What happens when a surgeon turns his eye from the operating room to crime fiction? In "Stone Hearts", Craig R. Smith, MD, cardiac surgeon and former Chair of the Department of Surgery, builds a medical caper rooted in transplant, intrigue, and the peculiar moral weather that hovers above and beyond the hospital.
Follow along each Friday as we release the novel one chapter at a time. You can also see more on Dr. Smith's Substack, Long Incision.
In Chapter Three, a terrible tragedy created a transforming opportunity.
Late April, 1990
The Director made an inviting gesture, and Lindsay sat down, facing him across his desk, in an affordable office decorated with conventional creative-class clutter. “Tell me what you’ve got,” he said.
“Denomination Med Center hired us to produce a marketing/outreach piece showing off their transplant programs. You remember?”
“I do.”
“Focused mostly on hearts. That’s what they’re best known for, and the heart, it’s the best hook anyway. They gave me background on four candidates for a feature interview. I went over medical records, looked at photos, pulled some local news stories.” On his desk she laid a manila folder with paper edges spilling. Neither of them opened it. “One of them really stands out to me. 35-year-old, tall, good-looking upstate guy, arborist—that’s a tree surgeon. He comes from a small town, an old farm family. Has an attractive wife and three kids. Well-known and admired in his community.”
“Sounds perfect. Say no more.”
“Yes, but there is more—both better and worse, I’m afraid. To the better, it’s nice that we’re coming up on his first anniversary; we can work with that. Best of all, he’s doing so well that just to look at him really sells the outcome, much more than the other three. He looks fitter, less steroid-y. Two of the others show some of that buffalo hump they get from the prednisone. I talked to all four candidates a bit on the phone and I think he’d be the most compelling interview.”
“I assume you’re about to tell me what’s worse.”
“Oh, yes! Denomination has some sensitivities around this patient because of news that popped up related to his surgeon, Dr. Bessette, not long after the transplant. Stories with sort of a “Suspicions Raised” lead. I think it caught eyeballs only because it’s jarring to imagine a fancy surgeon implicated in some sordid caper.”
“A little Jekyll-Hyde patina?”
“Something like that, yeah. But the story had no legs, and it had nothing directly to do with the patient or his outcome. Anyway, Denomination doesn’t want us blowing on the embers.”
“Seems to me if they’re that worried, they wouldn’t have suggested him to you.”
“Totally agree. And we don’t have to go near it.”
“Sounds good, Lindsay. Sit him down for a long-form, audio and video. Figure we’ll cut it into some short video pieces, and take excerpts from the transcript for the print pieces. We might be able to use the audio for something.”
Lindsay escorted Ronald Ellsworth into the conference room, thanked him again for his time, and worked on getting him comfortable. In her experience most people did better if they walked around the whole setup for a few minutes and shook hands with everyone on the team before being plopped into the chair under the bright lights. Once she had him seated her assistants emerged from the peripheral darkness to fuss with details of his appearance, attach his microphone, and do a sound check. Lindsay sat down opposite him, just left of the camera.
“I know we’ve talked about this, Mr. Ellsworth, but let’s review. I don’t want you to feel trapped at any point. I’ll be asking you questions, just like what we talked about. Please look at me when you answer, not at the camera. We want this to look like a friendly conversation. Remember we can stop any time you want and take a break. Don’t even think about whether you’re giving the perfect answers. We can do things over, and we can edit out anything we don’t like. I want you to ramble!”
Ron Ellsworth responded with a guarded half-smile, and his eyes flashed back and forth between Lindsay and the camera.
“So, let’s jump in!” Lindsay gave a meaningful stage nod to the crew. “We’re recording now, Mr. Ellsworth. The first anniversary of your heart transplant is coming up next week, on May 7, 1990. Congratulations on that big milestone! How are things going?”
“Great! Just great! Hard to believe that last year at this time I was dying at home. Huffing and puffing in my recliner, all swollen. Wondering if I’d get a donor in time. But you probably want to know how things are now. I’m back at work, exercising every day, sleeping through the night. It’s not quite the same as before I got sick, say, summer eighty-eight. I wasn’t taking all these meds then. The steroids and cyclosporine and such have some side effects I could do without, but they’re keeping me alive. At work they treat me like I’m made of china. I’m sure I could still climb, and do most of the bulling and jamming, but they have me supervising.”
“Can you tell us something about yourself before the transplant?”
“Going way back, I was born in 1955 in Sugar Hill. My family was small dairy farmers going back maybe two hundred years. But when I was growing up all the farms around were losing money, the town was half boarded up. In the sixties some downstate types bought places on the highway for next to nothing. Some of the people who were still trying to survive in town called them dirty hippies. They called themselves craftsmen, or artists. I used to snoop around their places and answer their questions about who used to live there. They were real nice to me, especially the word sculpture guy.”
“But Sugar Hill was over for my family, and in 1970 they sold all their land and moved to Rhinebeck. I had just finished my freshmen year at Warwick. It was tough in the beginning. My parents were in new jobs, feeling like failures, working all the time. Mom had to work at the Silver Lake Dairy. Some people in town said it made you dirty, to work there, because it had been owned by Bernhard Goetz. He went to jail for molesting children. Goetz had moved his family to Florida years ago but that didn’t stop people talking about it. I was the new kid and all at Rhinebeck, but I met my wife there, in history class. April. She’s a Van Vleet. Her family goes back over two hundred years. They have one of the most popular roadside farm stores in the Hudson River Valley, on Route 9. Folks from the City driving to their country homes love the place.”
