In Need of a Heart in Texas
Published in Rock and a Hard Place Magazine, Issue 3
Rachel sat in the hospital chapel, grateful for the inexhaustible supply of tissues. The cross and adjacent Star of David were burned into her retinas, so long had she stared at them. For weeks she had wrestled with her prayers. “Please, God, save my son” really meant, “Please, God, kill someone else’s son, but slowly enough that Blake can have his heart.” Not a prayer she said out loud, but one she felt with the deepest conviction of her increasingly damaged soul.
Her phone vibrated and she snatched it up. From the Transplant Coordinator, a possible match. “Thank you, God,” she said aloud. A couple in the back-most pew gave an encouraging nod as she rushed from the chapel, back to the ICU, to Blake’s bedside. She squeezed his hand and his eyes opened.
“Mom,” he whispered, it was as much breath as he could muster.
“It’s going to be okay,” she said, barely able to contain her excitement. “They found a heart.” She knew this would be the one. The last two possibilities didn’t match, but this time, she just knew it was his turn. Illness severity was a significant factor in the ranking, and he’d worsened over the last week. His doctor was threatening to put back in the breathing tube. Surely this organ would go to Blake.
The Transplant Coordinator arrived, Sheila tonight, but her face was all wrong.
“No,” Rachel said. “No, no, no. It’s Blake’s turn. It has to be his turn.”
Sheila’s solemn expression said otherwise. “I’m sorry. It’s not a match.”
Desperation took over. “It doesn’t matter. It doesn’t have to be perfect. He needs the heart.” They were being too picky, overly cautious, or someone was paying to get moved up the list. They said it didn’t happen like that, but Rachel had her doubts. Blake’s dad was rich. He could have fixed it. If he cared, if he’d ever cared about his son, if he’d ever acknowledged Blake was his son.
“I’m sorry,” Sheila said. She took Blake’s other hand. “You have one rare antibody in your blood that is making it tough to find a match. But we’ll keep looking. There’s still time.”
He nodded weakly. Nodded. He didn’t argue or cry or yell, even in a whisper. Rachel had raised a strong, independent, brilliant, kind young man. He didn’t deserve to die so young. He had so much to offer the world. How her no-good, cheating, bastard of an almost husband could have fathered such an amazing child boggled the mind.
Blake smiled at his mother and said, “Go home. I’m going to sleep.”
She faked a smile back and kissed his forehead. A long kiss where she hoped to add her strength to her child’s. If only she could give him her heart.
Sheila followed Rachel into the hallway. From the pocket of her white coat she pulled a packet of papers. “I know this is incredibly frustrating. This is the antibody that’s causing the problem.” She pointed to a highlighted row on the top page, a list of unfamiliar lab results, letter and number codes. Most were followed by “not detected,” except for the one in yellow—“DA-21: Detected.” Seeing it there, on an official record with the Baylor Medical Center logo, made it real.
Sheila flipped the top sheet, revealing a technical-looking article. “This might help you understand the issue. The medical terms may be a bit much, but read what you can, and we can talk about it later.”
So Rachel returned home to read, the traffic unusually heavy on US75, despite the late hour. With much help from Google and Wikipedia, she got through the article. Blake had an antibody, something in his blood that would attack a specific protein in the hearts of possible donors, causing rejection. He needed a donor who lacked that protein, that antigen, on his heart.
If Blake needed a kidney or liver, the best donor would be a relative, someone who shared many of his genes, including the lack of that antigen. Rachel would gladly donate to him, would give her life for her son, but she wasn’t a match. Not to mention the challenge of trying to convince the doctors to take her heart.
The antibody was Robert’s fault. He hadn’t been a father to Blake, he hadn’t even been a husband to her. He canceled the engagement before she knew she was pregnant. He’d met his soulmate, he said. And when, a week later, she told him of the pregnancy, he accused her of entrapment and denied paternity. He chose another family, another son, one that didn’t deserve to inhabit the same universe as Blake. She’d kept track of Alex—college dropout, in and out of drug rehab, a stint in juvenile detention and several arrests since, but a spotless record. Money did that, covered up mistakes. Robert’s former Dallas Cowboys’ cheerleader wife came from money and he built his career on the shoulders of his father-in-law.
Rachel would take Blake over money, no question. She was no cheerleader, now or ever, but she’d raised an amazing son, alone, on an IT consultant’s salary. Robert had given Blake nothing except his DNA, including a faulty gene…, which gave her an idea…a crazy, terrifying, insane idea.
