Stone Heart | Judith Petry

The hospital takes on a peaceful quiet after dark, especially on Sundays. If it is one of the few times when there are no pending emergencies, it is possible to feel the sighing relief of the whole organism. A respite, of indeterminate length. As the first to be called for any surgical crisis, I had developed the ever-present knowing that seeps into one’s cells; an autonomic readiness, silently alert, to spring into action, no matter how exhausted or depleted I might be.  Sunday night tranquility floated on a sea of potential disaster.

One such night, after I had been in-house as the surgical intern on the Cardiothoracic team since Saturday morning, I was approaching the end of my to-do list. I prayed that I would be able to lie down, perhaps even sleep after finishing a few more tasks. As I longed for the blessed relief sleep would carry with it, I heard the crisp footsteps of my senior resident, Steve, approaching. My heart skipped a beat in anticipation of what brought him to the surgical floor when he was usually asleep by this hour.

With cultivated snide humor, he greeted me, “Glad to see you looking so well-rested and spry, Doctor Petry.”

My heart plummeted.

“You will be thrilled to know that you will be scrubbing with Doctor Damon on a coronary bypass tomorrow morning. The patient awaits you in Room 347.”  He went on to explain that the patient had unstable angina, a nearly constant chest pain warning of an incipient heart attack. His surgery, scheduled for 8 a.m. would bypass areas of clogged arteries supplying blood to his heart.  Steve turned to leave, looking back briefly to warn me, “Do not miss anything, the boss would not be pleased.” And he was gone.

His final admonition provoked a cold shiver down my spine. My relationship with the boss, Dr. Damon, was not a friendly one.  He had arrived as the Chief of the CT Service a few days after I started my internship rotation with that team. I had met Dr. Damon and the Chief Resident Jim in the hall on his first day here. Jim, a beautiful blue-eyed young man who always looked like he had just rolled out of bed, introduced me to Dr. Damon as the intern on the team. The new chief whose strong, solid build, dark hair and stern poker-face reminded me of my father, maintained an energy about him that inspired fear. Always intimidated by authority figures, I probably looked at him like a frightened mouse caught in the stare of a large and menacing feline. 

He looked at me with a scowl. “Hello,” he said dismissively as he turned toward Jim. I continued down the hallway and heard him, as I was sure I was meant to ask in a stage whisper, “You mean there’s a woman on my service?”

They were walking away as Jim answered him, so I did not know if he defended my presence or not. It was an inauspicious beginning and did not improve as time passed. It was 1971 and I was the only female surgical trainee in the program and had come to understand how intolerable my presence was to many members of the white male surgical establishment. Dr. Damon was just one example of the prejudice I had encountered. It was, I sometimes believed, my naiveté that had allowed me to press ahead with my dream of becoming a surgeon. Had I known the animosity I would be exposed to simply because of my gender, I might have had second thoughts about my career choice.

I picked up the new patient’s chart. It was blank, but the medical record that came with it was dog-eared and two inches thick. It would take me half an hour just to go through the past admissions. I sat in the deserted nurse’s station and began the task of finding out what had happened to this patient to bring him to this night, in this place, under my care.

“Father Quinn suffers from severe coronary artery disease,” the first sentence of my new patient’s previous admission began. My breath caught in my throat. I felt a wave of nausea. What?! I thought. A priest? Steve had neglected to mention this detail. Here was the first member of the clergy I had had as a patient. Having grown up Catholic, I was daunted by the prospect of performing a physical exam on a priest. I had always been in awe of the ministry. As stand-ins for God, they still made me feel like a small child positioned before an all-powerful Deity, wondering how to behave. Thinking of a priest as a patient seemed impossible to me. How could I, a mere mortal, ask God to take off His clothes so I could examine Him?

