At twenty past midnight on what had been the longest day of her life, Dr. Mills finally entered the room. He was obviously tired, but he’d changed into clean scrubs before coming to talk to them. Amanda rose from her seat, as did Lynn and Frank.
“The surgery went well,” he said straight off. “We’re pretty sure Jared is going to be fine.”
Jared was in recovery for several hours, but Amanda wasn’t allowed to see him until he was finally moved to the ICU. Though it was normally closed to visitors overnight, Dr. Mills made an exception for her.
By then Lynn had driven Frank home. He claimed to have developed an intense headache from the blow to his face, but he promised to be back the following morning. Lynn had volunteered to return to the hospital afterward to stay with her mom, but Amanda had vetoed the idea. She’d be with Jared all night.
Amanda sat at her son’s bedside for the next few hours, listening to the digital beeps of the heart monitor and the unnatural hiss of the ventilator slowly pushing air in and out of his lungs. His skin was the color of old plastic and his cheeks seemed to have collapsed. He didn’t look like the son she remembered, the son she’d raised; he was a stranger to her in this foreign setting, so removed from their everyday lives.
Only his hands seemed unaffected, and she held on to one of them, drawing strength from its warmth. When the nurse had changed his bandage, she’d caught a glimpse of the violent gash that split his torso, and she’d had to turn away.
The doctor had said that Jared would probably wake later that day, and as she hovered at his bedside she wondered how much he would remember about the accident and his arrival at the hospital. Had he been frightened when his condition suddenly worsened? Had he wished that she’d been there? The thought was like a physical blow, and she vowed that she would stay with him now for as long as he needed her.
She hadn’t slept at all since she’d arrived at the hospital. As the hours passed with no sign of Jared waking, she grew sleepy, lulled by the steady, rhythmic sound of the equipment. She leaned forward, resting her head on the bedrail. A nurse woke her twenty minutes later and suggested that she go home for a little while.
Amanda shook her head, staring at her son again, willing her strength into his broken body. To comfort herself, she thought of Dr. Mills’s assurances that once Jared recovered, he would lead a mostly normal life. It could have been worse, Dr. Mills had told her, and she repeated that sentiment like a charm to ward off greater disaster.
As daylight seeped into the sky outside the ICU’s windows, the hospital began to come to life again. Nurses changed shifts, breakfast carts were loaded up, physicians began to make their rounds. The noise level rose to a steady buzz. A nurse pointedly informed Amanda that she needed to check the catheter, and Amanda reluctantly left the ICU and wandered to the cafeteria. Perhaps caffeine would give her the energy surge she needed; she had to be there when Jared finally awoke.
Despite the early hour, the line was already long with people who, like her, had been up all night. A young man in his late twenties took his place behind her.
“My wife is going to kill me,” he confessed as they lined up their trays.
Amanda raised an eyebrow. “Why is that?”
“She had a baby last night and she sent me here for coffee. She told me to hurry, because she was getting a caffeine headache, but I just had to make a detour to the nursery for another peek.”
Despite everything, Amanda smiled.
“Little boy or little girl?”
“Boy,” he said. “Gabriel. Gabe. He’s our first.”
Amanda thought of Jared. She thought about Lynn and Annette, and she thought about Bea. The hospital had been the site of both the happiest and saddest days of her life. “Congratulations,” she said.
The line crawled along, customers taking their time with their selections and ordering complicated breakfast combinations. Amanda checked her watch after finally paying for her cup of coffee. She’d been gone for fifteen minutes. She was pretty sure she wouldn’t be able to bring the cup into the ICU, so she took a table by the window while the parking lot out front slowly began to fill.
When she had drained her coffee cup, she visited the bathroom. The face reflected in the mirror was haggard and sleep deprived, barely recognizable. She splashed cold water on her cheeks and neck and spent the next couple of minutes doing the best she could to make herself presentable. She took the elevator back up, then retraced her steps to the ICU. When she neared the door, a nurse stood and intercepted her.
“I’m sorry, but you can’t go in right now,” she said.
