By Gene Weingarten
I stared disconsolately at three crumpled slips of loose-leaf paper. Separately, they had been drawn out of an old green fedora by three strangers in a restaurant, and together they created an ordinary day chosen at random: "December," "28" and "1986." That was the date I was going to be researching for the next six years. It was for a book to be titled "One Day," which would explore whether, in the insistent gyre of human experience, there even is such a thing as "an ordinary day."
The date seemed intuitively problematic: It was a Sunday, infamous among journalists for being the sleepiest news day of the week, and it was the week between Christmas and New Year's, infamous among journalists for being the sleepiest news week of the year. And it was a year that didn't seem all that historically memorable. Bad day, bad week, bad year.
One of my first discoveries involved an event that occurred in the early morning of that day, in suburban Washington, D.C. A woman received a new heart in a transplant performed by a surgical team that had never tried that operation before: It had worked only on corpses, in macabre rehearsals in a hospital morgue.
That was all I knew, at the start.
Alan Speir hadn't had a drop to drink. The reason for this was on the phone.
The call came at 12:01 a.m. He'd just fallen asleep in the guest bedroom of his sister's home in Charlottesville, Virginia. Speir and his family were visiting for the Christmas holidays, and now his brother-in-law was waking him, phone in hand.
Speir didn't have to be told who the midnight caller was or why he was calling, or that the next few hours would be eventful. OK, thrilling.
Speir wasn't famous in his field yet. A quarter-century later, he'd be the man who would sew a new heart into Dick Cheney's chest. But in 1986 he was a reasonably obscure cardiovascular surgeon in a busy hospital in the District of Columbia. His name had not been in the newspapers. That was about to change, for better or worse.
The midnight caller, as he'd assumed, was his surgical colleague, Edward Lefrak. The terse message, as he expected, was that there was a donor. Speir was now fully awake. Within three-quarters of an hour he was dressed and in his car, beginning the two-hour drive north to Fairfax, Virginia, going through a heart surgeon's mental checklist, which included, somewhere around step five, keeping your own heart steady.
Lefrak had made a few more calls himself; others, he delegated. By 3 am, the whole team had assembled. There were four doctors, 11 nurses, a physician assistant and two medical-instrument operators, gathered in two rooms.
In operating room 12 a body lay supine on the table, butterflied. This is an adjective no one who was there would have used - the terminology of transplantation is determinedly dignified - but that is what it was. A man of small to medium stature, well muscled, had been sliced open from the neck straight down to the crotch, and then cranked apart by retractors, for better access to the organs. There wasn't much talking. The loudest sound was the insistent whoosh-gasp of a ventilator.
The man's head was behind a vertical drape, not visible to the surgeons, which was just as well. A single .22-caliber rifle had been fired point-blank into the centre of the forehead, crossing the midline of the brain, tearing through both hemispheres. Such wounds - "insults," in the curiously mannered lexicon of medicine - are almost invariably fatal, as this one had been. But they sometimes leave the heart beating, as this one did, so paramedics in the ambulance had eased a tube down the dying man's trachea and hand-pumped a bag to keep the body breathing, which was why it was here, in operating room 12 in Fairfax Hospital, butterflied.
An exposed, beating human heart looks frantic and angry. Clench and release, clench and release. Because it is sheathed in a protective layer of fat, it's more yellow than red. It's only the size of a big man's fist, but it will dominate any operating room. You can't look away.
A tall, rangy man with weary eyes and a surgeon's preternatural calm, Lefrak was there for that heart. If everything went right, it would go into the chest of a woman just down the hall in operating room 6. Alan Speir was there, opening her up.
This was to be both men's first heart transplant, and the very first in the immediate Washington DC, area. In 1986, no one taught this procedure in a classroom. Lefrak had been training himself for two years, practicing on corpses with a handpicked team of doctors, nurses and technicians, the same people who would surround him for the next few hours in what would be a significant gamble, both with Lefrak's career and his hospital's fortunes.
A second team - an abdominal surgeon and his assistant - was in the room as well, to harvest the kidneys. "Harvest" is another word that lay people use but transplant surgeons seldom do, because it sounds impersonal and opportunistic, which of course it is. Organs are precious and prized; organs from young, healthy bodies, especially so. The dead man on the table, whose name was Mark Willey, was just 19.
Sometimes surgeons with different organs to remove find themselves working in an awkward scrum, jostling for position like basketball players under the boards. That almost happened here. There was to have been a third surgical team to take the liver, but at the last minute the intended recipient became too sick to survive surgery, so the liver would be wasted - there was no time to find and qualify another patient. That's the way it goes with organ transplants - they are dependent on speed and timing, but also on factors you cannot control.
That this was happening in the early hours of a Sunday was unsurprising. Young, healthy people are most likely to do life-threatening things late at night on Fridays and Saturdays, so organ transplants often occur at 1 or 2am on Sundays and Mondays. That's because it takes roughly 24 hours of lab work and paper-pushing to set everything up; felicitously, 2am also happens to be when operating rooms are free of scheduled surgery.
The process also involves diplomacy, a task that had fallen to a fourth man in the room, standing away from the operating theatre. James Cutler was the hospital's transplant coordinator, a meticulous man with the commiserating demeanour of a mortician, which was an occupational asset. Among Cutler's duties was to obtain consent from grieving next of kin, and this takes a subtle skill. He must be persuasive without seeming to persuade. The decision must be freely given, with no feel of pressure, even though, of course, at such times there is the extraordinary pressure of circumstance alone, the pressure of life and death.
Cutler had been the first in the hospital to learn of this death, from Fairfax police. As was his custom, he did not immediately alert the transplant team. Hospitals are careful about this; there must be no hint of collusion or ethical corner-cutting. A wall is maintained between the doctors who need the heart now and the team of people who must certify brain death (two opinions), test for blood-type compatibility, rule out certain diseases and blood-borne pathogens, and obtain unambiguous informed consent. Usually Cutler approached this last task through a gentle appeal to a greater good: Let something positive emerge from this tragedy, and so forth. Sometimes he had an added tool, one that he deployed delicately but without apology. He'd used it here.
You must understand, he'd said to the stricken parents of the dead man, that because of the circumstances, the medical examiner will be involved. There will have to be an autopsy, anyway. The body will be opened and organs removed, anyway. You cannot spare your son from that, anyway.
"Because of the circumstances" was enough to get a yes. He didn't need to elaborate. What he meant was that there would be a police investigation, because the young man butterflied on the table had committed an abominable crime.
