As a special online supplement to the Spring 2012 issue, the editors present the prizewinning story from the 2011 Zoetrope: All-Story Short Fiction Contest.
We start the day by going over the list of the dead. I'm new to this job as a transplant coordinator, and I find myself continually shocked by the many ways you can die. It makes me afraid to leave the house in the morning, to cross the street, to walk around in socks. I keep waiting for the story that ends, And then the patient fully recovered and walked out of the hospital with just a slight limp. It never once happens.
The receptionist distributes rolls of all the viable brain dead in the Tri-State area. This week we have two gunshot wounds (one accidental, one self-inflicted), one motor vehicle accident, a suicide via hanging from a NordicTrack machine, and one helmet-less bike messenger flattened by a car on the Walnut Street Bridge.
Alison, a large woman with a hangdog face and tiny hands, talks about her case—a sixteen-year-old boy in North Philadelphia who heard gunshots, stuck his head out his apartment window, and was struck by a stray bullet. The family had lost another son in a shooting two years before.
I consider moving to South Dakota and farming the land. I would raise good-natured beagles and drink only green tea.
Alison met with the dead boy's family for over two hours while they argued back and forth about what the boy would have wanted. Finally, the patient herniated and was declared brain dead. The family consented to donate all but his corneas.
"What did we learn from this case?" asks Andrew Clarke. He's the director. He has a rugged, pockmarked face and blue eyes. I imagine he'd be excellent in bed, persuasive and reassuring at the same time.
Alison looks at the ceiling. She's been at the hospital for twenty-four hours straight. There are dark circles under her eyes; traces of prettiness swim in the tired lines of her face. "We learned to stall the family until the patient throws a clot," she says.
We clap. I'm grateful for all of it—these people who make jokes and speak inappropriately so that we can get up and do this again the next day.
Training lasts two months.
Words and phrases we're taught not to use when dealing with the donor family: harvest, excision, cadaver, organ procurement, dead as a doornail.
Words we do use: saving the lives of others, donation, transplant, every form of to give. We talk about the patient in the past tense—What would she have wanted?—even as the blip of the heart monitor persists in the background.
We learn to compartmentalize our feelings. I picture giant pieces of luggage stuffed with body parts: a bowling bag with a head in it, a trunk holding a torso, a golf bag filled with legs.
Before we face real people, we practice the rhetoric of donation through role-play. One day I'm a mother of two who has lost her husband in a car crash late at night on I-95. I get carried away as the grieving widow, sobbing and exclaiming, "But he was so young!"
My partner, Jesse, pats me on the back with his fat, soft hands. "There, there," he says.
The instructor, a tall man with bangs, advises us to take a five-minute break. He comes over and asks if I'm OK. "You were very convincing," he says. I thank him. He asks if I can do it again for the next group of trainees. Of course. Of course I can.
We take numerous classes: Empathetic Listening, Donor Management, Donation after Cardiac Death, Donors without Heartbeats, and Ways People Die in the Bathroom. "You don't want to know," I tell my boyfriend later.
We're sitting in the living room in the dark watching cars blow up in an action-packed thriller involving a foreign invasion. He turns down the volume. "Let me guess. You fall off the toilet and hit your head, right? You slip in the shower?"
Yes, those are some of the ways. I don't mention the others.
A newborn is thrown into a Porta-Potty by his anxious young mother.
A guy OD's over a urinal at Locust Bar his first time shooting up.
A woman falls backward through a glass shower door because the water is too hot.
A man cuts an artery shaving.
He says, "Would you rather watch a movie with kitties in it?"
I say, "Yes, please," and he changes the channel to Animal Planet. But what I really want is for him to keep asking me questions.
Later that week I'm at my boyfriend's end-of-summer work party, stuck in a group of accountants who think that wearing a cartoon tie makes them whimsical. Most are drinking martinis.
I'm standing at the edge of a small knot of them when a tall woman with impossibly shiny hair turns to me. "And what do you do?" she asks.
