by Jon Franklin

This story was awarded a special Penney-Missouri award in 1986.

  

© 1985 by The Baltimore Sun

used with permission

 

 

Early one Wednesday morning in May of 1984, in the dark hours before dawn, Lorenz Buchser woke with a dull ache in his belly.  He looked at the luminous dial of his bedside clock.  It was 4 a.m.; too early to go to work.

 

He lay back on the pillow and looked up into the darkness. He should try to go back to sleep. He had a lot to do tomorrow — today, that is — at the office. He always had a lot to do, though it wasn’t something he complained about. Working was one of the principal joys in his life.

 

That, and playing tennis. He loved the thwack of a well-hit ball, the sweet feeling of winning. He usually got that feeling.

It was too early to play tennis, too.

 

Lorenz looked up into the darkness and willed himself to go to sleep. It didn’t work. The ache in his stomach, while not terrible, was distracting.

Maybe he just didn’t need the sleep. He didn’t usually get a lot of sleep – didn’t usually need it. Life was too important, too fulfilling, too crammed with things that needed doing, to sleep it away. Maybe someday he’d retire and do nothing — but at 38 retirement was a dim, surrealistic concept. Like death.

 

He looked at the clock. Only a few minutes had passed.

 

Tennis.

 

Tennis was a fast game, fast — and competitive. He liked almost anything that was competitive. He liked skiing, too. For someone who grew up inSwitzerland, that was natural.

Of course, as a child he didn’t get to ski nearly as much as he’d have liked. Skiing cost money, and his parents just . . . didn’t . . . have it.

 

Put bluntly, the Buchsers had been poor. Working poor, to be sure, but poor nevertheless. Bitterly poor, except that there was no bitterness in it — and no shame, either.

 

In fact, they had a certain stubborn peasant pride in their poverty — even an arrogance. In the littlevillageofSchoestland, some 30 miles southwest ofZurich, the Buchser name went back a long, long time. It was a clan, really. And they were all hardworking, good people. As eternal as the mountains. Proud.

 

Poor, though. And somehow, by some quirk of inheritance or training, by some product of fantasy  or imagination . . . Lorenz was different. He wasn’t proud of the poverty at all.

Perhaps it was because many of his classmates were as wealthy as he was poor. At school, the disparity couldn’t be overlooked.

 

Clothes, for instance. And when the class had a half-day off for skiing, Lorenz was the only one to show up with a sled. He didn’t have skis. Every year the school organized a week long camping trip, and Lorenz was the only one in the class who didn’t have the money to go.

 

Someday, Lorenz promised himself, not fully understanding the meaning of his promise . . . someday, it would be different. He would be Somebody.

 

The means to that end was education. Nothing else would do; he saw that from the beginning. When he was old enough, he would attend the university. That would be his ticket out of poverty, out of Schoestland, out ofSwitzerlandeven, into the great round world where important people flew in airplanes, bathed in the sunny waters of the tropics, and took skiing vacations.Education. The word was heady, like the word “freedom” to a prisoner, or “water” to a man lost in the desert. Education.

 

He kept the word to himself, though. He knew instinctively his father wouldn’t like it. To Lorenz it was a dream, but to his father it would be a . . . a . . . a betrayal.

So he kept his secret, but he studied hard. He studied competitively, trying with all his energy and insight not just to compete against others but against himself. Every day, every week, every month, he tried to do better than he had done before.

 

He paid special attention to mathematics and science. They were difficult subjects, but all that meant was that they gave Lorenz a place to shine. Besides, they were precise. When you had the answer you knew it, and nobody could tell you you didn’t. Nobody . . . could take it away from you.

 

Besides, if he was to attend the university he would have to make a good score on the examination that all Swiss children took at the end of the fifth grade.

 

That exam was everything. If you didn’t take it, you went to school for three more years and then you were out. If you took it, and did well, you could continue your studies until, finally, you left school for an apprenticeship. If you did very well, really well, you were bound for the university.

 

Lorenz wasn’t worried, though. He’d be spectacular, and he knew it.

And yet, there was some uncertainty that lay like a rock at the bottom of his psyche. The Buchsers were poor, they had always been poor. And who was he, to escape that? It all had the quality, somehow, of fantasy. Perhaps . . . perhaps he was fooling himself.

 

He shoved the thought back, and studied harder.

 

And the months passed, and the years. He studied, he worked, he dreamed. It would all come together. He knew it would.  And then, one day when he was 13, he was riding his bicycle down the streets of Schoestland when, suddenly, there was the squeal of brakes . . .

 

The world ended. After that, nothing happened for a long time. There was no Schoestland. There was no examination. There was no university. There was no Buchser clan. There was no Lorenz.

Then there were voices in the distance.

 

A great time had passed.

His mind worked sluggishly. He . . . had . . . been . .   hit . . . by . . . a car.

That was it.

He had been hit by a car.

Brain damage, the voices said.

For a long time Lorenz lay there, wherever he was, motionless, saying nothing, drifting in and out of consciousness. But hearing is the first sense to return, and he could hear everything. It took him a long, long time to understand it, but he could hear everything.

 

It was bad, the voices said. Bad, bad.

 

Sadness in the voice. He had been a smart kid.

Had been.

He might not live.

Death.

Death.

It meant nothing.

If he did live, the voices said, casually, he would be stupid for the rest of his life.

Stupid?

Stupid?

Stupid?

 

The word filled his young mind with rage. He fought the word, fought the cloudy, wispy, soft, beckoning grasp of unconsciousness.

Stupid?

Death was nothing, but . . .

STUPID?

 

No. Oh no. Not stupid.

He fought in anger, in panic.

Not stupid.

 

 

There was a fog in his mind and he fought his way through it.

Not stupid. Not stupid.

Slowly, he improved. The fog lifted, dropped, lifted, dropped, and lifted some more. He willed himself to speak, to move.

Not stupid.

Weeks passed. He didn’t hear the word “die” any more.

 

A month passed.

Yes, he would live. As for stupid . . . only time would reveal that. The nurses and the doctors conferred and, agreeing, sent him way to a rehabilitation center in the high, clean air of Gais, some 60 miles distant in easternSwitzerland.

 

There, recovering, Lorenz went to school and did exercises to regain the strength that had dwindled during his long period of unconsciousness. But as the weeks passed, and they didn’t send him home, he began to worry.

It wasn’t that he was homesick. It was that, back in Schoestland, his classmates were preparing to take that all-important exam.

 

Worried, Lorenz lobbied the doctors and nurses. Why wouldn’t they just send him home? He was fine, physically at least. But he wouldn’t be fine at all if he missed that exam.

 

No, they said, he wasn’t fine. Not yet. In a few months, perhaps. But he wasn’t ready to go home yet.

Okay, he countered. Then would they arrange to have him take the examination at Gais?

No, they said. They couldn’t do that.

 

In a panic, Lorenz wrote to his parents. He tried to communicate how important that exam was to him, without telling them why. He posted the letter and waited for a reply.

A week passed. Another. Then, finally, he had a letter from home. Eagerly, he ripped it open and read it. Then he read it again, in horror.

 

The letter contained all kinds of trivia from home. The family was in good health. The weather was excellent.

 

But they said nothing about the exam. Nothing.

He knew, in his child’s mind, even through the panic and despair, that it wasn’t that they didn’t love him. It was just . . . it wasn’t that important to them. But they didn’t understand, so on this issue, the most critical issue of his young life, their love was no help..

 

If he was going to be Somebody he HAD to take that exam.

If they wouldn’t help him, there was only one other possible solution. He would have to try and help himself.

He had no confidence; he had never before in his life taken responsibility for something so important. But no one else would do it. So, going over the heads of the school authorities at Gais, he began writing letters.

 

No, the officials said.

He wrote more letters.

No.

Back in Schoestland, Lorenz’s classmates took the exam without him.

 

In Gais, Lorenz stubbornly continued his studies and wrote more letters. No.

 

There was no way. No provisions.

Finally the doctors and nurses sent him home. Back in Schoestland, one of his first acts was to march into his principal’s office and register a single, non-negotiable demand: He, Lorenz Buchser, was going to take that test. Period.

 

And, eventually, he did.

He did well, of course, very well — as he had known he would. But it was more than an academic success.

It was a sweet victory on a personal level, and he turned it over and over in his mind.

 

His parents hadn’t helped. They hadn’t even understood. And yet . . . that hadn’t stopped him. He’d done it himself. On his own.

His parents’ limitations were not his own.

He could rely on himself.

 

He already WAS Somebody.

 

And he was free.

The change in Lorenz was profound, and if no one else saw it it didn’t matter. He knew. And it was no fantasy.

He bought a pair of skis.

Years passed. Lorenz studied, and progressed in school. At 16, with his father’s permission, he enrolled in a four-year technical school. As usual, he did well.

 

Finally the time came when he was 19 and he could no longer conceal his true ambitions. He sat down with his father, and confessed his dream of attending the university.

 

His father frowned. What Lorenz had done so far was all right, though unusual. But the university was another thing entirely. Lorenz’s father was against it personally but . . . still.

He threw his son a bone. He would consult the Buchser clan, see what his brothers and sisters and cousins would say.

 

Lorenz’s heart fell. He waited for the answer from the clan, but knew what it would be. He was right. The answer was no. Absolutely not. Never.

The Buchsers were workers, not “dummy academics.” No Buchser had ever gone to the university.

 

No Buchser lad had ever disobeyed his father on such an important issue, either. The answer was final.

Lorenz thought about it, and studied.

Somehow . . .

He met a girl.

Her name was Esther and she was pretty. What’s more, she lived in a mountain village, a skiing resort. She was, in Lorenz’s eyes, rich.

 

A skiing resort!

He wrote her a letter. She wrote back. He replied. He had never been much on writing letters, but now he felt like a poet. It took him about six months to wrangle an invitation to come and spend a few days with Esther and her family.

 

The skiing was wonderful. Esther wasn’t bad, either.

Back home, Lorenz made his decision.  Quietly, telling no one, seeking no permission, in defiance of his father and the clan, he applied to the government for a stipend to attend the university and study engineering. Admission, for someone with Lorenz’s academic record, was automatic.

 

In the autumn of Lorenz’s 21st year, he began his studies at the university. He found a cheap room near the university, landed two part-time jobs, and somehow made it work.

 

He was poor, of course. But he had always been poor. And he loved the university; it was a dream come true, a fantasy fulfilled.

 

He coped with his father by the simple expedient of not going home.

As his second semester approached, though, Lorenz was in dire economic straits. And so he applied to the government for a stipend. The government granted his request and sent a check.

 

The check went to Lorenz’s father.

Lorenz’s father looked at the check, processed the implications in his mind, and made his decision. He put the money in the bank.

Lorenz went back to Schoestland to plead for the money, but his father was adamant.

 

No, Lorenz couldn’t have the money. He didn’t deserve it.

It was only fair, the father explained to the son. After all he, the father, had supported Lorenz all these years. It was time now for Lorenz to go to work, to bring some money home instead of taking it away. Therefore, the money did not belong to Lorenz. It belonged to the family.

 

Years later Lorenz would come to understand what happened next as a classic confrontation between generations. But at 21, he was not so analytical. There was a fight. Angry words sizzled between father and son. The father ordered his son to go to work, like a man, or get out.

 

So Lorenz got out.

 

In the daytime he was a student, at night he worked as a bartender, in a slaughterhouse, as a mailman, as a waiter . . . anything to make a few francs. Whenever they could, his brothers and his mother secretly sent him money.

 

He was poor, of course. But he had always been poor.

Twice a year he went home. He avoided his father and, when he couldn’t, they talked stiffly about the weather. Lorenz’ anger was intense, and though he missed his mother, home was not home. He never stayed long.

 

Success meant violation of clan tradition; now, to violate clan tradition meant success.

For years Lorenz, like other Swiss lads, had done his time in the Army reserve. He had been a private soldier; the Buchsers had always been private soldiers, and proud of it. Now, in college, Lorenz worked for, and received, a commission. That drove  another wedge between him and his father.

 

He wrote to Esther frequently. She wrote back. She graduated, and got a job inNorwaywith the Swiss embassy there. At every opportunity, Lorenz visited her.

 

Esther lovedNorway. She loved the mountains, the people . . . the travel. But there was one thing thatNorwaydidn’t have, and that was Lorenz. Shortly before his graduation, she returned toSwitzerland.

 

As they grew closer, she became increasingly concerned about Lorenz’s estrangement from his father. It wasn’t right. So she embarked on mission of negotiation.

 

Finally, December of 1972, at Lorenz’s graduation, an unlikely guest arrived: Lorenz’s father, dressed in his Sunday suit and tie.

Lorenz was stiff but polite. Prideful, he was determined not to give a centimeter. Yet he could hardly refuse his father’s request for a word with him after the ceremony.

 

They went to a restaurant and ordered coffee. The father looked at the son, stared at his coffee, looked at his son, and finally, after several false starts, made an unthinkable confession.

 

“I’m proud of you,” he said.

 

Lorenz was dumbfounded.

 

It was only later, many years later, that Lorenz discovered the truth. Throughout his feud with his father, during his many years at the university, during the years of estrangement . . . his father had been constantly bragging about him to his friends.

 

So it had all worked out. The university. His marriage to Esther. His profession as an engineer. One job after another, each more responsible than the last. Finally he moved into aerospace engineering with Martin Marietta Company inMiddle River,Maryland.

 

It was a very good position. As manager of production engineering for the company’s civilian aircraft programs, he was responsible for perhaps 30 percent of the company’s production. He and his people built thrust reversers for General Electric, for use in aircraft like the airbus and the 747.

 

There was a lot of money and a lot of lives riding on what Lorenz Buchser did. He was in a position of trust and authority, and the future was bright. He would be a vice president one day. He might even be more.

 

In the meantime, he was no longer poor. He owned a split-level home North ofBaltimore. A Mazda and a Chevy Caprice sat in the driveway. He had skis; good ones. He played tennis. Soon, he would be an American citizen.

 

Best of all he had two children, seven-year-old Gregory and one-year-old Chantal. He didn’t get to see much of them, of course — but neither of them would ever know what it was like to be poor.

Lorenz Buchser was a credit to society, a producer, a force . . . a success. And there was no fantasy about it.

 

Now, in May of 1984, at 38, Lorenz lay in bed and stared into the darkness. Yes, it had all worked out beautifully, but nothing was perfect. There was always some little thing . . . like the ache in his stomach.

 

He wanted a cigarette, but he didn’t smoke in bed. Esther thought it was dangerous.Finally, at 5 a.m. the alarm went off. He silenced it before it could wake Esther, and then sat up on the side of the bed.

Careful to not disturb the sleep of the children and of his parents, who were visiting, Lorenz rose, dressed, and quietly left for work. He got to the plant, as usual, two hours before anyone else.

 

At the office, he poured a cup of coffee and started on his first pack of cigarettes. Damn! The pain in his stomach wouldn’t go away.

 

He threw himself into his work. That usually worked for minor aches and pains, or even a bad cold or the flu.

But this time it didn’t.

In fact, the pain got a little worse . . . enough so, by 8 o’clock, that it began to interfere with his concentration.

 

Irritated, resenting the interruption, pushed himself back from his desk and stood up. There was nothing to do, then, but to go down to the company doctor. Get a pill, or a pat on the head, or whatever was necessary, and then get back to work.

 

Lorenz sat impatiently on the examining table while the doctor took his pulse and frowned. It was high. 145. The stethoscope came out. The doctor listened to Lorenz’s chest, and the frown deepened.

 

Lorenz was feeling worse by the minute, and he could tell by the doctor’s expression that there was something wrong and that the something, whatever it was, was probably going to ruin his day. So he was not surprised when the doctor took off the stethoscope and said he wanted Lorenz to go over toFranklin SquareHospitalfor some tests.

 

Well, no life was perfect.

The doctors nurse telephoned Lorenz’s boss, who drove him over toFranklin Square. Over Lorenz’s objections, his boss came in with him.

The nurses put Lorenz in a small examining cubicle near the emergency room and, one by one, doctors arrived to poke and probe at him. They took blood and X-rays and, in about three hours, they told Lorenz’s boss he might as well go back to work. Lorenz was going to be there a while; a few days, anyway. By this time, Lorenz was too sick to object.

 

A little later Lorenz lay in a hospital bed and thought about calling Esther. He dismissed the idea, though. She was supposed to take his parents up to see the Pennsylvania Dutch country today, and if they knew he was sick they’d just worry. Why ruin their day, too?

 

He lay back in the bed, exhausted and . . . helpless. His stomach throbbed. It felt, he thought, like a stomach cramp.

As near as he could gather, the doctors thought he had pneumonia.

 

He tried to watch television, but daytime television was awful, awful, awful, awful. Or maybe that was just the way he felt. He turned off the television and dozed, fitfully.

That evening he called Esther and she came down to the hospital. It was nothing, he told her. A pain, an annoyance. He told her to pay attention to his parents. Make sure they enjoyed themselves. As for him . . . he’d be up and fine in a couple of days.

 

In the meantime, he felt terrible. He was tired, tired beyond anything he’d ever experienced. It was difficult even to raise his arm from the bed.

 

The doctors, in the meantime, seemed to be having second thoughts. It wasn’t pneumonia, apparently. It was, they decided, pericarditis — an infection of the membrane that surrounds the heart. So they gave him antibiotics.

 

It was he understood, a virus. Miserable little beasties, viruses.

Slowly the pain diminished and the lethargy receded. Just as he’d told Esther it would. He was ready, he told his doctors, to go back to work.

 

They disagreed. He should stay in bed a few more days.

So Lorenz lay in bed, reading newspapers and worrying about how the production line was going without him. Obediently, he let an orderly put him on a stretcher and roll him down to X-ray, where a doctor ran a sonar transponder over his chest. It was a routine test, they said.

 

God, he thought, things must be piling up at work. He had to stop this nonsense and get back to the office.

No, the doctor said with a new emphasis. According to the ultrasound tests, Lorenz’s heart was enlarged. Dramatically enlarged. And its pumping power was not what it should be.

 

Lorenz stared at the doctor. What did the fellow mean, ‘heart enlarged’? There was nothing wrong with him, not any more. He could tell. He felt fine. He had work to do.

 

But the doctor was insistent, insistent enough that Lorenz stifled his instinct to walk out and, instead, reluctantly agreed to let an expert over atJohnsHopkinsMedicalSchooltake a look at him.

 

THEN he would get back to work.

An ambulance?

Nah. Esther could take him over and . . .

A stretcher?

Absolutely not.

Lorenz Buchser could walk on his own two legs, thank you. A stretcher and an ambulance? They had to be kidding.

But they weren’t.

 

As they rolled the stretcher from the emergency room to the ambulance, Lorenz got a lung-full of fresh air and a glimpse of beautiful blue springtime sky.

This, he thought, was not just embarrassing. It was absurd. What was a perfectly healthy man like himself doing lying on a stretcher, bundled up like a baby or an invalid, on a gorgeous May day like this?

 

He should at least be out playing tennis!

 

 

-0-

 

 

AtJohnsHopkinsHospitalnurses and orderlies transferred Lorenz from ambulance stretcher to wheelchair and took him right upstairs — no paperwork, no insurance check, no waiting, no nothing.

 

If Lorenz had known anything about hospitals that might have worried him. But he didn’t know anything about hospitals. He hadn’t been in a hospital since his childhood accident, and if he had any choice in the matter he wouldn’t be in one now.

 

All the engineer knew was that he felt fine, fit as ever, perfect, and it was a beautiful May day, a day for tennis . . . and what on earth was he doing cooped up here like some runny-nosed kid with rotten tonsils? They tucked him into bed in a private room, and then left him alone.

 

He lay there, trying to absorb what was happening to him. He was tempted to get up, but from the way they were treating he had a hunch that would be counterproductive. So he stayed where they apparently thought he belonged and restlessly explored the room with his eyes.

 

There were light-colored walls, a bedside table with a pitcher of water, an adjoining bathroom, a call button in case he needed help — hah! — and the inevitable television. When he got tired of staring at the room he turned the television on and stared at that for a while. But not for long.

 

Yecch! People actually watched this stuff? He turned it off.

 

He wanted a newspaper, that was what he wanted. When the nurse asked him which one, he said he wanted all of them. Everything they had with the possible exception of the National Enquirer.