Later, much later, when she was going through her daughter's belongings, Ursula Ermert found the two letters. They were handwritten on loose-leaf paper, undated, from Mark Willey to Karen Ermert. They were love letters, of a sort. In hindsight, they were ominous. In hindsight, many things were ominous.
Mark and Karen, also 19, had been going out for almost two years - students from different high schools who had met the way suburban kids often met in the mid-'80s, at a mall. Karen was effervescent, with a broad, intelligent face under feathered blond hair. (Her hairdresser once observed wryly that other clients paid extravagantly for what nature had casually dropped on Karen - multiple shades of blond in captivating layers.) She was conventionally attractive, and a slight chipmunky overbite added a dose of adorable. In the high school band she played high and sweet: the flute and piccolo. She was strong-willed, stubborn, mischievous, spontaneously funny. When she posed for a graduation photo beside her mother, she subverted the solemnity by dropping a stockinged leg into Ursula's hand, a la Harpo Marx.
It is tempting to call Mark Willey a Lee Harvey Oswald type - insecure, nondescript, brooding. He worked as an auto mechanic and lived with his parents, in a sullen, silent standoff with an emotionally distant father. He was desperate for connection.
Ursula was in the high school bleachers with her daughter one day when she saw Mark walk onto the field below, his eyes searching the stands for Karen. Ursula remembers the exaggerated anxiety on his face, as though he felt existentially alone and hungered to belong. A vulnerable person, she thought.
Karen liked to fix things. Mark's vulnerability was appealing, at first.
In 1986, there was no term in the psychiatric lexicon for the infatuation with which Mark Willey would smother Karen Ermert. Today it would be known as obsessive love, and Mark checks every box in the clinical description. "Attracted"? Check. "Anxious"? Check. "Controlling"? Check. The final square is "Destructive."
Ursula Ermert was a 1960s German immigrant who had been widowed when Karen was 12, which led to mother and daughter becoming exceptionally close, which meant they could too easily hurt each other. The years of teenage rebellion had been particularly freighted for both. Once, at 15, Karen ginned up an argument over something trivial to undergird a foot-stampy, theatrical declaration that she was leaving home. Ursula was not about to loose a naive teenager on the streets. "If you find me so hard to live with," she told her daughter, "I will be the one to leave." And she did. She drove to the family's business, a dental lab, and slept on a bed in the back room. Eventually Karen figured where she must be and phoned in the middle of the night. Crying, she asked her mother to come home.
Ursula was crying, too. She said no, she would stay there until morning: "This has to hurt us both so much it will never happen again."
It didn't. Not that it would matter, in the end.
After high school, Karen went off to college in Shepherdstown, West Virginia, but soon dropped out because Mark Willey persuaded her to. He missed her too much, he'd said. When she got jobs - she was starting out as a clerk - Mark would show up at her workplaces, unannounced. He once crashed her office party. He didn't like these places in which she spent her days. They contained men.
It was all there in the notes, the ones Ursula found after it was too late. They were filled with incapacitating jealousy and lovesick histrionics, and in particular a suffocating need for control. Mark had evidently been monitoring Karen's movements, day and night, and found them wanting. He'd left each note for her when she had not been precisely where he'd expected her to be, precisely when he expected her to be there. The handwriting, corralled by blue horizontal lines, is neat but gallops to the right, as though he was racing to keep up with his emotions.
"I took a shower and dressed up and did everything I could maybe to look halfway as nice as all the gorgeous guys you see every day. I would just kill to look as good as them and be able to catch your eye. Karen, I'm really hurting, in fact, I'm starting to cry . . . Where are you? Did you go out to eat? I feel like a fool that has been stood up. I love you so much. If words could be put on paper to describe how much there wouldn't be enough paper. I'm gonna call your house again. Karen, if you want to go out with some other guy, please tell me. It would hurt less if I found out that way. Love, Mark."
"Karen, where are you? I am really worried. First thing I thought was that you stopped for dinner but I know you would have the courtesy to call me so I would not sit here and worry like this. I am always worried about you being in an accident because I would be the last to hear. God, if you aren't okay, I'll kill myself! You don't know what you mean to me."
One day near the end, Ursula drove her daughter to the emergency room to be treated for kidney stones. A nurse looked at Karen, did a double take and asked, "Weren't you here two weeks ago with a head injury?"
Ursula waited for Karen to say the nurse must be confusing her with someone else. She didn't.
"Mark hit me," she said later. She had wanted to get out of the car, and Mark hadn't wanted her to. The explanation was unnervingly matter-of-fact.
Imagine the dilemma facing Ursula Ermert in 1986, trying to decide what to do with a headstrong daughter who at 19 was living on her own and supporting herself because she treasured her independence. Karen would not be pushed to do things she did not want to do. In fact she might well stubbornly do the opposite, if nudged too hard. Should Ursula go to the police over Karen's objections? And what exactly would she tell them? What did she really even know?
Mother and daughter argued about it more than once. On one occasion Ursula infuriated Karen by telephoning Mark's parents, telling them that if Mark ever hurt Karen again, she would hold them responsible. Mark, it turned out, was listening on an extension and told her to butt out. What followed was a letter from Karen to Ursula; it was typical Karen - firm, but affectionate. It said in effect: Stop complaining about my friends, and you and I can still love each other unconditionally.
That was the dreadful state of affairs around Christmas 1986, when the tension lifted. Karen had decided she'd had enough. She told Ursula she was going to end the relationship, and she'd made the decision on her own. It wouldn't be a breakup so much as an escape. All that was left was logistics.
Mother and daughter conspired and came up with a plan. Karen would tell Mark a tactfully laundered version of the truth: She had just gotten a new job working at Dulles International Airport for the German military. That was true. She would tell Mark that she'd be so busy studying German that she would no longer have time for any dating at all. That wasn't exactly true - Karen was fluent in German. Mother and daughter reasoned that this story wouldn't seem so much like a personal rejection, and with luck, the "no dating" would keep Mark's jealousy at bay. But the answer would also have to seem final. For Christmas, he'd given her a table he had carpentered himself, and Karen was going to insist on returning it.
That was the plan. She was going to tell Mark on the phone on Friday, the night of the 26th.
Ursula waited by her phone. In early evening, Karen called.
"I did it," she said.
"How did he take it?"
"He said he'd kill me." Karen was giggling. She'd felt enormous relief, and it tickled her. It overwhelmed everything else, including caution.
"Come here now. Come stay with me."
But Karen demurred. She hadn't taken Mark's threat literally. His love for her was septic, but still it was love - how could he kill her? She didn't expect to hear from him again that night, but if there were problems, Karen promised, she'd call. Ursula slept with the phone next to her head.
