After Ava left the hospital, I went straight into surgery for sixteen hours. The heart transplant wasn’t a success. The man’s body rejected it so severely that we couldn’t keep him alive. I came out of surgery feeling like shit that I’d lost two hearts that day, not to mention guilty at the thought of Ava taking the bus home alone, so hurt and upset with me.
I texted her and called her a million times to no avail. Several days passed where I was stuck at the hospital, sleeping in the on-call rooms and feeling like the walls were closing in on me. On Wednesday, Uncle Dale gave me a pity call.
“Hello?”
“Hello, son.”
“Where is she?” I said, bone-weary and exhausted.
“She went to Spain.”
I bit my lip and felt my eyes water. Frustration and anger sent a rush of blood to my head. “Why? Why would she do that?”
“Nate, you have to realize that Ava was so young when she came to the ranch. She was barely nineteen. She might’ve been married but she wasn’t yet grown, you know? She still isn’t.”
“Yeah, I guess.” My voice was low.
“Trish used to say that Ava just froze in time when Jake died. She didn’t talk to anybody for years. Nobody really knows where she went all that time. She was locked away somewhere in her own misery or guilt. She wasn’t growing up emotionally.”
“What are you telling me?”
“Women are complicated.”
“I’m aware.”
“Do you love her?”
“What does that even mean?”
“It means you worry about her when she’s driving two and a half hours in the dark.”
I felt a stabbing ache in my chest. “I feel awful about that.”
“That doesn’t mean you love her.”
“I don’t know if I can.”
“Are you asking for my advice?”
“No.”
“Too bad. You’re capable of love and you need to fucking show her that, Nate. Show her that you will be there for her. That’s it. You think that the demand of your job is some sort of excuse to neglect the people in your life who care about you? Ask your dad what to do. He made it work, and I don’t remember ever hearing stories about your mom sleeping in the cold cab of a truck in a parking lot.”
I took a deep breath through my nose. Feeling resigned, I simply said, “Thanks, Uncle Dale. I’ll think about it.”
I hung up the phone and immediately dialed my father and asked him what I should do. His answer was simple.
“Go to Spain, you dimwit.”
“Wow, Dad. Thanks.”
“It’s like everything comes easy to you, Nate, except for this.”
“Well, it’s a bit hard for me to just up and leave.”
“It doesn’t have to be.”
I went home that night and the emptiness of my house reminded me that I was alone. My house was colder, darker, and I felt weird there, like I didn’t belong. I thought back to the warmth Ava had created and wondered how long it would take for me to stop missing that, for Ava’s presence to stop echoing through the empty house. I tried to read a medical journal but I could only think about what it felt like to pull Ava toward me while we slept, how her back fit perfectly against my chest. With my face resting against her hair, I had felt alive, whole, healthy, and relaxed. Alone now, I felt anxious.
I called her that night and pleaded, practically begged, for her to call me back, but she didn’t. I resigned myself to the fact that I might’ve screwed everything up with her once again. This time maybe it was beyond repair.
At work the next day, I caught up with Olivia in the hall as she was heading out to fly back to California. “You leaving?”
“I have an hour. You wanna get a coffee? Or maybe find an empty on-call room?” she said, completely straight-faced.
I laughed. Maybe Olivia did have a sense of humor but just enjoyed watching men squirm. I called her bluff. “On-call room.”
“Screw you. There’s a coffee cart in the lobby. Come on.”
I smiled and followed her down the hall. Her walk was the same as it had always been, almost a goofy speed-walk. She turned back and looked at me. “Do they have something against Starbucks around here?”
“I don’t know. Who cares.” I heard her laugh but couldn’t see her face. She was walking three strides ahead of me, like the coffee was going to disappear.
We got our coffees and sat at a tiny round table in the lobby.
“So, what do you think happened? Besides the fact that he rejected the heart?” I asked between sips.
“Well, he clearly wasn’t healthy. Maybe that heart should have gone to someone who was taking better care of himself. You have to want to live, you know.”
“His family seemed devastated.” She blinked, expressionless, and didn’t respond. I grinned. “Olivia, are you missing some sort of sensitivity chip?”