I tell her I'm into organs. At first, she thinks that means I play an instrument, so I begin with the most recent story: a family on vacation from China whose five-year-old son fell off the edge of the LOVE sculpture while his dad was taking a photo. They stare at me like I'm a monster. Maybe I am. I can't get enough of this stuff. I try to explain that in every story, no matter how ghastly, something funny happens, or something odd.
"Yes, it's hilarious that their child died," spits the lady with the glowing hair.
"Not that. The odd/funny part was what the father said after the coordinator explained brain death to him. He didn't speak English very well, and he nodded and nodded and then said, 'Yes, yes, I get it. We want brain transplant!' " No one laughs. "I didn't mean funny like, funny ha-ha; I meant funny like, awful funny."
I want to tell them that you have to talk about it this way; otherwise, you'd lie down on the floor and never get up.
Much later, after I've had my fourth glass of chardonnay and I'm finishing up a story about a girl whose parents refused to donate because they thought their daughter would snap out of it, a man with thick sideburns and an upturned nose announces, "Well, I for one don't want some guy letting me die so they can transplant my organs. No, thank you! That's what they do. They just take everything, before you're even dead."
The other guests nod or stare into their drinks.
They know about organ donation from TV shows like ER or Dateline—the transplant recipient who begins to act like the dead donor, the doctor paid off to remove the kidney of a perfectly healthy kid, the boy who receives a baboon heart. I know this, and yet I still can't quite believe it—I can't believe they believe it. "Yes, we want every last thing," I say. "Even your eyeballs." I fish the olive out of his drink and pop it into my mouth. "Mmm. Tasty."
My boyfriend pulls me into the kitchen. "Hey, listen, maybe you should switch topics. You know, try talking about the weather. And not about how it relates to a fatal car accident, if you can help it." He gives me a tight, angry smile.
The hostess enters the room and sees that we're busy hating each other. She says, "Whoopsie daisy!" and swivels away on her heels.
"Maybe we should make up conversation topics on index cards," I suggest, barely slurring, "and you can hand them to me as the evening goes on."
"Great idea." He takes my arm and steers me out the door, his grip hard against my elbow. Good, I think. Maybe tomorrow there'll be a bruise.
I want to be more giving to him. I leave him little Sticky Notes in the medicine cabinet. Don't forget your umbrella. Looks like rain. Or 2 good 2 B 4 gotten. He doesn't mention them. I want to give him something of myself: my eyes, my fingers, my heart. Instead, I mop the bathroom floor and check out books for him from the library, mostly about the American Revolution.
After my last day of training, I present him with a bicycle helmet. "Just wear it." He shakes his head. "Hey, try not to worry about your hair. Worry about your brain being splattered on the sidewalk outside of a Starbucks. Think how embarrassing that would be." I strap the helmet on my own head. "Look, look—you'll be the envy of all of your friends." I try to explain that he has no idea how dangerous the world can be. Bricks fall from the sky. Ice is slippery. You can be at a bar having a nice conversation, then say the wrong thing, and some burly construction worker can hit you over the head with a Heineken bottle. "These are matters of life and death. You should pay attention."
He says, "You were happier when you were an RN at that doctor's office. Remember those days? Remember when you always wanted to take my temperature?" At one time in our relationship this would've been a come-on. Now he gives me a look like I'm a defective purchase he wants to return. "I think I liked you better then."
I lie on the floor in front of him, still wearing the helmet. "I think I liked me better then, too."
He turns on the TV, to a rerun of Law & Order: Special Victims Unit, and politely asks me to move.
At our work Halloween party I count one Terri Schiavo, two blood bank operators with fake blood splattering their clothes, several ghosts, a few zombies, three vampires, and a cat. We're a scary bunch. My boyfriend has consented to go with me—a rare occasion. I parade him around the room, introducing him proudly as if to say, Look, look, this is the person who tolerates me!
He's dressed as a Holstein cow—the same costume he's worn for two years running. I go as the Bride of Frankenstein. We stand by the punch bowl spiked with vodka. I've made a mental list of conversational topics to use with him—ones that don't involve blood thinner or dead children.