He spent the rest of the day restlessly paging through the Wall Street Journal, The Sun, The Evening Sun, The Washington Post and The New York Times. The A section. The B section. Business. Sports. Even the want the want ads. Even, in the end, the personals.

 

He wanted a cigarette, but he looked around the room and didn’t see an ashtray. Damn.

 

For a while he tolerated the craving, but then he finally asked a nurse for an ashtray and she brought him one. He opened a new pack of cigarettes and lit one. It tasted good.

The economy, according to the newspapers, was mixed. Stocks went up, and stocks went down. The aircraft industry was in rotten shape, but Chrysler wasn’t doing bad, not bad at all. Lorenz turned a page and lit another cigarette.

 

Someone came in for a blood sample and he obediently stuck out his arm. He answered questions. A nurse brought in a tray of food, and he ate without tasting. He fidgeted. He lit a cigarette. He flipped through The New York Times again, to make sure he hadn’t missed anything.

 

Through the window he watched morning turn into afternoon, soon to be evening, then darkness, with rush-hour traffic crawling along the streets below. A beautiful day, a beautiful May day . . . wasted, wasted, wasted.

 

What on earth was he doing here?

 

 

-0-

 

 

Several hundred yards away, in another ofHopkins’ maze of interlinked buildings, a thin middle-aged man in a white coat was asking the same question. His name was Dr. Kenneth Baughman.

 

Dr. Baughman sat down at his desk, opened Lorenz’s medical record, withdrew one of the X-rays that had been taken atFranklin SquareHospital, and held it up to the light.

 

As soon as he saw the huge, dark heart-shadow on the film, he knew exactly why Lorenz Buchser had been sent to him. He was dying.

That was the human diagnosis. The medical diagnosis, naturally, would be more complex. There would have to be tests, lots of tests. Blood tests. X-rays. Sonograms. Among other things, Dr. Baughman would have to insert an instrument into Lorenz’s heart and clip out a bit of tissue for examination. That would tell Dr. Baughman for sure that the muscle fibers in Lorenz’s heart were dying, one by one. The technical term for it was “cardiomyopathy,” but in any terms it meant death.

 

The tests might even tell Dr. Baughman why his patient was dying, though they probably wouldn’t. Cardiomyopathy, in addition to being one of the most relentless killers in the specialty of cardiology, was also one of the most mysterious. The truth was, Dr. Baughman strongly suspected, that it probably wasn’t a single disease at all. It was probably many, all with the same terminal effect: progressive weakening of the heart and subsequent death of the patient.

 

It might be caused, sometimes, by a virus — by some unknown, senseless, submicroscopic particle that fouled up the muscle cells’ metabolic works. Or maybe the virus produced alien proteins that attached to the surface of the heart muscle cells, setting off an immune response in which the body attacked itself by biological accident.

 

Sometimes alcohol seemed to be the villain. That was controversial, but some people seemed exquisitely sensitive to the stuff. They didn’t even have to drink very much, it seemed. Then, on the other hand, some experts didn’t subscribe to the alcohol theory at all.

 

Sometimes an endocrine imbalance caused cardiomyopathy. That was rare, but it happened. When it did, and the problem was discovered in time and the balance corrected, the process of muscle death often halted. Sometimes the patient even got better. Dr. Baughman knew of . . . oh, two or three cases like that.

 

But most of the time, 95 percent of the time, Dr. Baughman never found out what was killing his patients. The phrase that went on the death certificates was idiopathic cardiomyopathy. “Idiopathic” was a two-bit word for “unknown.”

But plenty was known about the process.

 

Dr. Baughman examined Lorenz’s record in detail. The doctors atFranklin Squarehad done a good job, and their results were all consistent, too consistent.

 

One of the studies had measured the “ejection fraction” of Lorenz’s heart. Normally the heart fills and then squeezes, in the process ejecting 55 to 70 percent of the blood it contains. Lorenz’s heart ejected only 12 percent.

 

That was a measure of the nearness of death, and if Lorenz didn’t feel it’s approach, it was because of the heart’s ability to compensate.

 

The fraction of its contents that the heart can pump out in any given contraction is fairly constant for each person. When there’s a demand for a higher blood flow, as there is during exercise, the heart adapts by temporarily getting larger. That way it holds more blood, and the volume of blood it ejects is also larger. Fifty percent of a quart is more than fifty percent of a pint.

 

The heart adapts the same way when it gets weaker, too, as it does in cardiomyopathy. As Lorenz’s heart lost increasing numbers of muscle cells, it grew larger and larger until now it was beginning to crowd the lungs in his chest cavity.

 

The adaptation was so efficient that Lorenz never knew the difference . . . at least not so far. But there was a limit. Sooner or later and probably sooner, the whole system would collapse.

 

Lorenz’s medical record was very thin, for a cardiomyopathy patient. But it would get thicker.

Dr. Baughman turned a page.

The doctors atFranklin Square, listening to Lorenz’s heart, had detected a rubbing sound with each beat.

 

The heart is surrounded by a sac, called the pericardium. If it is infected and becomes inflamed, you can hear the heart rubbing against it.

The pericardium has many nerves; that was probably the source of the pain that brought Lorenz to the doctor in the first place.

 

In this case the patient had a fever, too. That was consistent with the idea of an infection.

Dr. Baughman turned another page.Well, at least there was one positive thing. The new patient was an engineer. Engineers are by and large intelligent, and intelligent people are easier to work with. With an intelligent person it is sometimes even possible to . . .

 

But no, it was too early to think about that.

Dr. Baughman turned another page, and then another.

 

Fifteen minutes passed, then thirty, until the cardiologist had digested the information in the record. It was all consistent, all too consistent, with his first impression. He would be very surprised if Lorenz didn’t have a cardiomyopathy.

 

Well, there was work to do. Unconsciously touching the pocket of his white coat to make sure his stethoscope was still there, Dr. Baughman rose from his desk and went to examine his new patient.

 

 

-0-

 

 

In the days that followed, Lorenz stoically endured the indignities of the tests. He didn’t worry about it, though.

 

Obviously, he surmised, the doctors had found something they were concerned about, or at least curious about, and they were checking it out. They were doing their job, which was what he was paying them for. He understood that, and tried to be patient. But the boredom was awful.

 

Occasionally, partly because he had to think about SOMETHING and partly because he was a curious person to start with, he became interested in the tests themselves. The biopsy was particularly fascinating.

 

Though Dr. Baughman was reassuring and appeared to know his business well, it was obviously a delicate procedure. Lorenz was not, repeat NOT, supposed to move. And then there was a paper he had to sign. There were many side effects. Internal bleeding. Punctured lung. Death.

 

The way he read the permission sheet, nobody was responsible for anything. Sighing, he signed.

 

He lay on the table, his head turned to the left, while they gave him a local anesthetic in the right side of his neck. Then they made an incision and threaded a long, rather stiff-looking instrument down the jugular vein into his heart.

 

There was something hushed and tense about it, and Lorenz would not have been surprised to find out that there were open-heart surgeons standing by in case Lorenz sneezed or Dr. Baughman slipped.

 

As he was moved from one examining room to another, as he lay on tables and watched the lights flash and the glowing dots bounce across cathode ray tubes, the engineer’s interest in the technology around him grew steadily. He’d had the vague impression that medicine was a dark art but, clearly, it was more sophisticated than he’d supposed.

 

It was ignoble to get pushed around in a wheelchair. That was something Lorenz could do without. But he forced himself to be tolerant. He took the medicine they gave him.

 

He felt fine, he told Dr. Baughman . . . wonderful . . .

So maybe his heart was a bit enlarged. Maybe it had always been like that . . .

 

No, said the doctor. He’d checked earlier X-rays, and it’d been a normal size then.

The days passed.

Obediently, Lorenz held out his arm for the needle. He pressed his chest against the X-ray machine. He held his breath. He let it out. He coughed. He swallowed the pills. He read the Wall Street Journal, and the New York Times, and The Sun, and The Evening Sun.

 

There was no doubt about it, he realized. They thought he was sick. He began to feel a little like a sane person in an insane asylum. Nobody would believe him.

 

It was becoming a real problem. He had to get out of here. Pondering, he idly turned the pages of The Sun. Eventually, he decided, an opportunity would present itself.

And, finally, it did.

 

The opportunity  came in the form of a stress test. They attached wires to him, put him on a treadmill, and told him to do his best.

 

Lorenz Buchser, the hard-driving engineer, the two-fisted drinker, the pack-and-a-half workaholic and top-notch amateur tennis player, decided to show them what his best really was.

 

He started running.

The technician watched his gauges, and his eyebrows went up.

This guy was supposed to have a cardiomyopathy? According to the readouts, Lorenz was . . . well, perfectly healthy was not a proper description. MORE than perfectly healthy.

 

Lorenz grinned widely. That was precisely what he had been trying to tell them if they’d only listen.

And then he was sitting in his room, listening to Dr. Baughman telling him how sick he was. It wasn’t a virus, the doctor said. The heart was enlarged, and there had to be a cause, but nobody knew what it was.

 

They had a name for it, though. “Cardiomyopathy.” Whatever that was.

Stop drinking, the doctor said. Drinking could sometimes cause the problem.

Lorenz heard that. Sigh. But sure. Okay. Okay. Whatever. If it was necessary to stop drinking, he’d stop drinking.

 

There was always a chance, the doctor went on, a slight chance, that if alcohol was causing the problem, and if Lorenz stopped drinking, the cardiomyopathy would cure itself. It was known to happen — rarely, but . . . still.

 

Dr. Baughman watched his patient intently.

He could tell that that Lorenz wasn’t hearing, let alone accepting, much of what was being said. After all . . . in Lorenz’s position, would he be any more receptive?But he wasn’t in Lorenz’s position. He had the test results and no, he didn’t know what was killing the heart muscle, but he knew it was dying. Lorenz was dying. But how was Lorenz supposed to deal with that, when he felt fine?

 

“Cardiomyopathy” didn’t have the finality of it that the word “cancer” would have had and yet Dr. Baughman knew, as Lorenz did not, that cardiomyopathy was far more deadly. The word didn’t mean anything, anything at all, to Lorenz.

The cardiologist he didn’t use the word “death,” or “dying.” There would be time for that later. Lorenz would be more receptive when he was sicker, when the heart began to give out and the fluid begin to build up in his lungs.

 

But the doctor did mention, just in passing, sort of brushing over it, the phrase “heart transplant.” It didn’t seem to have any impact, but he didn’t expect it to. He just wanted it to be said.

 

Oh, and another thing.

The cigarettes had to go. Cigarettes didn’t cause cardiomyopathy, but they did decrease the amount of oxygen the blood could carry and with a marginally functional heart that could in turn trigger a heart attack.

 

Did Lorenz hear him? Dr. Baughman didn’t know. He seemed, unlike some cardiomyopathy patients, to at least be listening.

 

In fact, Lorenz was listening attentively. He was not the sort of man to pay for advice and then not hear it. He clearly heard the doctor say that he should cut down some on his smoking.

But then Dr. Baughman said something that came through loud and clear. Lorenz could go home.

 

Home!

Finally!

After Dr. Baughman left, Lorenz sat and thought about it.

Okay. Okay. Obviously he would have to take better care of himself. He would have to quit drinking. Sigh. Watch his smoking. Not work such long hours.

 

If he did those things, well . . . his heart might shrink back to its normal size. That’s what the doctor said. That happened.

That was probably what would happen in his case, Lorenz reasoned. After all, he felt so much better after just a few days of rest in the hospital.

 

As a matter of fact, the more he thought, the surer Lorenz became that Dr. Baughman was exaggerating the seriousness of all this. It made sense. That was the way a doc put the fear of God into you, made sure you heard that stuff about drinking and smoking.

 

So you had to take it with a grain of salt, especially if you felt like getting up and running around the room and doing backflips just from the sheer jubilation of getting out of this crazy place. If he was sick he would, well . . . he would be sick. And he wasn’t.

 

And that, Lorenz decided, was the bottom line. He felt fine. Wonderful, in fact. In truth, stir-crazy. He’d been cooped up in one hospital for another for two weeks. It seemed more like two years.

Esther picked him up.

 

It was a Saturday afternoon, and the air smelled like a bouquet of May flowers.

On Sunday morning, he was on the tennis court. He stayed off work until Thursday, then limited himself to a 12-hour day.

 

 

-0-

 

 

Lorenz valued his life and, workaholic or not, he was a prudent man. So he did what the doctor told him, and he stopped drinking. That turned out to be no big deal. Smoking was a little tougher, but he quit that too.

 

Except for those two things, though, he resumed his normal life.

 

The day after he left the hospital he played tennis. He seemed as good as ever, more or less.

 

He felt exuberant. There was a pile of stuff on his desk, he bet.

 

The next morning he went back to work and, just like he’d figured, there was a pile of stuff on his desk. Some of it was . . . interesting. And it all had to be done.

 

At first he made an effort to take it easy, out of deference to Dr. Baughman if nothing else. But there were things to do. There were problems on the production line. There were requirements to mesh with design. He couldn’t help but get caught up in it, and as the days passed he pushed the unpleasant hospital experience further and further back in his mind.

 

He missed the cigarettes, desperately. Perhaps . . . perhaps a compromise. He bought a pack of lights. They were awful. Still . . .

 

He lit another, and then another.

He stayed late at work. Things needed doing, and he was the one who had to do them. He stayed late again, and again. The weekend came, and he played tennis.

 

Life at home was as busy as it was at work. There were friends to meet on the tennis court, at the pool. This was the summer he and Esther had planned to have a lot of visitors; his parents had returned toSwitzerland, but the guest bedroom was now occupied by Esther’s mother. So Esther was busy, too.

 

There didn’t seem to be enough time in the day to get everything done. Lorenz sat the alarm for early. 5 a.m.

Then — when it rains it pours — Lorenz caught a cold.

Or at least, it seemed like a cold. It was a cough. It couldn’t be the cigarettes . . . he’d never coughed before, and after all these cigarettes were lights. Anything that awful couldn’t possibly be dangerous. So it had to be a cold.

 

Esther’s mother. mother gave him cough syrup, but for some strange reason it didn’t help.

 

The coughing was worse at night, a lot worse.

He caught his wife Esther looking at him. Perhaps, she said, he should call that nice doctor atFranklin Square, Dr. Mamdouh Darwish.

Nah. It was just a cold. Medical science was helpless against the common cold and, besides, the last thing Lorenz wanted to do was to get tangled up with doctors again.

 

The days passed. The cough continued and got worse.

 

He got a pain in his chest.

It wasn’t exactly the same pain he’d had before, though. It was, well . . . a little different. Probably it was the damned cold. He ignored it.

 

He quit playing tennis because . . . well, he could have played if he’d wanted to, but he didn’t have the time. There was a big project at work . . .

 

But the pain didn’t go away.

Maybe he should take some time off. In fact he would have, if he’d had the time, but of course he didn’t.

Besides, the 4th of July holiday was coming up. He’d rest then.

The cold was getting to him, though. He couldn’t deny that. The Martin-Marietta plant was huge, and the meetings and conferences he had to attend were far-flung; he had to walk.

 

He’d once enjoyed those walks . . . but now they were a dragging effort. Stairs were an effort. He had to stop and rest now and then.

 

The thought crossed his mind that it might have something to do with his heart, and the problem Dr. Baughman discussed with him before sending him home. He tried to conjure up the conversation, but his memory was dim.

What could be wrong? Lorenz reasoned with himself. He’d just spent two weeks being examined by the best doctors in the world, and they’d sent him home, hadn’t they? They hadn’t even told him he couldn’t play tennis.

 

Maybe it was psychosomatic. A figment of the imagination. Nerves.

 

Anyway, there was work to do.

The coughing got worse, and increasingly interfered with his sleep. That made his days more difficult, and that was irritating. There was work to do, damn it! He didn’t have TIME for a cold.

He went to work, he came home, read his paper, and went to bed.Newspapers, in fact, seemed to be assuming an ever-more important in his life. He liked them, he found, and these days he was, well . . . more in the mood to read than he had once been.

 

There was another way to look at that, of course. Once he had been part of the world; now he was a spectator, watching it whiz by.

 

No.

No. He was tired, that was all. Worn out.

Stubbornly, he refused to let up, to give into a stupid cold, a few aches and pains.

Then the 4th of July came and he didn’t even consider going to work. Instead, he slept late.

 

Esther asked him if he felt all right.

Well . . . sure. Damned virus.

She looked at him intently. His face seemed puffy, and his color was somehow wrong. It was almost . . . greenish.

 

They had a date with friends at the community pool, a short distance away. Did he feel like going?

Go ahead, said Lorenz. Take the car. He’d walk up a little later. The fresh air and exercise would probably do him some good.

Esther was dubious, but she did as she was told.

 

A long time passed before he decided, what the heck, he ought to go. He gathered together his things and started walking. Then, before he had gone more than a few yards, he stopped, panting.

He was tired!

He couldn’t believe it!

 

He started walking, but he didn’t get far before he had to stop again. The day was hot, crushingly hot, hellishly hot . . .

Walk! Walk!

He walked.

He stopped. A cough wracked his body, then another.

Walk!

He got a few yards farther, then stopped again.The journey between the house and the pool, once just a few brisk minutes, took forever. But he made it. Esther saw him coming and jumped up.

 

He looked . . . awful.

“Get in the car!” she said, a tinge of hysteria in her voice.

 

He protested, but he was too exhausted to put up a real fight. Meekly, he got into the car.

A few minutes later the massive red brick facade ofFranklin SquareHospitalloomed ahead. He stared it with dread.

He knew Esther would be going home without him. He knew there was nothing, nothing he could do.

 

But God! he hated hospitals.

Esther pulled the car up outside the emergency room and helped him inside; chagrinned, he nonetheless accepted her help. While he sat and waited, she conferred with a nurse. She disappeared for a while, then came back.

 

Elsewhere in the hospital, a clerk found and withdrew Lorenz’s medical record. A doctor opened it and scanned the report sent fromHopkins.

Cardiomyopathy.

Oh.

Lorenz was moved from the waiting room into a curtained-off area. It was good to lay down. A nurse arrived to take his pulse and blood pressure.

 

She was very, very nice. Solicitous, even.

Lorenz stared at her. She was treating him like . . . like . . . like . . .

He was going to be fine, someone said. Just fine. Just needed a tune-up, a little tune-up. A few days in the shop and he’d be good as new . . .

 

Everybody was cheerful, upbeat — just the opposite from the way Lorenz felt. He was sick, but he wasn’t sick enough to be stupid, and he knew he was sick, sick as he had ever been in his life, sick unto death . . .

 

Why was everybody so cheerful? There must be a meaning . . . But he didn’t pursue the thought. He didn’t have the energy. He was sick, to sick to care.

A few minutes later he was in an intensive care unit, with people sticking needles into him and gluing sensors to his chest. Numbers flashed across computer screens. The heart monitor made a fast beep-beep-beep, faster than any heart should beat.

 

He slept, and woke, and slept, and woke. Time passed in fatigue and lethargy. Esther’s face swam into view, and became the face of a nurse, then a doctor who said something reassuring. Everybody was reassuring. Time passed, but he didn’t know how much.

 

It was always light, neon day, hard noises, stainless steel clicked against stainless steel, alarms went off at another bed, or was it his bed, the walls were white, the uniforms were white, the neon time passed.

 

A little tune-up.

Lorenz would not have been surprised, then, to be told he was dying. But no one told him that, and he didn’t die — though he had the distinct impression that someone else in the ICU had done just that. But it wasn’t him, apparently.

 

He got better.

Maybe they were right. Maybe he wasn’t as sick as he’d thought. In fact now, on the second day, or was it the third, he didn’t really feel very bad at all. He felt good, in fact, except . . .

 

He was bored.

There was television, of course. Television was always an option. But the same could be said of suicide.

 

No, they wouldn’t allow him to get up and walk around. But they would let him read newspapers and magazines. So he threw himself at the mercy of the Wall Street Journal, The Evening Sun, The Sun, Time,Newsweek,U. S.News and World Report . . .

 

They were starvingEthiopia, rioting inSouth Africa, fighting inIran. Mondale would raise taxes. Fire, famine, blight. Farmers were in trouble, they said. Was Hughes going to run for the Senate? It would take a miracle to save the Orioles. The winter Olympics were going to be worth seeing.