In the morning, she would purchase a gun. She didn’t like guns, but she was raised in west Texas and knew how to shoot. She researched where to aim to keep his heart beating, but ensure brain death. The logistics were tricky. She would have to call the ambulance in time to keep him alive, but not in time for them to stop her. She slept fitfully, dreaming of the scene. In the morning, she would go say a proper good-bye to Blake, and then save his life.
She overslept, waking to the sound of a car alarm somewhere on the street. Traffic would be impossible headed downtown. She needed Robert’s schedule. With a few keystrokes on her laptop, she hacked into his calendar. He hated technology and had used the same password for twenty years. He had an appointment that morning…at Baylor Medical Center…with an oncologist. Holy hell.
Rachel showered so fast the water had no time to heat. She pulled her hair into a ponytail, brushed her teeth, and returned to the hospital where she could log into the medical record system with the credentials she’d gleaned watching one of the night nurses.
Robert had leukemia, blood cancer. He wasn’t eligible to donate an organ, any organ. Of course, being alive also made him ineligible, but Rachel could have handled that, were it the only limitation. According to this morning’s progress note, Robert needed a bone marrow transplant. They’d found only one matching donor. His son.
No. How…? No. Robert couldn’t possibly accept bone marrow from his dying son, the one he’d never even acknowledged. Who was she kidding? Of course he could. The self-absorbed bastard had erased Blake from his life, and now expected his bone marrow? Over her dead body.
As she went to close the note, a word caught her eye—Alex. She re-read the paragraph. Robert’s son, Alex, was a match but refused to donate. Alex, not Blake. “I discussed the situation separately with the young man,” the physician wrote, “and he states he was coerced into being tested, but will not, under any circumstances, undergo a bone marrow harvest, even to save the life of his father.”
Good for him, Rachel thought. Alex was only months younger than Blake. He was the son Robert chose. He chose wrong. And now Alex was proving it, which gave her indecent satisfaction.
Rachel hated herself for such thoughts, but not too much.
She opened Robert’s tissue-typing results. “DA-21: Detected.” He would have been a match. And Alex was a match to his father. Before she could think it through, think logically, she opened Alex’s medical records. There it was, “DA-21: Detected.” But that didn’t mean he was a match. She pulled Blake’s report from her bag and compared the numerous other labs. Alex was a match. His heart could save Blake’s life. But Alex was using his heart. She was being ridiculous. It wasn’t an option. Though he did live a rough life, a life where drug deals can go wrong. It happened all the time in a big city like Dallas. Inevitably, her thoughts went where they shouldn’t. Could she somehow encourage a drug deal to go wrong for him? Facilitate in some way? But it had to go wrong in exactly the right way, the bullet in the exact right location. She squeezed her aching head. Such monstrous thoughts were incompatible with her fragile psyche, with everything she’d ever believed. But they were only thoughts. Or were they?
She returned to the hospital chapel, eyes dry this time. She prayed for, what? Absolution? Permission? Blake was a God-fearing young man who would do great things. Alex was trouble with a capital T, destined to die young, and probably take others with him. The greater good was to put the heart in the better man. Why had God done it wrong in the first place?
On her way to Blake’s bedside, an overhead alarm blared. She could hear it from the elevator bay, and knew it was her son. Just knew. Mothers know these things. She ran down the familiar hall, tears streaming, and pushed open the door to the ICU. A crowd surrounded Blake’s bed. Someone was sliding a breathing tube into his windpipe. As she stood, rooted to the spot, the alarms quieted and the crowd thinned. His vital signs were stable, she knew enough to recognize that. A hand squeezed her arm.
“He’s okay.” It was Dr. Harrison. “His breathing worsened and we had a little trouble with the intubation, but he’s okay now.”
He’s not okay. He won’t be okay until he gets a new heart. And now Rachel knew where to find one.
Blake would be asleep for a while, so she returned home and went onto the dark web. She’d been there before, out of curiosity. The services available sickened her. Not that they hadn’t been available since the dawn of time, many of them, but not to the average person on the street, or maybe they were and she’d been blind. She put in the request for a service, very specific, including exactly where the bullet had to go, and how soon the ambulance had to arrive. Within moments, multiple replies appeared. Scary. But the bids were beyond her limited resources, even with the second mortgage she’d taken out on the Plano house since Blake’s illness. Gradually the bids came down, and she jumped on the first one she could afford.
She followed the instructions, purchasing Bitcoin and forwarding it to an escrow service. Then she returned to the hospital, giving the chapel a wide berth. Holding Blake’s hand, her eyelids drooped, but an image of the cross and Star of David remained. She forced them open again.
