Alive

“The death’s been made official. That’s it.”

“Are you sure?” my mother whispers. I keep my breath steady. I don’t want them to know I’m awake.

“Positive. Family went in to say their good-byes. I just got off the phone. They pulled the plug.”

“And, will she…?” My eyes pop open. The shadows of my hunched mother and Dr. Belkin stretch over the wall of my hospital room.

The cardiac monitor beeps softly, once, twice, three times. “That’s the plan.”

---

CONFIDENTIAL

St. David’s Healthcare: Confidential Document

This information is subject to all federal and state laws regarding confidentiality and privacy and to the policies and procedures of St. David’s Healthcare regarding patient information. Any unauthorized use, disclosure, or reproduction of this information is strictly prohibited.

 

Transplant NTE

CROSS, STELLA M.

*Preliminary Report*

 

Document type:	Transplant NTE
Document status:	Auth (Verified)
Document title:	Pre–Heart Transplant Note
Performed by:	Belkin, Robert H.
Verified by:	Belkin, Robert H.

*Preliminary Report*

Pre–Heart Transplant Note

Patient:	Stella Cross
Age:	17 years
Sex:	Female
Associated diagnosis:	Acute cardiomyopathy
Author:	Belkin, Robert H.

Basic Information

History of Present Illness

---

I was fifteen when my heart betrayed me. Like with all truly masterful betrayals, I didn’t see it coming.

I had my eye trained on the outside world—bad grades, horny teenage boys, college admissions—and all the while the real danger was lodged square between my rib cage and spine. It hatched its plan, welcomed the poison in like a Trojan horse that pumped the disease through every artery, atrium, and valve until it turned my whole body against me.

That was two years ago. Life really isn’t fair.

The hospital bed mattress squeaks beneath me as I try to wriggle my way upright, digging my heels into the paper sheets. Even that makes me tired. I feel my breath get short and wait, still, until my pulse slows. A Bachelor rerun blares in the background. I’ve been on a two-day bender—the hospital only gets a handful of channels—and I’m holding out hope that DeAnna wins this season, only I’m not sure I’ll be around long enough to find out. I suppose I can Google it, but even the thought of that feels self-defeating.

I’ve been joking with Mom that I’m contestant material now. My athletic five-foot-nine frame has shrunk to a frail 112 pounds, burning calories overtime to keep the rest of my body functioning. Turns out not dying takes a lot of work.

I drum my fingers on the plastic side rail of my bed and Mom glances up from the magazine she’s been pretending to read. She’s been doing that a lot lately. I can tell by the way she keeps glancing toward me or the cardiac monitor—anywhere but actually at the magazine. She’s put on makeup for the first time in days. Blush sweeps across her cheekbones and the bridge of her straight nose. She must have snuck out her compact while I was sleeping. Wisps of her black hair still stick out at her temples, though, and she looks the most tired I’ve seen her in ages.

Dad took Elsie downstairs fifteen minutes ago, since she’d been crying like it was her heart that was about to get ripped out. That kind of attention-hoarding behavior is what makes Elsie the perfect replacement child. She fills up practically every nook and cranny of my parents’ attention.

I’m getting antsy when Dr. Belkin walks in, white tennis shoes squealing along the speckled tile floor. “How’s the patient?” he asks, making a beeline for the little digitized screens that will tell him exactly how “the patient” is doing. I don’t say anything, since I don’t really know. For the two years since my diagnosis with cardiomyopathy, computers have proven a much more reliable indicator of my overall health, seeing as I feel pretty much the same as always—kind of crappy, but not terrible.

“Her color’s good.” Mom folds the magazine without marking her page and sets it on the table next to her. She puts a lot of stock in my color. She adjusts the trendy Kate Spade glasses perched on her nose and reaches mechanically for her big stack of research, the voluminous file she keeps on Yours Truly. Career criminals have case reports that are shorter than my medical records.

