DRIVING THE HEART

BY JASON BROWN

Boston General Hospital

(Originally published in 1999)

Traveling between Danvers and Natick yesterday I saw a man in a flower truck drive by at 80 m.p.h. with his eyes closed. I turned to Dale, a guy the hospital hired for me to train, and said, "Nothing, not even someone's liver, is that important." He put his hand on top of the metal case marked Liver and nodded.

We drive the no-rush jobs, eyeballs, livers, morphine, or kidneys, through the day traffic to or from the airport. Sometimes when a patient decides to die at home and runs out of painkillers, we will bring extra morphine out to them at night. Tonight we are driving way out to Lebanon Springs, to the town where I was born, with a heart for a woman about to die from some accident or some disease. Hearts travel at night.

Dale sits next to me holding the metal box marked Heart. His eyes droop. His head leans to the right. Next thing he'll be sleeping, dreaming down the highway. I know what it's like.

When the weather is foul like tonight and the airplane can't make it, they send us. We're the only choice they have of reaching such a small town in such an out-of-the-way place. Cellular phone service is out and in many places the power is out, but most of the regular pay phones still work. We stop every hour at designated places and call the hospital to make sure the patient in Lebanon is still alive. The hospital is in contact with Lebanon. We are not allowed to stop for food or drink and, if we can help it, even to urinate on this six-hour journey. We make the call and if she's still alive we rush on. If not then we can pause briefly for food and bathroom before we turn around and drive without stopping for Worcester, where a plane will take the heart to some other person in a city with a major airport. This heart, however, is getting old. There probably won't be time to take it anywhere after Lebanon.

Hearts are packed in ice. But even a frozen heart will only last for twenty-four hours on the outside, unofficially. That's why if we have to take it to Worcester, there will only be time to fly the heart to a major airport, then rush it from there by helicopter to a hospital in the same city. There is always a patient. Driving to Lebanon, we shoot for six or seven hours at the most. Tonight we have to hurry through the high winds and beating rain, in order not to waste this heart.

I stop the car and have Dale run out through the rain to the pay phone with the number I gave him.

"What's her name?" he asks.

"You won't be talking to her," I say, "and it doesn't matter. Just give the hospital the job number. They'll say drive on if she's still alive, or turn around."

A few minutes later he comes running back, gets in the car, brushes the rain off his sleeves, and nods his head. After a few more minutes he says, "I'm hungry," even though I've already explained the rules.

Hospital delivery often attracts people like myself, who have cared very deeply about the wrong things. Who, in less than half an average life span, have been born, born again, arrested for armed robbery, and born once more. A person can only be born so many times before even the Christians don't want to take you seriously. The second time I was born I was twenty years old and lying in a donated suit on the floor of a jail in Sturgis, Michigan. I remember one of the officers brought me a bowl of stew and suggested I eat something before going into court, but I shook my head. I was being charged with driving under the influence and assaulting a police officer, although I didn't remember doing those things. The judge informed me that I had drunk ten ounces of 151 in a few hours. He lowered his head after this announcement, not because I was a startling case, but because I was the same kind of case he saw day after day and he was tired. I asked what I could do to show him that I had finally gotten the picture, that all I wanted was one more chance. He looked at me and laughed, which was to say: that's what everybody says. He didn't know that I was reborn, that over in Grass Lake, where I wanted to go after I was released, people believed.

We drive all over New England, sometimes to New York, but mostly we stay around the Boston area. If you know the Wenham-Woburn-Needham-Braintree route, then you know that the places to live are Belmont, Weston, Concord, or beyond but not so far out as Lowell. All the names up and down the coast, Weekapaug, Quonochontaug, Naquit, Teaticket, Menauhaunt, and Falmouth Heights, remind me of the life I could have had if things had been different. I have a friend living that life over in Sakonnet right now. I go over and visit him once in a while—from his second-floor bathroom window a sliver of ocean can be seen.

Dale reaches over and turns the radio up; he leans on his right elbow against the window. He slumps in his seat. I turn the radio back down. No amount of training will make a kid like this understand his job. Even as the passenger you should sit alert. Someone else's life sits in your hands. His head nods against the passenger window as I flick the radio off. "No more radio," I say. That wakes him up. Dale straightens himself and asks what happened to the woman who needs the heart, but I can tell by the way he fiddles with the buttons on his coat that he doesn't really care. I tell him I don't know, that the woman could be thirty, could be seventy. Could be heart disease, could be anything, they never tell me. Usually they take the heart from someone who is alive but brain-dead and transport it to someone whose thoughts are clear but whose heart is dead. And in truth, I explain, they usually give preference to the young. The moment the heart leaves the body of the donor, it is cross-clamped and the clock starts ticking. In the Lebanon hospital they are standing there in the operating room right now, smocked and ready, waiting for us. Dale nods and we drive on in silence.

