THE KINDEST GESTURE
After placing his usual order in the coffee shop’s drive-thru lane, extra-hot cappuccino, two-percent milk, triple-shot of espresso—he liked feeling his heart beating in his chest—the young doctor waited in his idling car for the window attendant to return and hand him the beverage and his change. From there he’d follow a certain routine where he pulls off the plastic lid, takes a couple of sips and slurps the foam off the top, then puts the lid back on and places the cup in the holder, where it sits until he gets to work.
He raised up the window of his leased Mercedes Benz E-Class while he waited. A fine drizzle had started and angled into the car, staining the chocolate-brown leather covering the inside door panel. He wiped the drops with his hand, then tuned the radio to a classical station, keeping the volume low.
He took in the traffic rushing past the coffee lane’s exit from the left and glanced up at the lights of the intersection to the immediate right. Most mornings he’s in and out within two light changes. He was hoping that would be the case today as he had an important meeting with his attending and he couldn’t be late.
The light had already changed three times, and he still didn’t have his cappuccino. He drummed his fingers against the steering wheel and craned his neck to see if there was any movement behind the checkout window but saw only his own reflection. At least he wasn’t stuck in the back of the line. He checked his teeth in the rearview mirror and saw a young woman in the car behind him. She was speaking to a child in the passenger seat. He could only see the top part of a small head behind the dashboard, but he could tell that the woman was getting agitated, the way she kept leaning over and stretching her arm all the way toward the passenger door to fasten the seat belt the kid apparently kept unfastening. The top of the seat belt above the small blond cranium would tauten, then go slack again whenever she pulled her arm back. The young woman—the mom, presumably—seemed to get more animated with every attempt to keep the kid strapped in. She finally wrapped her hands around the ten-and-two position on her steering wheel and looked straight ahead. Then she started crying.
“Come on, already,” the doctor muttered in the direction of the checkout window and checked his watch. He mentally rehearsed what he’d do next, as careful as if he were preparing for surgery. He would pull up fifteen feet to the mouth of the exit, inch the nose of his car forward by tapping the brakes, find an opening between the cars coming from the left, then swiftly pull out of the drive-thru with a sharp right turn to point his car at the massive intersection and floor it all the way across before the light changed from yellow to red and the junction of Queen’s Road and Lancaster Avenue resumed its fury. Once across he’d have a clear shot to the hospital, three minutes up the street.
Still no coffee. Behind the young woman someone was honking their horn, presumably protesting the long wait.
His eyes fixed on the rearview mirror to glimpse the growing chain of morning commuters, the doctor noticed another little one in the back of the woman’s car. This one was restrained in a booster seat and swinging a toy back and forth that seemed to whack the woman in the back of the head, judging by the way her hair kept flying up. She, however, didn’t move, just looked straight ahead.
He thought she might have been wearing scrubs but couldn’t place her as someone from the hospital. It’s hard to tell someone’s features when they’re crying, the thought occurred to him.
“I am so sorry!” The coffee-window attendant stuck her head out, looking apologetic. “We’re trying to get the steam wand to work.” He lowered his window halfway and looked at her. Something about the espresso machine’s boiler and getting the water temperature high enough to make steam to froth milk.
He took a deep inhale and looked at his watch again. He was by now on track to get an earful from his attending, who was already breathing down his neck about some due-diligence complaints he’d received from a couple of patients, and he probably should have just taken off and headed to the hospital to cut his losses. The struggling mom behind him was rocking back and forth as if she were trying to yank the steering wheel from its column. He decided to wait for his coffee.
His sister was about the same age as the woman in the car, also two kids—twins—three years old, and she’d get just as frustrated with their car-seat shenanigans as the mom behind him did. Except his sister had bigger problems.
