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 Two, Dr. Elias Bessette, early in his career as a heart surgeon, made arrangements to retrieve a heart donor from Montreal for transplantation in New York City. That process prompted contact with his estranged brother, Jean, a Montreal resident, and provoked rumination over Eva, who came between the brothers three years earlier.
Friday, May 5, 1989
A Survey of European History began the end for George McGowen—the first week of May was finally wrapping up as he sat through his last Friday class at Damson College, tucked away in the Westmount neighborhood of Montreal. George was practicing his most erect seated posture, trying to stay alert in case he was called on to say something about the Seven Year’s War of 1756 to 1763. He was prepared to comment on the part of that conflict that was fought in the northeastern British and French colonies of North America, a localizing memory peg from which George could demonstrate at least some knowledge, if not broad comprehension.
George was much better prepared to describe Katherine, a question no one knew to ask. Katherine had silky brown hair breaking over her shoulders and emerald-bright green eyes. George often lost himself studying the forest of freckles on her face. He was almost convinced that their patterns, spreading to the left and right of her fine nose, were perfectly symmetrical mirror-image isomers, which seemed impossible and therefore divine. No reverie was complete without thinking about her body, how its perfections were not quite hidden in loose, self-effacing clothing. They had met swirling around in the same peripheral circle of social purgatory at a Damson mixer. Katherine was his first serious girlfriend. George had pre-purchased tickets for Field of Dreams on Saturday night, just opening in Canada after great buzz in the US. The sweep of the second hand on the wall clock was soporific…the bell rang and he was free, his life stretching out before him.
At 16:30 George met with his guidance counselor. Damson College was a well-regarded, English-language Collège d’enseignement général et professionnel (CEGEP) that was preparing students like George to compete for acceptance to McGill, on which his heart was set. George was serious, reserved, a good student, and a hockey player good enough to play locally but not in the Quebec and Maritimes Junior Hockey League that groomed players for the NHL. Franklin McGowen, George’s father, was a veteran Mountie in Montreal, and George knew he would need scholarship support. George’s guidance counselor was encouraged by his academic performance during his first year at Damson. One more year like that, he opined, and George should have a great shot at a scholarship to McGill in 1990.
Public transportation carried George from Westmount to the edge of the tenaciously middle-class neighborhood in Notre-Dame-de-Grâce (NDG) where he lived with his parents and 14-year-old brother, James. The remaining three-block walk crossed busy Sherbrook Street West at the first intersection. Cautious by nature, before stepping into the crosswalk George waited for the green light, and for approval from the new blinking-white walking-man avatar. He had also looked both ways, but his timing allowed him to miss a van running the red light. The side panel grazed his hip just enough to spin him ninety degrees and send him sprawling, knocking a few things out his backpack. “Motherfucker!” he yelled, from the pavement, and sent his middle finger after the vehicle speeding away. George picked himself and his belongings up from the street and cautiously walked the last two sleepy suburban blocks, to the safety of home.
Aimee, George’s mother, was starting dinner when George arrived around 18:00. “Where’s Dad?” George asked.
“Where do you think he is?” she replied, with a familiar air of resignation.
“O’Donnell’s?”
“Bingo! At least he called.” That painted a familiar picture in George’s mind of his father throwing darts, watching sports on the CBC, and socializing—drinking—with his buddies.
“James is up in his room,” Aimee added, “doing what he calls ‘studying’.”
James was nearing the end of eighth grade at Marywood Academy, from which George had graduated in 1988. James had been born with a ventricular septal defect, cleft lip and palate, and pectus excavatum. James’s heart and face were successfully fixed early in life. His pectus was functionally insignificant but made him self-conscious when bare-chested. The treatment and follow-up of all three problems blessed James and his mother with the stoic patience learned while waiting to receive universal health care. James was also blessed with above normal intelligence and supranormal charisma that neutralized his indented chest and the faint scar on his lip. His popularity with classmates might have delayed the development of an academic drive comparable to George’s. George admired his little brother’s social gifts and never begrudged the extra parental investment in health and appearance.
