The Bluest Skies

I hear him before I see him. Everyone in the ICU does, this one long moan of a word, "Shellyshellyshellyshellyshelly."

I check in first with the head nurse, Joyce—I remember her from last time. She is not a fan of organ donation and calls us the Vulture Squad. When I first met her, she gathered herself up and said, "I'm going into the earth the way the Lord brought me in. Intact."

I said nothing.

What I wanted to say was, "Unless you're cremated, your internal organs will be removed by the mortician and placed in a silver basin like so many slippery fish. Then, formaldehyde will be pumped into your veins by a number nine needle. A dab of super glue seals your eye lids shut so that they don't pop open for the viewing and also because, guess what? Your eyeballs have been removed. Your hands will be shaped into a prayer position, because otherwise, they will curl up into your palms due to rigor mortis."

These are the inside thoughts. They come out in our Monday morning quarterbacks with other transplant coordinators, because they understand. We sit around and talk about who died that weekend, and how, and whether anyone was saved. In training, I distinctly remember a PowerPoint presentation by the county coroner called, "Ways You Can Die in the Bathroom, Part 1."

I am deferential to Joyce. She is accustomed to doctors who barely register her presence. I don't lean on the counter like an overly friendly representative from Pfizer. I stick with what I think will make her talk. "I was at HUP last night. I wish that you could have seen this nurse. She wasn't sure how much dopamine to administer on this nut job who shot a nail gun through his foot."

She glares but is compelled to answer, "Well, that depends on the body weight, doesn't it?"

"That's what I said." We both shake our heads. I don't make a joke about how the kid's name was Jesus and he was practicing for Easter Sunday. That's for a different nurse, one who doesn't have a gold cross swaying between the wide white sea of her uniform.

I've brought her two Kit Kats from the gift shop because I tucked that bit of information in my head from the previous aneurism case. I hand them to her, saying, "I don't like chocolate." She looks up. She doesn't say thanks, but she doesn't say no thanks. Now it may be easier with her the next time I'm called out to talk to a family after their kid hangs himself with a bit of nylon.

All this from the one business marketing class I took in college called, Knowing Your Audience: How to Seal the Deal.

I'm familiar with Jefferson's ICU and so many other hospitals like it in the City of Brotherly Love. Slick white floors, whooshing doors, a murmur of whispered voices and the occasional shriek from a bleeder. The last time I was on the sixth floor of Jeff, we had a gunshot wound from a drive-by: back of the head, twenty-one-year-old white male, and screen positive for crack cocaine. His organs turned toxic before the family could consent. They dawdled and prayed and fucked around and his heart went south and no one was saved and everybody died. We all went home, and some of us coped by watching the entire first season of House of Cards.

Before approaching the room, I get details on a call with John, the transplant intake coordinator. He wears a headset all day, like an air traffic controller. I imagine that he would be generous in bed, would touch your thighs with light fingers, testing—Is this okay? How does this feel?

This patient is Caucasian female, age 24, found unresponsive in her kitchen, slumped next to the stove with a gaping head wound, likely from a hammer of some kind. One apnea test and one scan. Zero activity. Not even a...