into iridescent beetle shells, he had the eerie feeling that he was home and sleeping, that this place and the test to come were all moments of a dream within a dream.
From the out-patient admitting desk, an orderly showed him the way to the cardiac diagnostics laboratory.
The head cardiology nurse, Kyra Whipset, could not have been more lean if she had eaten nothing whatsoever but celery and had run half a marathon every day. She had so little body fat that even in high-buoyancy saltwater, she would sink like a dropped anchor.
After ascertaining that Ryan had eaten nothing after midnight, Nurse Whipset provided a sedative and water in a small paper cup.
“This won’t put you to sleep,” she said. “It’ll just relax you.”
A second nurse, Ismay Clemm—an older, pleasantly plump black woman—had green eyes in which the striations were like the bevels in a pair of intricately cut emeralds. Those eyes would have been striking in any face; they were especially arresting because of the contrast with her smooth dark skin.
While Nurse Whipset sat at a corner desk to make an entry in Ryan’s file, Ismay watched him take the sedative. “You okay, child?”
“Not really,” he said, crushing the empty paper cup in his fist.
“This is nothin’,” she assured him as he dropped the cup in a waste can. “I’m here. I’m watchin’ over you. You’ll be just fine.”
By contrast with Nurse Whipset’s ascetic tautness, Ismay’s abundance, which included a musical voice that conveyed caring as effortlessly as it would a tune, comforted Ryan.
“Well, you are taking three pieces of my heart,” he said.
“Tiny pieces, honey. I suspect you’ve taken far bigger pieces from the tender hearts of a few sweet girls. And they’re all still livin’, aren’t they?”
In an adjacent prep room, he stripped to his undershorts, stepped into a pair of disposable slippers, and wrapped himself in a thin, pale-green, collarless robe with short sleeves.
Back in the diagnostics laboratory, Dr. Gupta had arrived, as had the radiologist.
The examination table was more comfortable than Ryan expected. Samar Gupta explained that comfort was necessary because during this procedure, a patient must lie on his back, very still, for at least an hour, in some cases perhaps for two hours or more.
Suspended over the table, a fluoroscope would instantly project moving x-ray images on a fluorescent screen.
As the cardiologist, assisted by Nurse Whipset, prepared for the procedure, Ismay Clemm monitored Ryan’s pulse. “You’re doing fine, child.”
The sedative began to take effect, and he felt calmer, although wide awake.
Kyra Whipset scrubbed Ryan’s neck and painted a portion of it with iodine.
After applying a topical anesthetic to steal the sting from the needle, Dr. Gupta administered a local anesthetic by injection to the same area.
Soon Ryan could feel nothing when the physician tested the nerve response in his neck.
He closed his eyes while something with an astringent smell was swabbed on his numb flesh.
Describing his actions aloud, Dr. Gupta made a small incision in Ryan’s jugular vein and introduced a thin, highly flexible catheter.
Ryan opened his eyes and watched the fluoroscope as it followed the tedious progress of the catheter, which the cardiologist threaded carefully into his heart, guided by the image on the screen.
He wondered what would happen if in the midst of this procedure he suffered a seizure as he had on the surfboard, his heart abruptly hammering two or three hundred beats a minute. He decided not to ask.
“How are you doing?” Dr. Gupta inquired.
“Fine. I don’t feel anything.”
“Just relax. We’re making excellent progress.”
Ryan realized that Ismay Clemm was quietly reporting on his heart rhythm, which evidently had become slightly unstable upon the introduction of the catheter.
Maybe this was normal, maybe not, but the instability passed.
And the beat goes on.
Once the primary catheter was in place, Dr. Gupta inserted into it a second catheter, a bioptome, with tiny jaws at its tip.
Ryan had lost all sense of time. He might have been on the table a few minutes or an hour.
His legs ached. In spite of the sedative, the muscles in his calves were tense. His right hand had tightened into a fist; he opened it, as if hoping to receive another’s hand, a gift.
Long he lay there, wondering, fearing.
The jaws of the bioptome bit.
Inhaling with a hiss through clenched teeth, Ryan didn’t think that he imagined the quick painful pinch, but perhaps he was reacting to the brief frantic stutter of his heart on the fluorescent screen.
Dr. Gupta retrieved the first sample of Ryan’s cardiac muscle.
Nurse Clemm said, “Don’t hold your breath, honey.”
Exhaling, Ryan realized that he expected to die during the procedure.
In just seventy minutes the biopsy had been completed and the incision repaired with stitches.
The power of the sedative was at its peak, and because Ryan had endured a sleepless night, the drug affected him more strongly than anticipated. Dr. Gupta encouraged Ryan to lie on the narrow bed in the prep room and rest awhile, until he felt fully alert and capable of driving.
The room was windowless. The overhead fluorescent panels were off, and only a fixture in a soffit above the small sink provided light.
The dark ceiling and shadow-hung walls inspired claustrophobia. Thoughts of caskets and the conqueror worm oppressed him, but the phobic moment quickly passed.
Relief that the procedure had gone well and exhaustion were tranquilizing. Ryan did not expect to sleep, but he slept.
To a discordant melody, he walked a dream road along a valley toward a palace high on a slope. Through the red-litten windows he could see vast forms that moved fantastically, and his heart began to pound, to boom, until it beat away that vision and harried in another.
A wild lake, bound all around with black rocks and tall pines, was lovely in its loneliness. Then the inky water rose in a series of small waves that lapped the shore where he stood, and he knew the lake was a pool of poison. Its gulf would be his grave.
Between these brief dreams and others, he half woke and always found Ismay Clemm at his bedside in the dimly lighted room, once taking his pulse, once with her hand to his forehead, sometimes just watching him, her dark face so shadowed that her oddly lit green eyes seemed to be disembodied.
A few times she spoke to him, and on the first occasion, she murmured, “You hear him, don’t you, child?”
Ryan had insufficient strength to ask of whom she spoke.
The nurse answered her own question: “Yes, you hear him.”
Later, between dreams, she said, “You must not listen, child.”
And later still: “If you hear the iron bells, you come to me.”
When he woke more than an hour after lying down, Ryan was alone.
The one light, the many shadows, and the sparely appointed prep room seemed less real to him than either the palace with windows full of red light or the black lake, or the other places in his dreams.
To