The boys were summoned for dinner around 18:30. To fill the conversational void George asked James if he was enjoying Mr. Zhou, who had been George’s favorite eighth-grade teacher at Marywood. James was equally fond of Mr. Zhou, and praised his efforts to make his students aware of a world larger than the Stanley Cup. Aimee was happy to encourage any pleasant family conversation and asked her sons to enlighten her. Both boys eagerly described the unrest in China, and the bold demonstrations in Tiananmen Square.
James concluded “Mr. Zhou doesn’t think China’s going to change. He says he was lucky to escape under Mao, and he’s afraid lots of people will die. He got more excited about the thing where some people cut down a fence in Poland or Hungary or one of those countries over there, in the Soviet Union. Just two or three days ago.”
“That could be the end of Red Army hockey!” George added.
“Speaking of hockey, isn’t there a Cup game tonight?” Aimee asked.
“Correctamundo, Mom!” said James. “In Philadelphia. Maybe we’ll get to see the Canadiens get their asses kicked again, just like Monday.”
“I guess you’ve forgotten whose asses got kicked on Wednesday!” retorted George.
“Right, Georgie, and they might be able to beat the Flyers, but they won’t beat the Flames!”
James loved to be contrarian about regional sports loyalties, and knew he could count on getting attention around town by rooting against the Canadiens. He didn’t particularly care which city he was adopting provided it wasn’t Montreal. He’d even liked the Bruins one year, which he rationalized because they were the Yank team geographically closest to home. Last year, it was the Toronto Maple Leafs. This year, the Calgary Flames were his team, and they’d be facing either the Canadiens or the Flyers later in the Stanley Cup finals if they beat the Black Hawks.
“Do you even know which Province Calgary is in?” George said, rising to the bait. James didn’t answer. “Well, do you?” he repeated, deducing that he was probably right and had gained the upper hand.
James finally said “I don’t have to answer your dumb trivia when I know the Flames rule!”
When the boys started clearing the dishes their mother glared at the empty seat and the untouched place-setting at the head of the table. “I guess we can be pretty sure your Dad won’t leave O’Donnell’s until the game is over.” That didn’t satisfy her, and her audience was escaping as fast as they could. “Of course he’ll have to stay until the celebration, or the mourning, is over. Then they’ll have to develop a detailed strategy for the next few seasons.” Aimee followed her conflict-fleeing sons to the sink and announced that she was going to a friend’s house to meet a few other women, most of whom had known her sons since they were babies. “I know you boys will take care of each other!” Aimee said, as she departed.
George and James bickered like most brothers but could pull together when necessary. Soon after their mother left, they had cooperatively washed the dishes and cleaned up the kitchen. George confessed he wasn’t sorry hockey season had been over for a few weeks because of the extra time it gave him; he didn’t mention how unimportant hockey seemed compared to Katherine. James talked about mountain-biking, which was just beginning to catch on with some of his friends. They debated walking up to the playground to shoot some hoops, but it was already 19:05, and the Canadiens/Flyers game was supposed to start at 19:30.
The boys walked into the family room. George picked up the remote from the coffee table and clicked around the channels without finding anything better than the pre-game blather coming from the Philadelphia Spectrum on CBC, where the teams were just finishing their warm-ups on the ice. Behind them was a long, cushiony couch facing the television. Out of habit they glanced at the couch to confirm it was unoccupied—on many nights it doubled as Franklin McGowen’s sleeping space, at least for the hours between shambling in late and creeping up the stairs just before dawn. They sat down to watch the game.
James yawned, boy-spread, and stretched. His hand hit something hard behind a cushion. He felt around, grasped the object, and pulled it into view. James recognized his father’s old Colt .45 RCMP sidearm. The RCMP had recently decommissioned the old Colts and replaced them with 9mm Berettas. James put his index finger through the trigger guard and lifted it up to show his brother. “Hey, Georgie, check this out!”
