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A short story by Oskar Magnusson published in Best of European Fiction in 2014.
Guðjón was the first doctor in the long line of doctors who took control of Ófeigur’s life and the increasing number of afflictions associated with it. Guðjón was the doctor at the health clinic in the village, a highly educated surgeon who had seen more than his share of blood and operating theaters. Consequently, he was the only health clinician in that part of the countryside and he dutifully attended to all its good, clean country folk. It wasn’t difficult to get an appointment with Guðjón; all anyone had to do was show up at the clinic and wait a bit. Which is how Ófeigur came to sit with the doctor a half hour after his incident:
“I was having a conversation with the mayor in his office when an odd sluggishness came over me and I just sat there in a daze. It didn’t last very long, maybe one or two minutes. I toughed it out and I don’t think the mayor ever noticed that anything was wrong,” said Ófeigur. Doctor Guðjón asked him to disrobe. The first parts of the examination seemed innocent enough. He put his stethoscope to his heart and then his back. Checked both eyes; for color blindness too. Took his blood pressure. “Please say the words, ‘blood pressure monitor.’” Ófeigur pronounced the words quickly and clearly. Everything appeared to be normal and they went into the adjacent room to do an EKG. Everything was still fine.
“TIA,” said Guðjón. “Oh, certainly, I’d love some tea,” said Ófeigur, who was raised to never admit that he was confused, and always look as though he was in control. “Perhaps something herbal—we wouldn’t want any heart palpitations!” “Transient Ischemic Attack,” said the doctor, ignoring Ófeigur’s attempt at wit. “A momentary hypoxia, I think that’s most likely.” Doctor Guðjón didn’t think he could do anything else for his patient and recommended that Ófeigur travel to Reykjavik for a complete cardiac workup. He would make a few calls and get the process going. It sounded simple enough when the doctor was talking about it, but the next day things had already begun to snowball. Ófeigur’s phone rang: “I’m calling on behalf of cardiologist Þorbjörn Guðmundsson. You have an appointment on Thursday at nine o’clock.” The woman on the phone went on and offered three other possible dates, should this one be unacceptable, and also mentioned something about several necessary tests. There was no indication in her voice that she considered any of this negotiable as far as Ófeigur was concerned—after all, she worked for one of the country’s most famous cardiologists, whose calendar was booked up a year in advance. Ófeigur took the first date offered. He didn’t have the nerve to ask any questions. He’d learn more soon enough, he figured. “Our Guðjón has some pull in Reykjavik!” Ófeigur thought warmly. “He’s already set things in motion. Not your run-of-the-mill country doctor at all.”
Over the following weeks and months, Ófeigur found himself in the hands of various specialists in the capital city while under the care of Doctor Þorbjörn. He quickly lost track of all the tests he was subjected to; it boiled down to vivid memories of pedaling an exercise bike, half-naked, and jumping rope until he thought he would collapse. He went for X-rays as well as ultrasound and blood tests. EKGs were done after each stress test, and he became quite the expert at carrying urine-sample containers in his inside jacket pocket. He was lashed to a table for twenty- four hours just so that they could monitor his heartbeat. There was little chance to get any of his own work done while all these tests were going on, but Ófeigur always showed up to his various appointments in good spirits, trying to bear in mind that all of these things were being done for his benefit and that there was nothing for it but to be patient.
Close to dinnertime on a Friday six months later, Ófeigur’s phone rang. The caller’s number was blocked. “Hello, Ófeigur, this is cardiologist Þorbjörn.” Ófeigur’s heart jumped in response. “I’m a dead man,” he thought. “The cardiologist calls me at seven o’clock on a Friday? This isn’t good.” “I felt it was best to call you and let you know before you start the weekend that I just got back the results from your latest tests, and it appears that there’s nothing wrong with you,” said Doctor Þorbjörn cheerfully. “But there’s just one more test we’d like to run at State Hospital next month, and then I think that we’ll be finished.” Ófeigur had been trying very hard to avoid thinking about his health before the phone rang. He had been sitting outside by the grill with a beer. His main concern had been the piles of leaves on the lawn. Now he grabbed another beer to steady himself after this conversation and soon a third to celebrate that he was in good health.