Dr. Belkin offers a thin smile. “Everything’s still on track,” he says kindly, which is nice of him to say and all—only one problem: which track? The one where Stella Cross goes on to stay up late nights watching reality TV, attend college, and lose her virginity, or the one where she dies, like twenty-five percent of other transplant patients, but in utter teenage obscurity, having never done a single thing with her life? Ever? “Are you ready, Stella?” he asks, apparently unable to read my mind. Dr. Belkin has bushy blond eyebrows and reddish skin, the face of a man who would sunburn in Alaska.

My rotten heart hammers at the inside of my chest. “So…I’m going to be dead?” I ask, even though I know the answer. “As in, one hundred percent not living?”

“Stella!” Mom shushes me like I’ve said something offensive instead of totally true. She’s always on me about asking too many questions.

“Yes, technically.” Dr. Belkin checks the tube that trails out of my left arm. I can’t say I like him much—not personally anyway—but we reached an understanding a long time ago. We’re on the same team, he and I. It’s my job to maintain a pulse and his job to see that I do and, believe me, I’m all too happy to be another bump in his success rate.

“What we’ll do is prepare the cavity in your chest. A spot for the new heart to sit.” Dr. Belkin draws a circle in the air and I picture a bunch of people in white face masks hovering over me at an operating table, scraping out my insides like I’m a human jack-o’-lantern. My palms start to sweat at the thought of the foreign heart. I dig my fingernail into the white flesh underneath my forearm, the spot where the blue veins push up into a plump little bulb at the base of my wrist, and scratch a cherry-red line. A nervous habit I picked up during my sickness. Illness upon illness, that’s how it works. “Once your new heart is positioned, we’ll sew it in place and stitch together the arteries.” He locks his fingers together to demonstrate and my stomach performs a flip-flop.

“I’ll look like Frankenstein.” I feel the sting on my skin leftover from my fingernail, and picture it fading away from red to pink to white. Then gone.

Dr. Belkin forces a chuckle that doesn’t reach his eyes, which are cold and calculating, as always. “Maybe a little. But at least you’ll be walking and talking.” The man makes a good point.

“And what if you put it in wrong?” I ask. This time my mom doesn’t interrupt me.

“We won’t put it in wrong.”

“But my body could reject it. The heart, I mean?”

Dr. Belkin frowns. “We’re going to do our best to make sure that doesn’t happen.”

There are more questions on the tip of my tongue, but I let them sit there unasked. Instead, I chance a look at my mother, whose expression is unreadable, and take a deep breath, thinking again about how there are fifteen dead people in the history of the world for every living one and wondering which end of the chart I’ll wind up on.

On the nightstand next to me, there’s a vase full of daisies from our neighbors and a big pink teddy bear sent by my teachers. Dozens of cards line the windowsill, some from my best friends, some from people I’ve never met.

My ears start ringing now, and I’m getting a tingly sensation in my toes, and I’m watching the room and my mother and Dr. Belkin, and suddenly it feels like there’s a piece of glass between me and the rest of the world. I swallow hard: the glass evaporates, but the ringing is still there.

The moment hangs there a second too long before Dr. Belkin asks me again if I’m ready and pats my knee under the thin hospital blanket. He’s awkward when he tries to have a good bedside manner, but I don’t mind, because I can barely feel the spot where he touched me. It’s as if this body is somebody else’s. “Three o’clock,” he says, glancing at the clock on the wall and then back at his clipboard. “We better get going.”

“Ready.” I lie.

Dad strolls in, holding the hand of a teetering Elsie, who toddles over the threshold and into my room looking frustratingly adorable, as usual. Big pink bow, soft brown curls, and chubby cherub fingers you can’t help but get the urge to lick icing off of.

Dad scoops her up and places her on the side of my bed. “Tell your sister we’ll see her soon,” he coos. He’s all scruffy beard and smiles and his calming presence spreads over me like a warm bath. When Mom’s watching Elsie he winks at me, and I know it’s a secret meant for just us two to share.