I remain surprised by the distress I felt then as a nascent surgeon and confirmed student of science. The effects of my Roman Catholic upbringing were more ingrained in my core than I realized. My experience in Sunday school had been with an authoritarian, humorless, frightening, white-haired pastor, Father Delaney. His chiseled unsmiling face, upright posture and resonant reverberating voice were enough to strike terror into the heart of any child sitting in the pews on Sunday morning. Despite this, I felt safe and calm in church. It was a refuge, a sacrosanct asylum where I was in awe of the pervasive peaceful beauty. It made me feel held, connected to something familiar yet mysterious, a gateway into a world of spirit.

Although my love for churches and especially old cathedrals fills me still, I have long since left the Church, unable to tolerate the hierarchy and the need for blind acquiescence to Church male authority. The irony of trading Church patriarchy for the surgical version of the same imbalance is not lost on me.

 ***

It was with trepidation born of many sources that I approached Father Quinn’s room.

I knocked on the door of room 347 and took a breath.

 “Come in,” a deep voice invited. The large room was minimized by the pervasive presence of the white-haired man who sat in a chair next to the bed, partially concealed by a curtain. I introduced myself as I entered the dimly lit room and noticed the solemn quiet infusing the space as I closed the door behind me. 

My patient put down the Bible he had been holding, tried to stand, winced with pain, stopped half-standing, took a breath, and came to his full height.  He was a very large man, stocky, in good shape. Not what I had expected given his cardiac history and age of sixty-eight. His round Irish face, ruddy complexion, and bright blue eyes brought James Joyce to mind.  Despite the hospital gown, his presence evoked a combination of authority and kindness.

 He offered his large hand, and I shook it. His handshake was warm and assuring. He winced and sat down quickly but gracefully. I asked if he was having pain. He said, “No more than usual,” smiling apologetically as his eyes met mine.

Father Quinn did not look at me. He saw directly into my center. I was acutely aware of his ability to perceive me, to recognize the essence of my Self. It defined for me the meaning of namaste. He could see the divine in me and I in him. Our hearts were joined in a way I had never experienced. I felt the aching pain in his damaged heart seeping into my own, as if I could neutralize it by the sharing. At the same time, he transmitted a sincere concern for me. We were enfolded in a sacred space.

I have never before or since experienced a spiritual union with another human in such depth. At the time, the exhaustion that saturated my body and mind prevented a realization of the profound bond that existed between us in that instant. I know now how momentous it was, how penetrating was the awareness it unleashed in my soul, the comprehension of the unity of all that is. The ripple effect of that moment continues to this day.

On that day, when the connection broke I was overwhelmed by something I did not understand. Disoriented, I felt as if my boundaries had dissolved. I needed a moment to reconstruct them. Startled and a little frightened, I wondered if he had this effect on others. Regaining my composure, remembering my task, I returned to my doctor reality and told him that I needed to ask him some questions and examine him to get him ready for surgery.

As he answered my questions I began to know a man who had been in pain for years. He had allowed himself to be admitted to the hospital for tests and to modify his drug treatment only when it was clear to everyone that he could no longer function. Each time, he had gone back to his work in the Church. He spoke of his vocation with such reverence and gratitude that I felt a kinship with him.

“I have never wanted to do anything in my life except serve God and His children to the best of my ability. This heart of mine does not always agree with my intentions. Doctor Damon tells me it is time to come to a truce with my body.”  There were no longer other choices for him. It was surgery or cease his work in the Church. He had agreed to the surgery. 

As we talked, he repeatedly made oblique references to dying. I diverted them all. I simply could not include his death as a possible outcome of the next morning’s surgery. I realize now that if I had been at another place in my own spiritual development, I might have engaged him in what he really wanted to talk about - his own mortality. At the time, I had no idea how to broach that subject with self, let alone with him.

Satisfied I had not missed any important information, I asked him to lie on the bed so I could examine him. By then I felt almost comfortable with this man. He was kind, solicitous, and cooperative, despite the nearly continuous crying out from his oxygen deprived heart that caused such pain he seemed to disappear into it. The muscle fibers gasping for air as a slow and grossly inadequate trickle of oxygenated blood barely kept them alive, a longstanding drought in the parched riverbed of his most vital organ.