“No.” She shook her head. “I feel for my patients, I just show it differently. Plus, we did everything we could.”
“Maybe I’m just really torn up about Ava.”
“I know.”
“You do?”
“At first I thought you were being silly. After that night in L.A., when you just left, I thought you were making a huge mistake. But then when she came here and I saw how you chased after her, I understood what you wanted, what was more important to you in that moment. And then I saw how devastated you were when you came back without her. People do it, Nate. They learn how to balance it all, and you can, too. It’s never really been my thing. I don’t want marriage and family. I like reading books and screwing cabana boys when I’m on vacation.”
“God, Olivia, I almost admire how reprehensibly honest you are.”
She laughed. “I always said you and I were the same, but we never were. I knew it a long time ago. I remember one time after . . . you know, one of our nights, you asked if you could sleep over, and I said no. At the time it was honestly such a bizarre question to me, like who would want to do that? Who would want to wake up in the morning and have to deal with another person? I used to think being this way made me a better surgeon, which probably makes me the odd one. Though I think it also means you’re kind of a pansy.” She smirked.
“You’re such a bitch.” I smiled. “You were almost nice to me for a second there.”
“I love you, Nate. You are, by far, one of the sexiest pansies I know. All that love and girlfriend and family stuff, you can keep it. I’ll still respect you because as torn up as you were after Ava left that day, you performed better than any other surgeon I’ve ever worked with. That man didn’t die because of you.”
I stood up and hugged her, even though her hugs were stiff and awkward. “You’re a cold fish, Olivia, maybe the coldest fish I know, but I still love you, too, and respect you. Now go back to L.A. and save some lives. I’ve got a ten-year-old patient waiting for me.”
As she walked through the sliding doors, she waved over her shoulder without turning around and shouted, “I have a full heart for the first time, Dr. Meyers. See ya around.”
Shortly after, I met Noah, a ten-year-old with aortic stenosis, which would require a procedure similar to the one I had attempted on Lizzy. I went over the chart with one of the nurses as we stood at the end of his bed. Freckle-faced, energetic Noah listened in.
“Dr. Meyers, my mom said you’re going to put a balloon in my heart?”
I always tried to take the honest approach with kids. “Well, when your parents come back I can explain it further, but basically we’re going to open up one of the valves in your heart with something similar to a balloon.”
“Okay cool. You seem really smart.”
The nurse left the room and I approached the boy to observe the monitor above his head. “Thanks, Noah, you seem really smart, too.”
“Can I ask you a question?”
“Sure.”
“You know how my heart is messed up?”
I cocked my head to the side. “Well . . .”
“I have a heart problem. Don’t worry, I know all about it.”
“Okay, go on.” I let him proceed but felt a bit of trepidation.
“Do you think I’ll be able to feel love?”
“Well, of course,” I answered quickly; then realization set in. “We don’t really love with our hearts. I mean, the heart is an organ that we need to stay alive.”
“Oh.” He nodded. “So do we love with our brains?”
“Yes. I think so.”
“It’s just that Emily at my school is really . . . well, she’s a know-it-all, you know?”
“Yeah, I know someone like that.” I wondered if Emily had red hair and a fiery personality like Olivia.
“Well, she likes me and my mom says she’s smart and pretty.”
“So you think you should like her back?”
He frowned, looking conflicted. “I guess, but it’s just that I know this girl, Grace, and every time I’m around her my heart beats super fast. I think I might be in love with her.” He looked me right in the eye when he said the last part. His face was serious, like we were discussing business between men. “So if you don’t love with your heart, then why does it do that?”
I had a physiological explanation, but it somehow didn’t make sense anymore. “That’s a good question. Maybe we do love with our hearts.”
“So if I have a broken heart, then . . .”
“I’m going to fix your heart, Noah, so you can love all you want with it.”
He smiled. “Really?”
“Yes.” I felt more determined than ever to deliver on my promise.
“Are you in love, Dr. Meyers?” His eyes widened.
“Yes,” I said instantly.
“How do you know?”
“Because my heart beats super fast when I’m around her.” I smiled and dropped my pen into my lab coat pocket.
He smiled back. “Cool.”