Elsie pats my arm and laughs. A lump grows inside my throat as I look at my baby sister. She was brought into this world a short ten months after I found out I’d probably be making an early exit. As if I was a replaceable doll that happened to be back-ordered by a few years. I wonder if she’ll grow up to look like me, with stick-straight black hair and green eyes that are too wide, or whether her hair will stay brown and curly, like Dad’s, her skin the same tan color. I wish someone could promise to send me a postcard in the afterlife just in case I die.

“Are you nervous, sweetie?” Big fat tears line my mother’s eyelashes as she slides off the bed and studies me with her head tilted.

I shake my head and force a smile. “This body ain’t big enough for the both of us,” I tease, donning a thick Western accent. My parents like when I joke around about my condition. That sort of humor is sick-kid gold. It makes adults think we’re resilient, when really, my limbs have that shaky feeling I get just after I throw up.

What I really want to tell her is that I’m terrified. Terrified I’ll miss high school and my friends and a normal life. Terrified that Elsie will take my place in the family and I’ll be forgotten. Terrified that I’ll never have a real boyfriend.

Dad ruffles my hair with the hand that’s not clinging to Elsie. “That’s the spirit, kiddo.” The creases lining the corners of his eyes are damp.

For a brief moment, my heart physically aches and I think maybe there’s some good left in it after all, but I catch myself right away, since now isn’t the time to get tricked all over again. There’s only one punishment for treason and it’s death. And if I have to wrestle my stupid, defective heart all the way into the depths of the underworld, then that’s what I’ll do, and I swear to God, if only one of us can survive, it’s sure as hell going to be me.

I slide my iPhone out from underneath the back of my hospital gown. I’ve been clinging to it—my only connection to the outside world—but now I’ll have to give it up. My hands shake as my thumb slides across the screen. The nurses are unhooking me from machines. My family is staring at me. Orderlies are busy clearing a path. And yet I’ve never been so alone. My bed is a planet around which everyone else orbits. It must be this realization that plants inside me the sudden desire to tell one person in the world how I feel. It’s a need that takes hold like roots in soil.

I’ve been avoiding Henry, but with trembling fingers I type one sentence: I’m scared. The words appear one letter at a time until I’m left staring at them all spelled out in front of me. If nothing else, I think, they’re true, and there are worse ways to end things. So I hit send and try to imagine I’ve mailed the fear along with it.

Mom pulls my head to her lips and pushes my hair back, so the scrub nurse can put a shower cap over it. Mom takes my phone and the jewelry that I’m wearing, along with the stuffed puppy I keep for good luck.

Before I know it, they’re starting to roll me away. Panic wells up inside me and I just barely get out, “See you soon,” even though I’m already facing backward as Dr. Belkin and the nurse push me out of room G216. Of course, Elsie’s crying again.

The double doors rush at me, swinging open at the last second. I stare up at the ceiling tiles instead and watch them whiz past one by one. We’re in a new room now, with a giant light overhead and a crowd of masked clinicians. From somewhere behind me, an anesthesiologist is telling me to count, so I do it, and I’m counting out loud: “Ten, nine, eight…”

I see myself holding Elsie, right after she was born. Seven…Covered in blood, she’s sticky and screaming, but brand-new and strangely beautiful. She stretches her fingers up, clasping at nothing. Her tiny mouth sucks the air.

Six…

I watch as black water closes over the top of her head, submerging tiny wisps of baby hair. My eyelids flutter. Or at least they try to. Bubbles break the surface.

Five…

Only I’m not sure if I’m counting anymore. There’s a boy. His eyes are shaded. His face is a flash and then it’s gone, replaced by a body. I can’t see whose. The face is turned, hair splayed out like it’s floating in the ocean. I should tell someone. I should.

But I can’t because four. The word is announced as if over a loudspeaker.

On cue, the room goes dark, or at least it’s dark for me. There’s a tight squeeze against my lungs and then—

---

Spoiler alert: I’m not dead.

