She left the RER suburban train station La Plaine-Stade de France at dawn and walked in the opposite direction from that now being taken by the mass of people surging in a continuous flow, increasingly compact as kickoff time approaches, joined in a collective fever—pregame excitement and speculation, rehearsals of songs and insults, Delphic oracles. She turned away from the enormous, naked stadium, indifferent to its massive bulk, as absurd and indisputable as a flying saucer that had landed in the night, and sped up as she walked through the short tunnel beneath the tracks. Coming outside again, she walked up Avenue du Stade-de-France for two hundred yards, passing the headquarters of banks, insurance companies, and other organizations, passing their smooth walls—white or metallic or transparent—and arrived at number 1. There, she rummaged inside her purse for a while, then removed her gloves so she could search more easily, and finally knelt down on the freezing sidewalk and emptied the purse’s contents, watched expressionlessly by the guy on the other side of the door who was very carefully peeling back the cover from a bottle of yogurt drink, terrified that a drop might spurt onto his beautiful navy-blue suit. And then, as if by a miracle, she felt the outline of her magnetic card at the bottom of a pocket, took it out, gathered her belongings, and entered the lobby. I’m on duty, I’m a doctor at the Biomedical Agency, she told him haughtily, without looking at him, and was crossing the lobby when she noticed the pack of Marlboro Lights lying next to the digital tablet that he must have used to watch TV all night—probably soccer games or trashy movies, she thought, annoyed—and, having reached the second floor, she walked about fifty feet, then turned to her right and pushed open the door of the National Center for the Allocation of Transplants.
* * *
Marthe Carrare is a small woman in her early sixties, olive-skinned and round-faced, with auburn hair, large breasts, and a spare tire contained inside a skin-tight beige-pink cardigan, a spherical butt bulging in brown wool pants, fairly slim legs, and tiny rounded feet in flats; she feeds on cheeseburgers and nicotine chewing gum, and at this moment her right ear is red and swollen from having various telephone receivers pressed against it all day long—work cell, private cell, landline—and, if you know what’s good for you, you won’t disturb her for anything, you will make yourself invisible and silent while she asks Thomas about the situation: So, what’s happening? Thomas replies: It’s okay. She is calm: All right, send me the report of his death so I can check the file, and Thomas says I just faxed it to you, and I also filled out the donor’s Cristal file.
Marthe hangs up and walks over to the fax machine, frown lines arrowing down toward the top of her nose, thick-framed glasses attached to a chain, lipstick leaking into the little wrinkles around her mouth, a heady perfume and cold tobacco fumes trapped beneath her collar: yes, the sheet is there—the official report of Simon Limbres’s death, filed at 6:36 p.m. Now she enters the adjoining office, which contains the national organ donation refusal registry, a file so high-security that only about ten people in the country are authorized to consult it, and only then after the legally attested death of the person in question.
* * *
Back in her office, Marthe Carrare tells Thomas it’s fine, then stares at her computer screen, opens the Cristal file, clicks on the various documents that comprise it—general information sheet, a medical evaluation of each organ, scans, ultrasounds, other analyses—and examines it all, immediately noting Simon Limbres’s relatively rare blood group (B negative). The file is complete. Marthe approves it and assigns it an identification number, a code that will guarantee the donor’s anonymity: from this point on, Simon Limbres’s name will not be mentioned in any future discussions between the agency and the various hospitals with which it is in contact. Thus begins the protocol for the allocation of transplant organs. Namely, one liver, two lungs, two kidneys. And one heart.
* * *
Night falls. At the end of the avenue, the stadium is illuminated, and its outline—like an oblong ring, like a bean—traces a grayish halo in the sky through which the Sunday-evening airplanes leave their vapor trails. It is time, now, to turn our attention to those who are waiting, scattered throughout the country and sometimes even beyond its borders, people whose names are on lists, classified by organ, to be transplanted, and who, every morning, ask if their position has changed, if they have moved up the ladder, people with no conception of the future, whose lives are restricted, suspended by the condition of one particular organ in their body. People living their lives with the sword of Damocles hanging above their heads. Imagine that.
Their medical files are centralized in the computer that Marthe Carrare is consulting at this moment, while sucking a nicotine lozenge. She checks her watch and thinks that she has forgotten to cancel her dinner date, two hours from now, at her daughter and son-in-law’s apartment. She doesn’t like going there—the phrase pops into her head that very second: I don’t like going there, it’s cold in that place—but can’t be sure if it’s the apartment’s walls, plastered with an expensive white milk paint, that make her shiver, or if it’s the absence of ashtrays, of a balcony, of meat, disorder, tension, or if it’s the Malian stools and the designer fainting couch, the vegetarian soups served in Moorish bowls, the scented candles—“cut hay,” “wood fire,” “wild mint”—the domesticated satisfaction of people who go to bed early under Indian velvet bedspreads, the tender lifelessness that stretches throughout their kingdom. Or maybe it’s the couple that appalls her—the couple that, in the space of less than two years has swallowed up her only daughter, dissolving her in a safe, soothing conjugality, a balm after years of nomadic solitude: her hot-headed, polyglot daughter now grown unrecognizable.