We all drink too much and get swept away by the karaoke. Andrew, the director—dressed as a caveman with a single, thick eyebrow drawn across his forehead—croons "Living on a Prayer." His eyes are squeezed shut with sincerity. It's the same look he bears when speaking to families, and the expression I imagine him wearing during sex.
I realize I'm staring at Andrew and turn instead to my boyfriend. His cow horns are crooked. I straighten them. "I find you udderly attractive," I say, knowing it sounds unconvincing.
He gives me a side hug.
I'll go on at least sixteen cases with a seasoned coordinator before I'm set free to convince families on my own. My first time out, I'm paired with Bryan.
The case is an eight-month-old girl whose mother accidentally left the baby carrier on top of the family SUV, then backed out of the driveway, still talking to the child she thought she'd clicked into the car seat. Halfway down the block she braked at a stop sign and heard a thump. She assumed at first that a neighbor's garbage can had tipped over. Then the truth of what occurred rose with appalling certainty in her throat.
You think this story is an urban legend; you've heard it before, or something similar. But here's the thing: it really happened. It happens and worse: a drunk father who accidentally runs over his son with his ATV, a hunter who mistakes his brother for a stag, a girl whose hits her twin sister in the head with a lacrosse ball.
While we're waiting for the neurologist to declare the baby brain dead, another call comes in on Bryan's Blackberry. Thirty-four-year-old Caucasian male, hit by a car while biking to work. I wonder how I would feel if it turned out to be my boyfriend. I find myself blushing at the thought. How selfish I am. Why must everything relate back to me? And yet, I imagine the funeral scene: me as the stoic girlfriend, his family caving under the grief. I try to work myself into tears, as I was able to do in training, but can't seem to muster up the correct emotion.
And of course it's not him. It's someone else's boyfriend, someone who's not as lucky as me.
After the baby is pronounced, Bryan and I go into the waiting room, where the father paces. The mother, hysterical, has been heavily sedated. We talk to the father about donation. He nods and looks back and forth between our faces with a look of complete bafflement. "Yes," he says when we're finished. "Yes, if she can save another baby, then yes. Do whatever you need to do."
He wants something good to come out of this tragedy—anything, anything, one good thing.
The baby has a full head of black curls like her dad. Her eyes are shut and rimmed with blue bruises. She resembles a baby panda bear. She is impossibly small and pale and I want to wrap her up and hide her in my coat, take her home with me, and pray for a miracle.
Initially we're hopeful. The doctors work hard to keep her heart beating so she can be a donor, so we can give the family something. They pump her body full of blood thinner to maintain her for the operating room. But she arrests. All her organs become toxic, unusable, worthless.
And she dies and no one is saved and my head empties of reason. The father shakes my hand with a blank look on his face. It will take some time for the truth to sink in.
I walk all the way home in my sensible black heels, hoping for blisters as penance for being one of the living, for not having to survive without someone I love.
I go into the house, where my boyfriend is sitting at the kitchen table doing a crossword puzzle. He's wearing his glasses, which reminds me of when we first met. He brought his mom into the doctor's office because she couldn't stop hiccupping. He wore his glasses then, too, and I thought, What a sweet guy. He loves his mother. He looks up. "How did it go?"
"We lost the baby," I tell him.
"Well, have you tried looking under the sofa?" He glances back to his puzzle.
I open my mouth to tell him what happened and then shut it again.
I go upstairs. He's plugged in the radio again over the bathroom sink, just a few feet from the tub. I unplug it, wind the cord around the center, and stow it in the closet behind a mountain of towels.
I lie on our bed, hands on either side of my body like a dead person. I begin listing parts of the anatomy, beginning with the letter a and working my way down the alphabet: aorta, bronchial tube, cranium, duodenum. This is how I distract myself from thinking about what I should do.
And then, just in time for Christmas, it's my turn to go on a case alone. They give me a black beeper. I might be called once on the shift, twice, three times, or never. The day burns bright with just a slight chance of snow. I pray this means no one will die today. Tomorrow, OK. But please not today.
