They were alone now, alone for the first time, the mother, the father, and their baby.
A light pulsed on the heart monitor next to the baby’s crib, every pulse accompanied by a high-pitched beep. His lips, rose-colored in the first few hours after birth, had taken on a bluish tinge. Sweat soaked his hair. His breathing was labored.
Clovis Oliveira flinched when the readout jumped from 136 to 137 beats a minute. He half expected to hear com-motion in the hall, someone rushing toward him from the nurses’ station. They had some kind of alarm down there, an alarm to warn them if Baby Raul’s vital signs turned critical.
But there was no commotion in the hall, only the normal sounds of the hospital: a muted conversation, the buzzing of a fluorescent light, the distant ping of an elevator.
Clovis put out a hand. His son’s forehead, barely two fin-gers in breadth, was moist and hot to the touch. Clovis tried to focus his mind as he’d seen the tribal healers do, tried to send energy from his body into Raul’s, tried to slow his baby’s heartbeat.
It didn’t work. The readout didn’t budge. Withdrawing his hand didn’t make any difference either. The monitor remained constant at 137.
Raul had fallen asleep again. He slept almost all the time. He had to. He needed all of his strength just to stay alive.
Clovis couldn’t bear to watch him anymore. He turned his back on his son, walked to the window, and leaned his fore-head against glass cooled by rainfall lashing the other side of the panes. It was coming down hard, the kind of rain that drenched Sao Paulo almost every day in summer, but rare in this month of June.
Morumbi Stadium, the skyscrapers of Avenida Paulista, the blue-gray bulk of the Serra da Cantareira, all were gone, van-ished behind a veil of falling water. On the street below, cars were creeping by, immersed to their hubcaps by the sudden flood. A long roll of thunder momentarily overpowered Ana Carmen’s voice. Then the thunder was gone, and he could hear her saying the same words over and over again as she fin-gered the beads of her rosary. She lay on the bed, covers tossed aside, her hair in disarray, staring at the ceiling. The grief on her face made her look far older than her twenty-eight years.
Clovis leaned back from the glass, took out the paper Dr. Levy had given him, and stared at it. There was a telephone number, nothing more. No name, no address. He took his cell phone from his pocket and walked out into the hallway to make the call.
By that time, the nightmare was sixty-two hours old. A nightmare that weakened when he snatched a few hours of sleep, returned with renewed force when he awoke. It had begun in the delivery room, just after Ana Carmen had given birth. It had begun, more properly, with the arrival of Dr. Dirceu Amaral, one of the house pediatricians.
Amaral, an outgoing fellow in his early forties, had arrived to examine the new baby, Clovis and Ana Carmen’s first. He gave Clovis a firm handshake and smiled at a weakened but beaming Ana Carmen. He was still smiling when he applied his stethoscope to the baby’s chest, the disk huge against Raul’s tiny rib cage.
But then the smile disappeared. He whipped the earpieces from his head, ordered an immediate electrocardiogram, and paged Dr. Jacob Levy, a cardiovascular specialist.
Levy arrived within three minutes, even before they had the electrodes in place. He hung over the machine, analyzing the results as the paper emerged. Then he and the pediatri-cian went into a corner and started conferring in low tones.
After that, things happened fast. Raul was carried off. Ana Carmen was given a sedative and wheeled to her room. Clovis was shown to Dr. Levy’s office and asked to wait. He took a seat on a couch between two end tables. Ten minutes later, a middle-aged woman in a blue pants suit came in with a stack of forms.
“What’s this?” Clovis said.
“Just some authorizations,” she said. “You sign here, here, and here.”
Clovis read the paper on the top of the stack and balked.
“You’re asking me to authorize you to cut his chest open?” he asked in disbelief.
The woman shook her head and put a motherly hand on his shoulder. “Only a precaution,” she said. “In very rare cases, something goes wrong. And if it does, we have to get at the heart quickly. There’s little chance of that. Dr. Levy’s the best, but the insurance people insist-”
“What’s going on? What’s wrong with him?”
She extended a pen. “Dr. Levy will come and talk to you as soon as he’s finished.”
“No. Now. I want to talk to him now.”
“You can’t. He’s with your son. Please, sign the papers.”
Clovis shook his head.
The edges of the woman’s mouth took on a stubborn set.
“We have no time for this,” she said.
“But-”
“Doctor has to do a cardiocath, and he has to do it now.
What’s a cardiocath?”
“It’s no big deal. We do it all the time. Now if you’ll just-”
“What is it? I have a right to know.”
She gave an exasperated sigh. “It’s a procedure,” she said. “Doctor makes a small incision in his leg, then slides a tiny tube, called a catheter, through his veins until it reaches his heart.”
“Through his veins?”
“Through his veins. That way it isn’t necessary to open his chest to have a look.”
“A look at what?”
“After the catheter is in place, doctor injects a dye. He uses the catheter to take samples and blood pressure meas-urements and uses a fluoroscope to photograph the dye as it moves through your baby’s circulatory system. The sooner he has the results, the sooner he’ll be able to come back here and give you his diagnosis.”
“But he must already have some idea. What does he think the problem is?”
“I couldn’t say.”
“Can’t or won’t?”
Again, she shook her head. Again, she held out the pen. This time, Clovis took it.
“Here, here, and here,” she said.
When he’d finished scrawling his signatures, she gathered up the papers and hurried away without another word.