* * *
In a specially programmed software, Marthe Carrare enters all the medical data concerning the heart, the lungs, the liver, and the kidneys of Simon Limbres, then searches her databases to find patients able to receive them—the list of matches being shorter when it comes to the liver and the kidneys. The short list of compatible recipients is then combined with the realities of geography, the location of the organs and the locations of possible recipients producing an operational cartography involving distances to be covered within a limited time frame, relating to the the viability of the organs. This leads to a logical evaluation of miles and journey times, the pinpointing of airports and highways, stations, pilots and planes, specialized vehicles and experienced drivers, so that the territorial aspect of the enterprise adds a new parameter, narrowing the list of possible patients even further.
* * *
The first compatibility issue between donor and recipient involves blood—ABO compatibility. Cardiac transplants require strict Rh compatability, and with Simon Limbres being B negative, an initial cut is made, considerably reducing the list of nearly three hundred patients waiting for a transplant. Marthe Carrare’s fingers tap more furiously at the keyboard, and her face shows the urgency of finding a recipient, perhaps some slight intoxication, the forgetting of everything else. Next, she uses the HLA system to examine tissue, which is equally essential. The human leukocyte antigen code is the patient’s biological identity card and relates to the immune system. While it is practically impossible to find a donor with an identical HLA to that of the recipient, their codes must be as close as possible in order for the organ transplant to take place under the best conditions and with the lowest risk of rejection.
* * *
Marthe Carrare entered Simon Limbres’s age into the software, so the list of pediatric recipients was searched first. Next she checks if there is a compatible patient in a state of HU (high urgency)—in other words, a patient whose life is in danger, who might die at any moment. She also carefully applies a sophisticated protocol in which each stage is connected to the previous one and is used to determine the next one. For the heart, in addition to blood and immune-system compatibility, factors such as the organ’s physical conformation, its shape, size, and weight come into play—the heart of a big, strong adult cannot be transplanted into the body of a child, for example, and vice versa—while the geography of the transplant is circumscribed by one unalterable limitation: there must be a maximum of four hours between the moment when the heart is stopped inside the donor’s body and the moment when it is restarted in the recipient’s body.
* * *
The search progresses and Marthe moves her face closer to the screen, her eyes enormous and distorted behind the lenses of her glasses. Abruptly, her yellowed fingertips immobilize the mouse: a high-urgency case has been identified for the heart—a woman, 51 years old, blood group B, 5' 8", 143 lbs., in the hospital at Pitié-Salpêtrière, in Professor Harfang’s department. She carefully reads and rereads the information, knowing that the call she is about to make will provoke a general acceleration at all levels on the other end of the line, an influx of electricity into people’s brains, an injection of energy into their bodies—otherwise known as hope.
Hello, this is the Biomedical Agency—an increase in diligence and attention at the department’s reception—the call is transferred several times until it reaches the surgical unit, then a formal voice says Harfang, and Marthe Carrare begins, quickly, directly, Doctor Carrare, Biomedical Agency, I have a heart—yes, that really is how she phrases it: her vocal cords, coated with forty years of cigarette smoke and nicotine gum, vibrating in her palate with every movement of her tongue—I have a heart for a patient in your department on the transplant waiting list, a compatible heart. Instant reaction—not even the briefest silence: Okay, send me the file. Already done, Carrare replies. You have twenty minutes.
After that, Marthe Carrare moves down one line on the list of recipients on her screen and calls the teaching hospital in Nantes, another cardiac surgery unit where the same dialogue is exchanged, this time regarding a seven-year-old child who has been waiting for a heart for nearly forty days. Marthe Carrare specifies: We are waiting for a response from Pitié, then, once again: You have twenty minutes. Then a third department is called at the Timone hospital in Marseille.