Midnight passed without a call, but the phone rang around 2am, or at least Ursula thinks it did. Her sleep had been fitful, and to this day she knows she may have anxiety-dreamed that ringing phone. In any case, by the time she worked the receiver to her ear, there was only a dial tone. So she phoned Karen.
An unfamiliar man's voice answered hello.
"Who is this?" Ursula asked.
"Detective Lee."
She apologised for having dialed a wrong number, hung up and called again.
"Detective Lee."
"This is Ursula Ermert. Are you in my daughter's apartment?"
"Yes."
"What happened?"
"I can't tell you over the phone."
So Ursula threw on clothes, ran to her car and drove the 15 minutes to Karen's apartment, trying to make no assumptions. The truth was, she didn't know. There were all sorts of scenarios, none of them benign but some less awful than others.
At the apartment, it fell to Detective Tommy Lee to confirm the worst.
Three decades later, Lee remembers the moment as the saddest thing he'd ever had to do as a police officer. He was 39. He had a 16-year-old daughter of his own at the time, and he was worried about the fast company she was keeping. Eventually he would lose her to a drug overdose. But on this day he was just someone's father who had to break some terrible news to someone's mother.
Ursula gasped, her knees buckled, and she collapsed into Lee's arms.
All that time later, sitting in her house, in the study that had once been her daughter's bedroom, with Karen's ashes in a box high on the top shelf, Ursula remembered what happened next.
She'd asked the detective, "How is Mark? Where is he?" Lee told her that Mark had shot himself and wouldn't survive, either.
It may have seemed like an oddly solicitous question, under the circumstances. It wasn't. If Mark was not dead, Ursula was going to see to it that he became dead, right then and there, whatever it took.
Ursula smiles. "If I had," this dainty woman says mildly, with a faintly Teutonic sibilance, "I would be getting out of prison right about now."
The call had come in as a shooting. Fairfax City patrol officer Ed Vaughan was among the first to arrive. He took Main Street toward Jermantown Road, alert for a car driving erratically, because that's sometimes how you catch the guy in the immediate frenetic aftermath of a domestic. But the streets were almost empty.
The address Vaughan was headed for, 11100 Gainsborough Ct., was at the poor end of the city of Fairfax - a homely two-story, U-shaped apartment cluster surrounding an inner courtyard. The front door was locked, so Vaughan went out back to find Apartment 6, which was on the second floor. It had a balcony. He saw a downspout he could climb, and a tree.
Then Vaughan heard a single shot, and he flinched and looked for cover. He needn't have. As it turned out, it was the final shot, the suicide.
Ursula had hated that tree beside the balcony; she thought it provided an excellent hiding spot for a peeping Tom or perfect access to someone intent on burglary or worse.
As police later reconstructed it, Mark Willey had shimmied up the tree with his rifle slung over his back. He'd stowed the weapon on the balcony and knocked to be let in. For reasons we will never know, Karen slid open the glass door. There was an argument. Voices were raised. Accusations were leveled. The finality of the breakup was confirmed. Mark stormed out. Seconds later, he was back, with the rifle.
That was the story line in the local newspapers on Sunday: Girlfriend breaks off relationship, returns Christmas present; enraged boyfriend commits murder and suicide.
As it happens, there was an added dimension, another stratum of pain, one that Ursula Ermert had not known about, one that never got into print. It's there in the police report.
Rich Lieb is now 51. He had been casual friends with Mark Willey since elementary school. In 1985 and 1986, he'd double-dated with Mark and Karen a few times, until Rich didn't have the stomach for it anymore. He didn't like what Mark became when he was liquored up, how he'd treated Karen.
Rich didn't know why such a feisty, self-possessed girl had accepted the abuse, but he had a theory. Early on, Karen had carried a few extra pounds, and maybe it affected her self-confidence. But by the end of 1986, she'd jettisoned the weight, looked great and gained moxie.
In the era of the long phone call, Karen was a letter writer; she considered it an old-fashioned virtue. In November, she wrote a letter to Rich. It was just a friendly hello out of the blue, an old friend remembering the good times they'd spent together. Because he was a 19-year-old guy with the requisite lunkheaded cluelessness about such things, Rich didn't take the hint. He accepted the letter at face value and never responded. Weeks passed. Then, on Christmas evening 1986, Karen telephoned him to tell him she was lonely. Even a 19-year-old lunkhead could figure that one out.
They spent the night together. It was electric. Part of that was the new intimacy, and part was simply a natural rapport - they liked each other. Permeating it was a sense of elation and relief, as though Karen's eyes had just been opened to the possibilities of a relationship that didn't hurt.
Rich felt that it was the start of a romance that would last a lifetime. He and Karen spent the next day together at the house he lived in with his parents. He was to leave on a ski trip at 3am, so a little after midnight, Karen left to return to her apartment.
What happened next is evident, if some of the details are not. Mark had somehow found out about Karen's new relationship. She may have told him when she broke up with him - she'd promised Rich that she was going to - or Mark may have discovered it on his own. But police are certain he knew, because before he arrived at Karen's apartment, he telephoned. Karen hadn't gotten home yet, but her roommate Christine was there, and Mark told the young woman of his anger, depression and feeling of betrayal. Karen arrived during the call and talked to Mark as well.
After she hung up, Karen took a bath. After he hung up, Mark wrote a bitter suicide note and left it on his bed. (It's not in the police file, but Lee remembers it well: It was sick, sullen and self-pitying, he said.) Then Mark loaded his rifle and carried it to his car.
Madness, it is said, is a private religion - a set of values and beliefs that may seem irrational to others but is perfectly manifest to the madman, consistent within his delusional world. Obsessive love is not formally classified as a mental illness, but it is a disordered mental state with some of the same rhythms. To Mark, all his dark suspicions were confirmed.
He was a paranoiac, but he had been betrayed. Beyond that bitter truth was blind rage, unmodulated by logic. It would not have occurred to him that his treatment of Karen had extinguished any right to demand or expect her loyalty; or for that matter, that killing her was a wildly disproportionate reaction to a predictable if painful development. He'd become unhinged, a lethal player in a dark psychodrama.
Rich Lieb didn't find out about the murder until he returned from his ski trip the following night to find his parents sitting up late, waiting for him, so he'd hear it from them first. For days afterward, he couldn't drag himself out of bed.
He still lives in Virginia. He works in IT. He's divorced and in a relationship. Asked to write down his memories of Karen Ermert, he took some time. The intensity of his response may seem incongruous for a romance that lasted, strictly speaking, 48 hours. But Lieb trusts his feelings, infused as they may be by anger and guilt and loss and, above all, a bedeviling regret.
