An essay by Doctor Veronica West, as provided by Maureen Bowden
Art by Leigh Legler
Lucas Vale, the most talented artist to emerge in over a century, was twenty years old and dying. He lay back against his propped-up pillows, eyes sunken in his pale face, his lips tinged blue. “This is for you, Doc,” he said, tearing a page from his sketchpad and handing it to me. “It’ll be worth a stack of cash when I shuffle off the old mortal coil.”
“Thank you,” I said, “but don’t start giving away your masterpieces just yet. There’s still time for me to find you a compatible donor heart, and the transplant team is on standby.”
He laughed, a hollow, breathless rattle. “I know you hate to lose a patient, lovely Veronica, but we both know that’s a pretty lie. Take the doodle and call it your retirement fund.”
The drawing showed a young man hanging by his fingertips from a crumbling cliff face. It was a self-portrait. Like all Lucas’s work, it was perfectly executed and strikingly beautiful. It was also disturbing, with a coldness that repulsed me. It lacked heart. I took it back to my office and shoved it underneath a pile of medical journals in my desk’s dungeon dimensions, where I wouldn’t have to look at it.
I called my secretary. “I don’t want to be disturbed, Saffron. Keep the world at bay for an hour or so.”
“No prob, Doc,” she said.
“And get rid of your chewing gum.”
The hospital administrators disapproved of Saffron Kray as my choice of secretary, but she was good at her job and that was all that concerned me. I wasn’t deterred by her spiky, blue hair, nose piercing, and the tattoo of a serpent twined around her left wrist, swallowing its own tail. “It’s the Worm Ouroboros,” she informed me during her job interview.
“Really?” I said. “I wouldn’t have slept tonight without knowing that.” She was unmoved by irony. I liked her, and I gave her the job.
With my tattooed guard-dog on duty at my door, I left my desk, reclined on the couch in the window recess, and thought about Lucas. His mother had abandoned him when he was six months old, and he was placed in the care system. If a short-term foster carer had not recognised his great talent, he would have had few prospects except a life of poverty and petty crime. He was now the darling of the art world, but his future was about to be snatched from him by a dysfunctional heart. I railed against life’s cruelty. “If anyone can provide me with a miracle,” I said to the universe in general, “now is the time.” I closed my eyes and indulged in the closest I’d ever come to praying.
Saffron knocked on my door and burst in, shattering my reverie. “Sorry to bother you, Doc, but some dude’s just barged into Reception and demanded to speak to you about Lucas Vale.”
“Oh no, not the press again. I’ve told them the situation. Without a compatible heart he’ll die, and there’s sweet Fanny Adams anyone can do about it.”
She shook her head. “I don’t think he’s one of that mob. His name’s Max Blackburn. He says you’ll remember him.”
My head reeled. Of course I remembered him. How could I forget the boy with two hearts?
Twenty years ago, I was a young surgeon with a growing reputation: the cardio-vascular department’s rising star. I happened to be on duty the day the post-natal surgical team encountered difficulties while separating conjoined twins.
They called me to assist. Baby Max Blackburn lay on the operating table. A chaotic mass of tissue and bone was attached to his chest cavity, enclosed by the left side of his ribs. Mother Nature had evidently intended it to be his twin, but she’d changed her mind and the foetus stopped developing. The leading surgeon had opened up the ribcage. He expected to face an easy task in separating the healthy baby from the mass, which was incapable of maintaining life.
“Look at this, Doctor West, he said. “We thought the second twin had no vital organs, but we were wrong.”
I examined the tiny chest cavity. It contained two beating hearts, connected to each other and to each twin by a branching aorta and vena cava. “Fascinating,” I said. “What’s the plan?”
He shook his head. “There isn’t one. I don’t see how I can separate the hearts without endangering the baby. Can you do it?”
“No,” I said, “but I can cut off circulation to the undeveloped twin, remove it, and leave the two hearts in the baby’s chest.” It wasn’t as science fiction as it sounded. In transplant operations, the patient’s own heart is often left in place as backup, in case the donor heart is rejected. This was a different scenario, but if Max ever had a heart problem, he’d have one to spare.