 

They moved him out of intensive care. They’d obviously decided he wasn’t going to die.

He looked back, sheepishly, on how sick he’d been, and he had to admit to himself what he’d done . . . he’d overdone it, working .

 

Clearly he’d overdone it. He’d worked too hard, he’d smoked — he’d smoked lights, it was true, but perhaps he’d snookered himself on that one. Anyway, he’d done all that stuff before he was ready and he’d had a relapse. He probably deserved it.

 

Well, okay. He was convinced. They’d made their point. He was a believer. He had a heart condition, and he’d have to live with it.

The days passed. Several times every day the nurses and young doctors came into his room, took his pulse, listened to his heart, and then gathered in a little knot outside the door to talk it all over.

 

But Lorenz reasoned that their conclusions must have been very good. Otherwise, why would everybody always be so upbeat, so very cheerful?

The economy, said the Wall Street Journal, was clearly rebounding beyond expectations. But there were dark clouds on the horizon in the form of the president’s huge budget deficits. There was a fire inWest Baltimore. The Orioles were out of it.

 

Somehow, as the days passed, the cheerfulness started to bug him. There seemed to be something . . . well, something wrong about it. But he couldn’t put his finger on what it was.

 

On the one hand he was sheepish about how depressed he’d apparently been during those first couple of days. He’d been almost . . . paranoid. Obviously he’d been sicker than a dog, but maybe he’d be okay, if he just behaved himself. Certainly he felt more or less okay now.Still, the cheerfulness seemed almost . . . overdone.

 

He was feeling pretty good, but not THAT good. The honest truth of it was that while he was bored in the hospital, he honestly didn’t feel much like playing tennis. And that was unusual.

 

Still, he was well enough that he wanted out. As each day passed, he wanted out more desperately.

The second week in the hospital he told the heart specialist that he’d learned his lesson. If they’d just let him go home, he’d take it easy. He promised.

One more test. Another.

Finally, just short of two weeks, they let him go — they let him go home, that is. But not to work, not yet.

 

Okay, he said, accepting the restriction without argument. And yes, he’d come back every two weeks. Yes, he’d make an appointment to go see Dr. Baughman again, over at theHopkins. Yes, he’d take his medicine.

Yes, yes, yes and yes.

 

And then, finally, Esther came and took him home.

 

 

-0-

 

 

This time, Lorenz Buchser promised himself, he would take it REALLY easy. This time he’d follow the doctors’ orders to the letter.

He’d stopped smoking in intensive care, having no choice. Now, he promised, he’d not start again. No, not even “lights.”

 

He had a cabinet full of medicine, and he took it exactly when he was supposed to.

And he rested.

That’s what the doctors called it, anyway. Rest.

But to Lorenz, the workaholic, the tennis player, it was a form of imprisonment. He chafed at the inaction. He wondered what was going on at the office.On the other hand, he had indeed learned his lesson. If he disobeyed the doctors he might end up back in the hospital. And it was Lorenz’s sincere ambition never to see the inside of a hospital again, if he could avoid it.

 

He struggled to understand what it all meant.

He would get better, of that he was certain. After all, wasn’t he doing everything the doctors told him to?

But at the same time, they’d made it very clear to him that he was never going to be able to do what he’d done before. He was going to be a . . . no, they didn’t use the word “cripple.”

“Limited” was the word they used.

Limited.

Okay.

That was what they said.

 

They were wrong, though. Deep down, Lorenz knew they were wrong. They had to be. He would be a perfect patient. He would get better.

In the meantime, the truth was that he didn’t really miss playing tennis. He just didn’t feel like it, at the moment. He was more interested in the newspapers, and watching the upcoming winter Olympics on television.

 

He played with his children. He liked that; playing with his children was the silver lining in the cloud. He had never realized what a luxury it was.

 

He and Esther began to study for their citizenship exam, which they were scheduled to take in January.

In three weeks he went back to the hospital. A young doctor examined him, and seemed pleased with his progress. That made Lorenz feel good. He was gaining!

 

He called Dr. Baughman’s office to make an appointment, but Dr. Baughman was booked up for July, and would be away in August. Would September be all right?

Sure, said Lorenz. Why not?In that fashion July ended, and the dog days of August passed. He returned toFranklin Squarefor another examination. Again he was seen by a young doctor who seemed pleased — almost astonished — by how well he was doing.

 

So far, so good.

The papers and newsmagazines were filled with the news of the upcoming election.

 

Lorenz might have shared the nation’s boredom with the flood tide of political news, except that it dovetailed nicely into his study of civic affairs for the citizenship exam.

Texas, everyone seemed to agree, was a pivotal state. If Reagan took it, Mondale had better look for a professorship somewhere.

 

Lorenz had the distinct impression he was getting better, little by little, and he was buoyed by the enthusiasm of the young doctors atFranklin square.

One Tuesday in early September he went toFranklin Squareand, again, the young doctor said he was doing fine. Terrific! Keep it up!

 

Then, that Thursday, he drove down toJohnsHopkinsHospitalto let Dr. Baughman take a look at him.

As soon as he got to the cardiologist’s office an orderly whisked him away for an echocardiogram, then deposited him in an examining room. In due time, Dr. Baughman showed up with his record.

 

Dr. Baughman listened to his heart. Lorenz sat cooperatively, waiting for the doctor to tell him how much better he seemed.

 

After the examination the doctor opened the medical record, flipped through several pages, frowned, and looked up at Lorenz. His heart was getting worse, he said in a sober voice. Much worse.

Lorenz stared at him, not comprehending.

Worse? But . . .

 

Definitely worse, the cardiologist said. Rather rapidly, in fact. It might soon be time, in fact, to think about a transplant.Transplant.

 

That word again.

It didn’t make sense.

Lorenz didn’t say anything, but his mind was racing.

 

Worse?

 

Just two days ago the doctor over atFranklin Squarehad told him he was doing beautifully! What did this guy mean, worse?

Dr. Baughman said some other things, but they made no impression on Lorenz. Finally he was alone, getting dressed, trying to make sense out of it.

 

How could the doc at Franklin Square say he was getting better and the doc atHopkinssay he was getting worse. How could the diagnoses be so opposite? It didn’t make sense. Unless . . .

A very unpleasant thought crossed Lorenz’s mind. Dr. Baughman had said “transplant” again. Was he looking for a guinea pig? The possibility made Lorenz’s mind roll. If he couldn’t trust . . .

 

No. That was a little farfetched.

There was only one other rational conclusion. Perhaps the doctors really didn’t know much about what was happening to him.

 

On the one hand, that was not very reassuring. On the other, it made Lorenz’s own opinion more valid.

And what was his own opinion?

Obviously, he was going to get better. He was going to get well.

 

 

 

-0-

 

 

Dr. Baughman knew when he walked out of the examining room that there was something funny about the Lorenz Buchser case, but he wasn’t sure what. It was almost as though the fellow hadn’t heard a word he’d said.For the moment he had other things to do, other patients to examine, biopsies to perform, sonograms to read. He tucked the Buchser case into the back of his mind. Later, when he got time to think about it, he did.

 

He sat with the open record in front of him.

Fact: In May Buchser had been admitted to Franklin Square and then toHopkinswith heart failure and pulmonary edema. Relatively mild drugs had stabilized the situation, but the diagnosis had been clear: cardiomyopathy.

 

Fact: On the 4th of July Buchser was readmitted toFranklin SquareHospitalwith worsening heart failure and premature heartbeats. The heart, on examination, was even larger than it had been in May.

 

Fact: The cardiologists atFranklin Squarehad used more powerful drugs, and had thereby saved the patient’s life. But the heart did not shrink.

 

Fact: On reexamination at theHopkinsin September, a sonogram showed that the heart had continued to enlarge despite the drugs and rest. In truth, Dr. Baughman hadn’t really needed the echocardiogram to make the judgement that Butcher’s condition was worsening.

 

Because blood wasn’t carrying quite enough oxygen to his tissues, his skin had begun to slow the slight purplish tint of end-stage cardiomyopathy patients. He had also begun to lose muscle mass, and as his arms and legs shrank his chest had begun to seem barrel-like.

 

A stranger could have picked Lorenz out of a crowd with no trouble. Surely his wife saw it. Certainly the doctors atFranklin Squaresaw it. Lorenz himself could see it if he but looked in a mirror.

 

And yet, when he, Dr. Baughman, had stated the obvious — that the condition was becoming worse — Lorenz had stared at him like he was some kind of an idiot.

Why?

Was it just a question of denial? People denied the approach of death, of course. Lorenz denied, for that matter, a little more than average.But at the same time this particular patient, denial or no denial, was an intelligent man. Intelligent patients might deny, and deny, and deny . . . but there always came a time when they saw, and confronted, the obvious.

 

Dr. Baughman remembered the look of total disbelief on his patient’s face.

Why?

And then it hit him.

Of course!

If it wasn’t so terrible, it would be funny.

Dr. Baughman summoned his secretary. Would she please callFranklin SquareHospital? He needed to talk to Lorenz Buchser’s cardiologist.

 

The problem was psychological, all right. But it wasn’t Lorenz Buchser’s problem.

Doctors, too, are afraid of death. And that’s what cardiomyopathy was. Death, death far more certain than with cancer.

 

The public didn’t know that, of course. You could say “cardiomyopathy” to a fellow on the street and he wouldn’t have any reaction at all. For all he knew, it was a skin rash. But the young cardiologists over atFranklin Squareknew exactly what it was.

 

Doctors, like other people, are afraid of death. What’s more, they passionately hate to be powerless in the face of it. So do nurses, and orderlies, and even administrators.

They wouldn’t hesitate to tell a co-worker with the ‘flu that he looked ghastly, but when they’re in the presence of real death, of a patient turning purple by its nearness . . . when they saw “cardiomyopathy” written in a patient’s record . . . then, in their helplessness, they’d give the patient the only thing they had left: encouragement.

 

“You look wonderful,” they’d say.

“My, aren’t you better today!”

“You’re doing well . . .”

When the truth is unacceptable, doctors are tempted to lie. And the younger the doctor, the greater the temptation.In his follow-up visits, Lorenz Butcher had almost certainly been seen by residents.

 

Dr. Baughman had spent enough time near death that he didn’t make moral judgements about denial. Perhaps it was best, sometimes.

But when it came to Lorenz Buchser, it was the wrong psychological prescription.

 

Lorenz Buchser was going to die. He was going to die soon. In fact, with his heart getting worse so rapidly, he just might drop dead at any moment.

He had one shot, and one shot only. But it had to be taken, quickly, before it was too late –and Lorenz would never take it if he thought he was getting better.

 

TheFranklin Squarecardiologist was on the line. Dr. Baughman picked up the telephone and explained what he thought was happening in the Buchser case. TheFranklin Squaredoctor understood immediately.

 

Yes, he assured Dr. Baughman. He’d talk to his residents.

Lorenz, in the meantime, read his newspaper and studied for his citizenship exam.

It didn’t take an expert on the American electoral process to see that Walter Mondale was in trouble. In the middle east, the problems remained intractable. The auto industry was on the rebound, but pundits wondered how the stock market would react to the rising national debt. The dollar continued to rise on the European markets. Housing starts were strong.

 

The days passed, with Lorenz Butcher obeying his doctors’ orders to the letter. No booze. No cigarettes. No tennis. He came due for another checkup atFranklin Square.

What the hell did they mean he was getting worse? He was following orders, wasn’t he?

 

Personally, he thought he was well enough to go back to work. At least part time!

Okay, the doctor said, looking at him speculatively. If he thought so, give it a try. Try it and see.

 

What they meant was that if he had to hit a brick wall to convince himself, then go ahead. But Lorenz thought it meant that the doctors still had doubts. Good. He’d show them.

When he got home, Esther asked him how it had gone. Fine, said Lorenz. He was doing quite well, in fact. Well enough to go back to work part-time.

 

The lie didn’t bother Lorenz; it was, after all, a white one.

For one thing, there was really no time for extended heavy conversations; this was the year for visitors fromSwitzerland. Lorenz’s parents having gone home, Esther’s mother having come and gone, Lorenz’s brother was now visiting.

 

Stubbornly, Lorenz didn’t want his family to know his troubles. He didn’t want them to worry. He didn’t want them to think of him as an invalid. He wanted his . . . privacy.

 

Besides, Esther was obviously enjoying his brother’s visit. He was active, alive, vibrant. He and Esther played tennis almost every day, for instance, and that was something Lorenz hadn’t been able to give her all summer. To tell her about the doctors’ confusion over his case would worry her for no reason and put a damper on her pleasure.

 

He called his office. A few days later, he was back at work half-time.

Only . . . it wasn’t what he had expected.

 

Work wasn’t pleasurable, now. It was grueling.

Every problem seemed insurmountable, every step leaden. Stubbornly, Lorenz endured.

But he didn’t enjoy.

One of his employees remarked that he had somehow gotten a lot easier to work for. He wasn’t so demanding, so hard-driving . . .

It was meant as a compliment, but it made Lorenz feel empty.

 

And then, when he went for his next checkup, the doctor atFranklin Squaretold him he was still getting worse, worse, worse.Damn, damn, damn.

He couldn’t remember what it felt like to play tennis. He couldn’t remember how it felt to WANT to play tennis.

 

Finally he was sitting, once again, on an examining table at theHopkins, and Dr. Baughman was using that phrase again.

Heart transplant.

And this time Lorenz was too sick, too exhausted, too worn down, to screen it out.

 

 

 

-0-

 

 

The vague and ancient perception that the heart was the seat of the soul still lurked in many minds on that December day of 1967, when Dr. Christiaan Barnard transplanted the heart of a 24-year-old accident victim into the chest of a dying heart patient, Louis Washkansky

 

The bold black headlines, followed shortly by photographs of Washkanski and his surgeons grinning victoriously into the cameras, destroyed that myth forever.

Heart surgeons had been impatiently awaiting the dawn of heart transplant surgery, and the Capetown achievement opened the floodgates. Within three days, a transplant was performed on a 17-day old baby inBrooklyn.

 

Around the world, the reaction was mixed. Some observers were fascinated and buoyed by this striking advance in medical technology. Heart ailments, after all, constituted the leading cause of death in the developed world; suddenly, in the heady excitement of the moment, it seemed as though the limits of life were about to be dramatically extended.

 

But some were horrified by the drama unfolding in full view of the international community. Surgery was one thing, they said, survival quite another. What about the patient’s quality of life? And what about the costs?For a few days the optimists held center stage, and the naysayers seemed like knee-jerk wet blankets. But then the winds shifted and the fates came down, hard, on the side of the critics.

 

InBrooklyn, the baby with the transplanted heart lived six and a half hours, then died of metabolic collapse.

 

Then, inSouth Africa, Washkansky’s immune system began to reject his new heart.

Alarmed, his doctors increased the drugs that suppressed his immune system. His body’s defenses thus compromised, Washkansky developed an infection that grew explosively.

 

Four days before Christmas, he too died.

Despite the two sad endings, many surgeons remained doggedly optimistic. They conceded that the procedure was very dangerous, but they predicted that the survival rates would improve quickly with experience. The first order of the day, therefore, was to get that experience.

 

All over the world, heart surgeons began gearing up for the bright new era. Shumway in California, Denton Cooley and Michael Debakey in Houston, P.K. Sen in Bombay, Negre and duPost in France, E. Zerbini in Brazil, J. Kaplan in Chile, Siska in Czechoslovakia . . . before 1968 drew to a close, dozens of surgeons would have cut out a total of 102 failing human hearts replaced them with the hearts of cadavers.

 

The operations were almost invariably successful but, one by one, with few exceptions, the patients died of rejection, infection, or other complications.

 

By the end of 1968, the bloom was definitely off the rose.

Some surgeons had second thoughts but others, stubbornly, went on. Surgeons are trained to cut, but also to have faith. The survival rates would go up. They HAD to.

 

But in this they were wrong.

More hearts were transplanted. More patients died. By 1970, heart transplantation had earned a reputation as one of the most dramatic and risky of all last-ditch medical procedures. Increasingly, it seemed not only risky but reckless. Public reaction swung hard toward skepticism, then cynicism. What were the surgeons trying to prove, anyway?

 

Spontaneously, a moratorium developed.

 

Almost by common agreement,StanfordMedicalCenterinCaliforniawas the one exception. There, where Shumway had been doing research on rejection since the 1950s, the heart transplants would continue.

Perhaps Shumway, with his experience, grant funding and research organization, could figure out what was going wrong and how it could be set right.

 

By the middle of the 1970s the issue of heart transplants had completely slipped off the front pages and, except for Shumway’s work, out of the medical journals as well.

 

But it had left an indelible impression in the public psyche.

If you got a transplant, you died.

So Dr. Kenneth Baughman, atJohnsHopkinsHospital, was used to his cardiomyopathy patients not hearing him when he said “heart transplant.”

 

He dealt with the problem subtly. If he thought a patient might be a candidate, he tried to use the words in an early interview . . . to sort of drop in the idea that, if all else failed, there was always the possibility of a transplant.

 

The words rarely registered in their conscious minds. But it seemed to give their subconscious minds something to chew on, and somehow that made it easier later.

It got easier, too, as the patient got sicker. And Lorenz Butcher, by November, was very, very sick. His heart function was so marginal that his body was automatically shunting what blood their was to his internal organs. His skin was blue, as a result, and the muscles in his arms and legs had wasted away. He looked more and more like a death camp survivor.

 

He stared at the doctor.

Heart transplant?

 

“Heart transplant,” the surgeon replied. It was time to start things rolling. Now.

Lorenz stared at him.

The doctor stared back

There was always the chance, Dr. Baughman knew, that the sluggish blood flow was affecting the supply of blood to Lorenz’s brain. In that case, Lorenz would be getting dumber and dumber. Too dumb to understand?

 

Dr. Baughman didn’t think so. The engineer, despite his wasted body, seemed as mentally sound as ever.

 

The problem, he explained to his patient, was that it took some time to get things set up. There were questions of insurance, for instance. And a committee had to agree to accept a heart transplant candidate. If he waited too long, he might be too sick to endure the operation. Then . . .

 

Dr. Baughman didn’t say the word “death.” It was not necessary.

But the best time to start, the cardiologist went on, was now. Perhaps, this afternoon, Lorenz could meet with the transplant program’s social worker, Helen Michalisko.

 

Lorenz’s mind swam. It was all happening so fast. He wanted . . .

No, he said, stalling. Not this afternoon. He had two meetings at work this afternoon. Later.

Later.

Very well, said Dr. Baughman. He gave Lorenz the social worker’s telephone number. But don’t make it very much later.

 

When the conversation was over, Lorenz dressed and drove home.

Esther asked him how it went, and he told her it went beautifully. He was getting better, better.

This time, though, the lie bothered him. He needed to talk to her, now. But not while his brother was still there. He would be gone in a few days, though.

 

In the meantime, Lorenz sat down and had a meeting with himself.Fact: The doctors’ confusion seemed to be resolving in favor of the worst. None of them ever told him, now, that he was doing fine. They were unanimous. His condition was, apparently, just rotten.

 

Fact: He felt like it, now, too. He didn’t feel like doing much of anything, in fact, except reading and going to bed. He was bored, bored, bored, and yet he didn’t have enough energy to do anything about it.

 

He remembered the man at work who had told him he was getting easier to work for. Yes, the man was right. He wasn’t a hard-driver any more.

The fact was, he wasn’t much of anything anymore.

 

The fact was, he was tired, lethargic . . . limited.

The fact was, any way he reasoned it out there was a solid chance that Dr. Baughman just might be right.

Heart transplant.

It seemed unreal.

He picked up a newspaper.

 

There was fighting inLebanon, fighting inSouth Africa, fighting inEl Salvador, fighting inNicaragua, fighting inCambodia, fighting in thePersian Gulf. . .

Heart transplant.

The days passed. He dragged to work. He dragged home.

Esther played tennis with Lorenz’s brother while Lorenz lounged, exhausted, at home. It was work to go to the bathroom, it was work to eat, it was work to focus his mind on Newsweek . . .

 

Finally, they took his brother to the airport. Esther drove; Lorenz was too tired.

 

It was November, Republican November, brisk, cold November. When they got home, Esther put the children to bed. It would be a good evening, she decided, to build a fire in the fireplace. She got the wood, of course; Lorenz was too tired.