I roll the window down for a moment to let in some air and then roll it back up again. I turn to Dale: "A man in Abilene, Texas, gets drunk and drives his car through a 7-Eleven. Three hours later his heart travels on a plane bound for Logan Airport. Six hours later his heart sits next to you in a large silver case marked Heart, and we are driving down the highway at the speed limit toward some supine client in a hospital room asleep or possibly in a coma who will not live another day without this heart. This," I say to Dale, "is the importance of your job." He nods, furrowing his brow. No matter how many times I explain, I don't think he will understand.

"What if something goes wrong?" he asks.

"Nothing will go wrong if you don't get any ideas. Now go make the call," I say, pointing at the variety store.

 

* * *

 

I live in a so-so neighborhood. The people there smell and never take out the trash. I look out my window at a funeral home. For four months each year the sun rarely shines in this part of the country. Some mornings I consider the consequences of quitting my job and doing nothing for the rest of my life. People will still get their organs and their drugs, driven here and there by someone like myself. A replacement. The hospital has them. The only thing that will happen differently in the world if I quit my job is that I will not be able to eat.

I ask Dale if he has ever donated an organ. He shakes his head, looks at me in silence, and then we sit there, ahead of schedule, thinking. I feel like telling him to keep his eyes open.

I've seen some strange things. A woman from Nova Scotia once came into the hospital and offered to sell two kidneys. She said she had four. The doctor on duty said he was interested in such a claim, but that it was the hospital's policy, the law in fact, not to accept such offers.

I know what it's like to want things. I've always wanted to travel the world but probably never will. I've seen pictures. I've always wanted to date a very beautiful woman.

Only once have I flown in an airplane, crossing the water to London with a case of hospital files to be signed by a man there. Somewhere out over Labrador the pregnant woman across the aisle started to scream. The husband started running up and down the aisle while his wife was pulling on her seat and pushing with her knees against the people in front, her stomach seizing with contractions. The man suddenly whipped around, focused on me, and yelled, "I need a doctor! Is anyone a doctor?" A woman sitting in back came forward saying she used to be a nurse. The man stepped aside, pointing at his wife in her light cotton floral dress, the makeup washing down onto her neck. "She's only seven months—not even," the husband said. When he stepped aside a little more to allow the nurse to move in, I could see liquid from between the pregnant woman's legs pouring off her seat and onto the floor. The woman who used to be a nurse looked directly away, holding her head with her hand. She was looking at me and through me. "How much time before we land?" the man blurted at the stewardess, who had just arrived. "Too much time," the ex-nurse, looking at me, said.

The most exciting thing that can be said about me is that I delivered pizzas in dangerous neighborhoods when I lived in New York. How I can be both obsessed and relaxed at the same time is a mystery to me, but I consider it one of my greatest accomplishments. I'm not very old, but I would say that so far nothing has gone according to plan, that people have been unpredictable and that's about the extent of it. I would also say that certain ideas seem basically true to me. You cannot serve two masters well. Our thoughts are of little consequence. Live cautiously. You have to in my family. Back when I was twelve, for instance, I was traveling down Capisic Street in Lebanon when a woman traveling thirty, forty miles an hour hit the rear tire of my bike. I rolled over the hood and the roof, bounced off the trunk, and landed standing on my feet. She screeched to a stop and broke out weeping on the steering wheel, afraid to look. I walked up and tapped on her window. Her fingers danced on the dashboard. She looked at me. "Are you all right?" I asked. "I don't believe it," the woman said, resting her head back down on the wheel. "I don't believe it."

The road we're traveling down tonight feels familiar, the rhythm of the bumps and ruts against the tires, but in the dark nothing looks the same. Dale fumbles with the map, turning it toward the window so he can read with the help of an occasional streetlight. "Where is this place we're going to?" he asks.

"Lebanon Springs."

"It's not on the map," Dale says.

"What?" I ask.

"Lebanon."

"Turn it over. It's on the other side." Dale turns the map over and brings it up close to his face. "Find the green line I made. It starts in Boston; follow to where it ends."

"I found it," he says. "It's tiny. There can't be much to this town."