The waiting begins, punctuated by telephone calls between the doctor in Saint-Denis and the coordinator in Le Havre, intended to synchronize the planning of the operation, to organize the surgical unit in advance, and to provide updates on the donor’s hemodynamic status—nice and stable, for now. Marthe Carrare knows Thomas Rémige: she’s met him on several occasions during training courses organized by the agency and at seminars where she has spoken, both as an anesthesiologist and as one of the agency’s founding members, and she is glad that she will be dealing with him today. She trusts him: he is a safe pair of hands, professional and sensitive, the kind of guy you can rely on, and she is probably even more glad that his emotions are well contained by his unwavering concentration, his intensity always carefully channeled, never giving way to hysteria in spite of the human tragedy that acts as the fuse to every transplant operation. It’s a stroke of luck for everyone, having a guy like that around.
* * *
The responses about the liver, the kidneys, and the lungs quickly follow after a round of the same procedures—Strasbourg takes the liver (a six-year-old girl), Lyon the lungs (a seventeen-year-old girl), Rouen the kidneys (a nine-year-old boy), while down the road, in the stands of the soccer stadium, spectators are unzipping their jackets—leather biker jackets, khaki bomber jackets with orange linings—and covering their faces with scarfs like highwaymen about to attack a stagecoach, or like student protesters protecting themselves from teargas, and hundreds of hands are taking out smoke bombs that were hidden under sweaters or tucked in the back of their jeans—but how did those objects get through security? Pins are pulled from the first grenades as the players’ buses are announced at Porte de la Chapelle—red smoke, green smoke, white smoke—and the clamor intensifies in the bleachers when a huge banner is unfurled: “Directors, players, coaches, everyone out!” The section where the hard-core ultras gather is impressive: all of them crammed into the small space, a unified block of aggression, a hostile mass, and the spectators coming into the stadium walk faster, enthralled, while the suited security guards frown and start to run, jackets unbuttoned and ties flapping against their bellies, mouths pressed to walkie-talkies, the North End’s getting messy, don’t let too many in. Chanted insults burst into the air as the buses, with their tinted windows, comfortable seating and remarkably silent engines, leave the main road and enter the VIP area that surrounds the arena, coming to a halt by the players’ entrance. Marthe stands up and opens the window: figures rush past the agency building and up the avenue, toward the stadium, local youths who know the area, and she sends a brief text to her daughter—emrgncy at BMA, call u tmrw, mom—then taps the chewing-gum box against the balcony railing and holds her hand under the opening, but the box is empty. She bites her lip: she knows she has cigarettes hidden in various places all over her office, the precise locations forgotten, but for the moment she decides to keep chewing.
She imagines thousands of people gathered around the field over there, with its grass so brilliantly green it looks like it’s been varnished, each blade illuminated with a mixture of resin and turpentine or lavender oil, which, after the solvent has evaporated, forms a solid, transparent film like a silverish reflection, like a preparation on a new cotton ball, a layer of wax polish, and she thinks that in the same moments when Simon Limbres’s living organs are being matched, in the moment when they are shared out among different sick bodies, thousands of lungs will swell as one across the way, thousands of livers will be soaked with beer, thousands of kidneys will, simultaneously, filter bodily substances, and thousands of hearts will pump blood, and suddenly she is struck by the fragmentation of the world, by the absolute discontinuity of reality in this small area, by the thought of humanity being sprayed in an infinite divergence of trajectories—an anguished feeling she has already experienced, that day in March 1984, when she was sitting in a number 69 bus, on her way to a clinic in the 19th arrondissement to have an abortion, less than six months after the birth of her daughter, whom she was bringing up on her own, rain streaming over the windows, and she looked at the faces of the passengers who surrounded her, one by one, those faces that you see in Paris buses in mid-morning, eyes gazing into the distance or staring at the safety pictograms on the walls or riveted on the call button, or straying into the auricle of a human ear, eyes that avoided each other, old ladies with shopping bags, young mothers with babies held in slings, retired people traveling to the municipal library to read their usual magazines, unemployed men in dubious suits, noses deep in their newspapers but unable to read a word, unable to make the slightest sense of any of those headlines, but hanging on to the paper as if it were their only connection to a world where there was no longer a place for them, where soon they would no longer have enough to live on, these people sometimes sitting only six inches away from her, none of whom had any idea what she was about to do, the decision she had made and which, in two hours, would be irreversible, these people who were living their lives and with whom she shared nothing, nothing at all except this bus, caught in a sudden downpour, these worn seats and these sticky plastic grip straps that hung from the ceiling like nooses, nothing at all, each keeping to themselves, isolated and alone, and she had felt her eyes welling up with tears, had gripped the metal pole tightly so she wouldn’t fall, and in that instant she had experienced solitude.