There were magazines on the end tables. One of them was Gente, a magazine that Ana Carmen never admitted to buying, but always seemed to be lying around the house. He picked it up and leafed through weddings, divorces, betrayals, and scan-dals until he came to an article about the bourgeoning love affair between a starlet in the current hit novela and a rapper.
He moved closer to the light and read the first paragraph without absorbing a thing.
He started again at the beginning and finished with the same result.
After that, he just sat there, the magazine on his lap. He wasn’t a religious man, but once or twice in the course of the next two hours he prayed.
When the door finally opened again, he sprang to his feet. It wasn’t Dr. Levy. It was the same middle-aged woman.
“He’s with your wife,” she said. “You’re to go upstairs and meet him there.”
Clovis brushed past her, hurried to the elevator, pushed the button, got tired of waiting, bolted up the stairs.
Dr. Levy’s diagnosis was dilated cardiomyopathy.
When he gave it to them, Ana Carmen, despite the fact that she’d been mellowed by the sedative, bit her lip so hard it turned white.
Clovis asked the question, “Dilated cardio what?”
“Myopathy,” Levy said. “The myocardium is the heart muscle. Cardiomyopathy is when the actual muscle cells are sick.”
Ana Carmen clenched a hand in front of her mouth, as if she were about to stifle a cough.
“Is it. . life threatening?” Clovis asked, glancing at his wife, then back at Levy.
“I’m sorry,” Levy said.
Ana Carmen started to cry. She’d apparently been doing a lot of that in the course of the last two hours. The area around her nostrils was red and raw. She snatched up a crum-pled paper handkerchief from the bedside table, gently blot-ted her nose, and studied the tissue for signs of blood as the tears rolled down her cheeks.
“I have him on four medications,” Levy said. “Captopril, digoxin, Lasix, and atenolol. The captopril will dilate his arteries and reduce the strain on his heart. The digoxin will improve the pumping function and combat arrhythmia. Lasix is a diuretic, to reduce fluid buildup in his lungs. The atenolol will help to control his blood pressure.”
Clovis didn’t care about any of the medical mumbo jumbo. He cut to the chase. “Will any of that stuff cure him?”
Levy took a deep breath. “No,” he said, “but it will help to keep him alive.” He didn’t add the words for a while. He didn’t have to. “There’s no repair. Raul’s heart just isn’t strong enough. The only way to save him is with a heart transplant.”
In the silence that followed, Levy opened a file he’d been balancing on his lap. Clovis suspected that consulting what-ever was in there was pure theater, that the doctor was only doing it to avoid their eyes.
“That having been said,” Levy went on, “the rest of my news isn’t bad. There are no other complications. It’s just the heart itself. The five-year survival rate for transplant patients is over 75 percent. It’s true he’d have a lifelong dependency on certain drugs, but if he had a transplant-”
“What do you mean, if?” Clovis interrupted. “Didn’t you just say there’s only one option? Of course, he has to have a transplant. No ifs about it.”
Dr. Levy raised his eyes and looked at Clovis.
“It’s not that simple. Finding a heart is. .” He sought for a suitable word and finally settled on “difficult.”
“Difficult?”
Dr. Levy nodded.
“He needs a heart from a healthy baby. They’re very rare. Raul will have to go on a waiting list, first come, first served. It takes. . time.”
Time.
Dr. Levy paused to let the word sink in.
Time was running short for Raul; he’d as much as told them that.
“We’ll take him abroad,” Ana Carmen said, speaking quickly, her voice sliding up the scale toward hysteria.
Dr. Levy shook his head.
“The shortage is universal. All countries give preference to their own citizens.”
“Are you telling me,” Ana Carmen said, “that, with all the infants who die in this country, every single day, my son could still lose his life because there are no available hearts? Are you telling me those hearts are just cast away, disposed of as if they were garbage?”
There were still tears on her cheeks, but she wasn’t crying anymore. Now, she was angry.
Her husband reached out and put his hand on her fore-arm. She pulled it away and sat glaring at the doctor.
Clovis intervened. “And there’s no way we could obtain preference? No way we could move him to the top of the list?”
Dr. Levy shook his head.
Clovis looked at his wife.
Ana Carmen was staring at the wall, her shoulders slumped, her anger suddenly dissipated.
The doctor studied her, ran a hand through his thinning hair, and then used the same hand to rub his chin. Then he nodded, as if he’d made a decision. He put a hand into the pocket of his green medical scrubs and took out a single slip of paper.
“This. .”-he swallowed and began again-“This will put you in contact with a man who might be able to help.”
Clovis studied the paper: eight digits in black ballpoint; typed not written, no city code; a Sao Paulo telephone num-ber. He opened his mouth to say something, but Levy held up a hand to silence him.
“I had a patient once,” he said, “a friend of my mother’s. Like your son’s condition, hers was critical. Unlike him, she was too old, and too sick with other maladies, to get an organ through conventional means. She was also a very wealthy woman.”
“What are you telling me?”
“I’m telling you that she couldn’t possibly have survived for more than six months with her heart in the condition it was. But then she went away for a while, and when she came back, she was. . much healthier. She stopped consulting with me after that. We’d had an excellent relationship, but I couldn’t get her to come in for an examination. It made me curious. She lived on for almost five years, and when she died it was cancer that killed her, not heart failure. I went to her funeral. I spoke to her son.”
“I don’t understand-”
“That’s all I’m going to tell you, except for this: the man whose telephone number is on that piece of paper runs a pri-vate clinic. As a doctor, it would be unethical of me if I were to suggest that you explore. . other sources. But, if Raul were my son, I’d call that man. His name is Bittler, Dr. Horst Bittler.”