"There's a woman who needs a heart," I say. "That's all you need to know."

 

* * *

 

Some people say I was thinking too much and some people say I wasn't thinking enough, but I probably just wasn't thinking about the right things. Don't take advice from yourself, don't leave your apartment without a good reason, don't have a telephone, don't own too many things, don't own too few. Live on the first floor. Watch out for people.

Dale lets out a long sigh. He runs his hands through his slicked-back hair, then rubs the back of his neck. Dale is wrong for the job. There's no use even getting to know him because I'll just be training someone new next week and asking all the same questions, explaining all the same rules.

Dale asks if he can look at the heart, to see how it's kept alive. He thinks it might be helpful for the job, but I think otherwise. Does he think I haven't sat alone in this seat next to a case marked Heart and not looked inside? There's nothing to look at. It either works or it doesn't.

I turn to Dale: "You've read the manual?"

He nods, but I'm not sure he even knows what manual I'm talking about.

"You get to one of the designated stops only to find that the phone is out. What do you do? Stop at the next phone along the road or drive on? No time to think. Page fifty-two of the manual, right?"

"Stop at the next phone," he says. "The next phone along the road, I mean."

"I know what you mean and you're wrong. You drive on." I let him fiddle with the glove compartment handle and crack his knuckles. "When in doubt," I tell him, "always drive on. Just remember that one thing, all right? All right?"

"All right," he says.

He looks out the window. I look briefly where he's looking, but the shape of the hills on the horizon depends on the phase of the moon. I don't recognize a thing. On a night like tonight when the moon is hidden by the storm, we can only recognize the windshield wipers, the sheets of rain, and the vague shape of the white road sign letters. We could be headed anywhere. The last time I traveled down this road I was hitchhiking home and ended up in a car accident. I told a guy and a girl who picked me up on Route 302 somewhere that I would go as far as they were going. He told me that they were headed for her parents' house in a little town out where 302 turns into 89, called Lebanon Springs. I nodded, and he drove faster than the speed limit. I had been outside in the snow for too long, and my feet were numb. I took off my shoes in the backseat and rubbed each toe, worried that they might not come back. Suddenly there was a thud, breaking glass, and we slid into the guardrail. The head of a large buck had smashed against the windshield, spraying glass shards onto the driver, whose head rested against the steering wheel. I crawled out the back door. The tiny glass fragments melted into the bottoms of my bare feet. The guy's girlfriend had to crawl out her window and over the hood. She walked toward me, swaying her hips like a model, rubbing her head. The deer stood in front of the car watching us. Then he closed his eyes. I never made it back to Lebanon that time.

In the dawn haze I start to recognize sections of forest from the last time I was here, eight years ago. We'll enter from the east side of town, so we won't have to use the Thurman Bridge, where I was born crossing over from Stockton in a Pinto, my father behind the wheel and my mother sprawled out in back. The story goes that my mother said she wasn't going to make it, and my father said she had to wait. She said she couldn't and there was much screaming. She wanted something to kill the pain. He told her just to think about something else and hold it in and then before she knew it they would be there. But all she knew was that she couldn't wait another second, and I was born at 11:42 p.m., before we even crossed the river.

Staring through the rain-splattered windshield into the dark gray forest, I am reminded of the same forest twenty miles from here, where I lived with my parents at the end of a long dirt road. We lived there for five or six years, but one morning it was so cold that the storm pane cracked down the middle and fell into the backyard. I woke up and wandered into my parents' bathroom, waiting for them to wake, stepped up on a stool, opened the medicine cabinet, and pulled down a box of razor blades hidden from me behind the shaving cream. Taking out two, I placed one in the palm of my right hand, then squeezed my fingers shut. With my left hand I ran the other blade lightly, painlessly up and down my arm from the shoulder to the palm. It was so long ago, I don't remember what I was thinking. The little slits remained dry for a second, caught off guard, before red lines appeared and eventually washed together like flooding rivers. I walked into their bedroom, groping my hand along the wall for the light switch. Her head bolted up. Then I found the light switch.

Several years later—I can't remember how many; we must have lived there for more than seven years—I was ten years old standing at the same window, my father having been gone from the house for quite some time, I heard my mother's faltering footsteps climbing the stairs. I locked my bedroom door, pushed one of the chairs up against the knob, and then returned to the window. I heard the floorboards creak as she crept up to the door and carefully, trying not to wake me, turned the doorknob and pushed forward. When the door would not open, she pushed more frantically and cursed under her breath. The rain splashed against the window.