They sat, looking at the fire.

 

“The doctor says I need a heart transplant,” Lorenz said.

It was Esther’s turn to stare.She had been worried about him, of course. His color had seemed . . . poor. He hadn’t had much energy. In fact, the man he had become, the sedentary man with the newspaper, the bored man without desires, without drive, was almost a stranger.

 

But every time she had asked, and she had asked often — every time she had asked, he had said . . . the doctors had said . . .

“I lied,” Lorenz confessed.

 

Suddenly, it all coalesced in Esther’s mind and she saw what she hadn’t seen before. Suddenly she understood, more deeply, more emphatically, more finally, than had Lorenz himself.

He wasn’t just . . . “limited.”

He was dying.

The fire crackled energetically, like something alive, coals glowing, sparks swirling up the chimney. But for Esther, it had no warmth.

 

She burst into tears.

He moved to comfort her and then, as he too cried, they comforted each other.

A few days later Helen, the social worker with the transplant program, called. Lorenz said he’d be there, but not alone. Esther would be coming too.

 

There would be no more secrets. From now on, Esther would be involved in everything.

 

 

-0-

 

 

Even more than death, heart transplants were something that happened to someone else. If you were an engineer, like Lorenz Buchser, death got you a nice local obituary but nothing special because it was so normal. Everybody died, eventually. But a heart transplant got you in Time magazine, on the evening news . . .

 

Except, it didn’t. Not anymore.Like most people, Lorenz hadn’t been very aware of the sea change in transplant medicine. It had been a big thing in the ’60s but then all the patients died and it dropped out of the headlines and most people’s minds. Now they were back but the patients were celebrities anymore. Now they were crowded out of the news first by the Barney Clarks and now by Humana Inc. and the William Schraeders.

 

As a news junkie as well as an engineer, Lorenz would have followed the artificial heart story under any circumstances. But now, with his own heart dying, the drama unfolding inKentuckywas almost personal; he avidly read everything he could find, which, in the closing days of 1984, was plenty.

 

He noted that the artificial heart had plenty of critics. It wouldn’t work in the long run. Even if it did work, the recipient’s quality of life was questionable. Even if it did work, and it led to a worthwhile life for the patient, it was too expensive.

 

Weren’t those the same criticisms that had been leveled, a few years earlier, at heart transplants?

 

But while the newspapers and magazines were filled with stories about the artificial heart, there was comparatively little about heart transplants. To find out about them, Lorenz had to expend some effort in the library.

 

In old magazines and in medical journals, Lorenz reconstructed the story.

In the early 1970s, after the optimism about heart transplants had turned to bitter failure, almost everyone who was doing them stopped. The operation was simple enough, at least for a top-notch team; it was the rejection that killed the patients.

 

That was why the lone exception to the moratorium was Norman Shumway, at Stanford. Though Shumway was a surgeon, he was also the world’s foremost expert on the rejection phenomenon. Even Shumway did fewer transplants than he had done during the late ’60s.The trick was to give the patient just enough medicine to stop rejection without suppressing the immune system so badly that the patient died of infection. It was a fine line and, during the ’70s, Shumway apparently learned some things. Certainly his survival rates got better. By the end of the ’70s, theCaliforniagroup was reporting one-year survival rates of 65 to 70 percent.

 

Then came cyclosporine. Cyclosporine made the earlier antirejection drugs therapies, which were based on high-dose prednisone and Immuran, look like bludgeons. The new drug preferentially suppressed the part of the immune system that caused rejection, but didn’t do quite as much damage to the rest of the system as Immuran did. Nor did it have all the other side effects, such as bone degeneration and facial disfiguration, that high-dosage prednisone did. Or, more correctly, if it did, nobody knew about it yet.

 

Not that cyclosporine was perfect; it wasn’t. For one thing, it was hideously expensive. For another, it sometimes attacked the kidneys; if the docs weren’t careful, a heart transplant patient who was doing well otherwise could end up on a dialysis machine.

 

So it was still tricky, very tricky — but not as tricky as before. The bottom line was that, with cyclosporine, survival rates went up another ten percent.

So the moratorium on heart transplants had ended quietly, obscured by liver transplants and artificial hearts, as a whole new generation of heart transplant experts, trained inCaliforniaby Shumway, spread out across the country to open new heart transplant programs and, presumably, usher in an age when heart transplants would be routine.

 

A measure of the change was thatJohnsHopkinsMedicalSchoolhad hired Dr. Bruce Reitz, a student of Shumway’s, to be its new head of cardiac surgery. In the first round of heart transplants the Hopkins, one ofAmerica’s most conservative medical schools, had done only one operation; when the patient died it declared its own moratorium.

 

But now much had changed. One of Dr. Reitz’s first acts as chief of heart surgery was to hire Dr. William Baumgartner, another Shumway trainee, to set up a heart transplant program inBaltimore.

 

That, thought Lorenz as he collected information on heart transplants, was reassuring. On the other hand, it raised a whole different set of concerns.

TheHopkinsprogram was new, and it had a point to prove. To prove that point, the doctors would need patients. Patients . . . like Lorenz Buchser.

 

Did he really need a heart transplant? Or did the docs just need a guinea pig?

In at least one respect, that line of reasoning was reassuring. Perhaps, thought Lorenz, he still had some options. Perhaps he could say no.

 

As the day approached when Lorenz and Esther were scheduled to meet with the transplant program’s social worker, Lorenz bought a notebook and began write down questions.

They met with the social worker in an examination room on the 5th floor of the Blalock building. Lorenz sat in a chair, his notebook open on his lap. Esther sat beside him, holding his hand.

 

Exactly why, asked Lorenz, did he need a transplant?

Because, said the social worker, his heart was becoming steadily weaker. The only thing that was keeping him alive, now, was medication — and THAT was slowly losing its effectiveness.

 

Lorenz made notes in his book, then went on to the next question. Exactly what were the alternatives?

There weren’t any.

 

When would this have to be done?

As quickly ask possible, said the social worker.

What did it involve?

That was a long answer; the social worker went into the process in some detail.

 

What it boiled down to was that Lorenz had to make a choice: yes or no. Then he would check into the hospital for a couple of days of tests, and to be examined by the various members of the transplant team. Then the transplant team would make a decision whether or not to put him on the transplant list.

 

Also if he had insurance or the money to pay for it was an important issue with the social worker.

 

It could take months before he received a heart. It depended, for one thing, on the blood type of the donor. For another, it mattered how sick Lorenz was. All else being equal, the sickest patients got the operation first.

 

What were the risks?

Well, the operation was a risk. People sometimes died during operations. But that wasn’t a big one; it wasn’t the operation that was a big deal.

The really big near-term risk was that, since his immune system would be compromised by anti-rejection drugs, was that he would develop a life-threatening infection in his surgical wounds. To help guard against that, he’d spend the first few days after surgery in an isolation room.

 

Long-term, of course, the risk was rejection. He would have to take medicine for the rest of his life, and he would have to come back to the hospital periodically to have his new heart checked.

But . . . he would be normal?

Except for the medication, and the periodic visits to the hospital, yes. Given skill, that is. And luck. The one-year survival rate was 80 percent, which meant that one out of five didn’t have the luck.

 

Lorenz put that out of his mind. If he did it — IF, IF — he would be one of the four. To him it wasn’t a question of risk, it was a question of rationality, should he or shouldn’t he, like shopping for a Chevy versus a Ford. Almost an engineering question. Lorenz asked his questions, and wrote down the answers to study later.

 

The social worker’s briefing was lengthy and thorough, and Lorenz took extensive notes. When the social worker was finished, Lorenz and Esther interviewed Dr. Baughman. His answers were consistent and yet, and yet . . . Lorenz and Esther left the hospital unconvinced.

 

Maybe, they both reasoned (or was it hoped?) a transplant wasn’t necessary. The whole idea seemed . . . well, weird. They went home and thought about it.

And he still had questions, lots of questions. He started writing them down in his notebook. Before he was done, they filled 35 pages. That would never do. He reduced them to four critical questions.

 

Who would he ask? Who could he trust?

Nobody.

But maybe he could trust everybody, if he questioned them separately, like a police detective grilling witnesses.

 

By this time, Lorenz had been examined by dozens of doctors. He wrote their names down in his notebook, and methodically went back and grilled each one.

Did you need transplant. Yes.

If he didn’t have the transplant, he asked each of them, what would be the quality of his remaining life?

 

Terrible, they all agreed.

How long would that life be?

Here there was less agreement. One doctor said six months. Another said eight. Another said a year. The longest estimate was 14 months.

 

But they all agreed that the quality of life, if he got a transplant, would be little short of normal.

Normal!

God, it would be wonderful to be normal again!

Lorenz wrote everything down in his notebook and then, at home, he studied what he had written.

 

It was curious. The answers somehow didn’t mean anything.  They added up to yes, yes, he would obviously have to have a transplant. That was the answer, staring up at him from his notebook, and yet it was somehow abstract, intellectual. It didn’t have any more impact than an engineering equation or an order for a ham on rye.

 

He dialedHopkins, and asked for the social worker. Yes, he heard himself say. He would have the transplant. He could come in whenever they wanted him to, for the tests.

A few days later the social worker called him back and set a date in the middle of December. Lorenz wrote it down on his calendar, but he didn’t think about it.

 

 

-0-

 

 

When the day came Lorenz checked into the hospital and lowered himself, not complaining now, into the inevitable wheelchair. They took him to his room, from whence he was whisked to laboratory and examining room.

 

He met a Dr. William Baumgartner, a Dr. Michael Borkon, and another doctor, and another, and another. They all had a professional look of competent concern, they were all enthusiastic about transplanting hearts, they were all very open about answering his questions . . . and they all blended together.

 

Hold our your arm. Make a fist. Urinate in this, please. Stand over here. Hold your breath.

 

By this time, Lorenz had done some homework and gained some experience. He knew how to read an echocardiogram now, in an amateurish way. At least he knew what a healthy one was supposed to look like, and that his wasn’t healthy.

God, Lorenz hated hospitals.

 

Sure, he told the doctors and the nurses, playing the game. He wanted a heart transplant. He was ready for it. Perhaps . . . after Christmas. But in the privacy of his own mind he was still shopping, still considering, still wondering if it was really necessary. It all seemed, somehow, unreal.Lorenz went back to work, but it was exhausting. As Christmas approached, he took a few days off. He read newspapers, magazines, played with his children. At least, he played with them when he felt like it . . .

 

It was while he was watching his children play around the Christmas tree one day that he suddenly realized they might have to grow up without him. The thought made him burst into tears.

Lorenz had never been afraid to cry, but that was not to say he’d ever cried much. For one thing, it rarely occurred to him that he might not get what he wanted — in his mind you set your sights on your objective and you worked hard to get there. You didn’t think about the possibility of failure.

 

Only, now, he thought about it a lot. He might die. The fact hung in his mind like a lead weight, and now he cried a lot.

 

Christmas came and went. On New Year’s eve Lorenz and Esther drove down toSouth Carolinafor a few days to visit some friends. They came back toBaltimoreon January second.

 

Lorenz was ready, now, to get his new heart and be done with it. He thought about it constantly now.

And then, suddenly, it hit him that he wasn’t the only one who had to decide. Getting a new heart wasn’t, in the end, at all like shopping for a new car.

 

The thought left him cold.

What, he asked himself . . .

Lorenz hated himself when he had a question he couldn’t answer, and yet . . . he had no answer for the one that exploded in his unprepared mind.

What if they turned him down?

 

What if they decided he was in such rotten shape that they didn’t want to touch him?

What if they wouldn’t give him a new heart?  What then?

 

It was an obvious question, painfully obvious, and yet through all the months of getting sicker and sicker, of dying really, it hadn’t occurred to Lorenz Butcher that this time he might lose. Perhaps he hadn’t let it. But now, on the second of January, it exploded in his mind and left him shattered.

 

Why hadn’t the people fromHopkinscalled? They should have made up their minds by now, shouldn’t they? On a pretext, he called the transplant team’s social worker.

 

No, she said, they hadn’t decided yet. They’d meant to have the meeting over the Christmas holidays, but surely Lorenz understood how it was. Holidays are bad; it’s difficult to get people together.

 

Sure, Lorenz understood. Suddenly he understood everything: His fate was in someone else’s hands.

The next morning was January 4th. He went to work, and sought to lose himself in his job.

 

He had a meeting scheduled for that afternoon, and at the appointed time around noon everyone arrived in his office. They talked about a regular program meeting for one of the products that MM was building.

At about that same time, at the Hopkins, the transplant committee was meeting in the conference room. Everyone was there: Dr. Reitz, the chief of cardiac surgery; Dr. Baumgartner, head of the transplant program; Dr. Borkon; Dr. Baughman, the cardiologist; Helen Michalisko, the social worker; and Sharon Augustine, the nurse coordinator.

 

Carefully, with attention to detail, the doctors, along with the nurse coordinator and the social worker, compared notes and impressions. They all agreed about one thing: Lorenz Buchser was pretty sick, and getting sicker fast. If ever anyone needed a new heart, it was he.

 

He had a good attitude too, and he was intelligent.

One thing they didn’t talk about, but they all would have agreed on, was that Lorenz Buchser, the engineer, was just the type of patient that proved heart transplants were economically justified. Fifty thousand dollars for the life of a janitor . . . well, that didn’t bother the transplant team, but they knew it bothered other people. But 50,000 for the life of an engineer was different. Give him a few more years at work, and Lorenz Buchser would pay that back in taxes.

 

Of course . . . the patient hadn’t really accepted what was happening. On one level, the intellectual level, he understood perfectly. But on another level . . .

Still . . .

 

As soon as the meeting was completed, the social worker dialed Lorenz’s home number. Esther answered. No, she said, Lorenz wasn’t home. He was at work. But why, what . . .

The social worker told her, then hung up the telephone and dialed Lorenz’s work number.

 

At Martin Marietta the meeting had just gotten underway when his secretary, Mary Wagner, Stepped to the door to say he had a call from Johns Hopkins. He had told her to alert him if the hospital called, but he was still irritated when he picked up the phone.

 

“Hello,” said the voice of the social worker, “This is . . . ”

Lorenz knew who it was. I can’t talk now, he said. Let me call you back. He hung up the telephone.

His co-workers immediately resumed their discussion. He tried to join them, but his mind wouldn’t function. The meeting went on, and on. A minute passed. Two. A century. Finally, Lorenz could wait no longer and ended the meeting abruptly: “I have a very important call to do.” Surprised, his coworkers filed out, leaving him alone. Mildly surprised, his coworkers. Not coworkers, they worked for him. My engineers for one program. CF6-80A, a general electric thrust reverser.

 

With great, almost reckless urgency, Lorenz dialed the telephone.

“Congratulations, Mr. Buchser!” said the social worker brightly. “Congratulations . . .”

 

Lorenz’s mind lurched.

. . . congratulations . . .

Lorenz’s world collapsed inward. A tide of exhilaration rushed over him.. . . there has been a terrible mistake. You do not need a heart transplant. We thought you did, but we were wrong . . .”

 

But no. That wasn’t what the voice on the telephone was saying.

“Thank you,” he said, and hung up.

He sat at his desk and forced his mind to function.

There had been a mistake. He had been misdiagnosed. It happened . . . medicine wasn’t perfect, like engineering. He could forgive him, though they’d frightened him almost out of his wits. He’d almost thought . . .

 

But no.

He forced his mind to work logically, rationally. That wasn’t what she had said at all.

 

She had said congratulations. Congratulations, you have been accepted. You will go on the computer tomorrow. With luck, you will get a new heart.

The news cut deeply into his psyche, and it bled.

There had been no mistake.

 

He sat. Time passed, but he had no measure of it.

Dully, he picked up the telephone and punched out his home number. Esther answered on the first ring. There was joy in her voice. Thank goodness, she said, you’re accepted. Isn’t that wonderful?

Wonderful?

 

Lorenz’s mind was dull, but it was beginning to function again.

Wonderful?

They were going to cut out his heart.

Wonderful?

They were going to cut out his heart, and his own wife thought that was wonderful?

A dark storm of rage swept through his mind, and Lorenz said some things to Esther that he would later regret.

 

It took a long time for the storm to clear, but when it did, it was replaced by acceptance.

 

 

-0-

 

 

So Lorenz Butcher was in the computer, on the list. It was almost like expecting a baby; Esther had packed a bag, to have it ready. She would leave Gregory next door, and take the baby to her best friend, who lived nearHopkinsUniversityinBaltimore.

 

Tomorrow, in a week, in eight weeks — maybe never — he would get a new heart.

 

Every time the telephone rang, they jumped.

In the meantime, Lorenz worried about how he was going to pay for the operation and the intensive care that came after.

It cost $50,000, the doctors estimated, plus more for repeat hospitalizations if required. Who would foot the bill?

 

Lorenz had his doubts. He knew Maryland Blue Cross and Blue Shield would pay, but he had private insurance. And from what he had read, most private insurance companies were still saying heart transplantation was an experimental procedure.

 

Helen Michalisko, the social worker with the Johns Hopkins heart transplantation program, said the program had experts who would check into it for him. Later, she called back and assured him that his insurance program would indeed pay for it.

 

Lorenz was skeptical. A careful reading of his insurance policy had not reassured him. Did Helen have a piece of paper somewhere that said they’d pay for it?

Well, not personally. That is, she didn’t have such a piece of paper in her hands. But she was sure that, somewhere in theHopkinsbureaucracy, SOMEONE did. She told Lorenz to quit worrying about it.

 

But he didn’t. He couldn’t. With his family’s future at stake, he was not about to take someone’s unsubstantiated word for it.

That evening, while Esther was doing something in the basement, Lorenz went upstairs and took out his insurance and financial records. He went over them, line by line, and added them up on a pad of paper. The bottom line was that, whatever happened to him, his children would never be as poor as he had been.

 

When he was finished he called Esther in and went over it all in detail, line by line, to make sure she understood it. Yes, she agreed, pain in her voice. She and the children would be all right.

Of course . . .

Of course — and this was a thought that Lorenz kept to himself — there was one possible exception to that outcome. If the social worker was wrong, and his medical insurance wouldn’t pay for the transplant, then all bets were off.

 

If he had the transplant, and died, and Esther had to pay $50,000 out of the insurance, well . . . in that case, the family wouldn’t be in very good shape at all.

 

If the Lorenz’s insurance wouldn’t pay for the transplant, then his wife and children might well be better off if skipped the operation and just died, straight-out, like other people did.

 

The next day at work Lorenz went down to the insurance office and, trying to seem casual, struck up a conversation with the woman who handled the company’s medical insurance.

Just checking, he said . . . he just wanted to understand his policy. It seemed pretty good.

 

It was, said the personnel woman, who proceeded to explain it to him.

He waited patiently until she was finished and then, trying to approach the subject obliquely, mentioned that it certainly did seem to be good insurance. It MUST be, to cover heart transplants and things like that. He knew Blue Cross covered it, but Blue Cross was pretty liberal . . .

 

The woman looked at him, puzzled. Heart transplants? Oh no. She didn’t think it covered things like that.

 

They didn’t?

 

The woman looked confused; she’d obviously never been asked the question before. Probably, she said . . . perhaps someone at the insurance company’s office, out inHuntValley. . . perhaps someone out there would know.

 

She gave Lorenz a telephone number. As soon as he got back to his office he called it, and asked to speak to the supervisor. He asked her the question, straight out. She gave him the answer straight back.

No, she said. Experimental procedures are not covered, and heart transplants are still considered experimental.

 

Lorenz thanked the woman and hung up the telephone.

Well, he thought. This is going to be tough.

He picked up the telephone and called the transplant program social worker at theHopkins. She listened to his story and promised to check into it.

 

Lorenz went back to work, trying with mixed success not to think about it.

God, his life was a shambles. He didn’t have any energy. His work wasn’t what it was; nobody complained, but he could tell the difference and he knew other people could. Sometimes he wished that whatever was going to happen would just . . . happen.

 

But he didn’t have any control over it. The only thing he had any control over, any more, seemed to be his work. He promised himself to do better.

 

Later, Helen called back.  The insurance was okay, she said; theHuntValleysupervisor just hadn’t been told.  There was a private arrangement between the transplant program and the insurance company.

 

January the 9th was a Wednesday. He went in early and, ignoring his fatigue, he worked a full day — unaware that, a hundred miles away, a tragedy was unfolding that would alter his life.