“Why not?” Amanda asked, coming to a standstill. The nurse wouldn’t answer, and her expression was unyielding. Amanda felt the coils of panic tighten inside her once more.
She waited outside the door of the ICU for almost an hour, until Dr. Mills finally emerged to talk to her.
“I’m sorry,” he said, “but there’s been a serious development.”
“I was j-j-just with him,” she stammered, unable to think of anything else to say.
“An infarction occurred,” he went on. “Ischemia in the right ventricle.” He shook his head.
Amanda frowned. “I don’t know what you’re trying to tell me! Just say it so I can understand!”
His expression was compassionate, his voice soft. “Your son,” he finally said, “Jared… he had a massive heart attack.”
Amanda blinked, feeling the corridor close in. “No,” she said. “That’s not possible. He was sleeping… he was recovering when I left.”
Dr. Mills said nothing and Amanda felt light-headed, almost disembodied as she babbled on. “You said he was going to be fine. You said the surgery went well. You said he’d wake up later today.”
“I’m sorry—”
“How could he have had a heart attack?” she demanded, incredulous. “He’s only nineteen!”
“I’m not sure. It was probably a clot of some sort. It might have been related to either the original trauma or the trauma from surgery, but there’s no way to know for certain,” Dr. Mills explained. “It’s unusual, but anything can happen after the heart sustains such a serious injury.” He touched her arm. “All I can really tell you is that if it had happened anywhere other than the ICU, he might not have made it at all.”
Amanda’s voice began to quiver. “But he did make it, right? He’s going to be okay, isn’t he?”
“I don’t know.” The doctor’s face was shuttered again.
“What do you mean, you don’t know?”
“We’re having difficulty keeping a sinus rhythm.”
“Stop talking like a doctor!” she cried. “Just tell me what I need to know! Is my son going to be all right?”
For the first time, Dr. Mills turned away. “Your son’s heart is failing,” he said. “Without… intervention, I’m not sure how long he’s going to last.”
Amanda felt herself stagger, as if the words were actual blows. She steadied herself against the wall, trying to absorb the doctor’s meaning.
“You’re not saying that he’s going to die, are you?” she whispered. “He can’t die. He’s young and healthy and strong. You have to do something.”
“We’re doing everything we can,” Dr. Mills said, sounding tired.
Not again, was all she could think. Not like Bea. Not Jared, too.
“Then do more!” she urged, half-pleading, half-shouting. “Take him to surgery, do what you have to do!”
“Surgery isn’t an option right now.”
“Just do what you have to do to save him!” Her voice rose and cracked.
“It’s not that simple—”
“Why not?” Her face reflected her incomprehension.
“I have to call an emergency meeting with the transplant committee.”
Amanda felt her last threads of composure give way as he said those words. “Transplant?”
“Yes,” he said. He glanced toward the ICU door, then back to her. He sighed. “Your son needs a new heart.”
Afterward, Amanda was escorted back to the same waiting room she’d occupied during Jared’s first surgery.
This time, she wasn’t alone. There were three others in the room, all wearing the same tense, helpless expression as Amanda. She collapsed into a chair, trying and failing to suppress a horrible feeling of déjà vu.
I’m not sure how long he’s going to last.
Oh, God…
Suddenly, she couldn’t stand the confines of the waiting room anymore. The antiseptic smells, the hideous fluorescent lighting, the drawn, anxious faces… it was a repeat of the weeks and months they’d spent in rooms identical to this one, during Bea’s illness. The hopelessness, the anxiety—she had to get out.
Standing, she threw her purse over her shoulder and fled down the generic tiled hallways until she reached an exit. Stepping into a small terraced area outside, she took a seat on a stone bench and drew a deep breath of the early morning air. Then she pulled out her cell phone. She caught Lynn at home, just as she and Frank were about to leave for the hospital. Amanda related what had happened as Frank picked up the other extension and listened in. Lynn was again full of unanswerable questions, but Amanda interrupted to ask her to call the sleepaway camp where Annette was staying and arrange to pick up her sister. It would take three hours round trip and Lynn protested that she wanted to see Jared, but Amanda said firmly that she needed Lynn to do this for her. Frank said nothing at all.