I listened to that heart with my stethoscope. It sounded strong and even, with only an occasional extra beat. I was in awe of the miracle of the human body, especially the heart that seemed to me to be the most impossible organ to have come from any creative source.  Its structural, dynamic, electrical aspects perfect for their continuous lifelong function of connecting the cells of the entire body with the nourishing, cleansing, miracle of blood. I was sure it was the home of the soul, directly connected to the sacred.

There were no surprises in the rest of my examination of him; his body was in remarkably good shape – except for that failing heart.

My final task was to explain the surgery to Father Quinn and witness his signature on the operative consent form. I described what would be done to him tomorrow. That he would be put under anesthesia, and a machine would breathe for him. Another machine would circulate his blood while his heart was stopped and packed with ice so Dr. Damon could replace the diseased arteries with veins taken from his legs. When the procedure was complete, his heart would be restarted with an electric shock, and the wound in his chest closed. 

I described how he would wake up with a breathing tube in his throat, and that there would be tubes in his chest to drain blood and fluid, and a tube in his stomach to drain gastric fluid, and a tube in his bladder to drain urine, and IV’s in his arms and another cannula in his wrist to measure blood oxygen. He seemed to understand. I told him what the possible complications were, and ended with the required admonition, “Do you understand that you could die from the surgery?” He looked at me with soft, kind eyes, as if to reassure me.

“I’m ready,” he said. I felt a sob rise in my chest at the finality and acceptance in his words, coughing to disguise my weakness. He signed the form as I asked his God to protect him from harm.  I closed the door softly as I left him to his thoughts.

He had opened his Bible again as soon as I said, “good night.” God was the only one willing to engage him in his conversation about death.

Walking back to the nurse’s station, bewildered by what had happened in Room 347, I was acutely aware of the still, quiet hallway, the dimness of the light, and felt as if I were in a cathedral, not a hospital.

The next time I saw Father Quinn he was going under anesthesia the following morning. Once again, he looked fully at me and I was stunned by the intensity of that gaze, as if he were seeing one last image before death stole his sight. I banished the thought.

Bracing myself for the case with Dr. Damon, I felt I had reached an inner truce with him, I was able to acknowledge respect for him as a teacher, and certainly as a capable surgeon. I still resented his arrogance and unmasked misogyny but begrudgingly admitted to myself that I was glad he was the surgeon operating on Father Quinn.

The surgery proceeded in a routine manner, though I sensed an uncharacteristic level of stress in Dr. Damon and the anesthesiologist. I assumed it was warranted by the degree of Father Quinn’s heart disease. They did not often operate on people who were in constant pain. I assisted Jim with the vein harvesting from the leg and didn’t get a look at Father Quinn’s heart until we were ready to put him on bypass. We had carefully wrapped the leg veins which would be the new lifelines for his heart in moist gauze and handed them to the scrub nurse for safekeeping. 

Jim and I took our positions back at the chest incision. There was Father Quinn’s heart, exposed, beating, but looking very pale and sickly. Much of the heart muscle looked stiff and scarred even to the naked eye. I wondered how many heart attacks he had suffered to result in so much damaged heart muscle. A hollow sensation filled my gut. Feeling so close to him in the brief time I had known him made me afraid for this clearly unhealthy organ upon which his life depended. 

Dr. Damon began the bypass countdown, speaking each step clearly and loudly so everyone in the room was on the same page. Gerry, the perfusionist who managed the heart-lung machine, repeated each step as it was completed until the last switch was pressed and Father Quinn’s life was transferred temporarily to the bypass machine.

“Aortic cannula.”

“Aortic cannula, check.”

“Vena Cava cannula.”

“Vena cava cannula, check.”  Each of the dozen steps in the process carefully performed, checked, and rechecked.