She was currently dying. She was born with a congenital heart defect—hypoplastic left heart syndrome—where the left side of her heart was unable to supply enough blood to her body because the lower chamber was missing. That and malfunctioning aortic and mitral valves made it so that all the work of pumping blood to the lungs, et cetera, was up to the right side of her heart. Three surgeries within the first two years of her life had allowed her to grow up in relative normalcy and get by with regular medical checkups and medication, even if she couldn’t actively take part in the more strenuous adventures of childhood, like storming cardboard castles or running up hills at full charge with plastic swords drawn for hand-to-hand combat with other milk-toothed warriors. But as her big brother, he always made sure she didn’t miss out on too much, often carrying her on his back when she felt faint or dragging her around in one of those little pull-carts when longer distances made it difficult for her to keep up. “Thanks to you, I had a childhood,” she’d told him a couple of weeks ago when he called her for her birthday, an anniversary that was far from guaranteed. “You always had my back. And I know you’ll be there for the twins, in case…you know…”
That was the day before she collapsed and wouldn’t get back up; the day before she was helicoptered from their small town of Hazleton to the acute care unit at Penn Medicine in Philadelphia, where she moved up three levels in status on the national heart transplant waiting list. He’d stood beside his distraught mother by his sister’s bedside when the heart transplant coordinator came into the room and, with a news anchor’s sincerity, congratulated his sister on being a status level 1 patient and, as such, first in line for an available heart, adding the rather morbid footnote that without a transplant, she wasn’t expected to survive for much more than a month.
As a cardiologist-in-the-making, he could appreciate the coordinator’s candor. He knew that there was no guarantee for even that period of grace, but it wasn’t the right time and place, and of course his mother lost it completely once the punctilious messenger had left the room. “How could she say something like that?” She looked up at her son and started sobbing, pressing a wad of tissues into both of her eyes. He put his arm around her shoulder and looked down at his sister, who closed her eyes to rest.
She had been put on that national waiting list a couple of years earlier as a status level 4 patient, around the time she found out she was expecting. She was supposed to never become a mother, and when it became obvious that she was going to be, in her condition, she took the cannonade of criticism in stride. “Who knows how long I’ll have,” she controverted anyone who had something to say. “At least I’ll have experienced motherhood.” Even the twins’ father—an on-again/off-again boyfriend—was blindsided at the time, accusing her of lying about contraception, and decided to make “off-again” their permanent relationship status. Her longtime cardiologist put the odds to her as clearly as he could in a sincere effort to nudge her to the side of reason and life, likening her refusal to terminate the pregnancy to something akin to Russian roulette with only one empty chamber, warning that she was unlikely to leave the hospital alive if she took the pregnancy to full term. But neither the cardiologist’s stark prognosis nor genetic counseling she received from another specialist had the effect of dissuading her from having those kids. If they would inherit her condition, she argued, she’d help them deal with it, just as she had dealt with her own situation her entire life. As her brother he defended her against some of their more plainspoken friends who felt she was being selfish for setting her kids up like that; as a fledgling medical professional, he was mortified at the risk she was taking, but he also knew his sister and that there was no talking her out of it. She was going to be a mother, even if it killed her. For a lack of remaining viable options, and to give her and the twins a fighting chance, it was subsequently decided that labor be induced at thirty-seven weeks.
Fortunately, the twins’ hearts were fine. Hers continued to deteriorate.
As the babies nursed she began to suffer from perpetually swollen legs and feet and, on two occasions, had developed blood clots that, had they not been discovered, might easily have led to a pulmonary embolism or a stroke. Still, she put up a sanguine front: “What doesn’t kill me…” she refuted anyone who tried to tell her they’d told her so, medical degree or not. And while the incredible strain on her heart of giving birth to twins didn’t kill her, in a direct refutation of Nietzsche’s little nugget, it did leave her considerably weaker.
A heart transplant from a good match was her only chance to see her kids grow up. Her level 4 status meant that she was able to live at home while she waited for a transplant, functioning with the help of IV medications and other cardiac support measures. How long she would have to wait for a heart, no one could say. The saddest waiting list in the world, as she called it, had many names above hers at the time.
And now she was practically on life support, with a reverse clock ticking down from two weeks, give or take a few days. Would the twins grow up knowing their mom as barely more than the occasional flicker of a memory? Would they remember anything at all about her? And where would they go? His life was too busy, ongoing medical training would make it impossible for him to look after them; the kids’ father had been a no-show for the duration of their short lives, their handful of birthdays coming and going without as much as a card or a phone call. Mother wasn’t an option either; she was too anxious, lacked the emotional stability it would take. But where else? Obviously not a foster home. Not his sister’s kids.
