Heart transplant donor heart delivery goes terribly astray, when the paramedic van driver sees his girlfriend with another.
Lub Dub is several love stories all wrapped up like a Valentine into one long, frantic chase scene: a job love story, a misunderstood homosexual love story, a spiritual brotherly love story, a patriotic love story, and above all, a romantic love story. They erupt into jarring chaos with a heart donor delivery to a transplant center. The mission almost immediately goes disastrously awry, when on route Daniel, the delivery driver, spots his girlfriend Vickie, a brilliant university student, in the arms of another.
Unable to resist, he follows her in his paramedic van through a succession of comic episodes until he loses the heart to an anti-transplantation Shinto priest and finds his delivery mission, his job, his lovelife and his sanity in total collapse. The chaos he causes results in several broken hearts in addition to the damaged donor organ nobody can seem to keep possession of for long. It is Vickie, whose smarts he berates throughout, who saves the day and restores their relationship with a single, magnificent stroke of genius.
As he washed his hands and forearms at the operating room basin, Dr. Nestor Lehman’s eyes watered mysteriously and his sight blurred, not a good sign for a surgeon about to remove a human heart.
If there is one process in medical science that requires absolute precision and efficiency, it is the surgical removal of a human organ and the transplantation of that organ into another human being. Anything less than diamond-cutter exactness, and the organ could become no more valuable than a dog bone.
On the operating room table of the Abington University Hospital was a recently-deceased man covered in a hospital gown from abdomen to feet. His body bore no ID tags dangling from wrist or foot, because technically he still had functioning organs, which kept his body at least partially alive. He looked about thirty-five. He was a light-skinned Japanese man, lean and muscular. He was dead because five minutes earlier, the cardiovascular surgeon, Dr. Lehman, his assisting surgeon, Rajal Loos, and a tough, intense twenty-six year old cardiologist (the youngest ever to work at the hospital) named Paul Deiner, pronounced him dead. This government-certified team had determined that the young accident victim had sustained intracerebral hemorrhaging brought on by the victim flying off his motorcycle cartoon-like into a long, headlong slide across the asphalt, sheering the plastic brim of his helmet and driving his naked head into a lamppost.
Deep purple gashes from the accident were still evident on the victim’s shoulders, right cheek and forehead. But no one bothered to do much more than clean them with an antiseptic and ignore them. Bandaging was cursory but taut wrappings about each wound to staunch any further blood loss.
His heart was another story. Its muscles were still sparking and it was still capable of pumping out life. But the dead man’s precious cardiovascular system now flowed through a heart-lung machine, a medical appliance hooked up to the victim by tubes in and out of a large locust leaf-shaped incursion cut by the surgeon into the victim’s flesh from his sternum to his mid-abdomen. A set of steel retractors kept the cavity open, giving access to the man’s manifold heart-lung infrastructure. The ventilator machine kept the victim’s heart and lungs and related systems vital by serving as a by-pass providing oxygen to the victim’s blood and removing carbon dioxide, while the heart was being prepared for extraction.
Brain death for the man had been tentatively diagnosed hours earlier by the organ extraction team. That was at 3 AM in the hospital’s large operating room. But it was only minutes ago at 5 AM that the team decided all corroborating evidence was in, and it confirmed the accuracy of the original prognosis: no electrical activity in the brain, and, even more telling, the victim responded to no pain stimulus anywhere on his body. Dr. Lehman’s circulating nurse, a veteran of such procedures with feathery agility around the instrument table, had also kept a close watch on the victim’s pupils. They remained lifeless.
Now it was time for step two, the extraction. The extraction was done with a fastidious, rhythmical and practiced routine, so not a word need be spoken. The circulating nurse readied the instrument table, and a solemn quiet among the others made the whole endeavor seem primitively sacred in some way. The four-person team, wearing surgical masks, caps, gloves and gowns were now ready to cut into the heart’s pericardium, its membranous under-sheath that protects it from infection.
The clock on the wall read 5:10 AM. Rajal, a slight, dark-skinned East Indian man with narrow shoulders and deep-set obsidian eyes, and the circulating nurse, watched for Dr. Lehman’s nod to begin. When Dr. Lehman looked up at the wall clock again, it read 5:15 and he nodded to everyone that it was time to harvest the organ. Paul took note of the time, marked it on his clipboard, then dialed final details on the heart-lung machine. He turned in a tight circle and returned alongside Dr. Lehman and, with the circumspection of a casino pit boss, watched every move as the surgery began. The circulating nurse raised a scalpel to eye level for Dr. Lehman, a tall hefty, white-haired man of sixty-two. The chief surgeon took the instrument in hand and lowered it into the chest cavity running a sleek, delicate t-cut across the pericardium. Just as he was about to separate the membranous flaps, Dr. Lehman's watery eyes began to get worse, flaring up with tears. It felt to him as though he was about to cry like a baby.
