Phantom Heart

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“See for yourself,” Jacob said, stepping aside.

“Oh, wow.”  The young reporter leaned down, her eyes widening.

Jacob smiled at the look on her face.  He glanced at the organ behind layers of glass and smiled even wider.  A beating heart.  An artificial heart.  And he had helped to create it, design it, mold it, and nurture it.  It seemed to beat stronger, as if it were showing off.  It still surprised him sometimes that he found it beautiful.  He’d seen so many hearts in his time with the tissue regeneration research laboratory.  Pig hearts, frog hearts, human hearts.  He had respected them all, but never found them beautiful.  Nor did he feel that way about this artificial heart until three days ago, when it started beating for the first time.

The reporter straightened and though she turned her head slightly towards him, her eyes remained on the heart.  “How long has it been going?”

“Three days.”

She was from the university paper.  But Jacob felt as if he were giving an exclusive to the world press.  The pride.  It was premature, years premature most likely, but he couldn’t help feeling it.

ArtHeart

“As you can see, ” he said, “we’ve even given it some artificial arteries and veins to pump the nutrient liquid through.  We want to test the strength of the muscle tissue and the ability of the heart to keep a steady rhythm.  We’ve got alarms attached to it so someone will get an automated call if something goes wrong, but so far, so good.”  He made a fist of his right hand and knocked against his right temple.  Knock on wood.

The reporter smiled politely.  “And no mechanical parts at all?”

“None.”

“Why did you choose the heart?  It’s pretty complex.  I mean it’s got a unique type of muscle.  It’s got chambers, and tubes, and nodes.  It has to be coordinated when its pumping.  Why not something simpler, like the stomach?”

Jacob smiled again, pleased that the reporter was asking more meaningful questions than he’d expected.  “I’d say none of the organs are ‘easy.’  Even the ones that look like one big blob are made up of several different types of cells forming different tissues.  If you look at a cross section of the stomach under a microscope, you wouldn’t say it was easy.  But we did decide to challenge ourselves when we chose the heart.”

Jacob walked the reporter farther down the corridor just outside the offices of the core organ fabrication team.  “We receive consultations and expertise from scientists and doctors all over the world,” he said.  “But the team doing all the hands-on work here is made up of only nine people, believe it or not, including this project’s principal investigator, my boss.  He broke us up into smaller teams that rotate the duties of monitoring the heart.  On duty today with me are my partners, Elise Hadley and John Kimura.”  He gestured through the window.

Kim and Hadley waved nervously at the reporter from their desks.  They were filling out the daily checklists and writing the daily reports, work that would have otherwise bored them.  Today they seemed utterly engaged.  Their boss had assigned one of the core team to speak to the reporter and Jacob had drawn the short straw.  But that had been four days ago, before they knew if this heart would work.  He hadn’t imagined then what it would feel like to watch the look in someone’s eyes when they realized the meaning of what they were seeing.  From behind the window to the offices, his colleagues kept glancing at Jacob and the reporter, looking a bit sheepish and guilty.  They hadn’t figured out yet that Jacob was enjoying the interview and the chance to share his excitement and his pride on behalf of the whole international team.

“Walk me through the general process that you went through to get from a vat of molecular soup to a working heart,” the reporter said.

“Well, we didn’t start with a vat of molecules.  We cheated a bit.  We used a biodegradable scaffolding to give the process a head start.   Added cardiac stem cells.  Used signaling molecules to direct the replication and differentiation of cells, all leading to the growth of tissues in a nutrient bath.  And we continued to guide and monitor the process as the organ developed.  The idea is to let the heart grow naturally, but to guide that growth because of the one unnatural aspect, the fact that the heart is growing outside of an organism.  The eight of us on the core team took turns doing rotations day and night during the two months or so that it took to grow the heart.”

“Two months?”

Jacob nodded.

“That’s very fast compared to the growth of a normal heart in utero, isn’t it?  Were you worried at all about the tissue turning cancerous or just collapsing or something else going wrong?”