The operation was a success. I undertook responsibility for the child’s follow-up care, and I saw him as an outpatient, every six months for the next seven years.
I remember a conversation I had with him when he was three years old.
“Hello, Max. How are you?”
He shrugged. “Me is okay and Michael is okay, thank you.”
“My brother. He’s not got a body, so I take care of his heart.”
I glanced at his parents. They smiled indulgently at their son, so I assumed that they had explained the situation to him in those terms. I considered it bizarre, but it was their business, and the child appeared to be comfortable with it.
He developed normally and both hearts remained healthy. After I felt it was safe to discharge him, I hadn’t heard from him again until today.
I told Saffron, “Tell Reception to send him up.”
Five minutes later, she escorted Max into my office. I motioned him to sit beside me on the couch, and I asked her to bring us coffee.
“How d’ya like it?” she asked him.
“Milk, no sugar,” he said.
As she turned away, he called, “Love the hair.” She looked back over her shoulder and winked. He grinned and watched her backside as she sashayed to the door. I felt old.
“Am I right in thinking that you’re here because Lucas Vale needs a heart transplant?” I said.
He nodded. “I know you couldn’t separate mine and Michael’s hearts twenty years ago, but I’ve done some research, so I know surgery’s moved on since then. Can you do it now?
“Yes,” I said, “but it would be dangerous. It’s very generous of you to offer help to Lucas, but you’d be risking your life.”
“I don’t see it as a favour to Lucas. I see it as asking him to make a gift of his body to Michael.”
“Doesn’t it amount to the same thing?”
He shrugged. “Maybe, but I’m looking at it from Michael’s perspective.”
Saffron interrupted us with a tray of coffee and chocolate macaroons. She placed it on the coffee table in front of us. “The old biddies from the Women’s Institute baked the choccy jobbies,” she said. “They’re well nice.”
“You have one,” Max said. Before I could comment she took two, and fled.
He drank his coffee and sampled a “well nice” jobbie. “Now can I visit Lucas?” he asked.
“I’ll arrange it, but you mustn’t build up his hopes too much. I need to do some tests to find out if Michael’s heart and Lucas’s body are compatible.”
“Sure, but don’t worry, they will be. Michael told me.”
Two days later, I had the test results. They were better than I’d dared hope. I almost ran to Lucas’s room to tell him the news. Max was with him. Lucas’s voice was barely a whisper, and I could see the vitality fading from his eyes, but the two boys were chatting like old friends.
“The tests are positive,” I said. “The heart’s a match.
“Of course it is,” Lucas said, “and I’ll willingly give my body to Michael. Our three lives are in your hands, lovely Veronica.”
Before the operation, I spoke to Max’s parents. I feared they may disapprove of the risk he was taking, but I was wrong. “We want to thank you, Doctor West,” his mother said.
“There’s no need, Mrs Blackburn. Max is helping me to save a life, and I’ll do all I can to keep him safe.”
“There is a need,” his father said. “You’re giving Michael a chance to live.”
Are these people truly deluded? I wondered, or at some level do they understand that the organ Max is donating to Lucas is no more than a biological pump? It’s not a person. His brother never actually lived.
Those were the undeniable facts, but when I separated the blood vessels and held Michael’s heart in my hands, I felt what I could only describe as a presence, and for a second, I wondered if I were wrong and they were right.
After the operation, Max recovered quickly. He was strong and healthy and suffered no physical ill effects. I was anxious that there might be psychological repercussions following his separation from Michael’s heart, but the only consequence that I observed was the bond between him and Lucas, whose convalescence would take longer, due to his months of debilitation. I believe that the hours they spent together every day aided Lucas’s return to health.
The other person who aroused Max’s interest was Saffron. The day he was discharged from hospital, she said, “Guess who I’m seeing tonight, Doc.”
I assumed that “seeing” was a euphemism. “If it’s one of my ex-patients who’s recovering from major surgery, remember he has no more spare hearts, and don’t be too rough with him.”
My feelings about this development were ambivalent. Max stirred a protective maternal instinct in me, of which I was previously unaware, but a blue-haired aficionado of the Worm Ouroboros may have been what he needed to combat his obsession with Michael.