The team watched as the tubing to and from the machine gradually changed from clear fluid to red blood. The comforting hum that accompanied its remarkable task became the background music for the procedure, each team member aware of any change in rhythm. 

Dr. Damon gently lifted the heart and turned it slightly to visualize each of its major feeding blood vessels. He pointed out the areas of blockage, “The origin of his pain,” he stated with his usual paucity of words. There didn’t seem to be any open arteries. What had kept this heart pumping?

The procedure from then on was routine. The vein grafts were meticulously connected with tiny stitches to the beginning of each of the blocked arteries, trimmed to fit the length of the area to be bypassed, and sewn in place beyond the obstruction. There were no new revelations, though each time the damaged arteries were opened to receive the vein graft, I took anxious note of the cement-like walls of what should have been rubbery pliable conduits for blood. As Dr. Damon finished the last anastomosis of vein graft to artery, he signaled Gerry to get ready to come off bypass.

The process was reversed step by step and as the last move was made, there was a collective breath holding by the team while Dr. Damon shocked the heart and watched for signs of activity in the muscle.

The heart did not move.

Dr. Damon put his hand on the immobile organ and looked at Jim with defeat and resignation, as if he secretly knew this would be the outcome. I didn’t understand what was happening. With a sigh of futility, Dr. Damon signaled that he would reshock the heart. Everyone stood back slightly as he placed the paddles and Gerry sent the electrical impulse that should restart Father Quinn’s heart.

Nothing. 

He went through the process of sequentially increasing the amount of electricity delivered to the heart as the anesthesiologist administered heart stimulating drugs. I recognized the underlying hopelessness of it all but remained confused. I had seen this sequence of events before, and eventually there was always a response from the heart, either ventricular fibrillation, a disorganized firing of individual muscle fibers that would respond to drugs and shocking, or an organized sinus rhythm that resulted in a sigh of relief as the refurbished heart took over its job. Father Quinn’s heart did neither. Panic overtook my body. I looked at Jim.

He saw my bewilderment and said quietly, “Stone heart.” 

Dr. Damon took my right hand and placed it on Father Quinn’s heart. “Feel this,” he said with surprising gentleness.

 The heart under my fingers felt like stone. The consistency was so foreign to what I expected that I whisked my hand away in horror. “What..?” I looked at Jim. 

His blue eyes regarded me sadly over his mask. “It’s called stone heart. Rare, but when it happens, there isn’t anything we can do about it. It doesn’t recover.”

 Stunned, I stood in a daze, staring at Father Quinn’s petrified heart. The scrub nurse nudged me gently aside and I realized my shock at what had happened had caused time to stop for me. During my trance Dr. Damon had left the room and Jim was on the phone outside the OR door.  

“What now?” I asked the nurse.

“Jim is calling the medical examiner’s office. When someone dies on the table they must be notified and then decide if they want to examine the scene. We can’t touch anything until they make that decision. It’s like a crime scene. You should go now. I’ll stay with him.”

I walked stiffly to the scrub room door, looking back as I opened it. I could see Father

Quinn’s white hair, the anesthesia machine still attached to his face, shut down and quiet. There was blood on the OR drapes and the huge retractor that kept his chest cavity open was still in place. The perfusion machine was off. The only sound was of the door opening as I left. 

Father Quinn was gone.

Sadness slowly replaced my shock at what had happened. I understood more than with any other patient the profound importance of what had been lost in that room. A persistent tugging at my body threatened to draw me back into the OR where Father Quinn had so recently vacated his body. Frightened by the intensity of the connection that had formed in my soul, I forcefully wrenched my awareness back to my rational mind and found my way to the surgical library to look up stone heart before I headed for the ward to finish my work for the day.

“Stone heart is a term indicating massive contraction band necrosis in an irreversibly noncompliant hypertrophied heart, occurring as a complication of cardiac surgery; believed due to low levels of ATP and to calcium overload.” 

