The Law of Bound Hearts (9 page)

Libby

As she pumped the blood pressure bulb, Carlotta bent over Libby. There was, on her breath, the rich whiff of coffee. Libby would have killed for a cup of coffee, a double latte with a free refill.
Killed
for it. Well, that was a privilege disappeared. Now all she allowed herself was a half cup each morning. She saved her liquids— her four cups of allowed fluids—for afternoons, when thirst hit the hardest. She portioned her fluids out, a half Dixie cup at a time. She had seriously contemplated drinking more than the amount set by the nutritionist, but so far had resisted the urge. Some of the other patients cheated on their diets. They talked about it in the waiting room. The Jesus Christ woman—whose name she had learned was Jesse—said she just couldn't give up her country ham. She truly didn't see how an occasional slice now and then would harm her. Like she was exempt from the rules. But Libby sympathized. She fully understood now why alcoholics soaked up booze, why emphysema and lung cancer patients sucked on cigarettes. The body wants what it wants.

Carlotta released the bulb, the cuff deflated. “Blood pressure's down,” she said, smiling.

“That's good,” Libby said. It should be down, the amount of salt she'd been reduced to. She wasn't even allowed commercial substitutes because they were almost all potassium salts. Two nights ago she'd had a dream about pigging out on junk food. Pretzels. Potato chips. Cheez Doodles. Stuff she hadn't allowed herself in years.

Carlotta unstrapped the cuff from Libby's arm, made a notation in her file.

Libby shivered and wrapped her arms close.

“Chilled?”

“A little.” She was always cold now, and hungry. Before she began dialysis, her appetite had diminished. Now it was back in full force, but there was so little that she was permitted. Her diet had gone from not bad to pretty dismal. The irony would make her laugh if she had a scrap of humor left.

“We're almost done here,” Carlotta said. “Then you can get dressed and we'll talk.” She finished the exam, taking Libby's temperature, pressing her abdomen, checking for excess fluid. Libby was used to the drill.

Carlotta lifted Libby's left arm, ran a thumb over the shunt. “Swelling's gone down and it looks clean,” she noted with satisfaction. “And you're checking it three or four times a day to make sure there's no clot?”

Libby nodded. She looked down at Carlotta's hand, noted for the first time her ringless fingers. To date, she'd had no more curiosity about Carlotta's personal life than she would have had about a plumber's, but now she found herself wondering if she was married, perhaps to a fellow doctor. Who else would put up with the hours? But there were no children, Libby thought. Carlotta had the boyish build of a woman who had never given birth.

“The graft is looking good,” Carlotta said. “It won't be long before we can switch and get rid of the catheter. Bet you won't be sorry to see that go.”

“No.” Once she had been worried that she would have a scar on her chest from the catheter, but now that seemed an insignificant concern.

“And no catheter means . . .” Carlotta beamed at her.

“What?”

“You can take showers again.”

For the first time, Libby smiled.

“With that good news, I'll leave you to get dressed. I'll be back in a minute.”

After Carlotta left, Libby shrugged off the thin gown and pulled on her sweater and a pair of gray trousers, glad for the warmth. If she was this cold in October, she could only imagine how she'd be come winter. She'd be wearing so many layers she'd look like the Michelin Man. Her charts lay on the stool by the examining table and she looked over at them, wondered what was written there. Were there things noted there that Carlotta had kept from her? She reached out, then hesitated, worried that Carlotta would return and catch her in the act. Well, what of it? They were her charts, after all. She had a right. Before she could pick them up, there was a soft rap on the door and it opened.

“All set?” Carlotta entered, picked up the folder, sat on the stool. She leafed through the pages, picked out the chemistry-levels report. “Your numbers are good,” she said. “Your iron is getting better. I don't think we're going to be looking at iron IV for a while.” Libby was on a supplement to prevent anemia and still had occasional EPO—erythropoietin—injections. She was on another supplement for bone health, an evil-tasting pill she choked down with a tablespoon of applesauce, heavy on the cinnamon.

