Julia Michie Bruckner (2019 Winner)
“Just when days were getting rapidly shorter and the sun seemed to go down all too soon, the harvest moon arrived to extend the hours that harvesting could be done.”
-The Old Farmer’s Almanac
The September moon hovered, low and generous. Its light cut through the blinds and cast bright bars over the still child, his mother twisted around him. The boy’s cheeks had the glow of alabaster, his under-eyes a violet translucence, his cracked lips a pallor. His fingers lay straight, with nails a seashell gray. A helium balloon drifted along the ceiling tiles, wrinkling.
Monitors surrounded the bed, with their green-glow flashes and red-blinking beeps, digits counting steadily downward. Tides of sterile saline entered his vein and traveled first to the heart, then to fingers and toes, then back heartward.
The breathing tube shone a lustrous blue, the moonlight catching its ridges as it curved between his lips. With each marching breath, the tube clouded, then cleared. Oxygen drawn in, carbon dioxide forced out. A measured rise of his chest – the essence of momentary endurance.
The boy’s mother lay in a heap of hands and hips, mountains surrounding a deep lake. Every so often she would tremble, quake, then wail.
She rose from the bed’s edge, shuffled to the window and struggled to open it. It would never open – hospital policy. She crumpled over the sill, hair hanging, a shadow among fluorescent machines. I watched her from the doorway as she swayed, her cries now muted.
I caught my own reflection in the window – a blur of stained blue scrubs and graying white coat. The day’s bustle and buzz complete, most of the staff had gone home to their beds, leaving the hospital to the handful of residents on call. The responsibilities of the unit became, at night, mine alone.
This twentieth hour of call is when the shivers, the nausea, the heaviness come – the body’s call for a sleep I cannot have. Three a.m. is the stagnant straining, the peak just before a tidal shift. The moon and I were now caught here, preparing for what dawn would bring.
The child had come to us after he did not wake from his nap, carried in, limp, by his panting nanny, her forehead glistening with sweat. The parents arrived soon after, sprinting in their work shoes, eyes frantic.
He’d looked perfect – nothing deformed or discolored, no hair out of place, both shoelaces tied. He made no squeals, no grimaces, no giggles. The life had been shaken out of him.
Exams and tests and scans revealed damage too devastating. A fate irreversible. A brain rattled by the hands of someone charged with his care.
We performed the rituals of the brain death examination: cold water dripped into his ears, light shone into his eyes, throat prodded for a gag, head scanned yet again. Then each step repeated for certainty. Finally, an attempt at spontaneous breaths. When the ventilator was transiently halted, his brain could not instruct his body to breathe.
At the close of these ceremonial days, his brain was declared lifeless.
What to do with a body empty of mind? What to do with a once rambunctious boy now devoid of soul?
“His organs can go to others,” the mother and father told us, finally. The dim sunlight filtered into the conference room as the social worker nodded and the paperwork was signed, nurses and doctors discreetly peeling off to answer calls and attend to other patients. The process of donation had begun. Time was now measured.
What to do or say in such a time? I knew no benediction for this upcoming night, nor for the sacrifice of the next day.
I found myself at the blanket warmer, opening its sturdy glass door, the heavy cotton blankets stacked, bleached white and hot. I took several, just in case, and entered the room with a gentle knock. She sat unmoved, my presence barely seen. I unfolded one blanket and placed it over her knees, leaving the others nearby. Her eyes, shimmering red, stared beyond me.
Any words of comfort I conjured seemed hollow, insufficient.
“I will be writing orders,” I murmured. I returned to the windowless ICU workroom to take comfort in tasks, processes, protocol.
The checklist was left for me by the organ donation coordinator: warming blankets, blood transfusions, dopamine, vasopressin, steroids, thyroid hormone, antibiotics. Elixirs to sustain his organs, plump them, trick them. Spells to suspend this mother’s child.
She had birthed him, his organs grown first within her, then released to pump, swallow, digest, breathe and excrete within her boy for a year.
Soon they would leave him to encounter new surrounds – foreign fluids, suspicious tissues, watchful immune systems – and attempt integration. His lungs would breathe another’s air; his heart circulate another’s blood. He would perish and transform, his vitality distributed. Extinction for one mother, salvation for others.
Right now, I was with the forsaken, tasked with shepherding this child’s body, giving those who loved it space and time. I finished the orders.
The moon lingered, softening the sallow dawn. Soon the sun edged in, peeking around the rows of buildings cocooning the hospital. Somewhere beyond phones were ringing, bringing the news of a kidney, a liver, a lung, a heart. Parents were waking their children with nervous enthusiasm, dressing and driving, eager for operating rooms, though wary.
I paused my morning pre-rounding to watch as the nurses, nearing their shift’s end, tucked his blankets, suctioned his parted lips, brushed his curls. Silently, they gathered mementos – a lock of hair, a stamped footprint, a hand pressed in clay – placing them in a box, tying it with ribbon.
The mother sat by his side, her grasp tight and tired, her breath slight, her eyes flat. We worked around her, quickly and quietly as stagehands during intermission, clearing out all but the necessary machinery for his trip.
The surgeons arrived, solemn in cloth caps and fresh-pressed scrubs. I assured them all was prepared – orders in, medications given, labs within normal limits, organs optimized.
The surgical resident unlocked the bed with a clang, turning toward the mother. Jolted, she gripped the bedrail as it began to move, her eyes pleading. The team paused. The mother bent to kiss his polished cheeks, anoint his smooth forehead with tears, squeeze his tiny fingers, gulp down her howls.
I stood by her at the door’s edge. Their blue gowns billowing, the surgical team rolled the bed away, the hallway filling with wheel whirs and steady drips of saline. They turned the corner. I glimpsed the straw-colored hair atop his slight frame, shrouded by the drape of sheets. He was soon out of view. We were left with echos of the ventilator’s beeps.
The mother let go of my hand and walked straight out of the unit, her gaze locked forward. She met the father by the elevator. I caught a glimpse of them, crumpling, as the doors closed.
The new resident arrived, handing me a cup of milky coffee. “Room 10 is on his way to the OR for the organ harvest,” I told him, catching the quiver in my voice, sniffling away my welling eyes, “Everything is taken care of from our end.”
The day team trickled in with chatter of Red Sox games and Fitbits and new haircuts. The boy’s room was empty but for a lone janitor methodically mopping. My shift was over.
The boy’s organs would soon be in other children. Other mothers would be crying, though happily, at other bedsides.
I left the hospital, a fall chill creeping, my coffee cooling in the morning air, my breaths becoming mist, the moon a ghost just above the horizon.