Couper is tired. He performed a second heart transplant only hours after scrubbing out of Helfgot's surgery, and he hasn't been to bed in over twenty-four hours. Transplants are a strange and unpredictable business. Sometimes it's quiet for days on end, and at other times it feels like sheer insanity, with hearts flying in like planes over LaGuardia. And you never know when one of your patients is going to die.
Like right now.
A former college wrestler, Couper had an instinct to hang on, to cling to something to keep his patient off the mat. He stares at the composite X-ray of Helfgot's brain, and the image makes him angry. He wants to pick up the monitor and hurl it through the nearest window.
"Okay," he says, "let's get the heart checked out. Maybe someone else can use it."
"We're doing one more scan just to be sure," Rawn tells him, but he knows the test is pointless. This movie is over.
Couper goes off to check on the other transplant patient who has come up from surgery.
Dr. Rawn prepares himself to walk into the room and inform the widow, who doesn't yet know she's a widow. For a long time he was never sure whether to call her Mrs. Helfgot or Mrs. Whitman. Finally it just became Susan. Now it's Susan the widow.
"So, what's going on?" she asks.
He has always been candid with her. She has a knack for medicine and has been a tireless advocate for her husband.
"He should be awake by now. We did a scan. It doesn't look good."
She suddenly knows that this is the worst moment of her life.
"Dr. Couper found a clot in the aorta during surgery," she says. "He's stroked out, hasn't he?"
"We're doing another scan."
"We just are. There might be something . . ."
They stand there for a moment. "It's okay," she says. "I get it."
He nods, unable to speak.
"So that's that, isn't it?"
He nods again.
"I'm really sorry, Jim," she says as she reaches out and touches his sleeve.
I had thought again and again about how not to fall apart when it finally happened, because I knew it would. The odds were always against us. It soothed me to go off in my mind and practice his death. It made me feel safer, more prepared.
And now Jim Rawn is looking at me, his eyes telling me Joseph is dead. Now there is no inside of me–only outside. All my rehearsing has paid off. The inside will come back. Later.
Just like that, it's over. No more ideas to try, no meds to tweak, no specialists to consult, no waiting for a damn heart. Just like that.
Now there will be crying children, phone calls to make, a casket to buy, plane tickets and food to arrange–all the unrelenting busy-ness that is the sole blessing attached to death.
On another floor of the hospital Esther Charves, a family coordinator with the New England Organ Bank, has just finished a case. On the elevator she recognizes one of the chaplains, a southern woman who has just left the ICU and who knows Helfgot well. Among other topics the chaplain and Helfgot liked to argue about how to make good barbecue. "Joseph," she would admonish him in her thick drawl, "you shouldn't be eating that stuff at all. Too much salt." But most of the time Joseph ate what he wanted.