If the Heart Does Not Restart

As I try to wonder about a stroke, an embolism, a rupture, or pancreatic pathologies, sudden invasive virulence, instead I think Go to the store for Roundup. Then the French neighbor gardening in her silk blouse hints chemicals might take care of the grasses on our side, the ones choking the basil. But I say bittersweet or Japanese creeper on the fence, what’s the difference. She’s saying it again. “Sweet Autumn Clematis should be more vigorous than the large-flowered clematis hybrids.” And on the internet: “I know she fought with every ounce of strength.” Or, “She died peacefully at home.” An appropriate response to this: bullshit. She wrote so many books. She is writing so many books. All of these books undulate from her like swells, like the yellow liquid left in the tube after selling platelets. I’m not saying vampiric when I think of everything going wrong in the blood. Or the tubes carrying blood. Or blood keeps going where it shouldn’t in quantities the brain can’t handle. When he took a job counseling terminal patients, when he no longer had clients but patients, then he had the stroke. He stroked. Who knows how to respond to this? During surgeries, I watched the blood spinning through tubes, getting aerated, oxygenated, whipped up and sent back to the limbs. I wished there was less hard blue plastic, less crisscrossing of tubes and wires. My nightmares in recent years involve violating the sterile field. I touch my neck, then I touch the edge of the wound, and I am filled with shame but also fear because maybe now there’s nothing to be done since I’ve contaminated the chest cavity and the patient will most likely move on to infection, fever, death, but I won’t know because, one, I’ll wake up or, two, wakes up will stop mattering. Option three involves me trying to cry in the locker room bathroom but instead wanting a sandwich, not knowing the patient’s name anyway. I’m on the hunt here, following the vine to its root only to find it’s one vine among twelve and we’d better get the shovel or decide this is probably just wisteria that hasn’t bloomed yet. In a nightmare, I once vomited on a patient. I just missed the chest cavity. Awake, I really did drop many valuable things. One of the things given to me to hold was the heart itself. I never held a warm heart but sometimes wish I had. I think I would have cried more for a warm heart that refused to restart. The cold ones, nesting in sterile ice, never inspired hope of life. The real difference between a surgery that ends well and one that doesn’t is the way the body is closed. If the surgery is successful, then the patient’s heart restarts and the pressure comes up. A regular rhythm is achieved and we close each layer—heart, sternum, any little blood vessels, fat, each layer of dermis. If the heart does not restart, there is no careful sewing. A staple gun closes the skin but not the layers underneath. The sternum is still pulled closed with wires, but fewer and less neatly tied. I grab the incision’s edges, tug them together with one hand, and with the other, start the grating plastic click click click of the gun. The table is pulled away and the drapes peeled off the skin. We wipe away the blood and the betadine. We pull the blanket to the chin. I never stick around to see what happens next. Or I do and now I don’t know.