Carlotta ran a finger down the chart. “Your potassium levels are fine. Creatinine and BUN are higher than I'd like, but nothing we need to be terribly concerned about at this point. Protein levels are a little elevated. You're watching that?”

Libby nodded. What wasn't she watching?

“Any dizziness, nausea?”

“No.”

“Fatigue?”

“No.” In fact, she was feeling better than she had expected to. She had energy again, energy she hadn't had in nearly a year. Over the past months, the loss had been so slow, so insidious; she hadn't realized how weak she had become.

“Any problems at all?”

Libby reddened. She absolutely hated talking about this. Disease stripped dignity away, one shred at a time. “One thing . . .”

“Yes?”

“Well, I've been a little—a little constipated.”

“That's not unusual. Nothing to worry about.” Carlotta picked up a prescription pad, jotted down a few words, and handed the slip to Libby. “A stool softener,” she said. “That should help. Let me know if it doesn't, or if it causes diarrhea. We don't want that either.”

“Okay.” Everything was such a fucking balancing act.

“How's your sex life?”

“Fine,” she said, thinking, What sex life?

“Some patients report a lessening of desire. It's not unexpected.”

Please, she thought, drawing the word out like Mercedes would have. Pulleeze. She managed a smile. “No. Really. We're fine in that department.”

Carlotta checked a page. “Let's see. You've had two sessions now. How is it going? You doing okay with it?”

“I'm managing.” She dreaded the dialysis, but what choice did she have? What was it one of the techs there told her? It's a part-time job you take to stay alive.

Carlotta closed the file. “You've met some of the other patients by now, I'm sure,” she said.

“Yes.” Barely. She had to go to the center for her part-time job of staying alive, but there was no rule that said she had to socialize. Mostly the other patients irritated her. The one-legged man wanted the TV volume so loud people up in Alberta could hear it.

“There's a support group that meets once or twice a week,” Carlotta said. “Shall I set it up for you to attend?”

“I don't think so.”

“Some people find it helpful.”

“Maybe later.” Fat chance. The last thing in the world she wanted to do was sit around with the other patients and talk about it.
And how are your creatinine levels, Mrs. Lincoln?
She had nothing in common with those people. Certainly not with the Jesus freak who told her at the last session that in the beginning she was fighting to survive and now she
wanted
to survive—wanted to survive for Jesus, was what she said. Nor with Eleanor Brooks, who told anyone who would listen how important it was to maintain a positive frame of mind, an upbeat attitude, and was always handing out little square cards with affirmations written on them. “Faith is daring the soul to go beyond what the eyes can see.” “ If there is no wind, row.” “Nothing is impossible.” A virtual pep squad of positive thinking, that woman. “If you can't plant a garden, be one.” Honestly, it made Libby ill. She wished they would all keep quiet, that they would keep things to themselves. The only one she found even remotely interesting was Hannah, the gaunt, blond Saint Joan creature. Richard was the one who eventually recognized her. Hannah Rose, whose husband, Gabriel, worked for the Open Lands Association. In the past, Libby and Richard had seen them several times around town. Libby was saddened by Hannah's transformation from a lovely woman to this wraith, but she also found the girl's presence deeply calming, soothing in a way she couldn't explain.

Carlotta absently tapped the file against her knee. “The other thing I want to talk about,” she said, “is that I've put you on the list.”

“The list?”

“For a transplant.”

Libby was stunned into silence.

“Right now there are sixty thousand names on the national list for prospective transplants,” Carlotta said. Libby knew this. Richard had done the research. “The average wait time is anywhere from two to five years.” Richard had told her this, too. “So the sooner we get you listed, the better. That said, I think it's time we set things in motion for your evaluation.”

“Evaluation?”

“Preselection testing. To make sure you're deemed an acceptable candidate.”

This was going too fast. Carlotta had brought up the subject in the past, and Libby had, at her urging, called Josh and asked him about the possibility of his being a donor. But the actual transplantation was to have been “at some future time,” and Libby was not ready to explore it now. “What's the rush?”