I know there are people at school wondering, wanting to ask one of my (very few) close friends, but not sure how. They’ve probably tried checking my Facebook page for signs of life—or death. They can’t. It’s locked unless I let you in.

The truth is, I’m superstitious. In the weeks after surgery, every day was a waiting game, breath held, an anybody’s-guess version of Russian roulette—will my body accept the new organ or not? Staying at the hospital was a routine step in the surgery, but it felt like purgatory.

Days turned into weeks and still my clock kept ticking. My parents are still the last holdouts, even more hesitant than I was to make the big Stella’s okay broadcast. Nobody wants to show our hand, to publicize that we cheated death. The weaker hand has won. Only you can’t live that way forever. Can you?

I snap shut the lid of a yellow marker and admire my handiwork. On the wall of my bedroom hangs a calendar. Between this year and the year before there are a total of 237 red x’s, one for each day of school I missed. The five weeks are a solid block of angry crosses. I slashed each over the date, often pushing so hard the ink bled onto the page beneath.

“Are you sure you want to do this?” Mom leans in the doorway, warming her fingers with a steaming mug of coffee. “Dr. Belkin said—”

“Dr. Belkin said it was fine.” The red marker lies in the garbage can beside my nightstand. With the yellow, I’ve colored a bright sun on today’s date to mark my return. At last, I think, unable to suppress a smile. My skin practically crawls with longing to get out of this house. Four weeks ago I’d have said I had cabin fever. By now it’s escalated to full-on cooped-up pneumonia.

“Fine.” She stirs her coffee with a miniature spoon and concentrates on the cream swirling into milky brown. “But that doesn’t mean advisable.”

“I was ready to go back weeks ago.” I tie a ribbon around the base of my ponytail and admire my reflection in the mirror. On my last visit to Dr. Belkin, I’d petitioned for a clean bill of health, but he’d sentenced me to another seven days. I would have invoked the rules of the Geneva Convention if I’d thought it’d convince anyone that I deserved an early release. But I waited. Patiently. So that no one would question my judgment the moment I was cut loose.

My recovery hasn’t exactly been a straight line. There’ve been side effects. Painful ones. In the mirror the remnants of dark, bruise-like circles peek through the concealer underneath my eyes. Bones protrude from my thin wrists. I keep these things hidden from my mom. They’re only distractions. I’m lucky she can’t see the worst of it. My chest has been feeding me a raw, incessant ache ever since I returned home from the hospital. Sometimes I peek underneath my shirt, certain that I’ll find pus oozing out of the wound. I never do. That’s the thing about pain: it’s invisible.

“What are the rules?” she asks.

I sigh, retucking my shirt. “Wash my hands frequently. Maintain a bland diet. Don’t elevate my heart rate unless I want to malfunction. Happy?” I say, grabbing my bag off my bed.

“I’d prefer not to think about my daughter malfunctioning.” She trails me down the hall toward the entryway.

“I figured it sounded nicer than the real word—dead.” I stop at the front door and turn to face her. The corners of her eyes crinkle like tissue paper under her wire-frame glasses. “Mom.” I try to sound firm, adult. “I’ll be fine. I promise.”

My mom’s cheeks cave as she purses her lips. “Another week at home wouldn’t kill you.”

I push open the door, letting in a burst of fresh air, which isn’t steeped in sun like I’d imagined, but slick and soggy. I breathe in a heaping mouthful and smile. “No, Mom. It would.”

Seven o’clock. I push the lock button one more time on the keys to my black Jetta before looking up at the school I never thought I’d see again. It’s already been in session for six weeks. The late September air’s filled with a million crystallized droplets so minuscule they seem to hang suspended rather than fall. They clog up my pores and pull at the strands in the hair-sprayed ponytail I spent fifteen minutes combing this morning.

Everything’s deadly quiet here. The gravel parking lot’s empty and the sky is still gray, making outlines fuzzy and out of focus. The oak trees, portables, and the American flag that droops limply from the pole all loom in the murky air like abandoned carnival rides. It’s my favorite time, these stolen minutes in a place normally teeming with people.

