I am a man of science. Reason. Logic. He told me I would never find the answers I sought in books, or in the deepest pools of human knowledge. The answer was within him, he claimed, tapping his chest where his heart was.
I started to argue, but reconsidered. Research indicated that the religious lived several years longer than atheists; then again I'd heard similar results from German men who spent ten or more minutes a day staring at women's breasts. I'd also heard a recent study claiming patients who were being praying for fared worse than those who were not.
Nevertheless, I invited him to continue the discussion over a drink, which I drugged. After he had fallen asleep I started an IV, inserted a Swan-Ganz catheter into his jugular vein, and threaded it into his pulmonary artery. Next I inserted an endotracheal tube into his windpipe. I also inserted a urinary catheter attached to a collection bag to monitor his output.
Next I made an incision from the top of the sternum to the bottom, and cracked his breastbone. Then I used a retractor to pull his ribs open, exposing the anterior mediastinum and pericardium. I opened the pericardium to reveal the heart.
I began a field aspiration. The blood trickled through a defoaming chamber containing a sponge impregnated with a substance that lowered surface tension, and into a hard plastic cardiotomy reservoir. To limit the incidence of hemolysis, particulate and gaseous microembuli, fat globule formulation, cellular aggregation or platelet injury I planned to store the blood rather than feed it immediately into the Cardiopulmonary Bypass Machine.
I primed the PVC tubing of the CBM with an electrolyte solution. Then I inserted a cannula into the superior and inferior vena cavae to pump blood through the CBM. I inserted a third cannula in the ascending aorta for the return of blood to the body. I added the anticoagulant Heparin to his IV.
I attached a heat exchanger to the CBM, which began lowering his core body temperature to 28° C from 32; for every 1 degree difference, his body’s metabolic demands decreased by 7%, reducing the risk of ischemic damage. I clamped the vena cavae, followed by the aorta; cut off from the blood supply, the myocardia is now ischemic.
I infused the aortic root with a cold cardioplegic solution under pressure. The high level of potassium in the solution caused asystole, and the combination of the hypothermia and lack of movement protect against ischemia. Finally, iced normal saline was placed on the heart to ensure hypothermia.
I detached the pulmonary arteries and veins, careful not to sever the vagus nerve running posterior to these. Next I cut the aorta and the pulmonary trunk and cut the left atrium to leave a seat for the new heart. The donor heart came from a man down the street. He occasionally attended church, particularly around holidays. Last week had been Easter Sunday, and he offered to give one of the children a ride home. They stopped at his duplex, for his medicine and some candy.
I trimmed the incision in the left atrium to match the seat, and placed the heart in his chest. One at a time I reattached the blood vessels, and sewed them up neatly. When this was done the heat exchanger was switched in the reverse, and I unclamped the aorta and vena cavae. I closed the pericardium, and eased the ribs into place. Then I sewed up the incision. In the morning I would dump him in the park, and call an ambulance, but for now there was the matter at hand.
Cursory examination revealed hard plaque deposits in the inferior vena cavae. There is some scarring from an AV nodal ablation, indicating that he suffered from a minor atrial fluctuation. I made the first incision along the right ventricle, revealing the tricuspid valve, and the right ventricular outflow, which includes the pulmonary valve. Following this was a second incision from the pulmonary trunk along the interventricular septum, then along the inferior margin of the heart. I pulled back the myocardium to examine the tricuspid valve and the chorda tendinae. On the left I cut from the aorta to the apex of the heart, and just superior to the atrioventricular sulcus.
There were various amounts of hardening in both ventricles, and the right atrium. I found a ventricular septal defect, a hole between the lower chambers of the heart, not much more than a pinprick, like a vestigial piercing hole. While there was romantic notion that Christ had penetrated into his heart, there was no scar tissue around the hole, indicating it was congenital.
The atrial tissue was thicker than usual, but not exceptionally so. The left atrium appeared clear, but closer examination revealed a myxoma on the atrial septum. I biopsied the tumor; I decided to search for the diuretic hormone Atrial Natriuretic Peptide at the same time. The hormone helps regulate blood pressure, and kept the heart healthier, which may have explained the devout's longevity.
Samples from the heart were fixed and processed for paraffin embedding, and slices were cut away from this. I used the Avidin biotin complex immunoperoxidase method to locate ANP immuno-positive cells; to check for metastasis I soaked cells in the blue hematoxylin to highlight the acids in DNA and RNA, and a red eosin to stain basic components of the cell. I examined the samples under a microscope. The cell nuclei appeared normal, making the likelihood of the tumor being cancerous small. If this was the seat of God, then God was dead, and as amusing as applying Nietzsche to the situation might have been, I knew it wasn’t an answer.
As a supplement to the ANP slides I attempted a radioimmunoassay. I injected marked ANP and blood from the patient into a cell solution, and found high competition for cellular binding sites, indicating an elevated instance of ANP. Profusion of this hormone could indicate high blood pressure, or diabetes, but the level was inconclusive. There was slight myocarditis, but this could easily be a symptom of the underlying myxoma.
Cardiac enzyme tests revealed a slight rise in troponin and creatine phosphokinase levels. However, increased levels of these two enzymes can result from injury to various body tissues, so it is inconclusive whether or not the heart had in the last six days been in a state of arrest, or if he had sustained some other injury recently.
Two days later I visited him in the hospital. He was already telling wild tales about organ harvesting, He was relating how he violently defeated his attackers when he smiled, and ask me how my quest had gone. I sighed, and wiped my brow. His eyebrows dropped, and he told me that all the answers were there, in his breast. When medical examination had failed to lead to a conclusion, I had in a moment of rashness taken a bite from his right ventricle. I chewed the tough meat and fought the urge to regurgitate, forcing it down. Not surprisingly, this desperate, unorthodox method did not add to my knowledge, but only gave me digestive problems. I told him that I had tried; I had looked for Jesus but could not find him, no matter where I looked.