of being struck by lightning and attacked by a shark on the same day. The network system administrators affirm the match through a system of double checks before any phone calls are made, and then they make the two phone calls to the physicians listed as responsible for both patients. That afternoon, both phone calls came to me.

"Hey." It was Royer. "We got ... an opportunity."

His tone of voice told me something else.

"We got a heart."

"And?" I asked.

"It matches Shirley ... and Emma."

Six weeks prior, Shirley Patton had come to see me. She had just turned forty, had two kids, thirteen and ten, a husband of fifteen years, and had one wish: "I want to see my children graduate college."

The only problem was, her heart wasn't going to let her do that. Her son had wheeled her into my office, and when I asked her to stand, she couldn't. She had heard about me and my team, about Royer's experience and my cutting-edge abilities, and had driven up from Brunswick to ask me to cut out her heart and put a new one in.

I saw the way she looked at her son, the way her daughter cared for her every need, and heard how her husband had worked three jobs just to give her the baseline of health care she needed.

She pushed her chair over to where I leaned against my desk, took off her reading glasses, and grabbed my hand. She turned it over in hers, studying every crack and callus, and then looked up at me.

"I've heard you have a gift," she'd said. 'Will you share it with me?"

Given her condition, we admitted her into the apartments owned by the hospital that sat adjacent to the trauma center. Shirley had weakened to the point that she'd never leave the hospital. Either we'd get her a heart or she'd die waiting for one.

Royer continued, "It's entirely your call. We can have Emma up and walking around in three days, and then get on the phone and get the word out about Shirley."

I shook my head, and Emma ran her fingers through my hair. Without ever hearing the conversation, she knew. Somehow, she knew.

"It's okay," she said. "I'm okay."

I studied her eyes, shelved the doubts that were screaming at me from behind her eyes, and said, "I'll be there in ninety minutes. Get Shirley ready."

Royer swallowed, said, "I've got ... 9:14 a.m.... now." He hung up and boarded a plane while I showered, kissed Emma, and called Charlie to babysit.

Emma led me with her hand, a forced smile, and hoarse whisper. "Go on. Give Shirley a hug for me."

I broke most every posted speed limit en route to Atlanta while Royer flew to Daytona. He returned, opened the cooler, and there, standing over Shirley, handed me a perfect heart.

I did what I needed to do, sewed the last stitch, and took Shirley "off pump." Her new heart filled with blood, turned bright red, and beat like a drum. I spoke with her husband and left him in the waiting room with their kids, where they'd been talking about, of all things, college. I returned home after dark, thanked Charlie, and turned to Emma.

She reached up and ran her finger along the dark lines that had permanently found a home below my eyes. When she saw my face, she smiled. She knew Shirley was well and would make it. Talking had become more difficult, as had whispering, so she scribbled a note and pointed with her pencil. "Why don't you get some sleep."

With my phone not ringing and my beepers not beeping, with no patient awaiting my arrival, and with no heart en route via a Learjet, I carried my wife to our bed, lay down next to her, placed my arm around her thin and bony waist, and closed my eyes. She locked her fingers inside mine and placed the warm skin of her back against my chest, and then the sleep crept in. When I woke in the darkness hours later, beneath a booming umbrella of Fourth of July fireworks, Emma wasn't there.

fter dinner, some brown rice covered in Worcestershire sauce and a piece of grilled salmon rubbed with cayenne pepper, garlic salt, brown sugar, and molasses, I drove up into the hills to my warehouse. I pulled back the dusty tarps, studied the stacks, pulled twelve suitable heart-of-pine planks and four four-inch-square timbers off the top, and drove back home, where I spent the night in my lakeside OR covered in sawdust and varnish.

By the time Charlie appeared at 5:30 a.m., intent on a row, I had turned the legs, built and snugged the skirt using mortise and tenon, screwed and glued on the top, and was ready for the second coat of varnish.

Charlie shuffled over, gingerly walked the perimeter, ran his fingers along the edges, and said, "Nice table."

"It'll do," I said, critiquing my own work.

