At last they had been summoned to surgery, and Count Ramstedt had been wheeled in. Everything had been efficiently readied. The patient had already been anesthætized, chest shaved and prepped, and merthiolate applied. The patient had received mild hypothermy to cool his system to 30° C. and he had received heparin intravenously to prevent clotting. The huge heart-lung machine stood ready, and the 4,000 c.c. of whole blood, cross-matched, awaited use in the event of emergency.
In his concern for the patient, Garrett had forgotten the presence of Farelli. At first, what was so well known to him-materials, procedure-seemed strange and otherworldly because of the quick singsong of the Swedish words that went from Öhman to his nurses and aides-läkaren and hud and bröstkorg and blod and ådra and skoterska and bedöva-and once, pulsen är mycket oregelbunden, which Garrett understood to mean that the pulse was irregular-and constantly, over and over, hjärta, hjärta, hjärta, which Garrett came to realize was heart, heart, heart.
But then, as Öhman flexed his fingers in the rubber gloves, and took the slap of the scalpel, complaining that there was a troublesome halation on the instrument and having one light adjusted, and then, as he performed the median sternotomy-the incision from the neck base down the middle of the sternum to the bottom of the breastbone-there was nothing any longer strange or otherworldly to Garrett.
As he observed what followed, Garrett’s pride swelled. This was his discovery, his immortality. Critically, yet with continuing inflated ego, Garrett watched a son of Hippocrates attempt to raise a Lazarus from the dead. Garrett watched, his head involuntarily nodding its approval… the rubber-shod clamps… the open chest wall… the anticoagulant… the endless connecting of the plastic heart-lung apparatus to provide oxygenation of the blood and to remove carbon dioxide… the withdrawal of all blood from the major venous return before it reached the ailing heart, bypassing heart and lungs, diverting the blood through the pump and then returning it to the arterial circulation system… the crucial minutes of surgery with the delicate excavation of the old heart, transecting the pulmonary artery and the aorta beyond their valves and cutting across the region of the atria at the back portion…
It was 10.52 in the morning.
The strain began to leave Garrett as his protégé inserted the cooled fresh calf’s heart-two young mammalian auricles and two ventricles-and then sutured the walls of the atria together, avoiding separate anastomoses of the veins leading to the heart. Now, for the final suture by the Russian vessel instrument, woven dacron to hook up the aorta, the pulmonary artery, the four pulmonary veins, the superior vena cava, the inferior vena cava.
Garrett and Farelli looked on tightly, as Öhman completed the transplantation. With the new heart freed of air to avoid air embolism, Öhman released the aorta to permit fresh oxygenated blood from the great plastic outer machine to pass into the coronary vessels. The new mammalian heart warmed and was filled with fresh oxygenated blood. Gradually, gradually, the new heart began to contract, to take over circulation on its own, receiving and pumping plasma. The patient breathed on. Lazarus alive.
Garrett’s gaze narrowed. Rhythm excellent. No electrical defibrillation necessary. He was about to speak up-there was another thing-he must remind Öhman to administer Polybrene to neutralize the heparin and to allow the resumption of normal blood clotting, but then he knew it was too soon and Öhman would not forget, anyway.
The lanky anæsthetist spoke. ‘Oxygenation satisfactory. He is also maintaining satisfactory blood pressure.’
Seventy beats a minute, thought Garrett, and 5,600 c.c. of blood pumping a minute-with a transplanted heart! His own private heart swelled once more.
‘Go off bypass,’ said Öhman.
The glass cardiopulmonary heart-lung machine was disconnected. The new heart was on its own.
Only three times, in English made awkward by emergency, had Öhman consulted with Garrett and Farelli in the hour gone by, and three times they had confirmed what he had planned, once both supplementing his ideas with ideas of their own, and now, at last, the transplantation had been successfully accomplished. All that remained was the routine removal of clamps and catheters, the closing of the chest cavity, the addition of Polybrene, the injection of growth-inhibiting hormones to contain the calf’s heart, and finally, the observation of life renewed and extended.
Öhman turned to the Nobel winners, and Garrett thought that he might be smiling wearily beneath the mask. ‘His Majesty will be relieved,’ said Öhman in an undertone. ‘It is done.’
‘Benissimo,’ said Farelli. ‘Felicitazioni!’
‘Congratulations, Dr. Öhman,’ said Garrett.
‘No-no-it is I who congratulate both of you for this,’ said Öhman. ‘I can handle the rest myself. Why do you not wash up and wait in the office? Nurse Nilsson will show you the way. I shall join you very soon.’
He had already returned to the patient, and the tiniest of the three nurses came towards Farelli, and Garrett followed them out of surgery into the antiseptic, tiled washroom of the Caroline Hospital. The nurse hung back as Garrett and Farelli worked free their rubber gloves and removed their surgical masks, and then, still unspeaking, bent over separate basins to scrub the starch from their hands with nylon brushes. Drying his hands, while Farelli still washed, Garrett was relieved by the presence of the nurse.
When they both were ready, the nurse said, ‘This way.’ They went with her into the corridor, and then into a small office, barren of all but a cigarette-scarred table holding several ashtrays and surrounded by five straight chairs.
But then, to Garrett’s dismay, the nurse left, and he found himself alone with Farelli. He extracted a cigar, and made much of preparing it, and when he looked up, he saw that the Italian was already drawing deeply on a cigarette as he stood by the window.
‘Still snowing,’ said Farelli.
Garrett said nothing. Now that the surgery was over, now that the worth of his discovery had been dramatized so remarkably and would soon be known around the world, the exhilaration had gone out of him. There could be no pleasure, he knew again, because Farelli existed, and somehow the transplantation would not be Öhman’s or even Garrett’s, but Farelli’s own, just as the discovery itself and the Nobel Prize in physiology and medicine this afternoon would be Farelli’s own.
As long as Farelli lived, Garrett’s instinct told him, Farelli would be the savant and the man, and he, himself, would be the shadow. Yet what could be done about it? He had tried everything, and everything had failed. There was only one hope. Öhman had been against it. Craig had deterred him from it. Or perhaps what had restrained him, actually, had been neither one of them, but his own good conscience.
Yet now this conscience of his did not seem good, but a weakness that would relegate him to eternal obscurity. But for this conscience, he would not have to live out the remainder of his days as pretender to the throne. Except for this conscience, he would have the throne.