After the final test at the State Hospital, Ófeigur went over to Þorbjörn’s office—where, at this point, he almost felt at home. “We believe we know what happened to you in the spring,” said Þorbjörn, leaning across his desk with a stern and professional expression. “It’s not serious, mind you, but we have to determine what the right course of action will be.” He told Ófeigur that they had found a very small hole in the wall between the valves of his heart. “Everyone is born with an opening on the septum— or wall—of the heart, but it immediately begins to close up and then vanishes completely over time. In your case, this didn’t happen, and we believe your condition may be the result of a buildup of pressure, causing the blood flow to reverse; in such cases, an obstruction or clot can form that later causes oxygen depletion. We believe that’s what happened to you—but we can’t be absolutely certain.” When Ófeigur asked what could be done, Þorbjörn told him that there were three options, in his experience: “First, do nothing at all. Second, we could put you on blood thinners in order to minimize the likelihood of another blood clot. Lastly, it’s possible to perform a small surgical procedure to remove the clot, or else close up the offending hole.”
Ófeigur didn’t care for the first option. Blood thinners, he believed, were not a good solution. “Isn’t it true that a person on blood thinners can bleed out in an instant if he cuts himself?” Þorbjörn told him that the surgery was relatively minor, it would be performed with a cardiac catheterization and wouldn’t require opening the patient up; he would only have to be in the hospital for twenty-four hours. The doctor looked at the clock and proposed that Ófeigur think it over. Ófeigur didn’t want to do that. “I want the surgery, without question,” he said. Þorbjörn said that he would have to consult with his friend and colleague, Hróar Heimisson, who had performed ninety procedures of this kind, all of them successfully. Hróar’s office was in an apartment complex on the second floor of a two-story house. At street level was a pharmacy that had been opened there to prevent patients from taking their business anywhere else. “Maybe our health-care system isn’t so different from the ones you hear about in other countries after all,” thought Ófeigur. Hróar came out into the corridor to greet Ófeigur at exactly the appointed minute—something that had never ever happened to him before with any doctor. Doctors Hróar and Þorbjörn looked almost identical. Both of them were tall, with strong features and short-cropped, graying hair. They both wore white, unbuttoned smocks and jeans, possibly believing that the smock “doctored” up what would otherwise look like a rather casual ensemble. Hróar placed a chair at one corner of his desk and placed another at the next nearest corner. He sat his patient down and they went over the surgery in detail. The doctor put a sheet of graph paper that he ripped out of a spiral notebook onto his desk and began to draw a heart with a blue Bic rollerball pen. The pen leaked, two inkblots indicated a vein and heart valve, respectively. Hróar reached into his smock pocket and took out a short wire stalk encased in plastic and then began to rhapsodize about it as though he were a salesman showing a customer the beautiful inner lining of a well-made woman’s coat. “We call this procedure ‘Amplatz surgery,’ named after a certain Doctor Amplatz—a German. This occluder at the end, shaped like a plug, is, as you can see, made up of a densely woven assemblage of wire. We draw the wires together and insert it through this type of sheath.” He handled the sheath and plug gently, rolling them between his fingers just like a mechanic might do with a screwdriver, and with as much of a sense that this was all a perfectly natural thing to do. “Once we’ve inserted it through the septum, we open it and then squeeze the plug in half, and the hole is closed for good. Tissue will grow over it, and you’ll be a new man,” said Doctor Hróar. Hróar suggested a possible date for the surgery—in about two months—but said he wanted to do some tests of his own over the intervening time. Over those weeks, Ófeigur drove to the city for a few appointments, either to the doctor’s office or to the hospital. He soon felt he was in very good hands, and got to know Hróar a bit over the course of these