 

Several days earlier a 17-year-oldNorthern Virginiaboy had received severe head injuries in an automobile accident. He’d been rushed to an emergency room, where the doctors had done everything they could, but it wasn’t enough.At first, neurologists could detect a flicker of electrical activity in the boy’s brain, but he remained in a deep coma. As the days passed the flicker grew weaker and weaker, then vanished.

 

Lorenz Buchser and his wife Esther were destined to never know who that boy was, or why his family had chosen to donate his organs to strangers.

Perhaps, as sometimes happens, it was the family itself who had the inspiration — a brother, perhaps, or an uncle, may have grasped the idea that by donating his organs something at least could be salvaged from what otherwise was an unmitigated tragedy. Or it might have been a doctor who mentioned it, or a nurse.

 

All that mattered, in the end, was that a permission form was produced and someone, whoever was designated as next-of-kin, signed it.

Before the ink was dry on the form, the process had begun. Telephones rang. Fingers flew over keyboards, and in the innards of computers data bits danced and flowed, matching names with numbers. There was a liver, a heart, two kidneys, bone, skin, two corneas . . .

 

At about 4 p.m. a telephone rang in the Johns Hopkins transplant center. Was Dr. William Baumgartner in?

 

No, the secretary answered. Dr. Baumgartner was giving a lecture. So the call went instead to the transplant program’s second-in-command, Dr. Michael Borkon. He listened intently as the donor network official read him the details.

 

The dead youth weighed 140 pounds and had type A blood. Lorenz Buchser weighed 145 pounds and also had type A blood.

So far, so good. Yes, said Dr. Borkon. He was plenty interested. But he wanted some reassurances about the condition of the heart.

 

Sometimes the heart escapes injury in the accident, but is damaged by the effects of shock or infection. A transplant surgeon’s nightmare is that he might implant a defective heart, leaving the recipient no better off than he had been before.

 

Was there a cardiologist on the scene, someone who could do an electrocardiogram, look at the X-ray, listen to the heart, do what he could to make sure the organ was in good shape?

The network official said he’d find out, then hung up. About an hour later, Dr. Borkon got another call, this time from a cardiologist. He’d examined the X-ray, done an EKG . . . the whole works, and found nothing alarming.

 

According to the records, the dead boy had been on a powerful heart stimulant shortly after the accident, to make sure he didn’t arrest as a result of shock, but that was several days ago. As far as he could tell, the cardiologist summed it up, the young man was in perfect health — aside from being dead.

 

Dr. Borkon hung up the telephone, then picked it up again. He looked at the clock; it was 7 p.m. It was going to be a long night.

 

Lorenz Buchser, in the meantime, had worked a full day — and then, stubbornly, had put in another hour. Then another. When he got home, he was exhausted.

He rested and read a newspaper while Esther fixed a salad and heated some chili. When it was ready Lorenz moved into the kitchen. He sat at the table with his son, eating salad and chili, while Esther fed the baby.

 

The telephone rang.

It was probably his office calling, Lorenz thought. There would have been a day, a year ago, when he would have jumped up and answered it. But a year ago seemed like another century. Instead, he sat where he was and let Esther answer it.

 

Esther listened for a moment.

“Yes, he is,” she said. “May I ask who’s calling?”

 

She put her hand over the mouthpiece. “Lorenz,” she said. “It’s Dr. Baughman, fromHopkins!”

Lorenz looked at her.

FromHopkins?

Already?

 

Flustered, he hesitated. Then he told Esther to stay on the telephone; he’d get on the basement extension. Hastily he went down stairs and picked up the receiver.

 

“How would you like to have a new heart?” asked Dr. Baughman.

“Uh,” said Lorenz, “Okay.”

“How soon can you be down here?”

“Well,” said Lorenz, looking at his watch. It was 6:45.

 

“We’re eating supper. How about 8?”

“No,” said Dr. Baughman. “How about 7:45?”

From a great distance, Lorenz heard himself negotiate for another 15 minutes. The children . . .

But Dr. Baughman was firm.

“Okay,” Lorenz said into the receiver. And then to Esther: “Let’s go.”

 

Lorenz put the receiver in its cradle and collapsed in a chair. It was like being in a dream.

Why was he crying?

Esther was there, touching him.

“We’ve got to go,” her voice said, husky but strong. “It’s something you’ve got to go through, but you’ll make it. We’re going to make it.”

 

“Absolutely,” Lorenz heard himself say.

Then Esther was on the telephone, alerting her friend inBaltimore.

Young Gregory sensing that something was wrong, grabbed his mother’s dress. “Mommy,” he said, trying to be reassuring, “I really liked the chili.”

 

Lorenz kissed the boy goodbye, and then Esther took him next door. She loaded the folding crib in the car, along with the suitcase, and then got the baby. The half-empty pot of chili sat, cooling, on the stove; the bowls remained on the table.

 

“I’ll drive,” she said, and he let her.

A few minutes earlier a dispatcher at the Medstar trauma center inWashington,D.C., had alerted the organ transportation unit. A pilot, already in his flight suit, climbed into a helicopter. The jet engine whined, then roared to life. The aircraft lifted off into the cold, night sky.

 

At the transplant unit, Dr. Baumgartner and Dr. Borkon worked their way down a memorized checklist, coordinating the events to come. Dr. Borkon would stay atHopkinsand do the operation on Lorenz; he would be assisted by the chief resident, Dr. George J. Magovern, Jr.

 

Dr. Baumgartner, accompanied by Dr. Steve Boling, a resident, and nurse Beth Nacincik, would go get the heart.

 

That settled, preparations began. Dr. Baumgartner, Dr. Boling and nurse Nacincik changed into operating room blues, threw on coats, and headed for the roof of the parking garage. They carried with them two metal suitcases full of instruments and a small red and white Igloo cooler (the size designed to hold two six packs of beer), several Ziplock bags and a Tupperware container.

 

The Buchser’s automobile, in the meantime, sped down Interstate 95, the speedometer climbing to 50, 60, 70 and higher.

 

“Slow down!” he said.

She obeyed, but then the speed began to creep up again and, again, he told her to slow down.

Soon, sooner than the traffic laws permitted, the car pulled to a stop in onKeswick streetinHomewood. Commanding Lorenz to stay in the car, Esther put the crib on the lawn, thrust the baby into the arms of her friend, and slid back behind the wheel. In minutes they were on the Jones Falls Expressway.

 

“Slow down!” he said.

The car whizzed past its exit.

“Don’t worry,” he said. “There’s another exit ahead. Slow down.”

She reached over with her and squeezed his hand.

He picked up her hand and firmly put it back on the steering wheel.

“I’ll worry” he said. “You drive.”

 

It was 7:50 when she pulled the car up outside the emergency entrance toHopkins. In the excitement, they did not notice the wop-wop-wop of the helicopter settling onto the roof of a parking garage across the campus.

 

Then Lorenz was in a wheelchair and they were taking him away.

Esther wanted to go with him, but they wouldn’t let her. She had to sign papers, they said.

 

Esther was furious. Sign papers? PAPERS? She’d already given them all the information they needed, many times. MANY times! And she needed to be with her husband . . .

 

But there is no fighting bureaucracy.

“Buchser,” she said. “B – U – C – H – S – E – R . . . ”

 

Outside, the helicopter roared and lifted into the sky.

Upstairs, in X-ray, Lorenz did as he was told. He stood, chest against the X-ray machine. Then, arms up, he held his breath while they took a side shot.

 

He held out his arm, and a nurse wrapped a blood pressure cuff around it.

They put papers in front him and he scanned them. They said the hospital wasn’t responsible for anything. Having no choice, he signed them.

 

They took him to a small intensive care room off a busy hallway. He stripped and lay down on the hard bed. Someone put a towel over his private parts.

Make a fist. Lay down. Sit up.

All stethoscopes are cold. All needles are sharp.

 

There were a lot of instruments in the room. A nurse stuck EKG leads on him. A big man with a beard and a southern accent came in, talked briefly with a nurse, consulted a bank of electronic instruments, and rushed out.

Where, Lorenz wondered, was Dr. Baumgartner?

 

Dr. Baumgartner sat back in his seat and let the helicopter carry him through the night. It was a beautiful night for flying, crisp and cold. The stars were hard points of light beyond the Plexiglas canopy; theMormonTemplepassed below in its white and gold glory. A few minutes later, on the far side ofWashington, he could see the toweringWashingtonmonument in the distance. TheJeffersonmemorial sat like a alabaster jewel beside the tidal basin.

 

They were making excellent time. Dr. Baumgartner calculated they were flying at, oh, 150 miles an hour.

 

At about 8.20 the helicopter touched down outside a large, modern hospital. Dr. Baumgartner and his teammates ran beneath the rotors and walked quickly into the hospital. Pneumatic doors hissed open. They piled their coats on a chair, scrubbed, and entered the operating room.

 

The dead boy lay on an operating table, his skin white beneath the lights, his chest rising and falling with each stroke of the respirator.

His belly was already open and the kidney team had already begun the process of removing their two organs. They moved a little, making room for Dr. Baumgartner and his assistant to close in around the chest.

 

Dr. Baumgartner’s knife cut deep into the still-living body of the brain-dead boy.

 

The clock on the wall said 8.45.

Back at the Hopkins Lorenz Buchser lay, almost nude, on the bed while three nurses and a doctor rushed around him. Everybody was in a hurry.

Esther came in and stood by his side for a moment, holding his hand. But she was definitely in the way, and it wasn’t long before she had backed into a corner.

 

A nurse pushed a sheet-covered gurney into the room.

When did you last eat?

Make a fist.

The needle dimpled the skin as it went into his left arm. The syringe filled quickly with blood, and someone took it and ran, somewhere . . .

 

The thought hit him: My God, this is real.

 

But there was no time to think.

A tall young man in a white coat stood in the doorway. It was Dr. Borkon. Lorenz had met him before, he knew; the name sounded familiar, but the face meant nothing. Anyway, he’d thought Dr. Baumgartner was going to do the surgery. Apparently not. The change was confusing, but he was in no position to haggle.

 

“Hello, Dr. Borkon,” said Lorenz.

Esther stared at her husband, a haunted look on her face.

“Are you ready?” asked the surgeon.

“I’m ready,” Lorenz heard himself say in a steady voice. “Let’s go.”

 

 

 

-0-

 

 

It was 8.50 when they wheeled Lorenz Butcher out of the room, down the hall and around the corner. The pneumatic double doors hissed open in front of them and they went through and, without a pause, continued into a room on the right. There, they transferred Lorenz to a stainless steel table..

 

Lorenz tried to relax, but it wasn’t easy. Because his heart was so weak, he hadn’t been given the usual pre-operation tranquilizers. So he lay there on the steel table, his eyes nervously darting around the room, taking in the green-draped equipment and following the half-dozen nurses and doctors. Everybody but Lorenz had a mask.

 

He was cold.

They were going to take out his heart and give him a new one. Then everything would be different. He would get well, or he would die. Either way, the sickness that had marred his life since May was over.

 

His hands started shaking, and he couldn’t stop them. He licked his lips.A long time seemed to pass, though in reality it was only minutes, before a big man with a beard approached the table, put a hand on Lorenz’s left shoulder, and introduced himself as Dr. Robert L. Stevenson, the anesthesiologist.

 

“We’re not really ignoring you,” he said in a melodious southern accent. “We’ve just got a lot to do. Besides, when we get done we’re going to start sticking needles in you so you’d probably just as soon we ignored you.”

 

Lorenz laughed. It felt good.

The anesthesiologist left, and a nurse came and put a blanket over Lorenz. But he was still cold.

He wondered where his new heart was coming from, but it was an abstract, idle curiosity. He didn’t really care. Lorenz didn’t really care about anything, except getting through this minute, and the next.

 

The nurses had attached EKG sensors to Lorenz’s chest before bringing him to the OR. Now, an anesthesiology resident ran wires from the contacts to a nearby bank of instruments.

 

A tiny amber light began to flash with each heartbeat. A glowing dot moved across an oscilloscope screen, leaving behind it the graceful, repetitive tracing of the heart’s rising and falling electrical potential. Below the screen, a paper record slowly rolled out and fell, folding, into a bin below.

 

The anesthesiologist’s eyes focused intently on the readouts. Lorenz’s heart was in terrible, terrible shape. But then, on the other hand, if it weren’t in terrible shape Lorenz wouldn’t be here.

 

Well, that heart would only have to last another hour or an hour and a half at the most.

“Okay,” Dr. Stevenson finally said to the room at large, “You about ready for action?”

Everyone answered yes except Lorenz, but Lorenz was ready too. As ready as he would ever be. He looked up at the anesthesiologist as the man moved back to his side, picked up his wrist, and started counting the pulse rate.The clock said 9.24. On the wall underneath it a nurse stuck up a wide piece of masking tape with, “Buchser 66.5 kilograms” written on it.

 

“This is going to smart a little,” said the anesthesiologist, producing a thick needle. “You ready?”

“Yes,” said Lorenz, then winced as the needle pierced the skin on top of his right hand. Expertly, Dr. Stevenson found a vein, slid the needle into it, and taped it down. Then he attached the needle’s fitting to a plastic tube that ran up to an IV bottle.

 

Another doctor pushed a needle into Lorenz’s other hand and injected a local anesthetic. Then he slid a blood pressure probe into an artery. Lorenz studiously looked the other way.

 

It was 9:28. The pace was picking up.

A physician’s assistant smeared shaving cream over Lorenz’s chest and, producing a safety razor, began to shave. Lorenz was now totally surrounded by people, all paying attention to his body but leaving him, Lorenz, the man inside the body, completely alone. Lorenz stared up at the ceiling.

 

The anesthesiologist studied the tracing of the heart. The rate was fast, too fast. Well, the anesthesiologist’s own heart would be racing if he were laying on the table instead of Lorenz. A little Valium, he decided, might be in order.

 

9.29.

“You’re going to feel a little drowsy now,” said Dr. Stevenson as he injected the Valium into an IV line.

 

Lorenz stared at the ceiling.

9.30.

9.31.

“Can you feel it yet?” asked Dr. Stevenson.

“No,” said Lorenz. “I don’t feel anything.”

“Well,” said the doctor, “when you can smile without trying hard you’ll know you’re getting the medicine.”

Lorenz smiled a trembling, thin smile. Then, almost inexplicably, the smile broadened into a woozy grin.Lorenz’s hands were no longer shaking. He committed himself to the room, to the hands of the doctors, to the future, to the soothing mercies of the Valium.

 

More people entered the room. A nurse began breaking open sterile packs and two perfusion technicians undraped the heart-lung machine and stood beside it, scrutinizing a clipboard.

9.40.

Lorenz stared at the ceiling.

The anesthesiologist turned a valve, and the anesthetic rushed into Lorenz’s veins.

 

9.41

Lorenz was suddenly sleepy. He gave a half-yawn and closed his eyes.

His heartbeat stuttered, jumped, hiccoughed. Dr. Stevenson’s head snapped around toward the glowing dot on the oscilloscope screen. Every eye in the room followed his.

 

The glowing dot jumped, shuddered unsteadily, leaped, fell, and lapsed into the meaningless vibrations called fibrillation. The blood pressure reading fell precipitously to zero.

It was what doctors call a “sudden death” heart attack.

 

9.42.

The reaction of the team was instant, silent, complete.

The anesthesiologist moved quickly to his patient’s side, crossed his hands one over the other over Lorenz’s heart, and began to push, rhythmically. A nurse tore open a package of emergency supplies. A resident anthesthesiologist clamped an oxygen mask over Lorenz’s face. The heart-lung technicians stood and stared.

 

“Lidocaine,” snapped the anesthesiologist. Lidocaine might quiet the fibrillation.

Lorenz’s skin, already purple from lack of oxygen, slowly darkened as his tissues began to suffocate.

 

A nurse prepared the defibrillator paddles.

9:45.

 

Dr. George J. Magovern, Jr., the chief resident and the man assigned to assist Dr. Borkon during the transplant, ran down the hallway outside and burst into the room. There he stopped, his eyes on the oscilloscope. The anesthesiologist pushed rhythmically against Lorenz’s chest. One.Two. Three . . .

 

Dr. Magovern took in the scene, thinking fast. He would have to crack the chest . . .

 

“Okay!” he snapped to the nurses. “Let’s set up!”

The order had already been anticipated. Two nurses, communicating in urgent whispers, begin tearing open sterile packages. Stainless steel instruments clatter like silverware.

The anesthesiologist ignored what’s going on around him. He pushes on the chest and watches the oscilloscope. Five, six, seven . . .

Suddenly the dot bounces high, vibrates, bounces high again. Dr. Stevenson’s own heart leaps, now; the blood pressure reading begins, slowly, to climb.

 

The surgeon hesitates, his eyes, too, fixed on the oscilloscope. Perhaps . . .

Slowly, Lorenz’s natural heart rhythm is beginning to reestablish itself. The anesthesiologist lifts his hands from the chest and stands back, hopefully.

 

The pulse is rapid, 165. But at least there is a pulse.

9:49

Then the rhythm collapses again into fibrillation and again the blood pressure falls. The anesthesiologist steps back, resumes closed chest heart massage. One, two, three . . .

 

Dr. Michael Borkon, the lead surgeon on the transplant team today, comes through the doors just as Lorenz’s heart recovers a second time, the zigzag tracing of death reverting *suddenly to the rhythmic bounce of life.

Sighing, the anesthesiologist steps back for the second time.

 

Dr. Borkon’s eyes join the others, watching the bouncing dot. Clearly, Lorenz’s heart is dying. If only it can be kept beating . . . . But can it be?

InVirginia, in the meantime, Dr. Baumgartner and his assistant had carefully opened the dead boy’s chest and isolated the heart. Carefully, hopefully, Dr. Baumgartner’s hands palpated the chambers with his rubber-gloved hands, feeling the reassuring strength of the heart. He concentrated, trying to feel the distinctive buzz, what cardiac surgeons call a “thrill,” that would signify a valve defect. There was none. Good.

 

Carefully, he examined the organ. There was always the danger that it had been bruised in the accident. But this heart seemed in good condition.

A few minutes later, in the operating suites at theHopkins, Dr. Borkon picked up the telephone.

 

The heart was fine, reported Dr. Baumgartner.

That was great, said Dr. Borkon. Unfortunately, the same could not be said for Lorenz Buchser.

Dr. Baumgartner listened soberly to Dr. Borkon’s description of the two heart attacks. In light of that development, they agreed, they should change their procedure.

 

Normally the operation on the recipient’s chest is timed to coincide with the arrival of the new heart. This both minimizes the time the new heart must be without oxygen and also minimizes the time that the patient is under anesthesia. By that timetable Dr. Borkon wouldn’t begin cutting for almost an hour.

 

But now, in view of Lorenz’s grave condition, the plans changed. It would be a shame, a crying shame and a terrible waste, for Dr. Baumgartner to arrive with the new heart to find that the patient for whom it was intended had died in the interim.

 

The best course of action, the two surgeons agreed, was to go ahead and open Lorenz’s chest now. Then they’d wait with the chest open and the heart-lung machine hooked in and ready to go. That way, if Lorenz’s heart fibrillated again they’d have direct access to it. Maybe they could restart it again. If not, they could at least go on bypass.Agreed, the two surgeons hung up the telephone and went back to their respective tasks.

 

In theHopkinsOR, Dr. Borkon and Dr. Magovern stood for a moment, talking in low tones, then Dr. Borkon turned and went back outside, into the hallway, to stand before the deep sink for the ritual washing on the hands.

 

Inside, the team began its preparations. The ancient Aztecs placed a stone beneath their sacrificial victims, causing the chest to arch up and better expose the heart; now, a pillow serves the same purpose. Then a physician’s assistant covered Lorenz with layer after layer of green surgical drapes.

 

By the time Dr. Borkon reentered the room, his patient was all but invisible.

The process of opening the chest is the same for a transplant as it is for the most routine of heart operations, and the team knows the procedure by rote. A sensor was threaded through the jugular vein down into Lorenz’s heart. A flexible temperature probe disappeared into his left nostril.

 

There is a radio in the far corner of the operating room, and the circulating nurse turns on the dial. Classical music fills the room. The bypass technicians begin adding the first of four pints of blood to the heart-lung machine.