 ***

A massive irreversible muscular contraction that turned his heart to stone.

Father Quinn was the first OR death of my young surgical career. The strength of my brief union with him which had touched so closely my relationship with the sacred, and the unexpectedness of his death, struck like an arrow through my heart. I had no experience in how to deal with the overwhelming feeling of loss. It did not occur to me then that death had never been talked about in medical school or in residency except to point out that someone had failed if a patient died while in our care.

The dichotomy of being presented on the first day of medical school with a cadaver for dissection, and the deliberate absence of any mention of death other than that which must be fought against, took all these years for me to recognize. Confronted with death repeatedly in my medical school years and the interminable torture of residency, it seems now impossible that no one ever talked about what death was, what it meant, how to deal with it, or even that it must be acknowledged at all. I remember only that when the code blue was over, when the resuscitation effort had failed and the patient had died, that we walked away and went on to the next task. There was no reflection on the significance of the event.  Rather, we talked about which of us would do the paperwork, make the calls to families, and present the case to Morbidity and Mortality conference.

These were the important things. Not who had ceased to exist in the physical world, what ramifications that had for friends, relatives, community. Not where that soul had gone, or what it had accomplished while in that body. No sense of meaning in the event. It was an end. One of which we were not proud. One that required examination and analysis so we could prevent it from happening again.

The atmosphere when a person had recently died, as in Father Quinn’s case, was one of failure. There was an enveloping stillness, a sense of something undefined. It made me want to flee. It never occurred to me that a soul was hovering nearby watching me. Perhaps that was the discomfort I felt, being observed by someone I negated. Part of my unease was knowing that I had no instruction in how to behave, but I did not need any. My lack of training was the training. I was taught to ignore the importance of the moment, of the event, of the process; schooled by omission that all that was required was a rote process of confirmation that the body had died. The implicit ignoring of the soul that was leaving this dimension was eloquently unstated.

The importance of Father Quinn’s death has stayed with me for fifty years. The sacredness of his life, my intense connection with him, and the impossible outcome of his surgery left me with a sense of inadequacy around the dying that was never addressed in my training, or afterwards. On that day, I knew in my heart that I needed to stay with his body. I could feel the nearly physical pull to do so, to hold the sanctity of his life in my heart while I sat with him and sent him on his way with loving companionship to meet his God. My failure was not that he died, but that I did not acknowledge the significance of that passing.

---

Judith Petry has been writing since childhood. She is in love with words, with their power to evoke universal feelings in readers. Her retirement from the practice of Plastic Surgery allowed her to explore the possibilities that language presents as a way to meet the minds and souls of the reader and to move them to think, to question, to delve into their own humanity and their own spirit. 

1970s misogyny, the male-dominated profession of surgery, and a naïve trust that she could fulfill her dream of becoming a surgeon set the scene for Dr. Petry’s surgical residency. In “Stone Heart”, her encounter with a priest and his failing heart, sears into her soul the reality that death follows the surgeon as a shadow on a sunny day, a presence she is taught to abhor, avoid, negate by any means possible rather than accept as an inevitable companion.

Her as yet unpublished memoir “Gowned and Gloved" was listed as a semi-finalist in the William Faulkner / William Wisdom Creative Writing Contest in 2021. her short story "The Kitchen Spider" was published in HerStry on-line 4/24/2020. Multiple essays and letters were published over the last 20 years in The Brattleboro Reformer, and a piece in The Boston Globe Magazine many years ago. Her essay "Real Doctors Don't Cry" was published in Holistic Medicine Fall 1998:11, 25. and in Network 1999 April;69:18. "Crying Over Spilled Peas" was published in Beyond Words Literary Magazine April 2022 (Issue 25). Her short story “Baby Boy Brown” was published in Freshwater Literary Magazine 2023, p.96.

She resides on a hilltop in Vermont with her husband, two llamas, and a formerly feral cat.