visits. “Hróar isn’t just a good doctor,” he said one night to his wife Lína, who had a growing interest in the procedure as the date drew nearer, “I really get the sense that he’s a good person. His associates are capable and compassionate people, and when he speaks about his family, there’s a touching quiver in his voice. And, you know, I’ve heard that he has, at a moment’s notice, traveled to Boston, for example, on account of emergencies arising from infant heart disease. He always goes, despite whatever might be going on for him at work or at home. He’s saved plenty of lives.” Ófeigur arrived at the reception desk in the basement of the State Hospital the day before his operation. The woman who checked him in was very inquisitive: “Do you have any allergies? Does diabetes run in your family? Is there any family history of heart disease? Have you been anaesthetized recently?” Ófeigur answered all the questions in the negative but recalled too late that he had indeed been anaesthetized nine years before. It didn’t seem to matter. He was whisked into a room and blood was drawn and no one asked him any more questions. After a short wait, he was directed to a small office, where the anesthesiologist sat waiting. She was a very tall, attractive, and energetic woman whom Ófeigur recognized from his university days. Her name was Hjörný Scheving. Ófeigur was grateful to run into someone he knew. Hjörný had always liked to talk, so their interview went long but interesting. Her oldest daughter played ice hockey on a school team in Canada. Hjörný asked Ófeigur if he had any allergies. She also wanted to know if he or any of his relatives had diabetes or heart disease. “Have you ever been anaesthetized?” she asked him at the end of their meeting. The X-ray room was so far away from the anesthesiologist’s office that someone had to escort Ófeigur through the long hospital corridors so he wouldn’t get lost. He was shown into a small, cramped area and sat alongside a dreadful oil painting donated to the hospital by a grateful patient. Still, in the waiting room he was shielded from questions and looked through the available reading material: How I Found Livingstone as well as such classic tales as Kit Carson and King Solomon’s Mines. He then met with the physician’s assistant, a young, beautiful woman. She was particularly interested in inspecting Ófeigur’s toes. She finally couldn’t refrain from asking him about allergies, diabetes, heart disease, and if he had ever been anaesthetized. The final interview was with Hróar himself. Again he went over how the surgery would proceed, and then moved into restating, with a great deal of authority, all of the things that he had already discussed with his patient over the previous months. He was formal, but casual, and at the same time Ófeigur felt that he radiated a real kindness, a quality that had been there from the beginning. Hróar checked off items on a form while talking to himself: “No allergies, no heart disease, no diabetes, anaesthetized before.”
In the early evening, a nurse arrived who said she wanted to shave Ófeigur’s groin area so she wouldn’t have to the next morning. While she worked, Ófeigur stared at the wall clock from the Milk Producers Association with its company motto: “Skim Milk / Every drop / Vitamin enhanced.” Just before he was sent home, he had to track down another nurse to take the warm urine sample that he had been carrying in his jacket pocket all day long.
Ófeigur arrived at State Hospital at seven o’clock on the dot the next morning, and was immediately whisked off to be prepared for surgery. He was assigned a bed with a partition blocking the view from the corridor and was asked to remove his clothes behind it and to lie down in the bed. Minutes later, two nurses released the brakes on the bed and he was wheeled away. He could tell that they had just come on shift because their uniforms were stiff and crackly. A soothing and pleasant scent of perfume lingered over the bed on the journey through the long corridors. After they waited a while outside the operating room, a bearded man appeared in green scrubs and introduced himself to Ófeigur as Kjartan, the assistant anesthesiologist. “No and no and no and yes,” Ófeigur said before the doctor could say anything else. Kjartan seemed satisfied with his answers and Ófeigur was moved onto the operating table.