“The accelerated growth is part of our procedure.  We’ve already done this about a dozen times with all manner of things going wrong.  Each time we learn and make corrections.  And other things go wrong.  This time, things went right.”

“I hope you were taking copious notes.”

Jacob laughed.  “We tried.”

“So what’s next?”

“Replicating our results, growing another heart.  It’s a very delicate and involved process.  Definitely not anywhere near ready to be scaled up.”

“No human organ assembly lines?”

Jacob grinned.  “Not yet.”  But he pictured what she’d said.  And he took a breath.  How many lives would they save?  How many limbs and senses would they restore?  The money—no more grant-writing.  The fame—he frowned, he didn’t care for pop culture fame.  But historical fame…

***

In the several weeks since Jacob had given the interview with the university paper, the mainstream press had picked up on the story as expected.  The university had a public information officer dealing with all media inquiries, but the laboratory was not some top-secret government facility.  Their number was public information and the core fabrication team, who had already received training in how to answer media inquiries, had been re-trained twice already.  Each time, the training followed media leaks about abnormal readings in the artificial heart along with the fact that further attempts to grow another heart had failed.  So when their boss called an impromptu meeting that morning, Jacob thought there must have been another leak of data.  And the team wondered if the leak had been traced and if someone was being fired.

But Jacob could have never foreseen the real reason for the locked-door meeting.  And when their boss began to speak, the team became stunned.  A decision had been made regarding the artificial heart.  A recipient had been found and vetted and approved.  It was someone with a rare illness that only affected the heart muscle, something Jacob had never heard of.  A transplant procedure had been scheduled.

Their boss gave them a moment to react.  The room erupted in multiple conversations at once.  The team was conflicted.  Someone’s life could be saved and the heart could be proven.  But if the transplant did not work, the heart might be ruined.  They still did not know why it was working.  How it was working.  Their boss held out his hands to quiet them.

“I know I just dropped a bomb on you,” he said.  “I realize we’re in totally uncharted territory.  But I think we’re ready for this next step.  We haven’t managed to grow another heart yet.  But we have managed to stabilize the first heart.  We’ve kept it alive for two months despite a few minor emergencies.  I was not at liberty to tell you this until now, but we already had this candidate in mind when we started the first batch of fabrication.  We finally received approvals from all the involved authorities—review boards, researchers, everyone.  The process has been moving faster than light speed, which is unheard of, but this candidate doesn’t have much time.  It’s actually astounding that she has survived this long.  But her heart will fail her long before a donor heart will be available to her.  So, ready or not, we’re going forward with this.”

He looked at each of the eight people in that room in turn.  “Your job is to keep that heart alive and healthy until the day of the surgery.  Get as much data from it as you can while it’s still out here.  After next Wednesday, if all goes well, you’re going to have a whole new set of data to collect.  And we’ll have a whole new level of scrutiny.  Do not talk to the press.  Do not talk to anyone outside of this room.  Leave that to those who are authorized.  You have all signed on the dotted line, so if you talk, at best you’ll lose your jobs.  At worst…well don’t let the worst happen.  Understood?”

There was a general murmur of consent.  And in the midst of the tension and excitement, Kim leaned toward Jacob and whispered, “Things just got real.”

***

The ringing woke Jacob up from a dream, and he woke in confusion about whether that sound he was hearing was still part of the dream or part of the waking world.

It was his phone.  And it was definitely real.  He frowned.  A call in the middle of the night was never a good omen.  He rubbed his eyes and his hand reached out toward the bedside table to fumble for his phone.  He squinted at the bright screen to see who was calling.  And he was jolted awake.

***

He didn’t bother parking within the lines, or giving the night guard an adequate greeting, as he sprinted past the security desk.  He cursed at the slowness of each keycard reader and dashed into the laboratory, barely hearing the alarms over the pounding in his ears.