 

Restlessly, ceaselessly, the anesthesiologist’s eyes darted from one sensor to another, checking, checking.

 

“Scalpel,” said Dr. Magovern, and the scrub nurse laid it in his hand.

At 10 minutes after 10 the blade parted the skin deep, scoring Lorenz’s breastbone. Blood bubbled up. Suction. The field was cleared and the bleeders were sealed with the electric heat of a cauterizing instrument. The bone saw buzzes angrily, splitting the ribcage down the middle.

 

A large retractor forcefully pulls the two halves apart and the surgeons peer into Lorenz Buchser’s chest.

 

Far away inVirginia, Dr. Baumgartner has inserted a tube into the aorta of the donor’s heart. Now, at his command, a very cold solution of potassium chloride flows through the tube and into the  coronary arteries.  Instantly, the heart stops beating.

 

Now, the two surgeons work quickly; time is of the essence. The sooner they can get this heart into Lorenz Buchser’s body, and start it beating again, the better. As the organ cools, rapidly, the two surgeons carefully cut it free.

 

AtHopkins, the two surgeons stare into Lorenz Butcher’s chest. The organ is huge and purple. The assisting surgeon makes a whistling sound between his teeth and then, carefully, cuts open the thin, enclosing sac of the pericardium.

The chief heart-lung technician reports that the bypass pump is ready. Dr. Borkon glances up at the clock.

 

It is 10.34.

The next step is to connect Lorenz’s circulatory system into the thick plastic tubes that run to the heart-lung pump. This involves stitching fittings into the right atrium of the heart, from which blood will be carried to the machine, and the aorta, to which it will return.

 

Dr. Magovern has both hands deep in Lorenz’s chest; Dr. Borkon wears a headlight, similar to a miner’s light, on his forehead. Someone changes the station on the radio, cutting off the classical music in mid-note. Now a rock singer screams unintelligible phrases into the room.

 

One by one, the plastic tubes are stitched into the atrium and aorta, but they remain clamped. The heart-lung machine, miraculous as it may be, does not duplicate the chemical and metabolic activity of the heart, and the longer a patient is on bypass the sicker he will usually be afterwards.

 

So Dr. Borkon’s intention isn’t to switch his patient to bypass, not if he can help it. He just wants it ready to go in case Lorenz’s heart fails again.

 

Which in fact, Dr. Borkon says as he stares at it, it might well.

At 10:53 the bypass hook-up is complete. Now, should Lorenz’s heart stop again, the heart-lung machine could take over in seconds.

 

Now the surgeons absently clean the blood from their gloves with cotton pads, wet with a saline solution.”Look at it,” says the junior surgeon, staring, fascinated, into the open chest cavity at the dying heart. “It must be five times its normal size.”

 

“And notice the way it shudders,” adds Dr. Borkon. “When it beats it should snap — there should be a strong, healthy snap. Instead it just sort of shudders. That’s a very angry-looking heart.”

Ten minutes pass, then twenty. The surgeons stand, resting their sterile hands idly on surgical drapes. Occasionally Dr. Magovern squirts a syringe full of sterile water into the cavity, watches it mix with the seeping blood and turn pink, then sucks it out.

 

InVirginia, Dr. Baumgartner and the resident lift the cold heart from the dead boy’s  chest and put it into a plastic bag. The bag is tied off at the top and the excess plastic cut away. Then the bag with the heart in it goes into another bag, this one filled with ice-cold saline solution. That bag is tied, and put into the Tupperware container, which in turn goes into the Igloo.

 

The nurse, in the meantime, has been hurriedly gathering up the team’s instruments. Now she shuts the second case and snaps the lock. Dr. Baumgartner’s gloves come off with a snap.

 

The anesthesiologist has turned off the respirator, now, and the brain-dead boy, split open by the surgeons, lies white and still. As theHopkinsteam rush from the room, a junior resident begins the job of stitching up the body for the undertaker.

 

 

 

-0-

 

 

AtJohnsHopkinsHospital, the heart transplant surgeons wait patiently, one on each side of Lorenz Butcher’s open chest.

 

The two bypass technicians sit in front of their machine, watching the flashing lights and flickering numbers, handing a clipboard back and forth, checking, checking. If the patient’s heart stops again, its function will be transferred immediately to the heart-lung machine.”Strange dreams,” the rock singer shrieks from the corner. “Strange dreams!”

 

At 11:17, there is a sharp click from a squawk box high on the wall.

“Dr. Borkon?” said a tinny, feminine voice.

“Yes,” replied the surgeon.

“Dr. Baumgartner just called. He’s on his way. He expects to be there in 15 minutes.

A rock singer yells semi-intelligible stanzas about sadness, unrequited love, a broken heart. Dr. Magovern squirts saline solution over Lorenz Butcher’s heart, then sucks it out.

 

The minute hand crawls slowly across the face of the clock. 11:23. 11:26. 11:31.

 

Dr. Borkon tells a nervous joke; the scrub nurse laughs too loudly.

 

11:35. Owwwwwwwwwww croons a feminine voice from the radio. Owwwwwwwww, owwwwwwww, owwwwwwww.

At 11:38 the operating door opens partially and a nurse, holding a mask over her face with her right hand, said, “It’s here!”

 

One of the bypass technicians tilts his head toward his partner; his partner listens, nods, and adjusts a dial. Hemostats unclamp the plastic line and Lorenz Butcher’s blood, destined for his failing heart, begins flowing instead to the machine.

 

Now the OR door swings wide and the resident comes through with the Igloo cooler in his right hand. A nurse breaks open a new tray. Dr. Magovern reaches purposefully into Lorenz Butcher’s chest. Suddenly, everyone seems do be doing something.

 

11:41.

Hemostats come off the bypass tubes, and blood rushes into the machine and back again into Lorenz Buchser’s body. Scissors snap into Dr. Magovern’s hand, and he begins to cut the old heart free.

On the heart monitor, the glowing dot moves, flat, across the screen. The igloo cooler, still unopened, sits on the floor at the far side of the OR.Dr. Baumgartner, scrubbed once again, enters the room.

 

11:52. Dr. Borkon reaches beneath Lorenz’s heart. It moves freely. The scissors slice through an artery, then a vein.

 

A minute passes. Someone opens the cooler, removes the Tupperware container, and sets it on a steel tray. The resident opens it and takes out the plastic bag. Scissors slice through the first bag, and the cold saline solution rushes out.

 

The new heart, red as a rump roast on a supermarket shelf, seems small and quiet. The final bag is cut free and lets the heart slides gently into a shiny metal pan. The resident squirts a syringe full of saline solution over it.

On the operating table, Dr. Magovern hands his scissors to the scrub nurse, reaches in, and lifts out Lorenz Butcher’s heart.

 

The chief resident pauses for an instant, Lorenz Butcher’s heart held above his open chest. It is huge and, in death, flaccid as a hunk of soft rubber. Everyone in the room stares at it.

 

The scrub nurse holds out a kidney-shaped pan, breaking the spell; Dr. Magovern drops the heart into it. The scrub nurse passes the tray to a pathologist, who disappears with it. Perhaps, before all the life is gone from it, it will reveal some hint of the disease process that led to this moment.

 

The hole in Lorenz Butcher’s chest gapes wide. The diaphragm is white and still. The peristaltic pumps of the heart lung machine silently move around and around and around.

 

A resident holds the new heart in its tray. “Are you ready?” he asks. “Do you want it up there?”

“In a minute,” says Dr. Borkon, examining the chest cavity. “Uh . . . okay.”

The second hand moves around. It is six minutes after midnight. The new heart passes to the scrub nurse, then to Dr. Magovern. He picks up the heart, lowers it into the cavity, then take it out again. Momentarily, he and Dr. Borkon discuss how the new heart, so much smaller than the old, should be positioned.There is also the question of how it should be cut, to best fit the dangling arteries and veins. One surgeon holds, then the other trims. The heart-lung pumps go round and round and round. Lights flash. The glowing dot of the heart monitor moves, flat, across the screen. The heart is gently laid in place.

 

A nurse notes the time: It is exactly midnight.

The scrub nurse hands Dr. Borkon a pair of forceps-like needle holders, a tiny curved needle clamped tightly in its beak. The needle hooks through what remains of Lorenz Buchser’s atrium, then the ragged edge of the new heart. The needle comes out of the hole and it, along with the end of the suture, is carefully laid aside.

 

Another set of needle holders snaps into the surgeon’s hands, then another. It is a careful, tedious process. The assisting surgeon keeps the threads straight.

 

It is 12.10. The roller pumps on the heart-lung machine turn silently. One by one, the sutures go in. It is a silent, tedious job, but not one that carries the surgeons to the frontiers of surgery. For decades surgeons have practiced most of these procedures; a heart transplant simply puts them all together, at one time.

 

Ten minutes pass. Twenty.

Finally the sutures are in and one by one the surgeons pull them tight, snugging the old tissue against the new. Dr. Magovern cuts off the needles.  Expertly, Dr. Borkon twists one thread around another, and the first knot travels down into the chest. Then he ties another, and another, and another. Tight, but not too tight.

 

Love, croons the rock singer. Love. A nurse ducks out to have a cigarette in the dressing room.

 

12.48.

The knots are all tied, now, the loose ends of the sutures have been clipped off. The two surgeons stand for a moment, checking and admiring their work. Dr. Borkon unclamps the aorta, and warming blood rushes into the cold tissue of the heart.

 

On the monitor, the moving dot twitches, then twitches again. The heart is getting some electrical activity back. A nurse prepares the defibrillator paddles, in case it needs to be shocked into a rhythm.

 

The heart vibrates, then convulses. On the screen the dot leaps high and the blood pressure monitor twitches, an instant later, in response.

“Look at it!” a junior anesthesiologist says, awe in his voice. “That sucker’s starting to beat on its own!”

 

“It’s a good heart,” said Dr. Borkon.

Twitch. Twitch. Twitch-twitch convulse. Convulse.

The two surgeons stare intently at the awakening heart, watching for leakage around the suture lines. That is a major problem with heart transplants: There are so many suture lines, so many opportunities for seepage. To make it worse, a transplant patient must be given blood thinners before surgery to prevent his blood from clotting as it passes through the heart-lung machine.

 

Dr. Magovern empties a syringe of warm sterile water into the cavity and then removes it with a sucker. Both surgeons stare, searching for fresh blood.

 

The heart beats; it is clearly a beat, this time, not just a convulsion. The scrub nurse produces a pacemaker; its wire will be tied in to the new heart, just in case. But if all goes well it will be removed in a few days.

 

The heart beats again. On the screen the dot bounces, bounces again, vibrates, then bounces again. The two surgeons stare into Lorenz’s chest, searching for leaks.

 

Minute by minute the heart comes alive. Finally, Dr. Borkon calls for the defibrillator paddles. He places one paddle on each side of the heart and there is a sharp snap as the electricity flows. Instantly, the heart settles down into a strong rhythm.

 

Dr. Borkon hands the paddles to the nurse, not taking his eyes off the heart. It beats strongly, perfectly.

“That’s pretty, isn’t it?” says Dr. Borkon. “There are damned few things prettier than that.”The clock says 1 a.m. 1.10. 1.20.

The surgeons begin to prepare the plastic bypass tubes for removal as the heart-lung operators begin the process of shutting down their equipment. Each tube comes out of the heart, and the hole is closed almost immediately by a the same purse-string suture that held it in place. But each time, a little blood is lost.

 

Dr. Magovern washes the cavity, suctions out the water, and the surgeons search for leaks.

The disconnect procedure goes slowly, with infinite care. One mistake here, and they will have to reoperate to stop the bleeding.

 

The bypass technicians begin to roll their equipment back out of the way.

Finally, at 1.30, Dr. Borkon steps back; Dr. Magovern will finish, now. A resident steps up to assist.

Outside, Dr. Baumgartner is waiting in the tiny glass-enclosed nurse’s station that guards the operating room doors. Dr. Borkon comes in and settles into a chair.

 

“He’s super,” says the younger surgeon, grinning tiredly and absently rubbing his right shoulder. “It went super, he looks super. How was your trip?”

 

“It was a pretty night,” said Dr. Baumgartner. “You should have seen theJeffersonmemorial. It was all lit up; it was beautiful.”

Dr. Baumgartner fished a piece of paper out of his pocket.

Mrs. Buchser waited several hours in the waiting room, accompanied by her friends fromHomewood. Then they took her home with them, leaving their number with a nurse. Now Dr. Baumgartner punches it out. The telephone rings. It rings again, and again, and again.

 

Finally, he hangs up the telephone. “Maybe she came back here,” he said. He glanced at the clock.”You know,” he said, “they almost always happen at night. In fact, this is early. I can’t believe it; here it is, only 2 o’clock. They’ll be done in there before 3. Usually it’s 6 or 7.”

 

Dr. Baumgartner got up, announcing he was going to duck back into the OR for a moment, to check on some things.

 

Dr. Borkon remained in his chair, remembering his first transplant. It had been in 1983, at theHopkins. Afterwards, like a sleepwalker, he had gone up to the roof of the parking garage, to the deserted helicopter pad, and stood there. It was just before dawn. The stars were out. There was no traffic.

 

“I was really . . . humble,” he said. “You read stuff about surgeons and egos, but your ego doesn’t inflate. Instead, you feel an incredible humility. We all feel that.

 

“This is a real emotional business. The transplants . . . they aren’t like regular patients.  Regular patients are in the hospital for a week, and maybe you see them once after the operation. Unfortunately, it is rather impersonal. But it’s not like that with the transplant patients.

 

“We see them beforehand, we evaluate them, we learn something about their lives, and who they are, and we agonize over whether they are appropriate candidates. Then we do the operation and take care of them for the next month in the hospital and then . . . forever.

 

“You become attached to them and then when something . . . when something unfortunate happens to one . . . rejection . . . or infection that takes their life . . . it’s like losing a brother or sister . . . ”

 

His voice trailed off, then picked up again.

 

 

“It’s funny. I’m almost 35. I’ll be 35 this year. This is really corny but . . .

 

My dad was a doctor and I had always been interested in biology. I cut out frog’s hearts and did a whole bunch of things. At an early age I had the mystique of being a heart surgeon. I made heart models.  Did all those crazy things kids do.”Then, when I graduated . . . that’s when Christian Bernard did his first transplant. I was struck by that. It made me stop and think, but I never dreamed I’d be here . . . I sort of laugh at it every once and a while, but I’m very humbled by all of this. I’m just . . . ”

 

He paused, searching for a word.

“. . . grateful . . .

 

“I get a thrill . . . it was really a thrill in there, seeing that heart start up. The heart is a phenomenal organ. You can stop it and put it in an igloo that you put a six pack of beer in and transport up to a thousand miles and have the damn thing work!”

 

Dr. Baumgartner stood in the door. Everything was fine, he said, in the OR. TheHopkins’ eighteenth heart transplant was doing fine, perfectly.

“Stay where you are,” he said to Dr. Borkon, pulling the OR cap from his head. “I’m going to see if I can find Mrs. Buchser.”

 

The outer doors hissed open in front of him and he walked slowly down the hallway to the waiting room. There were perhaps a dozen people in the room, and they all anxiously looked up at him as he entered. But he didn’t see who he was looking for.

 

“Mrs. Buchser?” he said to the room. No one answered.

Thoughtfully, Dr. Baumgartner walked back outside. Perhaps she was on her way. Perhaps . . .

There was another waiting room, a smaller one. He walked down the hall, around the corner, and into the room. There were three people there; a man and two women. Mrs. Buchser jumped to her feet.

 

“It went perfectly,” Dr. Baumgartner said. “He’s still in the operating room . . . they’re finishing up. But, gosh everything went just like clockwork.  That new heart is ticking away like crazy . . . as soon as we put it in it started right up and we are very pleased with that . . . ”

 

Esther Buchser’s face was impassive but her eyes stared, unblinking, at the doctor.

 

She had questions, and she asked him.

 

His heart had been terrible. It had even stopped. Twice. But all had gone well. He was only on the heart-lung machine for less than two hours.

Her mind clung to each word as though it were a pillar, and yet the words themselves, their meanings, didn’t register. Except . . .

 

Except that it was over.

It was over. Or . . .

Had it just begun?

For some reason, she had no tears to cry.

She swayed, slightly, on her feet. Firmly, her friend’s arm circled around her shoulder.

 

 

-0-

 

 

For hours after the heart transplant operation, Lorenz Buchser lay senseless and isolated in room 664 as, outside the window over the foot of his bed, the sun rose on a crisp, cold January 10. A nurse, gloved, capped, masked and wrapped in a sterile yellow gown, moved briskly around the room checking the various wires and tubes who led to her patient. High on the wall over Lorenz’s right shoulder a screen recorded the strong, rhythmic beating of a 17-year-old heart.

 

Morphine flowed in Lorenz’s veins, and he felt almost nothing — and what little he did feel, hurt. Sometimes he grew restless, and the morphine drip was increased.

 

The nurse made entries in her log book.

Inside Lorenz’s brain, some light flickered. He was choking. He was choking to death.

 

Some deep instinct, something far below the level at which Lorenz Butcher was Lorenz Butcher, directed his hand. There was something in his mouth, blocking his throat. He tried to pull it out. But someone held his hands down, and the morphine dripped, and he forgot it.

 

The respirator clicked and hummed.Time passed. It was light outside. Then it was dark. There was a muffled roaring in the background.

Outside, in the antechamber to the clean room, a nurse explained to Esther the procedure she must use each time she visits her husband. Paper booties go over her shoes, a yellow robe around her body, a paper hat on her head.

 

Lorenz is already taking two suppressants: prednisone and the new drug, cyclosporine. Together they keep his immune system from rejecting his new heart, but they also, now and forever, lower his resistance to infection. His unhealed surgical wounds, coupled with the puncturing presence of the IV needles, make his especially vulnerable during this first few days after the operation.

 

Esther ties a mask around her nose and mouth and pulls on rubber gloves. When she is finished, nothing of Esther Buchser is visible except her eyes.

The nurse opens the door to the clean room. She is smiling; Esther can tell by the wrinkles around her eyes.

 

“Thank you,” said Esther Buchser, and stepped inside. Her ears were filled with the roar of the air filter.

Esther went right to her husband. The nurse said he was doing very well. His vital signs were as expected. His kidneys were producing urine. He showed no signs of internal bleeding around the sutures.

 

She stared at him. He was different, somehow . . .

They had told her he would know she was here, even if he made no sign. They had told her to touch him. So she did. He didn’t respond.

The nurse adjusted the drip on an IV, checked a computer readout, entered something in a log book. The air filter roared.

 

There were hands touching him.

Familiar hands even through the barrier of rubber gloves. A comforting voice he knew, a smooth voice from somewhere in the past, or was it the future?

 

He was choking.

Dimly: He was alive.

An alarm beeped.

 

He was choking.

He was choking.

He was choking to death!

Desperately, he tried to rip the thing from his mouth, from his throat. But his hands wouldn’t obey.

 

Esther stared at his feet, and suddenly it dawned on her what was so different.

Lorenz’s skin had changed color so slowly, over so many months, that Esther hadn’t noticed her husband had turned purple. But now his feet were pink! Healthy pink.

 

The nurse was there. “He’s waking up,” she explained, slipping a hypodermic needle into one of the IV lines and pressing the plunger. “That’s why I had to tie his hands. Otherwise, he’d pull out the respirator tube.”

Esther nodded. So she touched his shoulder, and spoke to him in Swiss-German. Somehow, that seemed to quiet him.

 

He fought for consciousness, but each time he did, each time he seemed to be winning, he began to choke to death. He struggled, again and again, to rip away the thing in his throat.

 

That was the respirator? Was that what the nurse said? Oh.

And then the feeling overwhelmed him again: He was choking to death! He struggled, he fought, but he had no strength, and he lost.

There was a window, and it was dark outside. Was that a siren he heard, behind the muffled roar?

 

He was in the hospital. He had a new heart. The doctor, the man behind the mask, said he had a new heart. The man said he was fine, he was doing well, but that they couldn’t remove the respirator tube. Not yet. Not yet?

 

When?

 

But he couldn’t ask, with the tube in his throat.

He tried to be patient, but the minutes crawled. Everything in him cried out that he was choking to death!

Behind the choking feeling was something else.

Pain.Esther’s face, Esther’s voice. The children were fine. Everyone was fine. He was fine.