"She made me want to move mountains for her," he wrote, "and also made me feel like I could do it. She was everything I ever wanted and to this day is the standard against which I measure other women."
When Mark Willey walked back from the balcony into that apartment, he was firing, and firing with precision. Christine, who had witnessed the confrontation, ran.
Karen took five bullets, three to the head and neck. The crime scene photos are difficult to look at. There is a Christmas tree, and beside it, a wall with four Christmas stockings, three big ones for the roommates and a smaller one for the dog. On the floor is a young woman in a powder-blue bathrobe and a white patterned nightgown. Karen's hair is almost unmussed, but blood streams from her eyes and nose and mouth, soaking into a ratty rug and a dingy parquet-floored hallway near the dog's bowl.
In the police file, in plastic bags, are a half-dozen misshapen, sharp-edged pieces of bullet that had tumbled through the brain. So much tissue was destroyed that Karen's heart stopped.
Mark postponed the end as long as he dared, until there were police officers in the courtyard and officers banging on the front door. He backed away from Karen's body, turned a corner, steadied the rifle against the floor, and reached a thumb for the trigger.
There's no way to shoot oneself multiple times in the centre of the forehead. Mark Willey got one shot only, but aimed true, and that's why he died but his heart did not.
The heart did not stop for another 26 hours, at a few minutes after 4am on Sunday, December 28, 1986, when Dr. Lefrak stopped it. He placed a clamp on the aorta, signaled to anesthesiologist Mokie Shakoor to turn off the ventilator, and the room went quiet. The lungs deflated. Lefrak inserted a needle below the aortic clamp and injected two liters of a chilly cardioplegic solution. Within 20 seconds, he'd induced cardiac arrest.
Medically, the moment was of no significance: Mark Willey had long been officially dead. But when the heart stops beating and the lungs are suddenly still, the illusion of life is gone. Even among the experienced surgeons in the room, it was a gulp moment. Over surgical masks, eyes met eyes for an instant. And then they went to work.
If you've read about open-heart surgery or seen videos, you may have a mental image of what followed: hours of precise, delicate work on gossamer tissue and threadlike vessels, performed by beetle-browed people wearing those eyeglasses with little telescopes in them.
Discard everything but the furrowed foreheads and telescope glasses. Compared with other open-heart procedures in which Lefrak was already expert - say, coronary artery bypass - heart transplantation seems like butchery. The heart as a whole is a large, unsubtle organ, and those vessels feeding it that aren't the circumference of a D battery are still as fat as thumbs. Edward Lefrak removed Mark Willey's heart with a single tool: a pair of scissors not all that structurally different from what second-graders use on colored paper. There were no nurses beside him handing him tools or mopping his brow.
First he separated the superior and inferior venae cavae, the two large vessels that return blood from the body into the right atrium, and severed them. Then he lifted the organ with his left hand and cut behind it with his right, one snip on each of the four pulmonary veins that run lung to heart. He lowered it back into the chest. Below the clamp, he cut through the aorta and finally the pulmonary artery, which runs heart to lung. The heart was now in the doctor's hands, free of the body. It felt cold, even through a latex glove.
Donor hearts, once removed, can typically last four hours or a little longer before their cells begin to degrade; sometimes, circumstances push that deadline harrowingly. Doctors bearing donor hearts have sprinted to charter airplanes, or sped long-distance on country roads, with police escorts.
In this case, the heart would travel all of 90 feet. Lefrak zipped it into a plastic bag, put that bag into a second and then both into a third. This was to limit the possibility of contamination, since what was about to happen was not entirely sterile. Lefrak placed the tripled-bagged organ into a receptacle perfect for the purpose, if not designed specifically for it. It was a standard lunchbox cooler packed with ice. A human heart now was in a container labeled "Igloo."
The entire extraction had taken 4 and a half minutes.
By 1986, heart transplants were not yet completely routine, but they were at long last no longer completely irresponsible.
Pioneered in Cape Town, South Africa, in 1967 by the debonair heart surgeon Christiaan Barnard, the procedure was seen as a milestone human achievement, the medical equivalent of landing on the moon (which was still two years away). The celebration was somewhat disproportionate to the accomplishment; the operation was technically not all that difficult, except in the degree of nerve it took to attempt it. But the heart had always been a mystical organ, imbued in mythology and literature with powers and properties beyond the remarkable thing it already is - a mighty, indefatigable muscle, pumping 2 and a half billion times over a lifetime.
Being first to transplant a heart made Barnard, for a time, the most famous doctor on the planet. But the underlying truth was that in the early years, transplant results were too dismal to be clinically justified except for what they really were: learning experiences. Barnard's first patient, a 54-year-old grocer, died 18 days after his transplant. His second patient survived 19 months but suffered in poor health for most of those. In the month between Barnard's first two transplants, a New York surgeon named Adrian Kantrowitz tried a transplant on a newborn. The baby lived six hours. Though there were a few remarkable, sustained survivals, for a time during the early years the average length of survival was 300 days. The whole enterprise was intoxicating and held vast promise, but to many it had a disturbing feel of human medical experimentation. Even worse, it seemed to be done mostly to massage the vanity of celebrity surgeons.
For another decade, as survival rates improved but remained largely disappointing, heart transplantation was attempted sparingly, and after a time it stopped altogether. The principal problem was rejection, the process by which a body's immune system gangs up on what it perceives to be an intruder and tries to kill it. Drugs to mitigate that were unevenly effective. All of that changed with cyclosporine.
Isolated from a soil fungus found in Africa, cyclosporine was synthesised as an immunosuppressant by the pharmaceutical company Sandoz in 1980, and after wide testing was released into the market in 1983. Its effectiveness was exponentially greater than anything that came before. The effect on transplantation was immediate and profound.
In 1986, Edward Lefrak, then 43, was already among the most highly regarded and lavishly remunerated surgeons on the East Coast. He had trained at Baylor College of Medicine in Houston under the famously demanding (and perpetually feuding) doctors Michael DeBakey and Denton Cooley, in what was then a crucible for cardiac surgeons, with a boot camp atmosphere. Lefrak missed the birth of his first child because DeBakey had him on a 91-day tour in the cardiovascular intensive care unit, finding sleep when he could in the patient recovery rooms.
Baylor was a training ground for the next generation of heart surgeons, people with immense talents and corresponding egos. In that last sense, Lefrak was an outlier. He didn't swagger, he shuffled. He didn't bark orders, he mumbled them. He seemed to carry himself with an air of apology. He was a man you could underestimate, initially.