When he stood before the artificial heart, he froze for a few seconds, breathing hard, not knowing what to do.  The alarm on the heart rate monitor indicated arrhythmia.  But the heart rhythm seemed normal now, if a bit fast and forceful.  The liquid nutrient bath rippled from the force of the contractions.  A glance at the monitor showed the maximum rate measured was 157 beats per minute.  But the rate was quickly dropping.  Now 143, now 129.  Jacob muted the alarm and watched the heart and the heartbeat while he checked other readouts—oxygenation, concentration of nutrients, electrical activity.  He logged into the computer and brought up the electrocardiogram readings from the past hour.  And there it was, about twenty minutes ago, just before he received the automated phone call.

A spike.

He glanced at the heart.  Its beat was slow and steady now.  Alert but normal.  The monitor displayed a rate of 84 beats per minute.  Almost resting rhythm.

Jacob rolled his chair before the glass tank.

“What happened to you?” he asked.  He raised his brows.  “All right now?”

As if in answer, the heart rate monitor gave a beep.  The rate had reached 75 beats per minute.  The baseline resting rate they had assigned to their still-young heart.

He raised his hand to the tank, but hesitated at touching the glass, afraid of triggering another attack or whatever it had been.  He took a breath and exhaled.  He tried to think of what he was supposed to do next.  He’d been in the laboratory at this hour before, working on the heart.  He knew other core team members had been called out of bed by alarms in the night, usually from primary instrument failures or imbalances detected in the nutrient bath.  He had responded to alarms before while he was already in the lab.  None of the emergencies had resulted in any permanent harm.  But this was different.  This was the first time he had been summoned to the laboratory by an emergency in the middle of the night.  As it turned out, the experience was frightening.

Jacob rolled back over to the computer console.  The phone was next to it.  He finally thought about what he should do instead of just staring at the heart and the instruments.  He dialed security and asked if there had been a power outage or some other electrical malfunction or irregularity in the environmental controls in the hour before he arrived.  The instruments and equipment keeping the heart alive were connected to two levels of back-up power, but there was no way to prepare for every possible thing that could go wrong.  The guard reported no unusual power fluctuations or other building issues that he was aware of, but he told Jacob he would check and report back.

Jacob hung up and the phone rang again immediately.  He frowned.  That was fast, he thought.  But then he recognized the incoming number and picked up.

“Kim,” he said.

“Oh good, you’re there already.  How is she?”

Kimura had given the heart a gender.  But not a name yet, thankfully.  He was convinced it was a “she” because he had come in one day the previous week with his guitar and serenaded it, swearing he’d made it skip a beat.  The data showed otherwise.

“The heart looks all right now,” Jacob said.  “I’m watching it and going through the data for the last hour.  Just called the guard to check on the usual building maintenance items.”

“I’m on my way, but I figured you’d be there by now.  Should I still come in?”

“It’s up to you, but the heart seems fine for now.”

“You staying the night?”

Jacob glanced at the clock on the wall.  It was past two in the morning.  He sighed.  “Yeah, I will.  I’ll do some preliminary analysis and leave it for you guys in the morning.”

“Thanks, man.  I’ll head home then.  But hey, call me if you need me.”

“Will do.”

Jacob hung up and he realized he was cold.  The laboratory was at a constant 68 degrees Celsius for the sake of the equipment.  That temperature was bearable during the day when he was fully rested and fully dressed.  But he was still in his pajamas, wearing no socks, operating on three hours of sleep after a twelve-hour work day, and he felt cold.

And hungry.  His stomach gave a small complaint.  If he was staying until morning, he would need something.  He glanced at the now-calm heart.  The immediate crisis was averted.

He headed to the kitchen to put on some hot water for tea and found something in the freezer that he could pop in the microwave.  While the dish of Salisbury steak and macaroni and cheese was warming, he strolled back to the laboratory.  He looked through the glass window.  The heart was deceivingly accessible.  They had put it in prominent view of whoever walked the hallways, so everyone could marvel, and share in the coming prestige of their institution, and feel a twinge of envy, and marvel again.  But between the viewer and the heart were several levels of physical and mechanical and electrical barriers.