Rachel refused to leave Blake’s side.
“You have to eat,” his nurse said. “Get something while I give him a bath.” It wasn’t a request. Rachel wasn’t hungry. She stood in the hall for thirty minutes, then returned. She focused on memories of Blake, from childhood, through teen years and into adulthood. She named each of his teachers, all his many friends, and their moms, the theme of each birthday party, from Sponge Bob to Pokémon to Avengers. A new shift of nurses came on, still Rachel remained. Visiting hours were nearly over when the Transplant Coordinator entered.
“We have a possible match.”
Rachel let out a long breath, tears burned her eyes. What had she done? She kissed Blake as they rolled him from the ICU. She longed to pray in the chapel, but couldn’t force her feet through the door. Instead, she sat alone in a corner of the waiting room, staring at nothing, trying desperately to be numb. Her son would live. Blake would live. That’s all that mattered.
A scream broke the silence, the agonized wail of a woman. Rachel’s heart seized. Would that be her later that night? No, Blake would be all right. He would recover. He would live.
A small group entered, the wailing woman in its midst, supported by two young men who led her to a seat. Her screams quieted to sobs. The others milled around her, bringing water, more tissues. There were young people and old, well-dressed and rough, all red-eyed and consoling one another. They had lost someone and Rachel’s heart ached for them. And then her heart stopped completely. Standing in the doorway, staring at her, was her almost-husband, Blake’s father, indescribable pain on his pale face.
For an instant, she thought he’d come for her, for their son. But he went to the wailing woman and folded her into his arms. Oh my God, Rachel thought, Alex’s mother. She’d lost her son. Rachel had taken her son. She ran for the bathroom, just in time. But there was nothing in her stomach, nothing in her soul. She was empty.
Rachel found another waiting room for the next several hours, and even fell asleep at some point, awakened by the buzz of her phone. She met the surgeon in a consultation room. There had been a small complication coming off bypass, but Blake had come out of it. They hoped to remove the breathing tube in a few hours, and so far everything looked good.
Looked good. Blake looked good. But images of Alex’s grieving mother, and the sound of her screams, echoed in Rachel’s head. Once she saw Blake, all would be forgotten, the end justifies the means. She needed to see him. To see she’d done the right thing.
She hovered outside the ICU, hoping to catch a glimpse when the doors opened, but the clerk asked her to return to the waiting room. Several more hours passed. At long last she was called back to the ICU. Blake was breathing on his own, eyes open. He was beautiful. Tears renewed, she hugged him carefully.
“Hi, Mom,” he said, his voice hoarse, but stronger than before, or maybe it was her imagination. “I made it,” he said, his eyes drifting closed.
She could only nod and squeeze his hand.
“I had the strangest dream,” he said, and faded off to sleep.
They let Rachel stay. She sat at his side, hand in his, drifting in and out of sleep, still with the image of the chapel’s altar always in the background. She jerked awake to alarms and Blake thrashing in bed. His heart rate and blood pressure flashed dangerously high on the monitor.
“Blake, wake up,” his nurse said. “What’s wrong?”
His eyes flew open, wide, full of terror.
“It’s okay,” she reassured him.
Rachel stood and leaned over him. “You’re safe. I’m here.”
The alarms quieted as he calmed. “I had a nightmare,” he said. “A gun, pointed right at my head. I was going to die. It was so real.”
The nurse’s brows relaxed. “Strange dreams are common after surgery, especially after heart surgery.”
“Dreams that I’m about to be shot in the head?” Blake asked.
“Well, not that one in particular.” She smiled. “More often bright lights, but it was just a dream. Would you like something to help you fall back asleep?”
He declined, and soon dozed on his own, with Rachel rubbing his hair. The nightmare recurred twice more. Blake’s surgeon ordered a psychiatry consult. “Sometimes patients suffer intraoperative awareness that manifests as strange nightmares. Our psychiatrists might be able to help you sort through this.”
Alone again, Blake spoke softly to Rachel. “Was the donor murdered? Could I be seeing his death?”
She recoiled, but kept her face impassive. “We don’t know anything about the donor. We’re not allowed to. But regardless, it’s impossible. You got his heart, not his brain.” But as soon as Blake closed his eyes, she searched the internet. She found no credible references for organ recipients channeling the donors’ lives. Even if he did see the murder, the dark web deal couldn’t be traced back to her. So why was she so uneasy?
That was obvious. And it was a feeling she’d better get used to.