 

He had a new heart.

Someone else’s heart.

It was someone else’s heart, but it wasn’t someone else’s life. It was his own life. The heart was a pump, that was all. A pump.

It was all very academic. What was not academic, screamed every panicky neuron in his skull, was that he was choking to death!

 

Moments passed, and he forgot them. Other moments, moments of agony and panic, hung forever in his head. It was light outside. It was dark. He heard a nurse’s voice, and then it was a different voice, then it was his wife’s. The children were okay.

 

Children.

I’m choking to death! He panicked, struggled to grasp the offending tube, to pull it out. But he couldn’t raise his hands. He settled down to fight the panic, and did. He relaxed.

 

It exploded in his brain: I’m choking to death!

He was not afraid of death. Death wouldn’t hurt. Death was absence of panic.

Take me home! he tried to scream to Esther, but his vocal tubes couldn’t respond with the respirator tube jammed between them. Take me home! Take me home! I’m choking to death!

 

Esther held his hand, touched his shoulder. Time passed. There was a nurse’s voice on an intercom. An alarm went off, then abruptly ceased beeping. Two nurses and a doctor conferred in murmurs at the foot of his bed. Someone touched one of his toes and said something in an awed voice about color.

 

The window looked out on the eves of an ancient building. It had a slate roof, and there were pigeons walking on it.

 

Lorenz looked at the ceiling. Willing time to pass. Minute by painful, choking minute, it did.

 

The nurse untied his hands. Immediately, involuntarily, they grabbed for the respirator tube protruding from his mouth. Gently but firmly, she pulled his hands back down.

 

The nurse seemed strong, strong. Lorenz felt like a baby.

Time passed. It was day. It was night. It was day. An alarm went off. The air filter roared. The doctor said he was doing fine, fine, fine, fine . . . fine, hell!

He was choking to death!

Finally, they took the tube out.

It was good to be able to breathe, clearly, fully, like a human being . . .

But the removal of the tube unmasked something else: pain. Pain in his raw throat, pain in his chest, pain with each breath. He could breathe now, but he was bathed in pain.

 

He felt something . . . something adult . . . slip away.

He took his first oral dose of immune suppressant.

Later that day a headache germinated somewhere behind his eyes and, from that focus it spread through his skull, pounding, throbbing, sending pain reverberating through his very being. He had never had a headache before, he didn’t know they could be so bad!

 

His stomach churned and heaved. He vomited, and vomited again.

“Take me home,” he begged Esther. He didn’t care about dying, he didn’t care about anything. “Just take me home.”

 

Esther explained patiently that she couldn’t. He needed the doctors and the nurses to care for him. She spoke as though he were a child. He turned his head, anger filling his brain. Anger at Esther, at the doctors, at the nurses, at the room, at the pain . . .

 

The winter Olympics were on, Esther said. He had looked forward to watching them for months. Should she turn on the television set.

No!

He turned his head. Petulant tears filled his eyes. I want to die.It was light outside the window. Esther came, and went, but the nurses were always there. Slowly, ever so slowly, the pain began to subside.

 

It was replaced by . . . boredom.

He asked the nurse for a newspaper. She refused. There was no way to sterilize a newspaper.

 

He looked at the ceiling, watched the hands of the clock.

A sudden curiosity. What day was it?

Monday, said Esther. Monday.

He tried the television.

Turn it off, he said. Turn it off.

 

Instead, he watched the pigeons on the roof across the way.

Slowly, an awareness slipped into his mind. The worst was over. A few more days, and he would be out of this place. Just a few more days.

With a nurse’s help, he sat up. It was a labor.

 

The next day, he sat up in a chair.

The day after that, two physical therapists came in, pushing a sterile exercise bicycle.

Lorenz looked at the bicycle.

He was going to make it.

 

He was going to get out of here.

 

 

They taught him to do exercises, sitting in a chair. Raise the right leg, raise the left leg. Raise the right leg, raise the left leg.

 

He felt a little silly at first, but he didn’t mind. It was, at least, something to do. Right leg, left leg, right leg. They gave him a device to blow on; his breath drove a little ball up a tube. Blow on it every hour, they told him, and he obeyed. Again, it was something to do.

 

Finally . . . boredom is pain, too. And enough is enough.

This time Lorenz was firm. He wanted a newspaper.

The nurse was sorry . . .

 

No, Lorenz explained. She didn’t understand. He wanted a newspaper . . .

That was his flat, non-negotiable offer, an offer without compromise. He wanted a newspaper, and he was going to get a newspaper if he had to get permission from the supreme court.

 

The nurse looked at him, understanding better than Lorenz did what was going on. But this . . . this posed a technical problem. Someone on a higher level than she would have to decide if it was worth the risk.

All right, she said, she’d see what she could do.

 

Lorenz didn’t know how far the appeal went, and he didn’t really care. All he cared was that, in the end, a newspaper was produced.

The decision fell to Dr. Borkon. Okay.

He had asserted himself, and had carried the day.

 

He focused on the newspaper like a starving child focuses on a dish of chocolate ice cream.

Only rarely did it occur to him that a dead boy’s heart beat in his chest. A heart was a pump, after all. There was nothing mystical about a heart, as long as you had one. It was the brain that counted, and Lorenz’s brain was good, very good. And it was very much his own.

 

He turned the page of the paper. The stock market was doing fine. There was a blizzard somewhere out west. Different factions of the Palestinian Liberation Army were locked in combat. The MX missile was either absolutely necessary to the nation’s defense or it was a Republican boondoggle designed to funnel money into the pockets of the military industrial complex. Inflation was going wild inIsrael.

 

Lorenz looked up at the pigeons outside the prison window.

God, but he hated hospitals!

 

 

-0-

 

In the days that followed, Lorenz Buchser did his exercises religiously. He blew on the device designed to increase his lung capacity. He raised his right leg, his left leg, his right leg, his left leg. The physical therapists brought in a sterilized exercycle, and he mounted and rode it mile after mile, going nowhere.

 

Slowly, he began to recover his strength. He could walk on his own, now, pushing the pole with the IV tube in it — except, of course, that there was nowhere to go.

 

About a week after the transplant he was allowed to leave the room for the first time — masked, gowned, and on a stretcher. They took him to the biopsy room where he lay on a table, being very, very still, while Dr. Baughman made an incision in his neck.

 

The cardiologist carefully inserted the biopsy instrument, ran it down the jugular vein and into the new heart, and clipped off a piece for the pathologists to look at. Then a nurse and an orderly rolled Lorenz’s gurney back to the clean room.

 

The biopsy, Dr. Borkon told Lorenz the next day, showed a few white blood cells had invaded the heart tissue: the rejection process was underway, as expected. Fortunately, it was very mild. With luck, cyclosporine and prednisone, it would soon run its course.

 

The rejection alarmed no one, including Lorenz. He had expected to have some rejection; everyone, they had told him, did. But the doctors would adjust the medication, do this and that and something else, and finally it would disappear.

 

In the meantime, Lorenz rode the exercycle. He did his exercises. He read the morning paper, the evening paper, the New York Times, The Wall Street Journal, Newsweek and Time. He tried to watch some television.

 

New Yorkwas in an uproar over the shooting of three teenagers in a subway. Was there going to be a summit? Oil prices were falling, the stock market was rising, interest rates were going nowhere for the moment. Neither was the budget deficit.

 

Finally Dr. Borkon, examining Lorenz’s healing surgical wounds and scrutinizing the chart, decided isolation was no longer necessary. The next day Lorenz was transferred to a room on the eighth floor of the nearby Nelson building.

The room was much larger than the clean room, it had a huge picture window that looked out over the city and, because it lacked an air sterilization and filtration system, it was quiet. Altogether, Lorenz decided with satisfaction, the move was a step in the right direction.

 

Not than infection wasn’t still a concern; it was, and, with his suppressed immune system, it always would be. But the intensity of concern was falling steadily. At the moment, on the nurse’s instructions, the door to the room had to remain closed and visitors had to wear paper masks. Whenever Lorenz left the room it was he who had to wear the mask. But at least he could leave.

 

Esther brought him a red sweat suit, and it was a real joy to finally get out of the split-up-the-back hospital gown.

 

Already he was settling into the routine of drug-taking, a routine that would punctuate his days for the rest of his life. The cyclosporine was a liquid, about the color of lemon juice, and twice a day he measured out his dose in a thin, graduated tube. Then there were some little white pills he took four times a day, for the heart and arteries. Then, twice a day, there were the prednisone pills.

 

The following week, on January 24, an orderly came and got him for the trip to the biopsy room. Again he lay on the table while Dr. Baughman carefully inserted the instrument through his neck and into his heart. This time, he assumed, the results would be better.

 

But he was wrong. In fact, the next day, his doctors seemed downright concerned. There had been more white blood cells in the heart muscle, and clearly they were attacking it. Under the microscope, the pathologist could see some cells being destroyed. That evening, after the transplant doctors visited his room, they stood around outside and talked in low voices for a long time. The next day, the nurse brought Lorenz more steroids to take.

 

Lorenz wasn’t particularly worried — they had told him, from the first, that it often took some time and tinkering to get the rejection under control. A couple of months, maybe. Three.

 

Dimly, Lorenz remembered that someone had hinted that it might even take longer. But presumably they were talking about someone else, someone who wasn’t such a good patient, someone who didn’t do the exercises, say, or was uncooperative when the nurses and doctors stuck needles and probes into them. But Lorenz was a good patient, a perfect patient. He rode his bicycle, did his exercises, took his medicine . . . he did everything he was told, everything.

 

He wanted a cigarette. But he didn’t smoke one.

 

A day passed. Another, and another. Lorenz took his pills, did his exercises, and read his papers.

It was, he realized with a new intensity,  good to be alive.

As he regained his strength, he began to recognize just how sick he’d been before, and how limited his life had become — it had been, in hindsight, almost a living death. Things were different now, wonderfully different. He stood before the picture window and looked out overEast Baltimore, watching the chimney smoke rise into the frigid February air. He was ready to go home, more than ready.

 

Sure, he’d have to take it easy for a few days. But then . . . back to work. Back to normalcy.

Back to normalcy!

Or “back” was perhaps an incorrect word, for Lorenz had no intention of returning to life exactly as it had been.

 

In the pain after surgery, in the quiet of the night afterwards, as he lay in bed listening to the sound of the sirens far below, he realized how lucky he was. This was a second life, a second chance. And, this time, he would do it differently.

 

For openers, he was no longer going to spend so much time being Lorenz the workaholic. He was going to spend more time, a lot more time, being Lorenz the father and husband.

It was a big room, and most of the time he was alone in it. He rode the bicycle. He did deep knee bends. Upper body turns. Stretching exercises, being careful not to pull the still-tender seam of stitches up his chest. Push-ups. Once a day he went to physical therapy and walked on a treadmill. At other times, wearing his mask, he paced the hospital corridors. Each afternoon, Esther came to visit.

 

Each evening Dr. Borkon, Dr. Baumgartner and the rest of the transplant team stopped by to look at his chart and examine him. Afterward, they stood outside his door, their heads close together, and discussed his case.

 

InNew York, Bernard Goetz had admitted shooting the four teenagers in the subway. He was either a hero or a racist creep, depending on whose opinion the commentators quoted. Congress vowed to cut the budget, so long as nobody had to suffer in the process.

 

Iacocca, the autobiography of the man who managed Chrysler through its dark days, was on the bestseller lists. Lorenz read it and then, fascinated, read it again.

That guy, Lorenz thought, was one hellava manager. Dynamic, that’s what it was. So, for that matter, was Lorenz . . . rather, he had been. And would be again.

 

He felt stronger each day, and the future took on reality in his mind: Back to work, back to work, back to work.

 

Of course, there were all those new life resolutions, about being a better father and husband. How would he square them with reality?

Obviously, it was going to be difficult. Reading Iacocca reminded him, as if he needed to be reminded, that a man’s work was important, almost a definition of the man himself. It had always been important to Lorenz, as it had to Iacocca, and he’d be lying to himself if he said THAT had changed.So if he was to fulfill his resolution to spend more time with his family he’d have to be . . . well, more efficient. He’d have to delegate more responsibility, for one thing. He’d have to quit trying to do everything himself. He’d have to rearrange his whole department.

 

As a matter of fact, once he thought of it, it made such good sense! The truth was that he should have reorganized his department long ago, regardless of his own health. He could, in fact, make it more efficient . . . make his people feel more a part of what was going on, play bigger roles . . .

 

The thought filled him with excitement and anticipation. He lay awake at night, thinking about it. He could hardly wait to get out of here and get started!

 

First, though, one more biopsy — a clean biopsy, and they’d let him go home. And it would surely be clean, by now .

 

Another day passed, then another. January was ending, and on the 30th Lorenz again lay, still, on the table. He felt the novocaine needle pierce the skin of his neck, but he hardly winced. He was getting used to it.

But his immune system was not getting used to his new heart. The pathologist, Dr. Borkon told Lorenz, had found the rejection process still very active despite the increased prednisone.

 

The doctors were obviously puzzled, now. Lorenz could tell by the intense way they talked to one another on their evening rounds. But still, Lorenz wasn’t worried.

 

But they’d figure it out; Lorenz knew they would. It was, after all, their job to figure it out. His job was to ride the bicycle and think about how he would reorganize his department.

 

The doctors raised the oral dose of prednisone again, but this time they didn’t stop with that. For three days running they stuck a needle in his arm and gave him a whopping additional dose directly into a vein.

Maybe, they said, mentally crossing their fingers, that would do the trick.

 

Maybe he would do better, Lorenz suggested, at home.The doctors were skeptical.

Still, as Lorenz so reasonably pointed out . . . why keep him? He could come back to the hospital on a daily basis if they needed him to.

 

On Friday, February 1, he could see they were weakening.  But they weren’t ready, yet, to let him go.

Wait until Monday, they told him. They’d schedule an echocardiogram on Monday, to see if rejection was impairing the pumping power of the heart. If not, well . . . they’d think about letting him leave then.

 

So Lorenz waited another weekend, reading the papers and peddling his bicycle and trying hard not to be impatient or resentful.

That weekend another heart transplant patient, a middle-aged man who’d been theHopkins’ seventeenth patient — the one just before Lorenz — stopped by the room with his wife.

 

The conversation was polite, with each assuring the other that he was doing fine, but it was a little awkward. They had nothing in common except for the remarkable fact that both were alive; in as few minutes, the visitor left. Lorenz did some exercises, read a paper, looked out the window, did some more exercises, and went for a walk.

 

On Monday morning an orderly came and got him, and a few minutes later he was laying on a table while a doctor ran an echocardiograph transponder over his chest.

 

Lorenz had had enough echocardiograms by this time that he fancied he could tell a good result from a bad one, and he watched the screen as intently as the doctor did. In Lorenz’s mind, at least, it looked pretty good. Trying not to get his hopes up too high, he went back into his room.

 

That afternoon a nurse, a blonde young woman who would always register in Lorenz’s mind as stunningly beautiful for the message she brought, entered the room with a smile on her face.

 

“Mr. Buchser,” she said, “you can go home now.”

Lorenz, of course, was already packed. He immediately picked up the telephone and punched out Esther’s number.Outside, he stopped, took the mask off, and inhaled deeply.

 

The sky was a clear, pale blue. The air was cold, bitter cold, and after living for a month like a hothouse plant it cut right through Lorenz’s coat. But he didn’t mind. The air was frigid, but it smelled of freedom, and it made his new heart pound.

 

 

 

-0-

 

 

For Lorenz, the man who’d just gotten out of the hospital with a new heart beating in his chest, the future was a smorgasbord of wonderful things to do.

 

This, he told his wife Esther, was going to be different.  He swept his daughter into his arms. After that, Lorenz got down the cards and he and his son played Milleborne.

 

As they played, and the boy studied the cards, Lorenz studied the boy. He was a fine son, a fine young man. And it was good, good, good to be alive.

Once, years ago, Lorenz had smoked a pipe. He didn’t intend to go back to cigarettes but now, idly, as he played cards, he wondered . . .

 

As the days passed, Lorenz continued to regain his strength. He put together an exercise program for himself and, each day, he and Esther went on long, wandering walks. His legs, though, weren’t recovering as well as the rest of his body. He bought a stationary bicycle, and put it in the family room.

 

Every day he took medication. He took 3.3 milligram pills of cyclosporine twice a day. He bought it in 100 mg bottles for 175 dollars. The insurance paid for it, thank goodness.

 

He went back to the hospital several times, for brief clinic visits and for echocardiograms. He was, as far as anyone could tell, doing quite well. Then, on February 19, he went in for another biopsy.

 

By this time he knew exactly where the biopsy room was, so he picked up his paperwork at the desk and met Dr. Baughman and the technician at the room. Again he lay on the table, not moving, while the doctor slid the instrument down into his heart and clipped off a piece of tissue. Afterwards, sitting up on the table and putting pressure on a piece of cotton that was covering the puncture wound in his jugular vein, he joked that he expected the doc to do better this time. This biopsy, he said, had better be clean. He wanted to go back to work.

 

But when Dr. Borkon called him at home the next day, the news wasn’t good. The tissue sample, he said, wasn’t improved at all over the previous biopsy: rejection was still at work, killing the muscle. The team, Dr. Borkon told Lorenz, had agreed on a new dose of intravenous steroids.

 

Lorenz, following the doctor’s orders, upped his dose of oral prednisone. And, for the next three days, he reported to the hospital where a nurse gave him large injections of steroids. Then, over a period of a week, he tapered his oral dose off until, finally, he was back to his normal number of pills.

 

That, he figured, would do the trick.

Later that week there came a day that, for February, was unusually warm. Lorenz puttered around the house, took a short walk in the spring-like air, and then had an inspiration. A few minutes later he and Esther, tennis rackets in hand, were on their way to the deserted tennis courts.

 

There, next to the drained swimming pool, they batted balls back and forth. The balls made a satisfying thwack against the rackets and on the court, but it was soon apparent that, had they been playing seriously, Lorenz wouldn’t have had a chance.

 

It wasn’t that Lorenz’s arms weren’t strong, or that he would have run out of breath the way he would have before the transplant. No, it was his legs. They just wouldn’t respond. And, after a half hour, he was actually wobbling.

 

Damn! Apparently, he thought, he hadn’t been paying enough attention to exercising his legs. He started spending more time on the exercise bicycle; for good measure, he bought a set of weights to strengthen his upper body.

 

Still, his legs didn’t respond. Sometimes, after long walks, his knees felt like jelly. By the time he went back toHopkinsfor his next biopsy, on March 20, it was apparent that nothing he did seemed to strengthen his legs. So, when he was sitting on the table after the biopsy, holding the piece of cotton on his neck, he asked Dr. Baughman about it.

 

The cardiologist nodded. That was normal, he said, and was due to the prednisone. Steroids tended to increase muscle strength in the upper body, close to the heart, while decreasing it in areas distant. In particular, patients on steroids had trouble with their legs. It would be a long time before Lorenz got his strength back there — if ever.

 

That was sobering. In that one respect, at least, Lorenz might never be what he called “normal.” It was, on the other hand, a relatively minor problem. As he drove back home he resolved to keep up the exercises; Dr. Baughman, after all, was quoting averages. And Lorenz wasn’t average, whatever that was. He was . . . well, Lorenz.

 

The next day the telephone rang and Lorenz picked it up. It was Dr. Borkon, and he didn’t sound happy. He didn’t sound happy at all.

 

The rejection, he said, was worse.

That evening, dejected and angry, Lorenz packed his bags. God, but he hated hospitals!

The next day, the 22nd of March, he checked in, ruefully signed all the papers that absolved everybody of all responsibility for everything, and was taken to a private room. Later Dr. Borkon, the transplant surgeon, came in to talk to him.

 

Clearly, Dr. Borkon said, the combination of Cyclosporine and prednisone wasn’t working. They would have to go, now, to a different tactic. They would inject him with immune cells from a horse — serum engineered to attack the part of Lorenz’s new immune system that was rejecting the new heart. The stuff was called Atgam.

 

He might get a little sick, the surgeon added. To make sure he wouldn’t get too sick, they’d give him an allergy test first.

 

The surgeon had another paper for Lorenz to sign. Lorenz, feeling that he had no choice, quickly skimmed over it and signed his name. Then a doctor injected a small amount of the serum just under the skin of his lower arm to see what would happen.