My boyfriend has called in sick to work. He perches on the sofa in his droopy gray jogging pants, playing a video game that requires him to shoot people with a semiautomatic machine gun and drive a sports car. I sit next to him. "What's the point of this game?" I ask.
He can't answer because he's concentrating, speeding down a twisting highway in Southern California. He's explained to me that the game is an exact replica of Los Angeles and the outlying areas, down to each building and street. Just like real life.
I nudge him with my foot. "How do you win?"
"Damn it!" We watch his car careen off a cliff and plunge into the water. Seconds later his man surfaces, unharmed, and begins swimming toward shore. "You don't win."
"Then why do you play?" I don't state the obvious: that his video game hero would've been an organ donor a hundred times over by now—because at some point, my God, I have to shut up.
"It's a rush." This is what he wants our life to be like—one long, fun-filled adventure after another with no real casualties.
The beeper goes off an hour later.
I call the office. Marla, the receptionist, gives me the details. Couple involved in a car accident, sideswiped by a truck whose driver had been awake all night trying to make a noon delivery to New York. The husband has superficial cuts on his neck and chest. Doctors are working to save the wife, but she has an internal bleed. I ask the questions I think I'm supposed to ask while putting on my hat and shoes. I attempt to zipper my coat and realize my hands are shaking.
Marla tells me to call if I don't think I can handle it and she'll send in another coordinator. She tells me I'll be fine. This is my first conversation with her, and she's managed to calm me down in a way I know my boyfriend never could.
"Leave the light on for me," I tell him. He nods. I waver by the front door. "Good-bye, then."
"Good—" he begins, but stops as his car plummets off yet another cliff.
I see the truck driver who killed the woman, sitting in the waiting room. He's a mammoth of a man in red flannel, a John Deere cap tucked back on his head. His eyes are wide, and his face is a picture of raw disbelief. When he sees me, he stands, taking off his hat.
"I didn't mean it," he says.
"I know," I say.
The rush of people swooshes around us—nurses, a little boy wailing, families arguing. A TV mounted near the ceiling broadcasts close-up after close-up of beautiful soap opera actors, their artful faces bearing a whole range of recognizable expressions: sadness, joy, jealousy, triumph, fear.
I ask a nurse if she can find an open bed for the trucker, so that he can lie down for a while. She says OK and he follows her obediently, like a large child.
The surgeon greets me as I walk into the ICU. He's an older man with graying hair and deep-set brown eyes. I'm in luck: he's one of the good doctors, one who's treated transplant recipients in the past, not one who calls us "the death squad."
He explains the situation. No hope of survival for the wife. She hasn't taken a breath on her own in two hours and has failed two apnea tests. The CAT scan shows no cerebral blood flow. I nod. "OK, OK."
He knows it's my first solo case. "You can handle it," he says.
I take a deep breath and go into the patient's room. The husband sits beside her bed. My training has taught me that the dead look dead. They don't appear kind of dead or somewhat dead. Even as their chests rise and fall because of the ventilator, there's something missing in them.
The woman's dark hair is pulled off her face with a headband. Around the room her family and friends have left flowers, balloons, stuffed animals, as if she were a kid having her tonsils out. One of her eyes is half open. If I pulled up the lid, I'd see the pupil blown out, filling the white. In slide presentations during training, it looked like something from a scary movie—the eye of death, one might say, if one were given to such dramatizations. Her other eye has been covered by a white bandage, giving her a slightly jaunty air.
The husband is tall and handsome with stubble on his chin. He's been told that there's no chance of recovery, no miracle on its way. He's seen the nurse put a cotton swab to his wife's eye and watched as it didn't blink or move. "We were only married for a year," he tells me. "We just moved into a new house. We haven't even hung up the pictures yet."
"I'm sorry." Instead of dispensing the platitudes we've been taught (You can give the gift of life! It's your time to make a difference. One dead wife equals seven others saved!), I listen to him. I listen to him talk about his wife, Lena, for a long time. They met in a dive bar in Northern Liberties. He thought she'd be a one-night stand, but he stayed that night, and the next, and the next, and then he moved in his stereo and that was it. They were married in Hawaii by a priest with a lisp. They have a fat golden retriever named Jack. He pauses, staring off toward the wall. His eyes are clear and blue. "How am I going to break the news to Jack?" he says. His gaze turns to me. "Maybe I should tell him to sit first?" His laughter comes out in a burst.
