* * *
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.