There was nothing tentative about Edward Lefrak in the operating room - or for that matter, in the way he approached the business of medicine. It was Lefrak who had pushed his hospital to move into heart transplantation, and to do so at enormous financial risk. The potential advantages may have been evident - in 1986, when it became known that a hospital did heart transplants, its reputation soared, and all departments benefited. The patients' thinking goes: If these guys can install a new heart, fixing my hernia must be a piece of cake.
But you cannot just declare yourself a heart transplantation center and expect a flood of referrals from local cardiologists with deathly ill patients. In 1986, they had other, if more distant, options at hospitals with a track record. What Fairfax Hospital needed was a track record, Lefrak argued, and there was only one way to get one. It had to make itself the last refuge of the desperate and the destitute.
Lefrak proposed that for the first handful of transplants - the first eight or 10 - the hospital eat the cost: Offer them to the uninsured completely for free, with free lifetime follow-up care.
The hospital's administrator, Knox Singleton, was a grown-up with a grown-up job, a punctilious businessman with grave responsibilities. But Singleton had the soul of a gambler. He never did a detailed cost-benefit analysis on Lefrak's proposal, mostly because the results - each operation would amount to a $200,000 gift in 1986 dollars - might well require a fiscally prudent no. Singleton pushed all the chips in. Fairfax would be giving away millions of dollars in heart transplants with a free lifetime service contract. For the foreseeable future, no one would make money on any of it, including Lefrak.
All of that was theoretical, however. If Patient One did not survive the operation, Lefrak was not at all sure there'd be a Patient Two.
Another hurdle loomed. Getting the program medically certified by the state of Virginia would mean overcoming a widespread institutional bias against exactly what was being proposed. In 1986, the consensus in many medical communities was that envelope-pushing procedures were best reserved for the ivory tower - large teaching hospitals affiliated with medical schools, which were places with greater resources, underwritten by greater endowments. Two such places were within a couple of hours of Washington, D.C.: Johns Hopkins University, in Baltimore, and the Medical College of Virginia, run by Virginia Commonwealth University, in Richmond, Virginia. Both had been doing heart transplants for a few years.
To get certified, Fairfax would have to submit to hearings before a Virginia medical tribunal. This was an adversarial proceeding with testimony pro and con, a political process masquerading as a medical process. Some doctors and institutions were openly aligned against Lefrak and Singleton, including the two hospitals that already did transplants and did not relish additional competition for both patient dollars and donor hearts.
The hearings were to be public; the media would attend. So Lefrak decided his side needed some oomph. Oomph, as it happens, was living in Oklahoma City.
Crippled by rheumatoid arthritis in his hands, Christiaan Barnard had stopped doing surgery in 1983 and had become scientist in residence at the Oklahoma Transplant Institute of the Baptist Medical Center. He was still an international star. Lefrak went to visit. Might the doctor testify on Lefrak's behalf?
Barnard smiled. He was famously photogenic, with teeth that seemed to carry their own gleam. "You didn't have to come here," he told Lefrak; a phone call would have sufficed. It turned out Christiaan Barnard had strong feelings about the spread of heart transplant surgery, and he wasn't bashful about expressing them.
When the renowned surgeon arrived in Richmond, state health authorities treated him with giggly deference. The Washington Post described Barnard's arrival as having the feel of "Hank Aaron dropping by a neighborhood baseball sandlot."
Barnard, 63, was in the company of a sultry young brunette. This was his girlfriend, Karin Setzkorn, a 22-year-old South African fashion model. (They would soon be married, and stay married for 12 years until Karin discovered in her 77-year-old husband's travel bag some Viagra pills and condoms. He'd been cheating on her with a still younger woman.)
This was not a man habitually given to caution or to judiciously qualified statements. Barnard's testimony surpassed anything Lefrak could have hoped for. Gesturing grandiloquently with his ruined hands - you couldn't miss the pathos - he informed the Virginia health establishment that given the lifesaving nature of the procedure, any bureaucratic process that denied a competent cardiac surgeon the right to perform transplants was "immoral."
Fairfax Hospital got its certificate.
When Lefrak walked in, Alan Speir moved to the opposite side of the operating table. The younger doctor's principal job was over. In time Speir would become one of the most skilled surgeons in the country at heart transplants, but in 1986, he hadn't yet learned how to do them. His job had been to perform the median sternotomy on the recipient, sawing through the centre of her breastbone, cranking it apart, cauterising the bleeding vessels and oozing bone, slicing through the membrane that covers the heart, and then standing down. The rest would be Lefrak's show. It was 4:15am.
The exposed heart in operating room 6 was structurally the same organ as the one now in the cooler, but it looked entirely different. For one thing, it was huge - almost twice the mass of the donor heart, inflamed from whatever unknown microbe or whatever other unknown process was killing it. Also, it was barely beating - in medical terminology, it was hypokinetic - pumping at one-fifth the strength of a healthy heart, scarcely hard enough to keep the body's blood flowing.
Eva Baisey was a 20-year-old single mother of two, an amiable nursing student from Anacostia, one of Washington, D.C.'s poorest neighborhoods. Eva had been in good health until early October, when her breathing suddenly became laboured and then deteriorated into a strangled wheeze.
Two steps, stop to catch her breath. Two steps, stop to catch her breath. The stops became longer until it would take her the better part of an hour to walk a block and a half. A flight of stairs seemed Himalayan.
She was in and out of the emergency room at D.C. General Hospital, where doctors found nothing wrong with her lungs. Eventually they referred her to a cardiologist, who did some tests, stared grimly at the results, then telephoned a man he'd met a few times, Ed Lefrak.
Baisey's diagnosis was idiopathic cardiomyopathy. That sounds bad, which it is, and also sounds definitive, which it isn't. It's weasel-word medicine - essentially a shrug. Cardiomyopathy means "something wrong with the muscles of the heart," and idiopathic means "of unknown origin," or more accurately, "we have no idea what's causing it." What Lefrak did know, for certain, was that Eva was dying, and dying short term. Also, she was poor and uninsured. Also, she was an admirable person.
That last fact was not of incidental importance. The qualifiers for transplantation do not end with ruling out diseases and confirming tissue compatibility. Also considered is the patient's overall health despite the failing organ, as well as his or her lifestyle. Organs are often denied to people who are mentally unstable, or chronically familiar to the police, or who have drug or alcohol addictions or other life-threatening habits. The lawless and rootless and feckless and helpless are not good gambles for too-scarce, meticulously rationed organs.