It has stopped raining now and the sky has started to lighten. Dale runs off into Ken's Variety, twenty miles east of our destination, to make our last call. Twenty minutes to go. I decide that when Dale returns I'll ask him some questions about his life, about the letter D sewn onto his high school jacket, about what he wants to do with his life after this. I should try to be nice.

Maybe he wants to live over in Wayland or Lexington and summer down at Marion or Pocasset, slightly off the beaten path, where it's warm and the grass comes right down to the ocean and the beaches keep going. It sounds like a good life to me.

I hear a car engine gearing down behind me and then the grumble of the braking wheels against the gravel of the shoulder. Two guys pull up beside my window in a pickup. The truck weaves a little as it comes to a stop. The driver rolls down his window, spits out some of his chew, and moves his hand in a circle, signaling me to roll my window down. When I do he raises his upper lip and asks me what time it is. I look down at the blank face of my digital watch, tap it a couple times, and tell him my watch is dead. There is a clock on the case, but I would have to get out of the car and walk over to the passenger side to check it. I'm not about to waste time doing that. The guy says he thinks I'm lying about not knowing the time, so I show him the watch. "The watch is dead," I say. Then he asks how much money I have and I tell him. "Nothing." He says he knows I'm lying and I say, "Is that so?"

"We're hungry," he says. "We're driving all the way down from Elmira with no food. We want to buy some food at the store."

His partner raises a shotgun and hands it to the driver, who points it at me. "How much for your life?" he says. He turns back to his buddy, then back to me. "My friend here says ten dollars. Fair price, huh? Ten dollars and your life is yours."

I put my hand over the wallet in my pocket and thumb through the bills inside, thinking about the heart. "I don't have a dime," I say.

"Not a dime," he says.

"Not a cent."

The driver squints and releases the safety on the shotgun. "I know this isn't true," he says, closing one eye and lowering his head down next to the stock. "My friend says shoot you before someone comes along, but I'd rather have the ten dollars, so I'm waiting another couple seconds to see what happens."

I look down the double barrel, stop breathing, and I wait to see what happens. For a long time I listen to the unsteady rumble of their truck's engine like it's my own breath.

Suddenly he opens his eyes wide. "Bang," he says pulling the gun back in but leaving his eyes pointed at me. His lips move up around his teeth. "Guess you're hungrier than we are," he says, and they drive away. I fall against the steering wheel, my chest heaving, my right hand on the silver case.

Dale comes out of Ken's, trips on the steps, picks himself up, and keeps running. He climbs in the car, sucking in a mouthful of air, and says, "I couldn't get through." I throw it into drive and pull forward, knowing perfectly well what the situation is and what we have to do. "The phone lines around here are fine," Dale explains, "but Ken said the storm is worse back in Boston. Maybe the lines are down there."

"No matter," I say.

"Hey," Dale says, sitting up in his seat as if remembering an important message. "When I was on the phone, Ken looked out the window and mumbled something about your being in trouble. Anything happen?"

"It was nothing," I say. "Now in this situation, what do we do?"

"What situation?" Dale says, rubbing his forehead.

"You made the phone call and were not able to get through."

"Oh. We drive on, right?"

"You tell me."

"We drive on," Dale says, and we sit there in silence. After a few minutes a police car approaches from behind and flashes its blue lights. I pull over to the side of the road and roll down my window. The officer parks his car, pulls some papers off the dashboard, opens his door, closes it carefully, and starts walking toward us. He stops halfway, removes his cap, smooths back his gray hairs, and puts the cap back on before continuing forward. Dale looks at the floor.

"How are you this morning?" the old officer says.

"Fine, sir," I answer.

"Glad to hear it," he says. "I stopped you because old Ken gave the dispatch a ring saying you were having some trouble out in front of his store."

"It was nothing," I say.

"Ken said that some guys in a pickup—"

"Officer," I say, "I hate to interrupt, but we are on an urgent job, delivering a heart to the hospital just across town. We're coming all the way from Boston through the storm and every second counts. We have to drive on. After we deliver the package I will be happy to answer any of your questions."

"A heart, you say?" the officer rubs his head. "I've never heard of such a thing."

"Yes, sir."

"Is that what your partner has there in that case?"

"Yes it is."

"And you're taking it over to Community?"

"Yes we are."

"Then I won't hold you up."

"Thank you, officer."

"Well. I won't hold you up," he says again, staring down at me. "But please stop down at the station when you're done. We'd like a description."

"Certainly."

"Thank you," he says and backs away from the car.