I say, "Maybe you should remind him that he's a good boy?" We're both laughing. It's hysterical, this laughter, and a blessing.
The doctor hovers in the doorway. It's time to go. I ask the husband if there's anything he wants to do before we take her to the operating room.
He doesn't hesitate. "Could you find me a brush or a comb? Her hair is a mess. She would hate that." I get him a brush. We set her headband on the dresser beside the bed. I hold her so that he can reach the back of her head. He brushes her hair with careful, clumsy strokes.
We don't talk about donation. The husband has already consented. I don't have to convince him of anything. He knows what she would have wanted. He knows what she would have said.
When he's finished, he puts her headband back on. I remain quiet, though I know they'll remove it in the operating room. "You're doing a good thing," I tell him.
He nods and I leave him alone for a moment, not because I'm generous but because I can't stand to watch them say good-bye.
I follow the transplant recovery team into the OR. The woman has become "the body," "the chest," no longer the person, the wife, Lena Dixon. They wrap her in clear plastic, cocooning her. The nurse swabs her with iodine and the room fills with the smell of it.
The surgeon picks up a scalpel. His eyes flicker to me as if checking whether I'm OK. I'm OK. Everything is a-OK. He makes a long incision from throat to stomach. Another doctor cracks open the sternum. The chest bone is difficult to break; sometimes they have to use a saw. The surgeon snips the aortic valve, delicately, his pinky raised, and then I see it. It's bigger than I thought it would betwice the size of my fist. Not red, not beautiful. A purple and black muscle, a wonderful and horrible thing, still beating.
The rest of the transplant surgeons do what they need to do. The heart will be placed in a red cooler and flown via helicopter to a different hospital where another family waits. The lungs are trickier and may not be usable. The liver might go to a local woman, the kidneys to two other people. Skin tissue for burn victims. Corneas for a blind person. One life to save seven others.
It's a good thing. It's a good thing. It's a good thing. I repeat this to myself while the nurse sews the empty body closed with neat black stitches.
It's 4 a.m. when I stumble through the hospital's automatic doors. My legs tremble from standing for so long. The parking lot is deserted, the moon just beginning to fade as streaks of orange and purple flood across the sky. The start of another beautiful day.
The porch light is off, which shouldn't matter really since it's already dawn. I fumble with the keys for a long time before I unlock the front door.
I pull off my shoes and notice a hole in my tights. This makes me think again of the black threads across Lena Dixon's skin, how the nurse stitched her up as though it were a normal procedure, and not the end of something.
I drag myself upstairs to the bedroom and stand over the sleeping shape of my boyfriend. His arm is thrown up over his head as if to shield himself from an attack. He seems younger; in sleep he doesn't have to arrange his face in any particular way to prepare for what I might say next.
He was dear to me once. At least, I think he was.
In training we learned the many reasons people say no. They say no because they look at the body and can't believe their son/daughter/husband/wife/brother/sister won't snap out of it. They say no because they understand that doctors make mistakes, or because they hear the word coma and believe there's a chance their loved one can be saved. Because they still have hope. They say no because they met someone who knows someone whose brother was in a terrible car wreck but made a slow recovery and is now bagging groceries at the local supermarket. They say no because they can't bear that their son's dog will outlive their son. They say no because they raised this child, fell in love with this face, remember with clarity how he used to move around in space, his habit of gesturing with his hands when telling a story. They say no because to say yes would mean accepting death.
I sit at the kitchen table and make a list. The sun creeps across the floor as I write.
Replace the tangle of cords beneath your computer. Buy new batteries for the smoke alarm. Sidewalk salt for when it's icy. A waterproof radio for the bathroom. Duck-shaped stickies for the bottom of the tub . . . I write until my hand aches; this is the last good thing I can do before I leave.
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