Eva Baisey lived clean. She was likable and ambitious, just a few credits away from becoming a nurse. Her will to survive was strong; she desperately wanted to be there for her two children, an 18-month-old son and an infant daughter. She had a healthy, self-deprecating sense of humor - about her taste for junk food, her less than svelte waistline, even about her sudden, bewildering medical straits. Finally, she was self-reliant - she'd been living on her own since she was 17, when her parents moved from the District of Columbia to North Carolina and left her behind in an apartment they subsidised.
Being unattached was bad for transplant protocols. Family support is the final qualifying criterion, an important one. Surviving this surgery is a life-changing ordeal. No one is stoic enough to go it alone. In the case of Eva Baisey, it was a potential dealbreaker - until it wasn't anymore.
Eva's mother, Barbara, had grown up unimaginably poor in the housing projects in southeast Washington. Her family's poverty was almost cliche: All the children shared the same toothbrush. That sort of background can break your spirit, or it can do just the opposite.
There was nothing broken or even slightly bowed about Barbara Baisey. When Eva got sick and became a candidate for heart transplantation, Barbara told her husband that they had to move back to D.C. He said no; he'd countenance weekend visits, but that was that. So she moved back on her own. Her daughter had been offered an astonishing gift, and Barbara felt her new purpose in life was to make it work, at whatever cost, including her marriage. She'd eventually get a divorce.
That was unimpeachable family support. Eva Baisey was approved as a recipient, and on December 4, 1986, she was transported from city to suburb, taken to Fairfax Hospital to await a donor.
Lefrak and his team might have been willing to relax some criteria to get that first transplant, but as it happens, in Baisey he had been handed a perfect patient. There was even a fortuitous intangible.
During the early years of heart transplantation - particularly in apartheid South Africa, but elsewhere, too - there was an undercurrent of controversy involving race. When Barnard's second transplant patient, a white South African dentist, received the heart of a mixed-race man, many grumbled about the unseemly precedent of an oppressed minority serving as an organ farm for the higher castes. It was an unfair charge - even early on, even in South Africa, some white organs went into black bodies - but it was understandable. In transplantation, racial concerns persist even today.
In 1986, in the majority black but still economically segregated Washington, there would be no such issues raised, either direct or whispered. Mark Willey was white. Eva Baisey was black.
At D.C. General, most of the patients and much of the staff had been African American, but when Eva arrived at Fairfax Hospital, she saw only alabaster. White patients, white doctors, white nurses, white orderlies. Eva was not conspiracy-minded, but when she initially got much sicker after her change of venue, she found herself wondering, almost amused, whether the staff was trying to do her in so a more ethnically suitable patient would arrive. What was really happening, of course, was by no one's design and to no one's desire: The patient was dying.
Then in the wee hours of the morning of December 28, the patient noticed an unusual number of people beginning to congregate in her room. She began to suspect something was up when nurses told her to soap herself really, really carefully. She was pretty sure something was up when they slathered her, neck to belly, with iodine-smelly Betadine. She knew something was up when, at 1am, her ma arrived.
It had taken more than three weeks, and a shattering tragedy, but Eva Baisey was about to get her new heart or die from the effort.
In the presence of death, the atmosphere in the donor room had been sepulchral. In the recipient room, with the possibility of a life restored, there was music.
Years later, no one could agree on what specifically was playing that night, except that it was twangy. Ed Lefrak was that extreme rarity: a devoutly liberal northeastern Jewish urban Yankees fan who happened to have a taste for country music. As was his custom, he'd brought a cassette tape, most likely Waylon Jennings or Emmylou Harris, or both. The music was just loud enough to provide a benign soundtrack that out-noised the respirator and other ambient distractions. It also discouraged talk. Some surgeons like chatter. Lefrak hated it.
He inserted cannulas - transparent silicone rubber tubes - into each of the vessels feeding and draining Eva Baisey's heart, and sewed them into place in the aorta and the two venae cavae. These tubes wove out of the body. The two venous lines met at a Y connector, turning into one. Baisey's circulation was now reduced to two tubes that fed out behind the surgeon and into a heart-lung machine.
Lefrak gave a nod to the perfusionist, Aaron Hill. The machine rumbled to life, and the tubes filled with blood - purplish dark coming from the body, then three shades lighter and a few degrees colder going back in. The machine was slowly cooling Baisey down - eventually all the way to 79 degrees, slowing her metabolism - but it was also breathing for her, oxygenating her blood. Her bad heart was now beside the point. Relieved of the burden that was grinding it to exhaustion, the organ shrank back almost to normal size, almost in an instant. It was dramatic. You could practically hear a whew.
Mary Dellinger, the scrub nurse to Lefrak's right, handed him scissors. What followed was not unlike what had happened in the donor room, with one principal exception: At the back of the organ, Lefrak left the pulmonary veins intact, slicing instead into the top of the damaged heart itself, leaving behind cuffs of tissue from Baisey's left and right atria. To these, the new heart would be sewn. It was an odd counterintuitive procedure - why invite rejection by sewing heart tissue to heart tissue?
There was a good reason - pulmonary vessels are notoriously tricky to splice together, and this allows you to avoid it, retaining the recipient's own vessels. The technique had been pioneered a quarter of a century before by Stanford University cardiac surgeon Norman Shumway, while practicing on dogs.
More than anyone else, Shumway was considered the father of heart transplantation, and he'd almost been the first to perform one. On November 20, 1967, he announced that he was ready for a transplant, what would have been the first ever. He had a patient and was waiting for a donor.
The wait proved too long. He lost the race to Barnard by 33 days. (Shumway's first transplant, the world's fourth, fared no better than the others, the patient surviving for just two weeks.)
Many years later, it would become clear exactly how Barnard had won. Shumway had been limited by international ethical conventions on certifying death. At the time, brain death was not sufficient; the heart had to have stopped on its own. That meant surgeons sometimes watched helplessly as potential donors slowly wasted away, damaging their tissues beyond recovery. Barnard was bound by the same strictures but was under less scrutiny from a despised government desperate for the feel of international legitimacy. As was disclosed 40 years later by Barnard's brother, Marius, in Donald McRae's 2006 book about the first transplant, "Every Second Counts," Barnard had gotten that first donor heart to stop by stopping it. He'd furtively injected it with paralysing potassium until the donor became officially deceased.
In operating room 6, Lefrak had also injected potassium into Baisey's exhausted heart, for an entirely different reason. When the heart was still, the extraction was easier. Once it was free of her body it became a specimen for the lab, for any secrets it might offer up to help take the "idiopathic" out of cardiomyopathy.