He watched the heart beating rhythmically, pumping away, his half-asleep mind becoming mesmerized until the beeps of the microwave snapped him out of it.

He looked at the heart.  Just getting something to eat, he told it mentally.  I’ll be right back.

***

“Did you get any sleep?” Kimura asked.  He was half an hour earlier than usual.

Jacob slapped a file to his friend’s chest, yawning as if prompted.  “A little.  I printed some of the stuff I thought was relevant.  Haven’t made sense of it yet.”

“So what happened?  An attack?”

Jacob shook his head.  “No attack.  No dead tissue.”

“That’s good,” Kim said.  “It’s T minus five days. Now is not the time for her to be weird.”  By “T” he meant “transplantation.”

“No wounds as far as I can tell.  It’s functioning normally now.  It seems more like it was a severe electrical imbalance.  Like the heart was in fight-or-flight mode or something.  We should check the bath today and all the instruments.  I want to stay, but my brain is useless right now.”

“And you’re not in proper work attire.  You might want to wait until the boss gets in.  He’ll appreciate your dedication.  Not stopping to even pull on a pair of pants.”

Jacob blinked slowly.  Now that someone else was there, now that his watch was over, the drowsiness was beginning to claim him.  As he left, he passed the heart and smiled at it and mentally bid it goodbye.

***

When Jacob came back in that afternoon there was a police cruiser in front of the building.  He rushed in again, feeling deja vu.  After all he had done, something else had happened.  Had someone taken the heart?  Were his friends okay?  There was an officer at his desk waiting to question him.  Kim was with him.

Jacob looked through the office window to the heart.

“She’s okay,” Kim said.  “But the officer wants to ask you some questions about last night.”

“What’s going on?”

“They just went to go arrest George,” Kim said.  “They think he was trying to steal notes and stuff, maybe even planning to steal the heart.”

“George?”

“The guard on duty last night, sir,” the police officer said.

Jacob frowned.  He hadn’t noticed anything weird about George.  He gave his statement to the officer, who gave them his card and made the usual request to contact him if they remembered anything else.

“What happened?” Jacob asked Kim after the officer left.

Kim gestured for him to follow and walked him to the front desk, where the morning shift guard was standing at the monitors.  He put a hand on her shoulder.  “Jesse is the one who figured it out.  She was being an overachiever and reviewing the security tapes from last night because she saw the heart alarm on their incident log.”

“Take a look at this,” Jesse said, pointing to the security feed from the time before the alarms went off on the heart.  “Sorry, it’s video only.”

It looked innocent enough, with George strolling through the laboratory’s hallways.  Then he entered the heart laboratory.

“That’s the first thing that’s off,” Jesse said.  “We’re not supposed to have access to that area, unless there’s a fire or something.”

Jacob, eyes furrowed, learned further down to look at the screen.  “No, you’re not.”

George stopped at the heart for a moment.  He kept his distance and didn’t appear to have any item or device that could affect the heart.  He bent down and stared at it.  It looked as if George was saying something.  But he wasn’t on a phone and didn’t appear to be wearing any earpieces.

The lights of the alarm went off.  The guard straightened right away and quickly returned to his station.  As he was supposed to, he checked the cameras, environmental controls. He went through the whole proper procedure.

“Looks like he was scared off when the alarms went on,” Kim said.  “He got back to his station and played dumb when you arrived.”

Jacob frowned as he watched.  “The heart is okay?”

“She’s been fine,” Kim said.  He slapped Jacob on the shoulder.  “I guess he scared her a little, that’s all.”

Jacob looked at Kim and wondered at his nonchalance.  But Kim was right.  All that day and the next, the heart was fine.  All readings were normal.  The heart functioned normally in all the tests, pumping as expected, beating as expected.

All was calm in the lab.  And all was calm with the heart.  If only it had remained that way.

***

“So, what are you saying, that it’s responding to us?” Jacob asked Hadley.