"You expecting company?"

"No," I said, not looking up.

Charlie smiled and said, "You gonna make some benches to go along with it?"

"Hadn't thought about that."

"Well," he said, scratching his chin, "where's she gonna sit?"

That got my attention. I looked up and saw him smiling. "I don't know."

FOR. SOME REASON CHARLIE WAS IN HIGH SPIRITS, MEANING the row was hard, long, and fast. I kept pace but only with difficulty. My mind was elsewhere. An hour later, we hung the boat up in its rack and Charlie patted me on the back, just before he dived off the end of the dock.

With one arm he grabbed the guide wire and with the other he pulled himself through the water. Georgia sat on the opposite dock, whimpering, her paws hanging off the edge, watching Charlie's ballet dance through the water. He reached his dock, rubbed her ears, and then made her walk behind him while he led her to the cabin for some breakfast.

The phone rang, and rang a second time before I picked it up. "Hello?"

"Hey, I've got a business proposition for you." Cindy sounded perky, which meant she'd been up all night thinking. In the background I heard people talking and a cash register ringing.

"Okay." I tried to sound upbeat.

She spoke to someone else. "I came in early to take care of the purchasing. Frank said I could use his phone. I'll be off in just a second. Sorry."

I could see her sitting up straight and chewing on her bottom lip. I heard a woman's shoes walk off across a hollow wooden floor.

"Okay, sorry. I'm back."

She paused, and I could practically hear her push her hair back behind her ear the way women do when they're thinking, nervous, or both.

"I grew up on this pecan farm just off 1-75, north of Tifton and south of Macon. About fifty acres in trees. We sold off the house years ago, but still own the groves. Unfortunately, most of the trees are dead or have been hit by lightning. Anyway, where was I? Oh, yeah, we've got this old barn." She paused to let old barn sink in. "It's about two hundred years old. I don't really know what I'm talking about, but it's pretty big and I think there's some good wood in it. If you'll pull out what you can, I'll split it with you fiftyfifty. I'll even help, if you'll tell me what to look for and what to do."

I figured the transaction in my mind, but the economics of it had nothing to do with money. I was silent a moment, so she filled in the space.

"I just thought that maybe with your expertise, well ... the money would really help. . . "

Annie coughed in the background, a deep, mucousy cough, and I heard Cindy whisper, "Annie, honey, cover your mouth. And don't put your pencil down, you get busy on that schoolwork." Annie said something I couldn't hear, and Cindy responded, "I don't care what that teacher says, you're not that far behind, and you're making it to the third grade next year."

I spoke up. "I'd have to see it first."

"Well, with enough notice I can get the weekend off."

"Is today enough notice?"

"Maybe. I'll ask." She lowered her voice. "Boss isn't in the best of moods today, but she never is this time of month. She's got the worst PMS of any woman I've never known." She paused, then spoke normally. "That's probably more information than you needed."

I smiled. Cindy had a wonderful way of thinking out loud. Annie coughed again, this time longer, eventually dislodging some of the mucus draining through her chest and bringing it to the back of her throat. I had heard that cough ten thousand times before. And every time, the picture that went with it returned.

"See what you can do about work, let me talk with Charlie because we'll need him too, and then we'll shoot for Saturday morning, early. That okay with you?"

She was quiet for a minute. In my mind I saw a lady sitting in a borrowed office talking on a land line because she couldn't afford a cell phone. I saw a lady who'd been working two, sometimes three jobs, trying desperately to break the vicious cycle she was in. I saw her take a deep breath, I saw her smile, I saw her shoulders rise and relief fill the aching cavity beneath. And, as I'd seen in hundreds of patients who had come through my office, I saw a glimmer of hope return from somewhere deep, rising like a phoenix out of the ashes of defeat and impossibility.

In a whisper I was accustomed to, she said "Thank you" and placed the phone quietly in the receiver.

riday night came and found me famished, but I had resigned myself to a microwave dinner. Apparently, Charlie had not. At 5:30 p.m. he appeared on his dock, dressed to the nines.