He’d been aware of his sister’s condition since she was born, had always been told that she’d need his help growing up, and that as a big brother, he needed to take care of her. His favorite toy as a child was a detailed human heart model his mother had bought him; twenty-nine realistically detailed pieces he would constantly take apart and reassemble. By the time he was eight, he could name and point out every major component of the human heart—the superior and inferior venae cavae, the tricuspid valve, the pulmonary artery, the mitral valve, the aortic valve and aorta, and the right and left ventricles. And every time he assembled his five-inch plastic heart, he left a gap where the left ventricle should be. He’d leave that piece on the table. Wishing he could insert it into his sister’s heart to make her well.
He excelled in medical school and developed a solid reputation as a resident, commended by two different residency program directors for his demonstrated involvement and interest in research, but now he was dangerously close to some form of disciplinary action at work, having stretched his supervising physician’s patience to the limit. The whole situation with his sister, and the nagging concern about the twins’ fate, had been distracting, to say the least, and as a result he’d dropped the ball with a couple of patients. In one case he had failed to order a necessary laboratory test for a patient with an ovarian cyst, in another he failed to properly monitor a patient’s anticoagulation therapy.
“You realize,” his supervisor hissed at him, purple-faced one morning the previous week, yanking him by his coat sleeve into an unoccupied office, “that as your attending, I would automatically be named as a codefendant in a lawsuit brought against you for medical negligence? You do realize that, yes?” He nodded and thought of his sister’s worsening condition, which he knew his supervisor was aware of but knew also that it wouldn’t have mattered. “And you do realize too,” the supervisor continued, lowering his voice to almost a whisper and getting close to his face, “that if I don’t report you to the board for your bullshit misconduct…that I myself could be found guilty of misconduct?”
The conversation, if it could be called that, ended with the supervisor leaving the small office with the imperative to “get your goddamn shit together!” and that if he didn’t, he could forget about the cardiology fellowship into which he’d been accepted.
As for this morning’s scheduled meeting with the attending, he had an idea what it would be about. His mother had been calling him at work nonstop for the past two weeks about whether he’d heard anything, what the chances were that “today would be the day,” and whether he’d been keeping an eye on new patients at his hospital who might be in bad enough shape and a potential match for his sister. A couple of the nurses at the nurses’ station on his floor had complained about taking as many as fifteen calls a day from his mother whenever he was on shift. He couldn’t dispute it and the barrage didn’t even account for the calls his mother had been making directly to his mobile, most of which he declined on account that he was either with patients or in a meeting with his supervisor or in a huddle with the other residents on his team. She had also been making random calls to emergency rooms across the state of Pennsylvania, it turned out, pretending to be the concerned relative of an accident victim she’d learned about on the news and asking whoever answered the phone in the ER whether the patient would “make it.”
As he watched thick drops absorb smaller ones from the drizzle that collected on his windshield, he reflected on the call he’d had with his mother yesterday afternoon. “Mom, please listen to me!” he’d said, trying his best to not make her cry. “That is not how this entire process works, okay? You’ve got the completely wrong idea! I have no insight, none whatsoever, because it’ll all happen in real time, right as it unfolds. And I certainly have no way, no means, no possible influence at all to accelerate this whole process, to make anything happen, to get her a new heart. Do you get that, Mom? There’s simply nothing any of us can do but hope and wait and pray.”
She didn’t speak.
“Mom, you there?”
He heard her blow her nose, and she took a long moment before responding: “Can you remind me again, please? Remind me how it all works? So that I’m ready?”
He could tell she was trying her best to keep it together. He took a slow, deep breath and exhaled. “Remember, Mom, at Penn? At the hospital, what they told us? That when a heart becomes available, the transplant coordinator will know right away, and she will call you and give you a heads-up about potential next steps. So, Mom, you really need to stay off your phone so you can receive the call when it comes in or you might miss it. You don’t want that, do you, Mom?”
“No.” Her voice filtered through layers of tissue.
“And then the donor team will inspect the available heart to make sure it’s good enough for transplant and a good match, and then, if it is, they’ll prep for surgery. Okay?”
“Okay.”
“So, Mom, please, I’m asking you, I’m begging you, stay off the phone. Don’t call me at work unless there’s either really good news or really bad news, okay? I have to focus. I need to be able to function at work, Mom. It’s bad enough already what’s happening. Listen, I’ll call you in the evenings…I promise…when my shift is over, okay?”