After hanging up, Amanda called her mother. Explaining what had happened in the last twenty-four hours somehow made the nightmare even more real, and Amanda broke down before she was able to finish.
“I’m coming,” her mother said simply. “I’ll be there as fast as I can.”
When Frank arrived, they met with Dr. Mills in his office on the third floor to discuss the possibility of Jared receiving a heart transplant.
Though Amanda heard and understood everything that Dr. Mills said about the process, there were only two details that she later truly remembered.
The first was that Jared might not be approved by the transplant committee—that despite his grave condition, there was no precedent for adding a patient to the waiting list who’d been in an automobile accident. There was no guarantee that he would be eligible.
The second was that even if Jared was approved, it was a matter of pure luck—and long odds—whether a suitable heart would become available.
In other words, the odds were slim on both counts.
I’m not sure how long he’s going to last.
On their way back to the waiting room, Frank looked as dazed as she felt. Amanda’s anger and Frank’s guilt formed an impenetrable wall between them. An hour later, a nurse stopped by with an update, saying that Jared’s condition had stabilized for the time being, and that they would both be allowed to visit the ICU if they wanted to.
Stabilized. For the time being.
Amanda and Frank stood beside Jared’s bed. Amanda could see the child he’d been and the young man he had become, but she could barely reconcile those images with the prone, unconscious figure in the bed. Frank whispered his apologies, urging Jared to “hang in there,” his words triggering a flood of rage and disbelief in Amanda that she struggled to control.
Frank seemed to have aged ten years since the night before; disheveled and downcast, he was the picture of misery, but she could summon no feeling of sympathy for the guilt she knew that he was feeling.
Instead, she ran her fingers through Jared’s hair, marking time with the digital beeps of the monitors. Nurses hovered over other patients in the ICU, checking IVs and adjusting knobs, acting as though the day were completely ordinary. An ordinary day in the life of a busy hospital, but there was nothing ordinary about any of this. It was the end of life as she knew it for her and her family.
The transplant committee was meeting soon. There was no precedent for a patient like Jared to be added to the waiting list. If they said no, then her son was going to die.
Lynn showed up at the hospital with Annette, who was clutching her favorite stuffed animal, a monkey. Making a rare exception, the nurses allowed the siblings into the ICU together to see their brother. Lynn went white in the face and kissed Jared on the cheek. Annette placed the stuffed animal next to him on the hospital bed.
In a conference room several floors above the ICU, the transplant committee met for an emergency vote. Dr. Mills presented Jared’s profile and case history as well as the urgency of the situation.
“It says here that he’s suffering from congestive heart failure,” one of the committee members said, frowning at the report before him.
Dr. Mills nodded. “As I detailed in the report, the infarction severely damaged the patient’s right ventricle.”
“An infarction that most likely stemmed from injury sustained in an automobile accident,” the member countered. “As a general policy, hearts aren’t given to accident victims.”
“Only because they don’t generally live long enough to benefit,” Dr. Mills pointed out. “This patient, however, survived. He’s a young, healthy male with otherwise excellent prospects. The actual cause of the infarction is still unknown, and as we know, congestive heart failure does meet the criteria for transplantation.” He set the file aside and leaned forward, facing each of his colleagues in turn. “Without a transplant, I doubt this patient will last another twenty-four hours. We need to add him to the list.” A note of pleading crept into his voice. “He’s still young. We have to give him the chance to live.”
A few of the committee members exchanged skeptical glances. He knew what they were thinking: Not only did this case lack precedent, but the time frame was too short. The odds were almost nonexistent that a donor could be found in time, which meant the patient was likely to die no matter what decision they made. What they didn’t mention was a colder calculation, though no one on the committee gave voice to it. It had to do with money. If Jared was added to the list, the patient would be counted as either a success or failure for the overall transplant program, and a higher success rate meant a better reputation for the hospital. It meant additional funds for research and operations. It meant more money for transplants in the future. In the big picture, it meant more lives could be saved in the long run, even if one life had to be sacrificed now.