“I decided not to follow most of the men in my family into the Marine Corp. Went straight into the tree business. I’m an arborist for Rhinebeck Tree Service, the biggest outfit in the Hudson Valley. I married April in 1979. We have three beautiful kids, eight, six, and three—Sarah, Emmett, and Autumn—all healthy as horses, thank God! April still works at the farm store on and off, and we have a nice four-bedroom house near Livingston—that’s the elementary school.
“Take us back to May 7, 1989. And what led up to it.”
“Everything changed in November. That’s November 1988. I got a really bad cold, same one that worked its way through the rest of the family in October. I figured it was just my turn. The stuffy nose and all that went away, but after a few weeks I kept getting worse and worse. Work was into the winter slow-down, and my crew was subcontracted to the power company, clearing brush along the big power lines. Pretty heavy work, but I’d done it every year, no problem. Right away I was so burned out the boys told the boss they were afraid I’d drop dead, and he sent me home to rest. Except I kept on getting worse. Couldn’t breathe, especially if I tried to lie down. Everything was swollen.”
“I’d been home maybe a week when I stopped making sense. Didn’t even know where I was. April called 911. Ambulance took me to an ER in Poughkeepsie. Told me my heart was barely pumping, that I had “idiopathic cardiomyopathy,” said it probably came from the cold I had. They put me on tons of medications, steroids and such, and I sort of stabilized through the holidays but into January I was still sick. That’s when they told me and April I might not live out the year without a heart transplant.”
“So April drove me down here, to Denomination. They stuck me in a bed, did all the tests, I met everybody on the team, and on February 2nd they put me on the waiting list for a donor. That’s when I met Dr. Bessette for the first time. He told me about the operation and the risks and all that, real straight-up, confident. Made me confident. He explained that it would be him or some other guy doing the operation, depending on the timing. I was hoping it was Bessette.”
“A day or so later Marcia—the coordinator—came in and explained to me about being a big guy who’s a type O, that I may wait a long time on the list. She said they’d decided I could wait safely at home and discharged me. April drove me back to Rhinebeck. It was tough on the kids, they were scared and nervy. We made sure they knew there was hope, but we were pretty straight with them about the odds, at least the older two.”
“You mean they knew you could die?”
“Yup, they sure did, they knew there was a fair chance I’d never get a donor in time. No matter how it came out I wanted them to know I’d never lie to them.”
“What about the transplant itself?”
“We got the call on that Saturday afternoon. April picks up the phone in the kitchen. She runs around the corner into the family room where I was in my recliner, it’s like she forgets she’s attached to the wall, the cord’s all straightened out like a cable. I thought she might yank it off the wall, she’s so excited. ‘They have a heart!’ Then the kids get into it. We threw the go-bag in the car and two hours later we’re in the holding area, me bare-assed in a gown again. We sat there sweating it out for what felt like forever, studying the ceiling tiles. We got updates from Marcia, waiting for the final green light from Montreal, until they finally took me in. My surgeon turned out to be the other guy—Bennett, I think it was. He introduced himself just before I went under, and he seemed okay. And later I learned that Bessette did most of it anyway, when he came back with my heart. That poor kid’s heart, my new heart.”
“Was it hard saying goodbye to April?”
“You know, you’d probably think so, I’m sure it is sometimes, but we were so damned hopeful it didn’t feel like goodbye. More like ‘let’s go play the game, we’ll celebrate at the awards ceremony!’”
“Tell me about when you woke up.”
“Have you ever had major surgery? Where they put you out?
“No, can’t say I’ve had the pleasure!”
“That’s good, I guess! Well, I can tell you when they put you under it’s like a guillotine. You’re just gone in a blink, then someone pulls the bloody blade back up and you wake up as if no time has passed. Everybody asks about all the pain, and yeah, there was some pain when I woke up, but I was mostly just happy to see April smiling at me and feel her hand! And I woke up in a whole new world. I could see my kids growing up, getting married, grandchildren, April and me—what’s a little pain against that?”
Lindsay could see he was fighting to hold back tears. “Mr. Ellsworth, let’s give you a rest while I go over what we have, see if there are holes to fill, and we’ll sit back down again at eleven.”
Lindsay found a phone in another room and called The Director in his office. “This is going well,” she said. “The basics for the PR piece are in the bag. He’s compelling, he’s sincere, and getting comfortable. Unless you need me somewhere else today, I’d like to sit him down again and follow up on some things I heard from his transplant coordinator. Some unusual, deep-background stuff…great, I’ll call you when we’re breaking down.”
Related:
- A Conversation with Dr. Craig Smith on His Novel “Stone Hearts,” the Art of Writing, and the Surgeon’s Imagination
- Lessons Learned: Surgeon Craig Smith Reflects on Career in the OR
- Nobility in Small Things: A Look Back at The Leadership of Craig Smith, MD