* * *
The first police sirens are heard around seven-thirty. She closes the window—it’s cold outside—still an hour to go before kickoff and apparently it’s proving difficult to contain the supporters’ excitement: all these hearts together, it’s too much. She wonders who’s playing tonight. Time passes. Marthe Carrare examines the first file again, strangely satisfied by its concordance with the donor’s file. It could hardly be any more perfect—what the hell are they doing at the Pitié? Just then, the telephone rings. It’s Harfang: We’ll take it.
* * *
Marthe Carrare hangs up and immediately calls Le Havre, warning Thomas that a team from Pitié-Salpêtrière will be contacting him to organize its arrival. The recipient is a patient in Harfang’s department—do you know him? By name. She smiles. Says: They’ve got a good team there, they know what they’re doing. Thomas checks his watch and replies: Okay, we’ll get ready for the removal, we should be going into the OR about three hours from now, I’ll call you back. They hang up. Harfang. Marthe says the name out loud. Harfang. She too knows him. Knew of him before she knew him—that beautiful name, that strange name doing the rounds of hospital corridors for more than a century, so that people said simply he’s a Harfang as a way of summarizing a discussion about a practitioner’s excellence, or they talked about the “Harfang dynasty” as a way of describing the family that had provided the faculty with dozens of professors and practitioners, men named Charles-Henri and men named Louis, men named Jules, Robert, Bernard, and now men named Mathieu, Gilles, and Vincent, all doctors who had worked, were working in public hospitals—we’re servants of the state, they liked to think as they ran the New York Marathon, went skiing in Courchevel, or sailed in the Gulf of Morbihan on carbon monohulls, distinguishing themselves in this way from the grasping medical masses, many of whom, including the youngest, opened private practices in calm, leafy quarters as soon as they had completed their training, sometimes going into partnership with Harfangs in order to cover the whole spectrum of pathologies affecting the human body, and offering quick checkups to overweight businessmen, guys who worked crazy hours and worried about cholesterol levels, hardened arteries, prostate troubles, and declining libidos—among them five generations of pulmonologists following a patrilineal filiation that prioritized male primogeniture when handing out chairs and department directorships; among them one girl, Brigitte, ranked first in the internship entrance examination in Paris, in 1952, but who abandoned her studies two years later, persuaded that she was in love with a protégé of her father’s when the truth was she was yielding to surreptitious pressure ordering her to make way, to leave more room for the young males of the clan; including this one, Emmanuel Harfang, the surgeon.
She remembers that during her internship, she had hung around for a while with a gang led by two Harfang cousins. One was in pediatric cardiology, the other in gynecology. They both had the famous “Harfang cowlick,” a shock of white hair growing over their forehead which they slicked back over the dark hair that covered the rest of their head, a distinguishing feature of the clan, a legendary family seal, rally around my white plume and all the ad hoc swagger intended to loosen the panties of the girls they met; they wore 501 jeans and oxford shirts, tartan-lined beige raincoats with the collars turned up; they never went out in sneakers, always Church’s shoes, though they absolutely scorned tassel loafers; they were of medium height, wirily built, pale-skinned and golden-eyed, thin-lipped, with prominent Adam’s apples that would make Marthe involuntarily swallow whenever she saw them sliding up and down under the skin of their throats; they looked like each other, and they also resembled this Emmanuel Harfang, ten years their junior, who repairs and transplants hearts at Pitié-Salpêtrière.
Emmanuel Harfang would descend the steps of the auditorium perfectly on time for his symposiums, staring straight ahead and jumping the final steps so that his momentum would carry him up to the lectern with an athletic bound, holding a sheet of paper that he wouldn’t read, beginning his speech without even greeting his audience, favoring direct openings and abrupt attacks, getting straight to the point without bothering with the usual civilities, without bothering to state his name, as if everyone in the room was supposed to know who he was—a Harfang, son of a Harfang, grandson of a Harfang—a tactic that was also designed, in all probability, to wake up an audience who had a tendency to nod off early in the afternoon, pleasantly drowsy after eating those famous meals in the nearby restaurants reserved for the occasion, where the carafes of red wine would be lined up on paper napkins, always that modest Corbières wine that went well with red meat, because as soon as Harfang pronounced his first words, the auditorium would snap out of its digestive torpor, every person in the audience remembering, when they looked at this slender, athletic man, that he was the pillar of a first-class cycling squad, part of a team that represented the hospital in various criteriums, filled with guys capable of riding 120 miles on Sunday morning, regardless of how difficult it was to combine such endeavors with their professional lives, guys ready to get up early to race, no matter how desperately they yearned for more sleep, for the chance to caress their wives, make love, play with their children, or simply just lie around listening to the radio, the light in the bathroom always brighter, the smell of toast always more desirable on mornings like that; guys who hoped to join this elite club and who would give anything, would elbow others out of the way, to be chosen by Harfang—“singled out” was the term they used, as Harfang, suddenly noticing their presence, would point at them with his index finger and, leaning his head to one side to assess their physical condition, checking out a possible rival, would ask them, a strange smile twisting across his face: You like cycling?