In the operating room, as I ran a line from Noah’s femoral artery to his heart, his pressure began to drop suddenly. I stayed calm, ordered the anesthesiologist to administer a certain type of drug, and then watched his blood pressure stabilize. There’s a balanced connection between fear and success. I had to regard each one of my patients as real people. That’s what I learned after Lizzy. I had to feel the fear of their mortality and push through it.
Facing the impossibly painful truth that people die all the time doesn’t make it any easier to accept, but learning from it can make the rest of your life less arbitrary and more meaningful. My career would be dedicated to saving as many people as I could, but my life would be about living. What good was repairing a heart if I was sacrificing my own in the process?
As I operated on Noah, the fear I felt about losing another patient fell away, only to be replaced by the fear that any hope for my future had flown across the Atlantic Ocean days ago.
I went to see Noah in recovery just as he was starting to wake up from his anesthesia. He was very groggy but his mother rubbed his back and encouraged him to wake up slowly. As soon as Noah realized his mother was there, holding him like a baby, he said, “Hey Mom, my mouth is dry, can you get me some water?”
His mother went for the water while I wrote some notes on his chart and observed the monitors.
“How’d I do, Doc?”
“Very well, Noah. I think you’re going to be feeling a lot better.”
“I was thinking about what we talked about.”
“Okay.”
“What do you know about sex?”
I burst out laughing and rocked back on my heels nervously. “Well, I think that might be a conversation for you and your dad to have.”
“I don’t have a dad. He bailed.” This poor kid.
Just then his mom entered the room. I turned away from Noah and approached her. She was a very sweet-looking woman with a heart-shaped face and full lips. I knew Noah had to have inherited his candor from someone, so I approached the subject directly.
“Noah is asking me about”—I cleared my throat—“sex.” I looked back at Noah, who watched me expectantly.
“What’d you tell him?”
“Nothing. It’s not really my place.”
She shrugged. “Well, Noah doesn’t have a dad, so I suppose a doctor would be the next best thing.” She reached up to hug me, which startled me a bit. I hugged her back, to my own surprise. While we hugged, she said, “Thank you for saving my boy. Now, can I ask you for one more favor?”
“Sure.”
She pulled away and in a hushed tone said, “Give Noah one real-life example of a good man. Even if it’s for a moment, I know it will have an impact.”
I blinked several times, wondering how I might fulfill what she was asking of me. “Okay, are you asking me to talk to Noah about the birds and the bees?”
It’s totally inappropriate to get involved with patients on a personal level, but Noah’s mom was very compelling. “I’m asking you to talk to Noah about being a man.”
She left the room abruptly while I stood there, staring blankly ahead.
“Dr. Meyers?” Noah asked.
I turned and walked toward him.
“You never answered my question, Doc.”
“Um, I know a thing or two about sex. What would you like to know?”
“Well, I’ve seen two dogs, you know, do it, and I just thought they didn’t seem to be enjoying it much. But everyone keeps telling me that’s what you do when you’re in love and get married. If being in love is so great, why do the dogs—”
“Hold on, Noah, let me think about this. When you’re quite a bit older, you know, when you’re a man?” He nodded enthusiastically. “Well, when you’re a man and you find the right woman . . .” I could feel a bead of sweat running down the side of my face. “Then you can be with her that way. But it’s not like the dogs, exactly.”
“Does it hurt?”
I was about to say no but quickly realized there was some untruth to that answer. “It can hurt if you’re both not ready. That’s why you have to respect the girl’s wishes and let her decide if she’s ready, as long as you’re ready, too. You have to be a good man about it.”
“What do you mean by a good man?”
“A good man is willing to promise himself to his girl so he can protect her and show her how much she’s loved. You can’t have too much pride when you’re in love. If you know for sure, without a doubt, that you’re both ready, then when you come together physically it’ll feel good and right.”
“Oh.”
“But you shouldn’t worry about that part until you’re grown.”
“Like you?”
“Yeah, like me.”
“Are you a good man, Dr. Meyers? I mean, to your girl?”
My jaw tightened. “I want to be, Noah.”
“Cool.”
“Cool,” I said back and then put my fist out to give him a fist bump.
I walked casually out of Noah’s hospital room and then ran full speed down the hallway to my office and booked a flight to Spain.