“The truth is, the earlier in dialysis treatment you have a transplant, the better it is. There are fewer complications. The body's in better shape. Systems aren't broken down.”

Libby had just
started
dialysis. She was not ready to talk seriously about transplants, not by a long shot.

“In the meantime,” Carlotta went on, “be thinking about whether or not you have friends or coworkers who might be willing to be a donor. Someone your husband knows at the college.”

“How would you ask someone that?” She couldn't control the sarcasm that crept into her voice. “Do I just walk up to them? Say, ‘Excuse me, but would you be interested in giving me a kidney?' ”

“You'd be surprised.”

I bet, Libby thought.

“Have you thought again about asking your children?”

“No. Absolutely not. I thought I made it clear that they are not to be asked.” Libby would not even consider this. Carlotta had told her that, with regard to their ages, they were both over eighteen and there was no reason they couldn't be donors. She'd had several patients who had received kidneys from their children and she said she would be happy to put Libby in touch with them. Wouldn't you want to give a kidney to one of your children if they needed it? she'd asked Libby. Well, naturally Libby would. No question. But it wasn't the same. Matthew and Mercedes had their whole lives in front of them. She wouldn't think of asking them to make this sacrifice and refused to discuss it further. Of course, they had known from the beginning that Richard was out of the running since his blood type was incompatible with hers.

“You might give your brother another call,” Carlotta said.

“I told you. He's not interested.” One call had been enough there. Josh, the Switzerland of relatives, stayed true to his policy of noninvolvement and nonintervention. Just as he had refused to take sides in her estrangement from Sam. “Keep me out of it,” he'd said to her, and that was pretty much his reaction when she'd asked him if he'd consider being an organ donor, although he'd used kinder language.

“That's not an unusual response,” Carlotta said. “You caught him off guard. Now that he's had time to get used to the idea he might be more receptive. He might at least be willing to be tested. I'd be happy to talk with him if you'd like.” She reopened the folder, removed two booklets from the back. “Here,” she said. “Take these home and look them over.”

“What are they?”

“Some material on transplantation. I think you'll find them interesting. The first contains information for potential donors. The other is intended for transplant patients. In the back there are some letters and essays from people who have donated organs. There are even a couple of poems; some of them are quite moving.”

Libby didn't reach for the booklets. Panic stirred beneath her heart.

Carlotta reached over and took her hand. “You're doing fine,” she said.

Libby looked at the booklets Carlotta held, read the quote on the cover of the one for patients. “Gifts make their way through stone walls.” Well, there was another quote for Eleanor Brooks.

Carlotta handed her the booklets. “Look them over,” she said. “Then we'll talk some more.”

It was after eleven when Libby returned to the house. It was Tuesday, her day for dusting and vacuuming. Once, she would have done it earlier, before she went out for the appointment, but these days she found it difficult to dredge up interest in the house. Her mornings at the center had completely thrown her schedule awry anyway. She hadn't even changed the sheets this week. She supposed she should vacuum, but right now she was hungry.

In the kitchen, she fixed up a plate—hard-boiled egg, sliced cucumber, cold asparagus, a half cup of applesauce—and took it onto the back porch, along with a copy of the
Tribune.
She stretched her legs out on the wicker ottoman and ate her lunch, drinking in the warmth of the noonday sun. She opened the paper, but must have dozed off almost at once. When she woke, the
Trib
was on the floor and the sun had moved across the sky. Her legs were in shadow. She got up and took her plate to the kitchen. She heated up the teakettle, permitted herself a half cup of mint tea. The booklets Carlotta had given her lay on the counter next to her handbag. She picked one up. “Your Kidney Transplant—Every Step of the Way,” she read. “A Patient's Guide to Transplantation.” There was a photo of a man on the cover. He held a brown dachshund in his lap. “Now I know that dreams do come true,” proclaimed the quote beneath the picture. The deliberately upbeat tone infuriated her. Why did everyone act so cheerful?