 

What happened was that the skin over the injection immediately turned red and swelled up. So Atgam was out.

Lorenz was alone in his room. The day, through the window, was as cold and gray as his mood. Bored, he went down to the lobby and bought a paper.

 

The planet continued to revolve. There was fighting inLebanon, cost overruns in the pentagon, drug trade inFlorida. InNew Yorkthere was talk of indicting Goetz. The argument over comparable worth was heating up.

 

The next day, Saturday, Dr. Borkon was back with another doctor, whom Lorenz hadn’t met before. Dr. Borkon introduced him as Dr. Jim Burdick, a kidney transplant surgeon. And they had an idea.

Dr. Burdick said there was another antibody that worked similarly to Atgam, but which was manufactured from mouse serum, instead of horse serum. It was called OKT3 and, like Atgam, there might be a reaction. The only problem, if Lorenz wanted to consider it a problem, was that OKT3 was experimental — and it had only been used for kidney transplant patients, never for hearts. It would probably be released soon, so it wasn’t all THAT experimental, but it might work . . . and, of course, there would be another paper to sign.

 

Lorenz read it. It said that there might be certain side effects. Diarrhea. Fever. And, of course, death. Lorenz reached for a pen. The doctors took the paper and left. A few minutes later, a nurse and an orderly moved Lorenz into an intensive care unit and gave him an injection of something that would help prevent severe reactions.

 

Several hours later, when it was time for the first dose of OKT3, a doctor and a nurse arrived in the room. A needle was filled, and the injection was made. Lorenz lay back on the bed and waited for the doctor and nurse to leave.

 

But they didn’t.

Their presence puzzled Lorenz. He felt fine, perfect in fact. In truth, he felt like getting up and going to work. But when the shifts changed, a new doctor and a new nurse replaced the original ones. The doctor hung around for a long time, and then left, but the nurse stayed all night.

 

The next morning Lorenz ate breakfast and dived into the Sunday papers. He felt just a little . . . queasy . . . but otherwise, he was perfect. The doctor read a book. The nurse fussed, like nurses do. At 11 a.m., they gave him the second OKT3 injection. Lorenz settled back in bed to read some more.

 

The room, though, was a bit hot. And his head . . . his head, suddenly, was pounding. Suddenly, urgently, he had to go to the bathroom. The room spun, and the newspapers scattered.

 

Esther? Was Esther there?

It was hot, burning hot . . . no, it was cold.

He shivered, beyond control, and his stomach churned. And yet the nurse made him lay on an icy-cold cooling blanket. Another one, as cold as the first, went over the top of him. Teeth chattering, he begged them to leave him alone.

 

Suddenly, he realized what was going on: They were torturing him!

Why were they torturing him? Why was everyone moving around, doing things, excited? Why didn’t they just take these damned icy blankets off of him, help him warm up? HE WAS FREEZING TO DEATH!

 

Esther!

 

The nurses pulled the cooling blanket off of him. For a moment he thought they were going to relent, but then they were splashing alcohol on him; it was so cold it burned. Then the icy blanket went back. He tried to pull it off, but they restrained him.

 

For hours, Lorenz’s fever hovered above 105 degrees, near the mark at which the human brain burns out, and throughout the evening the nurses fought to get it down while Lorenz thrashed and hallucinated.

 

Finally, in the evening, the temperature began to drop.

It was Monday morning. No, afternoon. He was sick, but he was better, much better. The icy blankets were gone now; he watched as they injected another dose of OKT3, and waited for the reaction. But, this time, there were none. By late Monday evening Lorenz was back reading the newspaper and the doctor and the nurse were showing distinct symptoms of boredom.

 

Tuesday morning, the doctor was gone. Soon after, the initial reaction over, Lorenz was transferred to an intermediate care unit. That evening, when he received the fourth dose of OKT3, the nurse was almost casual about it. Clearly they expected no reaction, and they were correct.

 

In the bathroom, Lorenz looked at himself in the mirror. His face, once clean-shaven, was scraggly with five days’ growth of beard. Listlessly, he thought about shaving . . . but he didn’t.

Perhaps, Esther said later, he should grow a beard again. He’d had a beard when they came toAmerica, and she’d liked it.

 

Sure, he said. Why not? He didn’t care much, one way or the other.

The next day he was back in a private room and, on Tuesday, April 2, Dr. Baughman did another biopsy.

 

The biopsy, once again, showed rejection. The doctors didn’t seem too upset, though, since the OKT3 really hadn’t had time to take effect. So two days later, on April 4, he was sent home with the understanding that he would return daily to get three more doses.And that, he figured, would do the trick. OKT3, whatever it was, was pretty powerful stuff.

 

Lorenz went shopping with his wife. He read the newspaper. He walked, endlessly, around the neighborhood. He fed the baby. He played with his son. The days passed. He took down a pipe, and caressed it with his fingers. Later he bought some tobacco.

 

He called his boss and had a long chat. Things were going well, apparently, though it was clear his boss would be relieved to see Lorenz back again. There was the unspoken understanding that his job would be held for him . . . but Lorenz knew, without being told, that that couldn’t go on forever.

 

His life seemed to be slipping away, day by day, neither life nor death. His beard grew longer, as did his hair. He didn’t care much.

 

The transplant team watched their once clean-cut patient grow shaggier and shaggier, and made note of it. Someone said something, jokingly, and Lorenz laughed. But he didn’t cut his hair or trim his beard.

 

On April 11, when he returned toHopkinsfor another biopsy, he said to Dr. Baughman that he, Dr. Baughman, had better do better this time. This business of one bad biopsy after another just wasn’t going to cut it.

Lorenz laughed when he said it, of course. It was very funny because, of course, it wasn’t Dr. Baughman’s fault. Lorenz thought it was very, very funny.

 

Dutifully. Dr. Baughman laughed too.

Again, the pathologist found immune cells in Lorenz’s heart. Rejection continued.

Perhaps, though . . . it was debatable whether it might not be a little better than last time. Perhaps, the transplant team decided, it would be better to wait and do another biopsy in a week. So Lorenz was told to come back on the 18th.

 

Lorenz interpreted the fact that he wasn’t immediately hospitalized as a good sign. In fact, it was quite the opposite. The doctors, uncertain what to do next, had gone into a watch-and-wait mode.

 

That, however, didn’t help either. The biopsy on the 18th again showed rejection. In fact, this time it was unquestionably worse than before.

 

The team debated trying OKT3 again, but rejected it as too dangerous. So, stalling for time and rapidly running out of ideas, they decided to go with another round of intravenous prednisone again. So for the next few days Lorenz went daily to the hospital to receive the drug. At the same time he started taking a new oral drug, Immuran.

 

Lorenz was under the impression that he was getting better, and nobody dissuaded him. There didn’t seem to be much point.

 

The next biopsy was May 2. This time, Lorenz pronounced, the result would be perfect. He made the sign of the cross over the slide. “Abracadabra,” he said. Dr. Baughman’s grin concealed his concern.

Lorenz went home, for some reason feeling more confident than he had for a month. His brother had just arrived for a visit, and the three of them went to an Italian restaurant to celebrate present life and future success. Then, late in the afternoon, Esther and Lorenz’s brother took the children shopping. Lorenz stayed home.

 

At about 8:30 p.m. was at the table, lost in the newspaper spread out in front of him, when the telephone rang. It was Dr. Baughman. His voice was strained. Lorenz’s stomach knotted.

The biopsy was bad, very bad. The worst yet. The cardiologist wanted Lorenz to come down to the hospital.

 

Well . . . Lorenz resisted, equivocating. He couldn’t do that, just let his wife and brother come home and find him gone. That wouldn’t be . . . right.Now, Dr. Baughman insisted. At the rate the rejection was proceeding, there was a chance that the heart might be irreversibly damaged.

 

No, Lorenz said, firmly. He would come down as soon as his wife got home.

Esther got home about a half-hour later to find Lorenz disconsolate. She had never seen him so depressed; the sight of him reminded her of that evening, which seemed like years ago but was really only a few months, when they got the call that a new heart had been found.

 

At the hospital, the doctors and nurses were glum and tense. They took a blood sample, and admitted him.

 

Lorenz spent the night in the hospital, and early the next morning Dr. Burdick came into see him.

There was one more drug they could try, he told Lorenz — one last experimental drug. Then, they were out of ammunition.

 

He waited for a moment, for Lorenz to ask the logical question: What then?

But Lorenz didn’t ask, so the surgeon had to volunteer. If this new drug didn’t work, there was only one way out. They would have to think of a new transplant.

 

 

-0-

 

 

The transplant team had tried everything. They had used cyclosporine and oral prednisone. They had administered high-dose intravenous prednisone, and OKT3, and Immuran — and still, still, Lorenz’s immune system continued to chew up his new heart. There was only one thing left to try, an experimental drug made from the immune system of an animal: Rabbit ATG.

 

If that didn’t work, the only way to save Lorenz’s life would be a second heart transplant.

Another transplant?

 

Lorenz looked away from the doctor and down at the piece of paper in front of him. Rabbit ATG, the surgeon told him, was like the horse serum they’d intended to give him, but had changed their minds when he reacted to a test injection. But this was rabbit ATG, not horse ATG. Maybe he wouldn’t react to that.

 

Maybe.

Otherwise . . . a heart transplant?

Again, on the list, waiting for a telephone call, wondering if a heart would come in time? Again the agony after the operation, the isolation room, the people in masks and gowns, the morphine, the pain, the swimming, foggy deja vu vision of death . . .

 

Nah.

Not him. Not Lorenz Buchser.

Lorenz kept his eyes focused on the permission slip. Rabbit ATG, like OKT3, was experimental. The paper clearly warned that it had all the usual side effects, including the ultimate one.

 

Calmly, Lorenz read the document through, from top to bottom.

Death? Nah. Not him. Not Lorenz Buchser. He heard what the surgeon said but it had no meaning, because it didn’t apply to him. It would not kill him, if for no other reason than he was not ready, yet, to die. What’s more, it would work.

 

He finished reading, picked up the ball point pen and, without hesitation, signed his name at the bottom of the page.

The injections, they told him, would be given in the fronts of his legs — and they were going to hurt. He’d better prepare himself for it. It was going to hurt like crazy.

 

He took the injections while sitting in a chair across the room from his bed. As the nurse approached with the needle, Lorenz steeled himself . . . and then relaxed. It hurt, but it wasn’t nearly as bad as they’d warned him it would be. Either that, or he was getting used to being hurt. He got one injection in each leg.He found himself reassuring the nurse. Don’t worry, he told her. He was fine. Fine. No problem. Finally, she left.

 

Lorenz sat, depressed, in the chair. Damn, damn, damn he hated hospitals. He couldn’t remember when life had been normal, when he had been a free man, a productive man . . . damn, damn, damn . . .

He stared down at the front of his gown. A drop of liquid appeared on it. Another. It was raining on his gown, pouring down off his face and his head. His hands were shaking. His stomach lurched. His head pounded. He hurt, all over. He tried to move, but he had no strength.

 

He stared at the call button across the room. He had to get to the call button. He tried to move. He couldn’t.

He had to get to the call button!

With a will he no longer knew he had, he forced himself out of the chair. Wobbling, stumbling, he projected himself toward the button.

 

He had to get to the button!

The room swam. He swayed, lurched forward, stumbled.

He had the button in his hand.

Time passed. Someone was shouting. The room was full of people.

He needed to get to the bathroom. Now. Now. Now.

 

While he was in the bathroom, the medical team stood, nervously, outside. Then the door opened and Lorenz stood there — tired, obviously, but just as obviously recovered.

He walked across the room and collapsed onto the bed. He slept. The doctors looked at one another, baffled. The human immune system was an eternal mystery.

 

A few minutes later, Lorenz was back in the isolation room, the same room he’d occupied just after the operation. “The hole,” he called it.

Protesting that he was okay, he demanded to be released. They refused. Once again, he was a prisoner, watched every minute as though he was a prisoner on death row.The next morning they gave him two more shots, one in each leg. There was no reaction, so again he demanded that they let him out of the hole. Again, they refused. But the following day, after he received two more doses of the rabbit AKG and again had no reaction, they relented.

 

His legs, in the meantime, had grown sore from the shots — so sore he could barely hobble to the bathroom. He massaged them with his hands, but that didn’t help.

 

Monday, the day they let him out of the hole, the physical therapists used a deep-heat massager on his legs. That helped a lot; after that, it was all downhill.

On Thursday, May 9, Dr. Baughman did another biopsy — and this one, Lorenz threatened, the joking manner wearing thin, had better be good. It was in fact somewhat better, but the rejection was still proceeding. So Lorenz got several more doses of rabbit AKG. Finally, on Saturday, they let him go home.

 

On Sunday, Lorenz started getting joint pain. It started in his knees, but it moved to his ankles, his hips, even his elbows. And it got progressively worse, so much so that on Monday he was reduced to calling the hospital. He was sure they were going to tell him to come in.

 

But they didn’t. The pain, they said, was an after-effect of the rabbit AKG. They assured him it would pass, and it did.

 

What they did not say was that the pain was a final indication that they didn’t dare give any more rabbit AKG. The doctors had now exhausted their last strategy; if it didn’t work, Lorenz would have to go back on the transplant list — and he would be, the second time around, in much more danger.

 

At theHopkinsthe doctors and nurses waited, fingers crossed.

 

The next day, on Tuesday, Lorenz developed diarrhea. It was bad enough that he was tempted to call the hospital, but he decided not to. He had a premonition that if complained he’d end up back in the hospital. Besides, it would probably go away.But it didn’t. It got worse. Wednesday night the diarrhea was so bad that he wasn’t able to sleep at all. At about midnight he had a red stool; by 5 a.m. he was passing pure blood.

 

The next day, May 16, he was scheduled for a routine clinic appointment and blood test, and it was all he could do to drag himself to the hospital. But when the nurse asked him how he was, he said he was fine.

 

God, he hated hospitals.

 

But as he was leaving the clinic he happened to pass Dr. Baughman in the hall. Dr. Baughman immediately recognized the shaggy Lorenz, whom he had jokingly begun to call “the ugly man of the mountain,” and stopped to say hello. But as soon as the cardiologist saw Lorenz’s sallow, haggard face the social contact turned professional.

 

Pointedly, the cardiologist asked Lorenz how he was feeling.

 

For a moment Lorenz equivocated, then gave up. In truth, he admitted, he was feeling lousy. Lousy. And he had blood in his stools, and . . .

 

And, Dr. Baughman quickly ascertained by taking his pulse, his new heart was pounding for all it was worth.

 

Once again, just like he was afraid would happen, Lorenz found himself laying in a hospital bed and being poked and prodded by an endless stream of worried and puzzled surgeons, doctors, and interns. They all agreed: A stigmoidoscopy was called for.

 

A stigmoidoscopy involves the patient being turned almost upside down while a doctor examines his bowel with a large instrument. Someday medical science may come up with something even more humiliating and undignified, but for the moment the stigmoidoscopy was the pinnacle.

 

Stoically, Lorenz endured it all. This year, he calculated, he’d been in the hospital more than he’d been home.

 

Eventually, the gastroenterologists solved the mystery. The immunosuppressants hadn’t been able to contain the rejection of his heart, but they had knocked down his immune system enough to allow a bacterial infection to establish itself in his colon.

 

Antibiotics were added to the daily dose of prednisone, cyclosporine and Immuran.

 

His next biopsy appointment was May 23, and he was still in the hospital.

 

By this time, Lorenz’s shagginess was a standing joke between Lorenz and his cardiologist — like Lorenz’s humorous blaming of Dr. Baughman for the disappointing biopsy results. So, predictably, Dr. Baughman made a comment about hair.

 

Lorenz was laying for him.

 

Okay, he snapped back, just enough humor in his voice to emphasize that he was only joking. If Dr. Baughman would get him a clean biopsy so he could get the hell out of here and back to work, then he, Lorenz, would get a haircut. But if not, he was going to let his hair grow until Dr. Baughman got the reputation of having the ugliest patient in town.

 

Dr. Baughman played the game with his patient; it helped him to hide his black mood. The fact was that it wasn’t funny, it wasn’t funny at all.

 

Lorenz Butcher was theHopkinsteam’s 18th transplant patient, and so far four had died. Increasingly, it appeared that Lorenz might be number five.

 

Carefully, Dr. Baughman inserted the biopsy instrument into Lorenz’s right jugular vein and pushed it down to his heart. Delicately, taking care to do no more damage than absolutely necessary, he clipped off a bit of heart tissue and withdrew it. In a few minutes Lorenz was sitting up, holding a compress on his neck and watching the cardiologist mount the tiny piece of tissue on a slide.

 

“It’s a good one,” said Lorenz. “I can tell.”

 

Dr. Baughman had been around a long time, and had seen a lot of denial, and had seen a lot of death. So he didn’t share Lorenz’s unreasonable faith. But at the same time he understood its necessity, so he forced himself to grin and agree as he handed the slide to take downstairs, to pathology. Sure, he said. It’s a good one.

 

He sure as hell hoped it was, anyway.

 

Lorenz went back to his room and read the Sun. It was May 23. 60 ARE KILLED AS CAR BOMB ROCKSBEIRUTsaid the lead headline. On the left side were three photographs of Ronald Reagan at theNavalAcademycommencement; below, the headline said “Reagan Promises Midshipmen a Strong Military.

 

Ah, yes. The world turns. Lorenz turned to the business page.

 

The next day, a day that Lorenz Buchser would never forget, a beaming Dr. Baughman burst into the room with the pathology report. The biopsy was clean. Clean! There was no rejection. None.

 

When the doctor left, Lorenz called Esther and told her the good news.

 

By the time he’d finished talking with his wife, it was after dark. Lorenz stood at the window, looking out at the lights of the city and contemplating the news. After a while he went to the closet, put on his street clothes, slipped out of the hospital, and went for a long, long walk through the inner city.

 

Life. He had life.

 

The jubilation was not confined to Lorenz’s room. By the time he got back, the news had spread through the heart transplant team and spilled out onto the floor. It seemed like everyone Lorenz saw was smiling at him. He, of course, smiled back.

 

On Friday, all but recovered from his intestinal infection and determined to keep his promise to Dr. Baughman, he arranged to leave the hospital for a couple of hours. Esther showed up and drove him toTowson, where Lorenz sat in a chair while an Italian barber trimmed his beard and cut and styled his hair.Two good biopsies in a row, Lorenz remembered them saying, and he could return to work. Two good biopsies. And now, finally, he had one. One down, one to go. He could not remember when he’d been in a better mood.

 

When the Italian was finished he spun the chair around so that Lorenz could look in the mirror. Lorenz stared, fascinated. The man in the mirror didn’t look like a mountain man, at all. He looked, in fact, very much like a successful engineer.

 

It’s going to end, he told himself. It’s going to end.

 

A few days later he left the hospital, convinced that it was over.

 

He knew, of course, that it wasn’t. He knew that the next biopsy could discover renewed rejection, or the next one after that. There would always be the chance, as the years passed, of rejection — of rejection, of infection, of death.

 

He knew this. But each day the weather was better than the day before. Flowers were blooming, birds were singing, children were playing . . . it was going to be all right, he assured Esther. It was finally going to be all right.

 

He played cards with his son. He walked. He mowed the lawn. He boughtWell, Dr. Baughman said. Probably Monday.

 

Couldn’t it be sooner? Lorenz asked. He didn’t want to wait the whole weekend on pins and needles. Couldn’t he rush it up, a little?

 

Dr. Baughman said he’d see what he could do, and Lorenz left the hospital and drove home to wait for the telephone to ring.

 

The day dragged passed, and then Friday. Lorenz took his medicine, puttered around the house, and fidgeted. Finally at 5.30 Friday evening Sharon Augustine, the heart transplant coordinating nurse, called with the results.

 

The tissue was whistle-clean, she said. There was no sign of rejection, none whatsoever.Lorenz kissed his wife, threw his son in the air and called his boss. It was over, it was over, it was over. Saturday there was fine red wine, snails in garlic butter, veal, and plans for the future.

 

Early the next week, the doctors atHopkinsagreed that Lorenz could go back to work.

 

Finally, on Monday, June 24, almost six months after receiving a new heart, Lorenz Butcher went back to work and life, for him, began anew. ###