I visited Lucas. He was sitting in an armchair, sketching, as usual. “Max has gone home,” I said.
“I know. He called in to say goodbye.”
I pulled up the visitor’s armchair and sat beside him. “Will you keep in touch?”
“Of course we will. His family and I are now part of each others’ lives.”
“I understand that, but I don’t understand why they feel that Michael has any real significance.”
He put his sketchpad aside and leaned towards me. “You’re a doctor, beautiful Veronica. You see reality in scientific terms.” He clasped my hand. “I’m an artist. I see it in humanitarian terms, but there doesn’t need to be a contradiction. When our perceptions complement each other, they give us a glimpse of the truth.”
“You make it sound so simple.”
“Maybe that’s because it is.”
“You’re wise beyond your years, beautiful Lucas.”
“I don’t know about that, Doc, but I know enough, and I’ve seen how you look at Max. You worry about him, but there’s no need. He’ll be okay.”
“I hope you’re right. Have you met Saffron?”
“Yes, she was with him when he came to say goodbye. She brought me a chocolate macaroon.”
“He’s seeing her tonight.”
He laughed. “I know. He’s a braver man than I am.”
The day Lucas was to be discharged, I arrived at the hospital to find the front entrance besieged by paparazzi pointing cameras at me, and journalists barking ridiculous questions.
“Doctor West, will Lucas’s new heart impair his creativity?”
“Is it true a living donor sacrificed his life to save Lucas?”
“Are you playing God, Doctor West?”
I ignored them and made my way straight to Lucas’s room. “There’s a reception committee waiting outside for you,” I said.
“They’re wasting their time. I’m making a fast exit out the back.” His belongings were scattered in untidy heaps, alongside an empty suitcase, on his bed.
“If you’re taking this lot with you it won’t be particularly fast. You’ll need a couple of trolleys.”
“No need. I’m staying with Max and his family for a while. Saffron’s arranged for it to be sent to their address.”
We heard a knock on the door, and Saffron’s voice. “I hope you’re decent, Michelangelo. We’re coming in.”
She and Max burst into the room. Max was carrying two motorbike helmets. He handed one to Lucas.
“What’s this?” I said. “You planning The Great Escape?”
“That’s about it, Doc. I’ve parked the bike by the mortuary. It’s quiet there. Saffi’s leading us out through the emergency fire exit.” He turned to Lucas. “Are you ready, Luc?”
“Just give me a minute.” He delved through piles of tee shirts, toiletries, and hair gel containers and found his sketchpad. He tore out a page and handed it to me. “For you, beautiful Veronica. It’s a companion to the first one I gave you. Thank you for giving me a family, as well as a heart.”
Fighting back tears, I hugged him. We said our goodbyes and the escapees headed for the fire exit.
I made a space on the bed, sat down and looked at Lucas’s drawing. It depicted three young men roped together, scaling the same cliff face as that shown in the first picture. Two were skilfully drawn likenesses of himself and Max. The third was almost identical to Max, but something indefinable in his demeanour and the expression in his eyes, was all Lucas. The warmth the picture expressed was new to his work. It had heart. He’d signed it “Lucas Michael Vale.”
Doctor Veronica West is an eminent cardio-vascular surgeon, recognised as the best in her field. In 2017, she was awarded the OBE for her innovations in heart transplant techniques. Her portrait, by world famous artist Lucas Michael Vale, hangs in London’s National Portrait Gallery. It shows an elegant, middle-aged woman, holding a heart in her outstretched palm.
Maureen Bowden is a Liverpudlian living with her musician husband in North Wales. She has had ninety-three stories and poems accepted for publication by paying markets. Silver Pen publishers nominated one of her stories for the 2015 international Pushcart Prize. She also writes song lyrics, mostly comic political satire, set to traditional melodies. Her husband has performed these in Folk clubs throughout England and Wales. She loves her family and friends, Rock ‘n’ Roll, Shakespeare, and cats.
Leigh’s professional title is “illustrator,” but that’s just a nice word for “monster-maker,” in this case. More information about them can be found at http://leighlegler.carbonmade.com/.
“A Gift for Michael” is © 2018 Maureen Bowden
Art accompanying story is © 2018 Leigh Legler