Their father had made sure that George and James were familiar with guns, and they both knew better than to fool around with one. Dad knows better than to be that careless, George thought. This never would have happened, when we were little, and he was better.
James asked—rhetorically, because he was thinking exactly what George was thinking—”Why the fuck would he leave a gun in the couch?” James laid the weapon on the coffee table in front of them not far from the remote and both returned their attention to the game, where the puck was about to drop. The Canadiens snuck in a goal in a first period that was well played by both teams. The second period was all Montreal—three more goals, putting the Canadiens up 4-0 heading into the third period. Even James couldn’t resist the excitement of seeing his city dominate the Yanks. The boys’ high spirits carried through the third period, in which each team scored one goal, leaving the Canadiens with a lopsided 4-1 victory and a 2-1 lead in the Stanley Cup semi-final.
Smiling broadly, George unfolded his lithe six-foot frame and spiked a victory fist in the air as he walked to the refrigerator, found nothing appealing inside, and closed the door. When George stood up, James idly picked up the Colt and started fiddling with it. He pulled back the slide. Both boys heard the click of the cocking mechanism. George was already halfway back to the couch and demanded “What are you doing?”
“What’s the big deal? Dad would never leave a loaded gun lying around.”
“Maybe not, but what’s the first rule, dumbass? Assume every gun is loaded!”
George had reached the couch, visibly annoyed, and was standing in front of James. James shook his head dismissively and said “You’re getting all wound up over nothing again, Georgie!” That was the last straw, and George snatched at the gun. It fired. George’s head snapped back and James saw blood explode into the room behind him. The impact knocked George to the family room floor on his back. The Colt hit the floor simultaneously with a metallic clank. George lay at the foot of the TV, where the announcers were excitedly recapping the game, and the screen was flashing back and forth between crowds of glum Flyers fans and clusters of cautiously celebrating Canadians.
To his credit, James was activated, not paralyzed, somehow knowing instinctively that he would have the rest of his life to self-flagellate and wallow in the horror of it all. He crumpled to his knees next to his brother, saw that he was still breathing, and felt George’s carotid pulse. James sprang back to his feet, snatched the receiver off the kitchen wall phone and called 911. He grabbed a kitchen towel, knelt back down, and tried to press the towel into the part of George’s skull that seemed to be the source of most of the bleeding. Family, faith, skating, dreams of McGill, and the symmetry of freckles were slowly spreading across the floor. Two or three minutes later James heard a siren, getting louder, and he started to cry. James was sobbing convulsively when they took George away, still breathing, with a slow heart rate and low blood pressure, but alive. The police stayed behind to interview James, study the scene, and locate his parents.
The neurosurgeons at Montreal General did what they could Friday night to stop the bleeding and minimize brain swelling but by Saturday afternoon George’s swollen cortices pushed down into the brain stem—herniation—and his brain stem ceased to function. The neurologist met with the family at the bedside while George was still hooked up to an electroencephalogram (EEG). In hushed and respectful tones, she pointed to the vertical stack of needles scratching parallel flat lines across the paper, like bird feet scribing staffs of blank music. The neurologist explained that George’s brain was no longer functioning—he was “brain dead”—but his heart, lungs, and other organs were still working because George was on a ventilator, with IV drugs helping to maintain his blood pressure. His devastated family had already expressed interest in organ donation, grasping for something positive.
Discussion intensified, permission for organ donation was obtained from George’s parents, the diagnosis of brain death was officially confirmed with an apnea test, and the organ procurement organization began contacting transplant programs. By early Sunday afternoon arrangements were complete for George’s salvageable organs. His kidneys, corneas, and other miscellany would be removed for patients in Montreal. His lungs were headed for Toronto, and his liver was going to the University of Pittsburgh. The cardiac transplant team from University Denomination Hospital in New York City was flying in to take George’s heart. James, and his mother and father, said goodbye to George just before he was wheeled to the operating room in his ICU bed.
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