The circulating nurse noted his sniffling and discomfort and lifted Dr. Lehman’s surgical mask, again without a word, to daub his nose with a tissue. She then replaced his mask over his mouth and nose. Dr. Lehman and Rajal then tried to go back to work. But again, Dr. Lehman had to stop his effort abruptly. He’d been caught in a sudden nasal spasm and he sneezed into the space under his arm, his lumpy upper shoulders rocking back from the surprise. “Damn it!” he yelled, removed his mask again and shuffled to a steel counter for a tissue from a dispenser-box. He blew his nose with a force that might have rattled a window, had there been one in the operating room. Paul was checking to see if the original sneeze had in any way despoiled the heart. He sprayed the thoracic incision with cold saline and daubed it with a sterile cloth, while he waited for Dr. Lehman to return.
Dr. Lehman washed his hands at the steel basin and took a deep trial inhale through his mouth and nose. He seemed okay. He returned to the business at hand and readied himself to begin once again. But before he could raise his mask over his mouth and nose, he sneezed again, and this time directly into the face of the dead man. While the dead man accepted the sneeze without an appeal, the nurse came quickly, if not purposelessly, to wipe the sneeze from the victim’s stone-still expression.
“Forget him!” Dr. Lehman yelled at her. “Does he look like he’s worried about getting a cold? Get me another tissue!”
Teetering on panic, the nurse rushed to Dr. Lehman with a fresh tissue and surgical mask. Dr. Lehman snuggled into his new mask, as she returned to the instrument table and readied a scalpel for the third time. Dr. Lehman reached for the scalpel and the team regrouped. But for a third time, Dr. Lehman sneezed uncontrollably. “Goddamn it!” He barked and flung the scalpel across the room. It bounced about the solemn chamber with a profane clatter. The nurse served up yet another tissue like a magician might conjure a coin from thin air.
“He's wearing something. Did you wash him down!?”
“Yes Doctor,” the nurse replied.
“Well, wash him down again. It’s a cologne or something? It’s making me sick!”
“It’s not a cologne!” That was Rajal.
“A mosquito spray? What is it?”
“He apparently had sex just before the accident,” Rajal said, bowing apologetically to be delivering such a message.
“Well, I think--his body was covered with an edible body cream. I think it’s called Cannoli.”
“One of those sex creams.”
“How do you know this?”
“Well, I don’t know it for sure.” Rajal said, preferring to appear intuitive. “It’s just a guess. I believe it might be that new fat substitute in it. And some are allergic. But again, it’s just a guess.”
“Okay,” Dr. Lehman said, the last syllable pleadingly long and anguished. “Wash the man down again and get it off!”
“It can be hard to wash out,” Rajal advised the nurse. “Sometimes it takes two showers… I mean two washings to get it off.”
“Use Mr. Clean if you have to!” That was Paul Deiner, the cardiologist, now venting his own impatience.
Doctor, we don’t wash bodies down with Mr. Clean.”
“The man’s dead!” Paul scoffed, “You can wash him down with hydrochloric acid! Now, do what you have to do, but we don’t want to smell Cannoli anywhere in this hospital! Got it? I have to deliver this damn thing. I’m going to look like a fool, if this heart is contaminated with strep!?”
“Yes, Doctor,” the nurse whimpered and moved off to find another cleansing lotion.
Paul, who assumed authority even when it was his to assume and was often despised for it, blew another command into her face. “And get Dr. Lehman an antihistamine.”
“I don’t know about the antihistamines.” Dr. Lehman said. “They make me sleepy. I don’t want to be nodding off with a scalpel--”
“Forget the antihistamines.” Paul interrupted, “I’d rather chance the strep than have my heart filleted.”
Dutifully but with admirable poise, the circulating nurse circulated with great rapidity, first to a cabinet with cleaning fluids where she grabbed a small spray container, then back to the operating table with a wet towel where she began spraying and washing the dead man down again.
“I’d especially wash the rear groin area again,” Rajal said bashfully. “And… uh… some people like to use it on their toes,” he added, his eyes darting about like fleeing fish.
The nurse tucked her arms under the victim’s gown and washed away vigorously at his groin and working down the legs to his toes. Dr. Lehman found a spot at the angle of the OR walls where he could lean comfortably and observe. Both his fists were stuffed with tissues in case of another attack.
When the nurse had finished, she rushed back to the instrument table and placed herself solicitously at its side, waiting for a nod from Dr. Lehman and Paul Deiner that they were ready once again. Dr. Lehman stepped imperially out from the corner and again drew air into his nose as a trial. He found himself free of irritation and stepped cautiously back to the operating table. At his little forgiving nod to the nurse, she raised a new scalpel again and Dr. Lehman took it, felt its fine balance in his hands and lowered it into the body’s chest cavity to begin the incisions to remove the heart.
Motion from the team accounted for the only sounds, until minutes later when Paul spoke. “Rajal. How many flavors does that cream come in?”
“More clips, nurse, please,” Rajal said, so he didn’t have to answer. And more clips to clamp Dr. Lehman’s incisions were delivered without a beat lost. After a nervous little reservation, Rajal said, without looking up, “Three. My wife likes the strawberry.”