He was having lunch with her and Kimura a few days later at the diner a block away from the lab.  After what happened with the guard, security had been tightened to protect all their data and the heart itself.  It was astounding that no one had leaked the news about the impending plans to transplant the heart.  But in the midst of all the drama and the intrigue, the core team was focused on the mystery of the heart itself.  Despite a day or two of calm, it was still doing things, on occasion, that they could not explain.  Sometimes the nutrient bath was full of proteins or chemicals that seemed to come from nowhere.  One of the other teams found traces of blood in the bath.  The arrhythmias continued.  And they all worried that someone would come in one day and find a tear or fracture in the organ.  Overall the heart seemed healthy.  It was just displaying some erratic behavior for an organ that was always in a controlled environment.

“She can’t be responding to us,” Kim said.  “She’s practically in a sensory deprivation chamber.”

“It’s responding to something,” Hadley said.

Kimura pointed a french fry at her.  “How do you figure?”

“Well, what do you think is going on?  Random anomalies?”

“Or…maybe it’s normal.  We don’t have instruments hooked up to our hearts all the time.  We don’t know what our hearts are doing.  Some people have atrial fibrillations and can’t even feel them.”

Hadley peered at her glass of cola.  “That’s why we have to brainstorm every crazy possibility we can think of.”  She sighed.  “There’s nothing for it to respond to.  Nothing real as far as we can tell.  But something is going on with that heart.”

“We’ve done our jobs in reporting it,” Jacob said.  “If they want to go ahead with the plans anyway, it’s their call nor ours.”

“Remember that one time you said it seemed to be having a fight-or-flight response?”  Hadley said.

Jacob shifted in his chair.  “I can’t confirm that unless I had more information.”

“Right, more information from other parts of the body,” Hadley said, “which doesn’t apply to our stand-alone organ.  But when you came in, you said it was beating in the same kind of agitated rhythm that we’d expect in someone suffering a high level of anxiety.”

Kimura held up a hand.  “Careful, now.  You’re making up a cause-and-effect story to fit our observations.  Our heart is not inside of a living body.  She doesn’t have a brain telling her that she should feel scared or anxious.”

Hadley looked at him.  “A man missing an arm doesn’t have an arm telling his brain it’s there, but he feels the arm anyway.”

Kimura frowned in confusion.  “What do phantom limbs have to do with whatever point you’re trying to make?”

“What if the opposite effect could happen?  Instead of a phantom limb, we have a single organ that is feeling the presence of a phantom body?”

Jacob looked down at his plate, not wanting to get caught up in the friendly bickering that he usually found fascinating but today found troubling.

Kimura shook his head.  “Setting aside all the metaphysical stuff, this heart was never inside of a body.  She can’t miss what she never had.  That’s the first place your comparison to phantom limbs breaks down.  Secondly, the reason phantom limb syndrome happens is because of the brain.  It’s the brain that misses the limb.  I could maybe buy it if we had grown a brain and it began exhibiting signs of experiencing distress at being outside of a body.  But a heart?  How?  A heart by itself cannot be sentient.”

“Didn’t some ancient cultures consider the heart the seat of the soul?” Hadley asked, leaning on the tabletop, raising her eyebrows.

Kimura looked at Hadley, exhaling a breath that sunk his shoulders.  “Guys, what is the point of discussing anything that we cannot measure or detect?”

“I think we should keep a separate record of our non-scientific thoughts on this project,” Hadley said.  She turned and looked at Kimura.  “There is a point that is relevant to our work.  A very important and dangerous point.  The ethics issue.  The easiest way to grow organs is to clone people and harvest the organs.  But the reason we don’t do that is obvious even to the most dedicated misanthrope.  Right now, the only worry people have about growing organs from scratch is safety and effectiveness, but no one is worried about the ethics.  What if ethics did become an issue, at least for some organs?”

“You think the heart has feelings, don’t you?”

“I’m not the one who sang to it–her.”

Kimura pointed up with the index finger of his right hand.  “Once.”

Jacob laughed silently at his friends.