Pedaling alongside Harfang, riding on his wheel for a few hours, was worth all the fury it provoked in their wives at being left alone with the kids on a Sunday until the middle of the afternoon, it was worth all the sarcastic comments—don’t worry, darling, I know you’re sacrificing yourself for the family—worth their more direct reproaches—you only ever think about yourself—worth the cutting remarks as they scornfully watched their husbands sucking in their paunches—careful you don’t have a heart attack!—worth coming home crimson-faced, exhausted, legs barely holding up their body and their backsides so sore that they dreamed of taking a sitz bath but collapsed onto the first couch they spotted, or onto their bed for a well-earned siesta—and, of course, this quickly grabbed nap would trigger their spouses’ ire once again, would fuel endless diatribes about men’s selfishness, their idiotic ambitions, their submissiveness, their fear of aging, would make the wives lift up their arms and yell loudly or put their hands on their hips, elbows out, stomach thrust forward, teasing them theatrically—and, once they had recovered from their efforts, it was worth wasting away the afternoon on their computers, buying a chamois on a specialized site, a matching bib, and all the other appropriate gear, finally screaming shut up! at the wife nagging from the other end of the apartment, making her cry, because—curiously—not a single wife ever supported this masculine obsession, not one, out of careerism or simple docility, ever encouraged her husband to straddle a bike and follow Harfang on the roads of the Chevreuse valley, to show off his speed, lightness, endurance, no, not one woman was ever fooled by this nonsense, and when they talked among themselves, the wives, deploring the insidious dragooning of their husbands, they would sometimes cite Lysistrata, plan a mass sex strike to make the men give up their extravagant toadying, or they would fall about laughing as they took turns describing how haggard their husbands looked after finishing a race, and in the end it was just funny, so let them go if they really wanted to, let them go and exhaust themselves, allies and adversaries, favorites and competitors, because soon not one woman would wake up at six in the morning to make coffee and hand the cup lovingly to her husband: instead, they would stay in bed, curled up under the comforter, hair tangled, skin warm, purring with pleasure.
* * *
The last time Marthe Carrare heard Harfang speak, he had delivered a sparkling lecture about the uses of cyclosporin in antirejection treatments that had revolutionized transplant operations in the early 1980s, setting out in just twelve minutes the history of this immunosuppressant—a product that weakened the immune system of the recipient’s body, thereby reducing the risk of the transplanted organ being rejected—after which he ran a hand through his hair, sweeping that famous white cowlick off his forehead, that distinctive shock of hair which allowed him to dispense with introductions, and barked out questions?, counted one, two, three in his head, and concluded his speech by foreshadowing the end of cardiac transplants, suggesting they would soon become obsolete because the time had come to consider the virtues of artificial hearts, technological wonders invented and developed in a French laboratory, with initial tests having already been authorized in Poland, Slovenia, Saudi Arabia, and Belgium. The nine-hundred-gram bioprosthesis, developed over twenty years by an internationally renowned French surgeon, will be implanted into patients with serious heart failure whose lives are considered to be in danger. A murmur ran through the auditorium, waking up the drowsier students. Harfang’s audience was disconcerted by this conclusion, by the idea that a prosthetic heart could rob the organ of its symbolic power, and while most of the heads obediently bowed down toward the spiral notebooks held below them, concentrating as the hands took notes of Harfang’s words, a few shook from side to side, signaling sadness, or even vague dissent, while some slid hands inside jackets, behind ties, under shirts, touching bare skin so they could feel their hearts beating.
* * *
The game has kicked off and the rumble rising from the stadium has become a ceaseless roar, growing even louder at certain moments—a shot on target, a suddenly threatening counterattack, a piece of sublime skill, a violent clash, a goal. Marthe Carrare leans back in her chair: the donor’s organs have been allocated, the trajectories calculated, the teams organized. Everything is on track. And Rémige is in control. As long as there are no unexpected problems during the removal operation, she thinks, as long as the physiognomy of the organs does not reveal something not spotted or even suspected by the scans and the ultrasounds and the analyses, it should all be fine, and she will smoke a cigarette, drink a beer, eat a cheeseburger with barbecue sauce. She chews a little harder in order to squeeze out the last atom of nicotine from the gum, even if it’s just the faintest memory of a taste, a smell, and she thinks about the security guard who by now must be bent over his tablet, following the soccer game, his pack of Marlboro Lights within reach.