Brovski stands. “I’ll see you in the OR.”
He leaves.
Half an hour later, Maggie is in the operating room and ready to go. Beads of sweat coat her forehead before she even starts.
“Doctor?”
It’s the nurse to her right.
Deep breaths, Maggie tells herself.
“Scalpel.”
Maggie begins by performing a median sternotomy to access the thoracic cavity. With the scalpel, she makes a vertical incision down the sternum and then, using the surgical saw, she divides the sternum to gain access. Maggie opens the pericardium, the membrane protecting the heart. They’ve already run the flexible tube down Oleg Ragoravich’s throat and into the esophagus and now, using sound waves from the transesophageal echocardiogram, Maggie can see the heart on his monitor.
It’s a mess.
The heart is gray and enlarged. She can see scars on the surface.
Man, this surgery is happening just in time.
The operating theater is, no question, fully stocked. The staff seems first-rate so far, even though Maggie did not meet any of them ahead of time. They, like Maggie, wear full-face masks and opaque goggles. Ivan Brovski, who, as promised/threatened, is also in the operating room, ominously explained that discretion is paramount in this strange hidden lair they vaguely call The Vineyard:
“They can’t know your identity — and you can’t know theirs.”
Oleg Ragoravich lies beneath a sea of blue drape. His rib cage is split wide open now, held in place by retractors. It’s gross to most, but Maggie finds it oddly beautiful, and yeah, she knows that’s weird. Right now, only one assistant surgeon is in the room with her. She — yes, the other surgeon is a woman too — clearly knows her stuff. The third surgeon, Maggie is told, is in the adjacent theater with the brain-dead heart donor. That surgeon has opened the chest and will extract the donor heart at the same time Maggie removes Ragoravich’s native heart and attaches the THUMPR7 in its place.
Beneath the glare from the surgical lights, Oleg’s heart pulses in a weak, spastic rhythm. The tubes from the cardiopulmonary bypass twist away from the venae cavae and aorta. Maggie nods to the perfusionist, and the bypass takes over.
Oleg’s heart sputters, slows, and then stops completely.
Time to move fast and disconnect the blood vessels.
Maggie uses scissors to part the aorta and pulmonary artery, their ends tattered by disease. She trims the right ventricle along the atrioventricular groove, preserving the tricuspid annulus. She does the same on the left side.
“Prepare the donor heart and THUMPR7,” Maggie says.
The Vineyard has the latest cardiac retraction glove and sling, which are designed to lift the heart out of the chest without damaging surrounding tissue. Maggie does that now, carefully yet quickly. The native heart is seriously diseased — thinned and stretched, weak and so fragile that Maggie worries the heart muscle might rip or crumble or even disintegrate upon extraction.
“Need another set of hands?” the assistant surgeon asks.
Her voice is high-pitched, with an exaggerated Southern twang, and Maggie wonders whether the voice is a put-on for further disguise.
Maggie is a photo of focus. “I got it.”
When the heart is clear of the chest, Maggie turns and drops it into a basin on the surgical back table. Normally a heart like this is sent to pathology for examination or disposal. What will they do with it down here in The Vineyard? Study it maybe. Use it for experimentation. Eat it. Who the hell knows?
Maggie lets herself smile at the thought.
In fact, she realizes, under her mask, she’s been smiling the whole time.
Because even though she’s scared out of her mind, even though she can almost feel the gun being readied if something goes wrong, Maggie loves this.
She loves being a surgeon. She loves operating.
“TAH,” she says.
One of the surgical nurses hands her the THUMPR7 artificial heart.
“Donor heart ready?” Maggie asks.
“Coming in the moment you need it.”
“Now,” she says.
Maggie takes hold of the THUMPR7. She looks down at Oleg’s vacant chest cavity. Where there should be a heart, there is nothing but a yawning, bloodless void. It is a sight to behold, this threshold between death and life, between an ending and a beginning, between emptiness and hope. This chest is the emptiest of vessels and a promise waiting to be fulfilled.
For the briefest of moments, Maggie considers ending that hope.
Her patient is a man with no heart, figuratively and, for the moment, literally. He is also, perhaps figuratively and literally, dead.
Only she can bring him back to life.
What would happen if she didn’t? What would happen if she just let Oleg die on the table?
She glances to her right, toward Ivan Brovski. He may be goggled and masked up too so that she cannot read his expression, but his little headshake says it alclass="underline"
Don’t even think it. He dies, you die.
The door opens. The other assisting surgeon, his gloved hands covered in blood — it’s a man — wheels an Organ Care System carrying the donor heart into the room. The OCS pumps an oxygenated blood base solution through the organ, keeping the heart viable.
The new surgeon stands on the other side of the table.
Maggie looks at him. He looks at her. But she can’t really see him, of course. She can’t see his eyes or his face. The shape of his body, too, looks pretty vague in the loose surgical gown. His hands are gloved.
He nods at her. For a moment, Maggie doesn’t move.
Ivan Brovski says, “Doctor?”
Maggie snaps out of it. With her gloved hand, she steadily lowers the THUMPR7 artificial heart — the one created by WorldCures but mostly by Marc, Marc’s brainchild, Marc’s work, Marc’s attempt to save lives on a massive scale — into the seemingly bottomless hole where Oleg Ragoravich’s heart once resided.
“Suture,” the assistant male surgeon barks.
His voice is gruff, muffled, and again she wonders whether this is his natural sound or if he is trying to mask his identity. With Maggie holding the THUMPR7 in place, her partner begins the delicate work of suturing the device’s inflow connectors to Oleg’s atrial cuffs.
Maggie joins in. Her adrenaline starts kicking into overdrive. She’s nervous. She has never done anything like this.
Gruff Voice stops for a moment. Maggie looks up into the goggled face.
“It’s okay,” he says to her. “You got this.”
Maggie is grateful for the encouragement. She swallows and nods.
The two surgeons — Maggie and Gruff Voice — work now in perfect tandem, threading the outflow connectors to the pulmonary artery and aorta, sizing the grafts with the precision of, well, cardiothoracic surgeons — too long and the lines will tangle; too short and blood won’t flow.
“Left ventricle first,” Maggie says, but Gruff Voice is one step ahead of her. He quick-connects — think “little snaps” — the heart to the Three A’s: artery, aorta, atria. Maggie does the same with the right. The THUMPR7 has four flaps. They are all open.
“Now,” Maggie says.
Gruff Voice opens the OCS or “heart box” and extracts a healthy, red, beating heart. He moves fast, guiding the donor heart into the THUMPR7. This, Maggie realizes, has never been done before. This, she realizes, would have been Marc and Trace’s dream moment — the THUMPR7 in tandem with a healthy beating-heart transplant donation. With a nod, Maggie takes over. She uses forceps to maneuver the heart into place. She attaches the donor heart’s pulmonary artery to the THUMPR7’s plastic valve in only one place. If this works, that should be the only attachment they need. The DNA sequencing machine is normally used after surgery to detect graft rejection. Maggie uses a specially designed one now, one that offers immediate feedback. She checks the readout.