“I don’t know what to think,” Hadley said, smiling.  “I’m just wondering.  What if this heart has a phantom body?  What if that body is having the feelings and its heart is responding?  And I’m wondering, why can’t we replicate another heart even though we have gone through the exact same process in minute painstaking detail half a dozen times already?  There is something unique about this heart that’s allowing it to survive.  Some condition that we have not or cannot replicate because we can’t measure it, detect it, or observe it.”

Jacob sat back in the booth.  “I’ve been looking through our notes from the day we made this heart.  I can’t find anything that makes that day special compared to any of the other days we’ve tried.  But guys, we should focus on the questions we can answer.  We don’t have much longer to study it.  The special day is coming soon.”

Special day.  That was their code phrase for the day of the transplant.  The good news was the patient seemed to be doing much better, well enough for the date to have been pushed back once already.  If it hadn’t been, the transplant would have happened that same day, right as they sat there munching on their fries and turkey melts.

***

“I think there might be some physics involved,” Hadley said the next day as she drafted the daily report.  “I didn’t want to mention it with Kim around.  He hates physics.”

Jacob yawned.  “Physics?”

“I mean some unusual physics.  We haven’t found any biological, physiological, cellular, even molecular reason for why the heart is working.”  She paused.  “We should consult some experts.”

“Yeah, maybe.”  It had been an easy day at work.  Jacob shouldn’t have been tired, but he was.  He was thinking of taking a sick hour.

“Have you ever heard of something called quantum entanglement?”

Jacob shook his head slowly.

“Einstein called it ‘spooky action at a distance.’”

“Sounds cute.”

Hadley grabbed two pens from the canister on her desk.  She wasn’t normally fussy, but she searched until she found two of the same pens.  She placed them next to each other.  “The basic idea is that if these two objects—and I think it’s usually referring to very small particles, smaller than atoms—if these two objects are entangled, then whatever happens to one happens to the other.”  She stood both pens up at the same time.  “And it doesn’t matter how far away they are.”  She moved the pens apart so that each was on either side of the table and turned them in her hands so that they made identical movements.

QuantumPensThen she placed one pen on the table and the other on the far side of the room.  She returned to her seat, then pointed to the faraway pen.  “Now imagine that instead of being just there, that pen was miles away, or light years away.”  She moved the pen that was still sitting on her desk.  “The other pen is making the same movement, no matter far away it is, because it is entangled with this one.”

Jacob nodded.  Hadley’s ideas were always interesting, if far-fetched.  “Okay, I follow.  You think our heart is entangled?”

Hadley nodded.  “With another heart.  And I think I know which one.”

Jacob raised his brows.

“I had a hunch and I looked into it, into her.  We know who the recipient is, and some of the reactions we’re seeing in our heart mimic some of the symptoms of her illness.”

Despite his exhaustion, Jacob’s eyes widened.  “Elise, please tell me you didn’t look into the patient.  It’s not a good idea for us to know anything about her.”

Hadley held up her hand.  “Her name is Natalie.  In her recent scans, they keep seeing what they’re calling a ‘cordumbra,’ a shadow heart.  I guess it’s supposed to be normal on some scans with that new version of the imager they’re using, but the tech did mention that it’s unusual for the shadow to show up on every scan as it has been.  Maybe that shadow is her.”  She pointed to the artificial heart through the office window.

Then she took a deep breath.  “Every time she was having some issue with her heart, medical or emotional, our heart had a matching issue.  That was the first few weeks.  Over time, the reverse started happening.  Every time our heart had an issue, she had an issue.  The hospital just chalked it up to her illness, but that night the guard came in here scoping the place out, she had an arrhythmia, and she reported feeling scared for no reason.”

Jacob looked at her.  He pointed to the heart through the window of their office.  “So, not only do you think our heart and the recipient’s heart are entangled, but you think our heart is feeling its own feelings?”