At a signal from Lefrak, the Igloo was brought in from operating room 12. The triple-bagged heart was unpackaged and laid out on a tray.
Unbidden, Mary Dellinger passed Lefrak a suture. She knew exactly what came next - much of what remained was sophisticated needlework. Dellinger had been helping Lefrak with this for two years, at the doctor's side since the beginning, a constant presence during most of the rehearsals. She was one of those invaluable surgical nurses whose hand was there with the next needed instrument even before the surgeon thought to reach for it.
In 1986, the only way to practice transplanting hearts was to transplant hearts, which meant, for Lefrak, a tip from a pathologist or morgue attendant, followed by an awkward conversation with next of kin, followed by hours at the morgue, working with a new cadaver. There had been more than a dozen such dry runs. The most memorable had been on February 27, 1986, the day before Christiaan Barnard's testimony in Richmond. Gamely, Barnard had agreed to join Lefrak in the morgue. There he sat at the head of the gurney and kibitzed as Lefrak rehearsed with a corpse.
From that day, Dellinger kept several photos - Barnard, gracious with his time, posing with the doctors and nurses. Among her memories of the day are Barnard's hands, still expressive, still usable for most things, but clearly stiff and gnarled, no longer supple enough for the thing that saved lives.
In the operating room, some of the sewing was as simple as splicing severed vessels, hose to hose, end to end. The whole transplant was a meticulous, repetitive process. Sew, check for leaks. Sew, check for leaks. This took hours. The sun rose. The sewing and checking continued.
When all connections had been sealed and the perfusionist began to slowly warm the blood, Lefrak released the cross-clamp on the aorta and the new heart began to tremble. A good sign. It was not beating, but it was fibrillating.
What happened next defied everything most people presume about the human heart. Lefrak lowered Eva's head, cupped her new heart with his left hand and tilted the bottom of it up so it became the highest point in her body. Then he accepted from Dellinger a long 18-gauge hypodermic needle and stabbed it into the heart's apex, clean through the muscle to the cavity of the left ventricle. From the plastic collet of the needle came a bloody froth. When that stopped, Lefrak withdrew the needle, then pushed it in again, a few millimeters away. More bubbles.
If a heart is sliced by the thrust of a knife, that is usually fatal. If it is pierced by a bullet, it is nearly always fatal. But the heart is, in the end, a muscle, and as anyone knows who has ever gotten a vaccination in the arm - or anyone familiar with the overdose scene in "Pulp Fiction" - muscles can withstand and survive a needle. They close back up and heal instantly. Lefrak repeated this unnerving stab of the needle more than a dozen times. The goal was to empty the heart of all air bubbles before reconnecting it to its prime source of blood, via the venae cavae. Air bubbles cause embolisms, and embolisms cause brain damage.
Satisfied all the air was gone - no more froth - Lefrak allowed the heart to fill with blood.
Typically, at this point, nothing happens. No beat. That doesn't occur until the blood is fully warmed, from 79 degrees to 98.6, and that process is gradual. Even then, often, nothing happens; with the majority of heart transplants, electric shock must be used to start the organ. The electrode paddles were readied.
They weren't needed. After the heart was fully warmed and Lefrak massaged it by hand for a minute or two, Mark Willey's heart started beating. His heart? Her heart? For the moment, pronouns became ambiguous.
It was an imperfect beat - the right atrium was stuttering - but that soon resolved.
In an understandable deviation from procedure, Aaron Hill abandoned his heart-lung machine, walked up behind Lefrak and looked over the doctor's shoulder, to take in the moment. The beat was strong, a young man's heart in a young woman's body, in powerful, controlled spasm. Clench and release, clench and release. The sutures all held.
It's perhaps odd, but three decades later there is no consensus on what happened next. Lefrak, who disdains shows of emotion in his operating room, remembers no celebration at all. Anesthesiologist Mokie Shakoor recalls the slowly building thup-thup-thup of applause through a circle of latex gloves. Speir thinks he may have reached around the table to shake Lefrak's hand. The clearest memory belongs to Mary Dellinger.
Dellinger remembers an almost matter-of-fact atmosphere, not a letdown or an anticlimax, but an exhilarating, satisfied collective nod. Of course it had worked. They had practiced so obsessively with the dead, there was no way it was not going to work for the living.
After major procedures, surgeons dictate operative notes, for the record. These tend to be laconic affairs, heavy on technical language, empty of drama. This one was no different, and it also reflected Lefrak's distaste for showmanship. It was three pages long, single spaced on a manual typewriter. Under "Operation" it says "orthotopic cardiac transplantation," just as it might have said "tonsillectomy." After three long paragraphs describing the patient's history, her diagnosis, the medications that had been tried and failed, the prep of her body and the mechanics of cardiopulmonary bypass, Lefrak summarised the entire four-hour transplant in one sentence: "The donor heart was sutured in place using the standardised technique." Like a successful fisherman giving credit to his line, he then notes the sutures were made with "3-0 Prolene." Finally: "The patient was taken to the surgical intensive care unit in satisfactory condition."
Three decades later, Lefrak, now 76, is a few years into his retirement.
He and his wife, Trudy, have five adult daughters. The Lefraks live in one of the grandest homes in stately McLean, Virginia. It's a mansion on a hill, a feat of modern architecture and design in which much of the furniture and infrastructure look as though they were carved out of the same enormous tree.
Unlike Christiaan Barnard, Ed Lefrak had an unforced retirement. His hands are fine. He uses them to resew his granddaughters' loved-ragged stuffed toys, and sometimes hauls out the surgical spectacles with those little telescopes to untangle his wife's necklaces. Once a month, he and Trudy - a registered nurse - volunteer their time at a free medical clinic in Arlington, Virginia, treating the uninsured for problems as plebeian as hemorrhoids.
Lefrak is one of those rare and lucky individuals whose personal fortune allows the sort of generosity of spirit we all like to think we'd show if we just had the resources. Most of us are never tested on this. For those who are, the rewards can be complicated.
In 1998, Lefrak was part of a medical team that volunteered to care for Nicaraguan peasants after Hurricane Mitch nearly annihilated the country, killing thousands, displacing hundreds of thousands, destroying hospitals, distributing willy-nilly through the floodwaters thousands of active land mines left over from the Contra insurgency of the 1980s. Many lives and limbs were lost.