I take a sip of coffee from a silver travel mug, and as if in response, my heart performs a kick. I rub at the spot on the outside of my chest where it feels as if my new heart may have left a bruised rib. I push on one of the bones to feel it. The muted pain spreads up my breast and I knead it with my fingertips.

Relax, I tell it. First-day jitters. I trudge through the parking lot to the mist-soaked grass alongside the library’s edge. Through the fog I see someone cut across my path. His figure is obscured by the gray dripping from the sky, but sharpens as our trajectories converge. He’s tall, with hands shoved into his pockets as he walks briskly in the opposite direction.

“’Morning,” I mutter when we’re only a few feet apart. His head tilts and he nods before brushing by without a sound.

I take another swig from my coffee mug and resist the urge to glance back. Our school is two redbrick buildings with cement trim framing a grassy quadrangle that’s dotted with picnic tables and black-and-white checkered benches. An arched covered walkway connects them, and portables lie on the outskirts like shantytowns for student body overflow. The school itself backs up against a thick stand of pine trees that Duwamish High students call simply The Woods. Where lazy prep school boys in wrinkled polos cut out to smoke cigarettes between classes and sneak their hands up the plaid skirt of any girl who’s willing.

It’s early still. Too early to head to class. The main entrance will be locked while the teachers try to enjoy their last few minutes of peace and quiet. But the janitor always props open the back door of the west-side building, the one closest to the woods and, conveniently, nearest to my locker. That’s where I head.

Inside, the hallway smells as damp and musky as the outdoors. My shoes squeal against the linoleum. My locker’s close enough to the open door that the early fall breeze plays with my hair.

The halls are silent except for the faint trickle of music from a teacher’s radio. In front of my locker, I slide off my book bag and plop down cross-legged on the ground. I’ve packed a copy of The Awakening, a book I was supposed to have finished the last week I was in the hospital. I almost did, but my life got pretty busy what with twice-daily naps and finishing up that last season of The Bachelor. It’s funny how the more time you have, the more nothingness there is to swallow it up.

I turn to the dog-eared page near the back of the book. I’m not sure what to make of this Edna character. She’s very whiney for someone who’s had three lovers in the past two hundred pages.

I lick my finger and flip the page, trying to see Edna’s life the way she sees it. I’m about to finish the chapter when a strong gust blows in and ruffles the pages. I rub my hands together and blow into them, cold. The wind howls as it sweeps through the long hall. I trace the direction it traveled with my eyes.

The tiny hairs on the back of my neck prickle. Reluctantly, I cast my eyes around, twisting my neck without moving. A creepy sensation inches its way up my spine. My fingernail finds the fleshy part of my forearm and I scratch into the smooth surface. Not enough to leave a scab, but the line stings like a mouthful of Listerine.

The feeling that I’m not alone makes me want to bolt. I peer down the hallway to the point where I can’t see around the corner. Someone’s watching me. Maybe I should leave.

No, I’m being silly. I force myself to settle down by rubbing my fingertip against the skinned patch on my arm. I push down. The stinging flares. Eventually, though, it calms me and I take a deep breath and return my attention to the book.

I pick back up with Edna, who can’t understand why Robert doesn’t love her. As far as I can tell, it’d be a lot easier if Edna just asked him. People in old books don’t communicate well.

But then there it is again. The watched feeling.

This time goose pimples spring up on my forearms. There’s a squeak—the sound of sneakers on a basketball court.

I tuck my heels in and slowly rise to my feet, new heart thumping. I tiptoe to the end of the row of lockers and peer around. Nothing.

A loud thump comes from behind me and my heart leaps clear into my mouth. I whirl around, hand clawing at my chest.

“Holy shit.” The words rush out in one long whoosh of air. A mangy Siamese cat peeps its head out of a trash can and stares at me with blank eyes as colorless as melted snow. I let my head droop, trying to catch my breath. “You’ve got to be kidding me,” I say out loud. “How the hell did you get in here?”