Hadley shook her head.  “No our heart is just reacting to stimuli, but I think it may be able to do that because…I don’t know, maybe other parts of the patient’s body are becoming entangled too.  Maybe that phantom body around our actual heart is Natalie’s body.  Maybe she and the heart are becoming more and more closely linked.”

Jacob put a hand on his forehead.  “This is beyond my capacity to understand.”

“That’s why I want to get a quantum physicist in here to tell me if this is even theoretically possible, or if I’ve just left science behind.”

“Far, far behind, my friend.  And what is the point now anyway?  We’ve run out of time.  The surgery is in two days.”

***

Jacob and Hadley arrived at the lab first.  The core fabrication team was not allowed to watch or interfere with the surgery because they were directly involved in fabricating the heart.  Something about a conflict of interest.  They weren’t even allowed to be involved in the heart’s transportation to the hospital.  It was strange.  They had been granted permission to learn about the patient, even see her and speak with her if they’d wanted.  Jacob wondered why that would not be a conflict of interest.  There was so much he did not understand beyond the making of that heart.  The core team would be kept up to date periodically by a liaison and by a member of the surgery team.

Kim and the others arrived after the surgery had started.  Their boss arrived last.  No one worked that day.  They just waited.  They paced, drank coffee, took bathroom breaks.  At lunch time someone went for a fast food run.  They ate.  They paced.  Their boss checked in with their liaison a few times.  There was no news.

The estimated time for the surgery was six to eight hours, but they had been warned that it could be much longer.  It had now been ten hours.  Half the core team were napping in the break room and on their office chairs.

Kim dozed in a chair in the break room.  Hadley paced the corridor, biting the skin around her thumbnail.  Jacob stood in front of a research poster hung on the corridor wall.  He couldn’t stand coffee.  He was on his sixth cup of the day.

The video call from the member of the surgery team came about twelve hours after the surgery started.

Jacob immediately called the others into their boss’s office.  As everyone gathered around, he focused on the face of the person on the monitor.  There was blood on the surgeon’s scrubs.  Her expression was blank, tired and alert, and blank.  Jacob had a sinking feeling in his gut.

“Everything was going well,” the surgeon said.  “We’re not sure why, but…both hearts began to beat erratically.  We reacted.  Did everything we could.  But we lost both hearts.  And we lost the patient.  She’s gone.”

The surgeon continued.  She started reporting details.  But Jacob tuned out.  He walked out of the office and dropped down into a chair in the empty corridor.  He leaned forward, elbows propped on his knees, and put his face in his hands.

***

Within the hour, the hospital had delivered both hearts to the laboratory so that they could do an immediate analysis of both organs.  The teams had been decided already, the ones who would do this analysis in case the surgery failed.  Kim, Hadley, and Jacob had not volunteered to be on those teams.  But they had stayed in the lab until the hearts arrived.  Jacob wanted nothing more than to leave.  But he waited for Kim and Hadley.

“Can we look at it?” Kimura asked the lead for the team that would analyze the artificial heart.  “Before you take it out?”  The team lead gave a solid nod.  A few others gathered around the cooler.  Their expressions were stricken, confused.

Kimura looked down into the cooler.  “It looks like it just…cracked open.”

Hadley stepped beside him and looked down into the cooler with him.  She was already frowning and she frowned all the harder when she saw the heart.

“It’s broken,” Hadley said.  “Our heart is broken.”  She looked in the cooler that held the patient’s heart.  The girl, Natalie.  “So is hers.”

Jacob didn’t want to look.  He looked instead at their boss’s office.  Through the window, he saw their boss on the phone.  He would likely be on that phone for the rest of day.

***

“We shouldn’t have tried to transplant,” Kim said later at the diner.  They had left the laboratory at Jacob’s insistence that there was nothing they could do for the moment.  “We should have left things as they were.  You were right, Elise, about the connection.  It was keeping her alive.  Who knows how long it could have kept her alive.”

Hadley shook her head.  “No, if anything the mistake we made was probably in not transplanting sooner.  The hearts were connected—through entanglement or some other thing.  Ours was keeping hers alive.  But at the same time, hers was making ours sick.  We all saw it.  She might have lived a little bit longer, but she would have died sooner than she should have anyway.  Trying to transplant was the right call.”