The psychiatrist, a Dr. Sutton, asked Rachel to leave while he interviewed Blake. Dizzy on standing, she walked, unseeing, to the cafeteria and ate some tasteless fare she couldn’t name afterward. Back at the bedside, Blake said, “Dr. Sutton thinks I should try hypnosis, to see if I can figure out more about the dream.”
Rachel bit her lip. It felt wrong, like a very bad idea, but she couldn’t explain why. “Do you want to?” she asked, desperately hoping the answer was no.
“Yes,” he said. “I won’t be able to sleep until I know. He’s coming back this afternoon. Why don’t you go home for a while?”
“No, Blake, I’m fine.”
She looked at him.
“You need rest, and a shower.”
“Are you saying I smell?”
“Maybe.” He smiled. “Just go. Please. For me.”
How could she resist that? But the drive to Plano and back would take too long. She found a nearby motel on Elm Street with a vacancy, and grabbed the overnight bag she’d kept in the car since Blake’s hospitalization. At check-in, the clerk offered Rachel a copy of the day’s Dallas Observer. The front-page headline caught her eye: “Son of Local Businessman Gunned Down,” and beneath it, a crime scene photo. He’d been killed in front of the Sky Mirror at Texas Stadium. Rachel stared at the photo. Right on that spot. Alex had been alive, and then he’d been dead.
She stumbled into the elevator, somehow found her room, and went immediately into the shower, turning the water to scalding. But no amount of steam or soap would be enough. She’d never be clean again. Her heart, which should be light at her son’s second chance at life, was a boulder in her chest. She heard again the agony of Alex’s mother, saw again the pain in his father’s eyes. This was her penance, forever.
She hurried back to the hospital and into the ICU, where Blake already had a visitor—Robert—his father. The nurse rushed over, clearly flustered. “Rachel, I’m sorry, one visitor at a time.”
“It’s okay,” Blake said. “She can stay.”
Can stay? What the hell?
“What are you doing here?” she asked Robert. “How did you even know…?”
“Sit down, Mom.”
She wanted to argue, but not at the risk of upsetting Blake.
“When I got sick, I decided I wanted to know my father, so I called him.”
“I’ve been visiting since he’s been here,” Robert said. “On the rare occasion you give him a break, that is.”
“I give him a break?”
Blake gave his father a withering look. “It’s fine, Mom. I didn’t want to upset you, but I wanted to know my father, in case I didn’t get the chance later.”
She touched his cheek. “How can you be so amazing? So forgiving?” She gave Robert a scathing glare.
The psychiatrist returned. He asked Robert and Rachel to step outside while the nurse pulled the curtain, blocking the three of them from view. Robert and Rachel didn’t leave, but hovered nearby, listening intently. Rachel imagined a swinging ball, but apparently that was only in the movies, because he had Blake close his eyes. His voice was so soothing, Rachel nearly closed her eyes. Blake’s answers were in a monotone, so soft she missed most of the words. Was he hypnotized? Had it worked?
Several minutes in, the beep of his pulse increased, causing the same reaction in Rachel.
“Look past the gun,” Dr. Sutton said. “What do you see?”
“A bright light. I see a bright circle of light.”
Robert scoffed. He scoffed, at her son.
“It looks like the moon, but distorted.”
“What else do you see?”
“There’s someone there.” The anxiety in Blake’s voice tore at Rachel’s heart. She wanted to rush in and stop this. But she held back. Could this be real? Could he be seeing who murdered the donor of his new heart?
“It’s a man. He’s older, Caucasian. Oh my God,” he said, his voice suddenly clear. “It’s my father. He’s going to kill me.”
Rachel froze, body, heart and mind, while Blake’s monitor beeped much too fast. Robert’s chin fell to his chest. Dr. Sutton told Blake to wake up, and the nurse flung the drape aside. “I need metoprolol,” she said to a nurse at the nearby med cart. Only then did she stare open-mouthed at Robert.
He approached Blake, whose own mouth gaped, his eyes wide and wet. “It’s just a dream, right? You’re back in my life so I dreamed…”
Robert shook his head. “I can’t explain your dream, but it is true. I failed you as a father. I failed Alex, too.”
“Alex?” Blake said. Then his face morphed into one of true horror. His hand drifted to the bandages on his chest. “The donor?”
“I chose. I don’t have much time, the police will be here any minute.” He took Blake’s hand in his and looked him full in the face. “You have a future now. I’m sorry you know where that future came from, but make the most of it, for both my sons.”
He stepped from the room, into the waiting arms of uniformed officers in the hall.
Rachel’s phone chirped a message. “Bitcoin returned. Unable to complete transaction. Target unavailable.”