I drive on, spinning the wheels a bit in the gravel and holding the pedal all the way down as the speedometer slowly climbs back up to fifty-five. After ten minutes of silence, passing swiftly over Washington Avenue, down Winthrop Street, and across Thorton Ave., we swing up to the hospital and stop outside the electric doors and the lighted sign, emergency. "Here," I say, grabbing the case. "Follow me." Holding the case in front of me, I head for the doors of the emergency room. Dale takes several leaps to keep up with me. I walk right up to the glass booth where a woman behind a desk is filling out forms. Someone else, an enormous woman, sits in one of the waiting chairs with no obvious injuries. The man next to her holds a rag clamped over his bloody hand. They both stare at the opposite wall.

I tap nervously on the glass. "Can I help you?" the woman says without looking up.

"I'm here with the heart from Boston General. Here are the forms," I say, shoving them in front of her face. She takes the forms but does not look at them.

"A heart?" she says, looking at me and my metal case.

"Yes," I say.

She takes a deep breath and shifts her behind on the swivel chair. "What do you mean, you're here with a heart?"

"Look," I say. "It's an emergency. We've been delayed. There is a woman here who needs this heart. Who knows how long she will last, but I know that this heart will not last much longer." The woman stares at me, looks at the forms. "Didn't anyone tell you?" I ask.

"I just came on," she says. "I haven't heard anything about this."

I set the case down and grab onto the edge of the partition separating this woman from myself. I stare down, fixed on her lower lip. "Look," I say. "The heart is here."

"I'll have to go back and check with one of the doctors," she says, smiling faintly and disappearing down a corridor. I lean against the glass and close my eyes. I can hear the large woman in the chair shift from one hip to another. The man with the injured hand coughs briefly and then starts tapping his foot. He taps it out of boredom, not pain. Once every couple seconds he lets the toe hit the floor. Then he stops and I feel his eyes on me and the silver case. The fluorescent lights lining the ceiling buzz like insects, becoming louder with every moment until in the distance I hear the clicking heels of the receptionist and the squeaks of a doctor's rubber heels coming down the corridor. I turn around suddenly, wondering what has happened to Dale. And just as the doctor comes up behind me, I see Dale appear from around a corner and pause next to a black sign with an arrow that says Cafeteria. The doctor puts his hand on my shoulder and rests it there, waiting for me to turn toward him.

"I'm sorry," he says when I don't turn. "Boston General should have told you on the last call."

He removes his hand and waits patiently for me to respond. The receptionist returns to her desk and picks up the next form off the enormous stack. Dale has stopped to unwrap the rest of a sandwich he just bought down the hall. He leans over, allowing the lettuce strands to fall on the floor instead of his jacket, and then continues toward me. A sliced tomato hangs over his bottom lip. He swallows and keeps walking. After a few steps he stops to take another bite, this time scooping up the strands of lettuce with his free hand and pushing them in the corner of his mouth. The doctor picks the case up and, placing it against the wall, says a few words to the receptionist, who opens a drawer and shuffles through a bunch of papers. It is too late for Worcester, I think. When Dale sees that I am staring he stops walking and tries to swallow what's left in his mouth.

The doctor steps up beside me again carrying a clipboard. "We need to have you sign these," he says. I take the clipboard and the pen without looking at him.

"I was hungry," Dale says, shrugging his shoulders. "I figured we were here. I couldn't wait any longer."

"That's no excuse," I say and lower my head to the forms resting in my hands. I sign my name. Time of arrival, it says. I turn my wrist and look down at my blank watch. I look at the doctor. "Time?" I say.

He raises his naked wrist. "Forgot to wear it today." He smiles, dark circles under his eyes.

Dale shoves the rest of the sandwich into his pocket. "It's seven o'clock," he says, pursing his lips in an effort to take our job more seriously. He walks over to the silver case and picks it up. "What do we do now? I thought we were here."

I walk over to him, take the case out of his hand, and lay it down next to the wall. "It's too late," I say, but he furrows his brow and stares at the case. It is a good sign when a trainee doesn't understand how a job can fail. I remind him as we head for the door that a heart, once removed from the body, will last only twenty-four hours. There is nowhere left for us to drive. At the door he turns away from me looking for the silver case, which a nurse is carrying down a long yellow hallway. I give just a light tug on his arm, but he won't start walking until the nurse has disappeared down another corridor. I understand that this is the hardest part of the job; there is no way for me to explain how we could have driven all this way with a heart for which, in the end, there is no life.