Jacob stared at the glass of ice water before him.  “But that same connection that probably killed our heart is the reason it was alive in the first place.  Every other fabrication attempt has failed.  Somehow, that girl gave our heart the spark of life.”

“I don’t get it,” Kimura said.  “Why that heart?  Why her?  How did it happen?”

Jacob raised his glass.  “Let’s find out.  For her.  And for our first heart.”

“I’m onboard, but we can’t,” Kim said.  “This is a fiasco, Jake.  Our funding is gone.  Everything is gone.  It doesn’t matter if all the right forms were signed.  They’re going to shut us down until they investigate.”

“And rightly so,” Hadley said.  “We thought we were just making an organ.  What happened with the connection was an accident.  But should we try again on purpose, even on someone who is terminal?”

Jacob shrugged.  “If we don’t find out what happened, how it happened, how to make it all work, than this has all been pointless.  Our heart.  That girl.”

Hadley and Kimura raised their glasses but they both looked conflicted.  They were still upset.  And they were right about upholding ethics.  But neither had been in that room with the girl before her surgery.  Jacob had.

***

BlueJournalFourteen Hours Before Surgery

“Hi Natalie, my name is Jacob,” he said, stepping hesitantly into the room.

The girl was fourteen, but she looked both younger and older at the same time.  Younger because she was small and had a turquoise barrette holding back the bangs above one eye.  Older because her illness did not let her rest properly, and she had dark circles under slightly bloodshot eyes.  But those eyes brightened when she saw Jacob.  Her smile was in part because of what he had in his hands, a fancy journal, the type with narrow ruled lines and a magnetic enclosure and faux dark blue leather cover.  He’d heard she liked to write.  And he’d heard she liked blue.  And her smile was in part because she had developed the habit of being upbeat.  Not optimistic about living—she often joked about how she’d written a will in which her younger brother was to inherit all her books and only her books, because she didn’t think he read enough.  No, she was upbeat and hopeful about what might come after death.

Jacob had learned all this about her from the nurses who regularly cared for her.  For all Hadley had found out about the girl’s heart, she had never asked about or gone to visit the girl herself.

There was a figure sleeping in the chair just inside the door, a man.  Probably her father.  Jacob handed Natalie the notebook.  Her smile grew brighter and her eyes grew wide with excitement.  His heart pounded with anxiety that he hoped he could hide.

Please, he thought.  Please let this surgery work.

She looked up at him.  “Thank you!  I will definitely use this.”  She offered her hand.

Jacob laughed a bit breathlessly as he shook her hand.

“I know who you are, Jacob.  You’re one of the people who made the heart that they’re going to put in me.”  She sighed.  It was from the effort of talking.  “Thanks for choosing me.  I mean, I know you didn’t make it for me specifically, but I’m glad you made it.”

Before Jacob could think of how he might respond, her smile faded and her expression grew serious, though her eyes remained bright.  She put her hand over his.  “I heard there’s only one.  I know you guys probably want to study it and make more and stuff before you give it up.  Sorry about that.”

Jacob opened his mouth, but he found no words.  He heard her father shift in his seat.

Natalie, bless her, continued talking.  Her expression was familiar, like someone breaking mildly bad news.  “I know it might not work.  But I’m kind of done for anyway.  I either want to live long or just go.  It sucks to be here in between.  For me and for everyone else too.”

She took another measured breath.  “I signed all the forms even though I didn’t have to since I’m underage.  My parents’ signatures are the ones that count, but whatever.  I understand the forms.  Really.  If I kick it in there, you guys take my heart and study the hell out of it, okay?”

Jacob nodded and they both smiled.

“We will,” he said.

Copyright © 2013.  Story by Nila L. Patel.  Artwork: “ArtHeart,” “QuantumPens,” and “BlueJournal” by Sanjay Patel.  All rights reserved.

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