In the operating room, there was a palpable atmosphere of professionalism. Two nurses, Þorbjörg and Hildur, prepared the room for surgery. They took out assorted apparatuses, instruments, and needles, and plugged in electrical cords. They removed tools from sterile, disinfected wrappings and placed them in precise places so that Doctor Hróar would only need to reach out his hand for them. Hildur hummed as she worked and made small talk with Þorbjörg. She turned toward a large stereo on a side table, couldn’t find a radio station, and decided to slip in a CD instead. After that, beautiful music filled the operating room. “There’s so much to keep track of . . .” Þorbjörg removed a long and narrow package, looked into the storage cabinet and talking to herself said: “Are we out of the sheaths?” She looked over at Ófeigur and asked: “Is everything all right?” “Yes,” answered Ófeigur, “or it will be. That’s why I am here.” “See the screen over here?” and Þorbjörg pointed to six flat-screen TV monitors joined together and mounted on a metal armature directly over the operating table. “The doctor performs the surgery while looking at the screen, so that he can see what he’s doing. We monitor what’s happening with your heartbeat, pulse, breathing, and other vital signs on the other screens.”
The number of bodies in the operating room was growing. Hjörný, the anesthesiologist, greeted him cheerfully. She was professional, deliberate, and very thoughtful. She placed her left hand on Ófeigur’s chest and her right on the lower part of his body, and said to him after a second that she would be the one to put him under. The last person to come in, of course, was Doctor Hróar in his surgical scrubs. He felt along Ófeigur’s groin and said to him calmly that this was the place where he intended to begin threading the sheath toward the heart and that they would then secure the hole in his heart with the plug at the end. Incredibly simple.
“He’s under,” said Hjörný calmly. Hróar felt again for the pulse at the groin, made a small incision in the skin, and inserted the needle. “I have the artery pulse,” he said contentedly and slipped the plastic sheath inside the vein and then the wire into the sheath. He never took his eyes off the screen that faced directly away from the patient. He saw the blood vessels and the sheath as it wound its way to the heart. On the other screen was the image of the spinal column. The doctor worked confidently and steadily and appeared to be as comfortable with the surgery as with cutting a loaf of bread in his kitchen.
“Ventilate him, does he have a pulse?” Anesthesiologist Hjörný’s voice was calm but her tone was urgent. “Get a monitor right away, vitals have dropped to nil.” She began chest compressions. “Give him oxygen and set up an IV line,” she said quickly and continued with the compressions. “We’ve already called for the crash team,” said the nurse Hildur as she set up the oxygen. “He’s fibrillating, we need the paddles,” said Hjörný. “Is he in sinus? Give him another zap.” They kept at it; each had their defined roles. The exchanges were short and to the point and no one asked questions. The crash team had arrived on the scene: the department doctor on shift, an anesthesiologist, a general practitioner, two nurses, and one intern. The operating room was crowded. “I administered adrenaline,” said the general practitioner, “no change in condition.” “Find out if Þorbjörn Guðmundsson is in the building,” said Hjörný and stopped her compressions as the department doctor took over. Things went on from there. Another electric shock, more adrenaline, oxygen, and constant CPR. Cardiologist Þorbjörn had long since arrived. A half hour passed, and then an hour, he was unresponsive.
“We’ve lost him,” whispered Þorbjörn, his voice cracking, and he walked out of the operating room.
“The funeral for husband and father Hróar Heimisson, who died in the State Hospital on May 4, will depart from Langholt Church . . .” he couldn’t read any more. He sat at the kitchen table: “You’ll come with me, right?” he asked. “I didn’t know the man at all,” Lína replied, “but it’s a different story for you, he saved your life.” She was silent for a moment but then added: “How could something like this have happened in a hospital with the best equipment and specialists.” She stood up and collected their coffee cups. “That’s the thing,” said Ófeigur. “The pathologist Guðlaugur told me that Hróar himself was living with an extremely rare heart condition. You’re fine most of your life, but once it decides to give you trouble, you might as well have been shot in the head.” Ófeigur ran his hands through his uncombed hair. “In fact, I heard later from cardiologist Þorbjörn that there was only one person in the entire country with the expertise and talent to treat to such a case, which is a little odd.” Lína came back from washing the coffee cups and looked at her husband: “Odd, what’s so odd about it since it was such a rare case?”
“Well, the only person who could have saved Hróar was Hróar himself.”
Translated by Christopher Burawa