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Bifurcation

Chapter Text



 

 

0.

“All right, Mr. Burns. I want you to relax, and count down from ten.”

A nod to the anesthesiologist, who begins to depress the plunger on her syringe of propofol. The patient blinks up at the white lights overhead and counts, voice muffled by the oxygen mask held over his nose and mouth. The surgeons wait, the scalpels and clamps and tweezers gleaming and untouched in their tray.

… six, five …

A soft, hitching sort of sound in the back of the patient’s throat, and then silence. Vitals are stable. The clock is set.

*

The way the light reflects off the green-painted walls casts a sickly hue onto the cadaver. Then again, ‘sickly’ would still be a far preferable state to the cadaver’s former inhabitant than its present status: which is ‘dead.’

The body is stripped bare. It was probably tall and imposing in life – but like this, naked and exposed on stainless steel, the effect is lost. Everyone is small in death, cycling back to the vulnerability of birth.

There is the flash of a camera bulb, and the pathologist speaks.

“Nigel R. Sullivan, autopsia cadaverum. 8:53 am. Erik Lehnsherr, presiding.”

--

“Scope, please.” The lead surgeon extends his hand, palm-up.

*

The voice recorder is set down next to the cadaver’s head. “The deceased is a forty-one year old Caucasian male ….”

--

They remove the oxygen mask from the patient’s face, allowing the surgeons to tilt his chin back and insert the endotracheal tube. The machines beep benignly in the background, keeping the man alive.

*

Small, clipped samples of hair and nails and dead skin, closed into small jars, sticker labels pasted over the lids and set aside on the shelf.

--

The nurse smears iodine on the patient’s chest to sterilize the area, staining it rust-red.

*

(The medical students wash the body, of course. It’s scut work; no self-respecting pathologist would deign to pick up a sponge.)

--

Skin, one will find, has the same approximate thickness and resistance as the peel of a citrus fruit. The blade of his scalpel splits it easily in the median sternotomy, the red line left in its wake as dewy and crimson as the flesh of a blood orange.

*

The first cut of an autopsy is the Y-incision, drawn from both shoulders to meet at the sternum and then pulled along to terminate at the pubic bone.

Incisions in an autopsy are pale and bloodless, and after enough procedures it no longer feels as if one is dissecting a human at all.

He likes the monotony of it.

--

Once the retractors are secured, the heart is exposed inside the chest cavity. It beats weakly, the muscle visibly thinned and deteriorated.

Even so, it is a beautiful sight. Life, marching bravely on.

*

After sawing through the ribs, the entire chest plate may be lifted away at once.

--

The heart is encased in a papery white sac, which the surgeon splits easily to expose the purple mass pulsing underneath.

*

Without the bones, the muscle of the thorax is limp and still, like so much raw meat. The skin is pulled back manually and snipped from the diaphragm with scissors, withering away from the long coils of intestines and sagging down toward the countertop.

--

“Transecting the aorta. Clamp?”

The great vessels are not nearly so delicate as one might think, and yet they feel fragile in a surgeon’s hands, so easily mangled with the tiniest flick of the wrist. A single slip.

*

He slides his scalpel into the cadaver’s pulmonary artery. A thick, glutinous streak of blood clings to the blade when it is withdrawn.

--

“Dr. Xavier, bypass is ready when you need it.”

“Yes, all right. Almost there – just one … more ….”

*

“The visualized great vessels display extensive fatty build-up, consistent with the typical American diet.”

--

The old heart is still and heavy when he lifts it from the chest cavity.

Someone takes in a shallow gasp.

“Jesus,” one of the residents murmurs. “Just look at the cardiomyopathy on that thing.”

*

“Heart weighs 11.2 ounces. Proceeding to excise the lungs.”

-- -- --

It’s Charles’s favorite part, when they stitch the donor heart in place and shut off bypass, and he is able to see the muscle beginning to stir – and the heart begins to pump on its own, throbbing stubbornly away beneath his fingertips. The resurrection of life.

*

According to the patient’s chart, he was third on the list for a heart transplant, at the time of his death.

A new heart, Erik estimates, would have given another seven years at least.

Though, for what? Erik sets the heart onto the counter, a plump mass of dead meat. Seven years: it is time, but it is not resurrection.

It is postponing the inevitable.

--