In Corinto, a poor coastal city ravaged by flooding, Lefrak found himself moved by the plight of a sickly 14-year-old girl, one hardship in all the rubble that was not wrought by Mitch. The mitral valve in Maria Eliset Centeno Hernandez's heart had been damaged from a bout with rheumatic fever at age 9. Her lungs were bubbly with blood, her breathing shallow and liquid. Lefrak knew what lay in store for her - a lingering death in her 20s, if she even made it that far, considering her straits. Orphaned at an early age, Maria lived with her doting grandmother and disabled brother in a leaky tin-roofed shack without electricity or running water. Dinner was sometimes bread and coffee.
Working with an international charity organisation, Lefrak brought Maria to Virginia, put her up for a few weeks in his palatial home and then, in a grueling day-long surgery, sliced open her heart and gave it a new valve. All of it was a gift - from Lefrak, his colleagues and his hospital.
Before the operation, Maria could barely move. A week afterward, she was rollerblading around the Lefraks' home and bonding with 10-year-old Mikaela, the youngest Lefrak daughter. Her suitcases fat with new clothes and toys, Maria returned with boundless joy and reckless energy to the reality that awaited her in the dispiriting grit of Corinto, Nicaragua - population 15,000.
Was it too much, too fast, with hope too easily extinguished? Eighteen months later, Maria was pregnant. Six years later, she was dead. Lefrak doesn't know what took her. On his desk, he keeps a picture of Maria, and of her two children, a boy and a girl. The boy's middle name is Eduardo, named for the doctor who had saved the mother's life.
When Lefrak closes his eyes, he still sees Maria at 14, copper-skinned, dimply, joyful, with a cereal-bowl haircut, looking like a little girl but for her strangely complex grown-up eyes.
Fairfax Hospital - now called Inova Fairfax - has become one of the leading heart transplant centers in the country. Its chief cardiac surgeon is Alan Speir.
Heart transplantation is now close to commonplace, with more than 2,000 a year performed in the United States alone. It extends life but is not without problems, still. For reasons that are not yet clear, transplant recipients tend to develop coronary artery disease more rapidly than most people. Transplant survival rates, while vastly better than before, are still not extraordinary. Only half survive for 10 years or more. Fifteen years is considered excellent. Twenty is remarkable. Twenty-five is nearly unheard of. Also, for unknown reasons, survival rates for black patients are significantly lower than for white patients.
What, then, explains Eva Baisey, here in her living room, three decades after her surgery, one of the longest-living transplant patients on the planet, joking about how she sometimes forgets to take her meds?
"I don't always take cyclosporine twice a day like I'm supposed to," she says in a conspiratorial whisper. "I'll remember after three or four days when I feel a little flutter or it skips a beat."
Eva considers what this must sound like. A big smile.
"Don't tell Dr. Lefrak. He'll kill me."
She and Lefrak remain friends. He calls her every December 28, every anniversary of the surgery that saved her life. He has done it 32 times.
Eva Baisey is a formidable presence, with long, striking purplish braids woven by her daughter. She is in a perpetual happy battle with her weight, something she talks about a lot. What she doesn't talk about much are the events of Christmas week 1986.
When she woke after surgery, Eva asked her ICU nurse to see the Sunday newspaper. The nurse laughed. Sunday was history; Eva had slept clear through it. So the nurse handed Eva the Monday Washington Post. She was on Page 1.
Soon Eva would get the bad news: She could not be a nurse. Her compromised immune system made it too dangerous for her to be around the sick. She was crushed by this; ever since childhood, all she'd wanted to do, she said, was to "help old people and babies." So for a time she studied computer science and worked with those machines, though, as she puts it now without irony, "my heart wasn't in it."
After five years, Eva's immune system seemed fine and her doctors relented. She was cleared to be a nurse, and that's what she is. She helps old people and babies. She lives in a nice garden apartment in District Heights, Maryland, not far from her son and her daughter, a security guard, and her mom, Barbara, who still has her back.
Eva says that in the black community, there is still some mistrust about donating organs, a suspicion that for African Americans the transplant business is a one-way street in the wrong direction. She tries to dispel that notion wherever and whenever she can.
Nothing convincingly explains the strange chemistry, the alchemy, that has kept the heart of a sullen, violent, tormented criminal beating for so long in a gentle mother's chest.
Doctors working with transplant patients have noticed that many of them tend to be incurious about the lives of the people whose hearts beat in their chest, or the circumstances of their deaths. It's not ingratitude - it's a form of self-defense. There is a burden in merely surviving this surgery and remaining optimistic, and it does not help to incorporate someone else's tragedy into the narrative of your life.
Eva's like that. It has helped her to think of her new heart as a thing, more like a prosthetic device than a part from another human being. She knew about the source of her new heart and the murder, of course - it, too, was in the newspapers - but she never asked about the details, didn't really want details, and did not hear them until this very day.
Taking this all in is Eva's son, Antonio, who was not yet 2 at the time of the operation. Antonio is a slight, elegant, soft-spoken young man, who is politically liberal but once worked as a waiter in a Republican country club. He held his tongue at work and suppresses a smile about that. Antonio has stayed quiet, too, for most of the last two hours, listening to the story of his mother's deteriorating illness, her near death, and of the murder-suicide that saved her life.
"This is the first time I've heard a lot of this," he says, shaking his head.
Doctors tend not to speculate why one transplant works so well and others do not. Surely it helped that Mark Willey's heart was fresh, that it had spent only minutes outside his body when it went into Eva's. But hundreds of down-the-hall transplants haven't been nearly as successful as this one. Other donors have been in better physical shape than Mark, other recipients in better physical shape than Eva. Nothing convincingly explains the strange chemistry, the alchemy, that has kept the heart of a sullen, violent, tormented criminal beating for so long in a gentle mother's chest. Her coronary arteries - his coronary arteries - are amazingly clear.
Eva has never before been asked whether it bothers her that she's got the heart of a murderer. She is asked now. She opens her mouth, then closes it again. She looks at Antonio, gets no help there, then back at the person who posed that impertinent question.
She is looking, perhaps, for a way to rationalise the unrationalisable.
Finally: "OK, it could have been a car accident. Someone dying for no reason at all, something meaningless." This is better, she said.
Yes, the man was a brute; his motives were warped and self-centered; his victim was blameless; his crime was unfathomably cruel. But, Eva says, it was not empty of meaning: "Someone loved someone so hard they couldn't bear to live without them. Yes, it's selfish. I don't want anyone to love me to death. But it all comes out of a need to be wanted, to passionately connect with another person. That is not meaningless. And something good came out of that."
Yes, Eva Baisey got a murderer's heart. But it was also a broken heart. It fixed her, and she fixed it.
- Gene Weingarten is a columnist. This article is adapted from his new book, "One Day," to be published October 22 by Blue Rider Press, an imprint of Penguin Publishing Group.