“Okay. I won’t call,” she said, sniffling.
“Okay,” he said. “You know I would give her my own heart if I could.”
“I know,” she said. “I know.”
They said I love you and she hung up first.
A small concerto of dueling horns was sounding off more regularly now from various sections back in the drive-thru lane, and he’d likely have joined in if he wasn’t literally next to the checkout window and would have to look the cashier in the face once she reappeared. The young mom in his rearview mirror was back at it with her obstinate passenger, who appeared to be exploring the outer limits of her patience with the click-unclick game the mom was clearly losing. He wished he could tell her how lucky she was to be able see her kids grow up, and how lucky they were to have their mom in their lives, and that whatever she was stressing over right now paled in contrast to what some other people are going through.
He lowered his window and was about to knock on the checkout glass pane when the attendant swooshed it open and stuck her head out to announce the imminent delivery of his order, grinning from ear to ear. He heard the hissing of a steam-wand submerged in milk next to her and said, “Really, about time,” with an edge in his voice. The window barista retracted her head like a threatened tortoise and materialized moments later with outstretched arms, one hand wrapped around a weighty paper cup, the other open-palmed with loose change and a couple of small bills.
He took the drink with his right hand and with his other hand pressed a twenty-dollar bill into the clerk’s palm holding the change. “The woman behind me,” he told her, “give her anything she wants.”
“Ohh, that is just the kindest gesture,” the cashier cooed. She extended her neck out the window to look at the woman in the next car. “I love this kind of stuff!”
The doctor nodded and placed his full cup directly into the cup-holder, forgoing his usual morning ritual because he anticipated the light to the right just outside the drive-thru exit changing any second. As late as he was already, he was determined to make it across that intersection, no matter what.
He stepped on the gas to lunge toward the exit before it would be blocked by cars coming from the left and hit the brake just as he reached the end of the lane, when he looked down and saw that half of his cappuccino had splashed over the rim of the cup onto the middle console, running in foamy brown streaks down the left and right of it and onto the floor. The plastic lid of his cup hadn’t been pressed down and slid off the moment he’d accelerated away from the checkout window.
“Motherfucker,” he said as he looked down at the mess, grabbing for anything in his glove compartment that could soak up the liquid before it would permanently stain the fine leather wrapping the center console. A pair of gray sheep-wool mittens was all he could find, and he wiped left and right and all over as fast as he could to avoid damage to his car’s interior, all the while cursing the moon-faced idiot who handed him the coffee. If there was one thing he couldn’t abide, it was when people with simple jobs couldn’t even do those right.
“Unbelievable,” he kept saying as he wiped. “Unbelievable.”
What he didn’t see was that the young woman, with her two kids holding sticky donuts in their little hands with rainbow-colored sprinkles all over them, had by then pulled up right behind him at the drive-thru exit. She waved and she smiled and through her teeth she said, “Look up, already,” undoubtedly to express her gratitude for his kind gesture.
His head was still down, and her hands were still gesturing when she gave her horn a quick tap. Startled at the honk behind him, he cursed, dropped the coffee-stained mittens, and stepped hard on the gas while pulling, with a sharp right turn, into the lane that would lead him straight across the intersection and toward the hospital. His foot pressed all the way down on the pedal to the floor, and in spite of the light having already made the switch from yellow to red, the young doctor made his squealing tires shoot him into the intersection just as oncoming traffic from two directions threatened to scissor his car in half. He never took his foot off the gas, and he turned up the volume on Mozart’s Requiem as he launched into the crossing, the angry sequence of “Dies Irae” drowning out the chorus of angry horns that surrounded him.
Day of wrath, that day will dissolve our times in the hot ashes of the dead, the Latin chorus was singing at the top of its lung, and as if by divine intervention, the young doctor made it all the way across the indignant junction unscathed, heart beating strong, eyes straight ahead.
He never turned down the music, not until he’d inserted his magnetic card at the top of the hospital’s underground parking section that swallowed him before he could register the fleet of wailing sirens and spinning lights launching in the direction of where Queen’s Boulevard and Lancaster Avenue intersect just three minutes down the road, where the miracle happened.
By the time the young mom’s car was halfway across the intersection, she had already repaid the kindness to the doctor and his entire family, for the universe is indifferent to orders of magnitude.