One For the Heart

A UN of doctors saves a little American from ventricular septal defect

He didn't look at me. He kept looking at the screen and said softly, "No. That's the problem."

He did a very thorough examination. The echo itself was well over twenty minutes. He checked everything out. He put the color coding on again and pointed out how it changed drastically, from orange to blue or blue to orange, on either side of that line. Which was blood being significantly slowed down. It was still getting out and getting to the lungs and getting replenished. But not at the rate it should be. He explained this to me calmly, and in terms that would not sound bad to Joe.

He wrapped up the examination and I wiped the jelly off Joe's bony breast and put his red Pokémon T-shirt with the Japanese script back on and we went down the hall. I suspected by now that something maybe Joseph shouldn't hear was going to get said, so I told him to go back out to the waiting room to look at the picture book of dinosaurs.

He loves dinos, and has extensive knowledge of them for a six-year-old. He can describe at least a dozen by name and characteristics -- sauropod, therapod, carnivore, herbivore. Triassic or Jurassic or Cretaceous. If you ask him what he wants to be -- in fact Aldousany had just asked him -- he'll answer: "Paleontologist," with a slight Italian accent ("paleontoll-o-gist!"). Though these boys are thoroughly gringoized after three-and-a-half years in the States, they still say some words in a more Italian way, like aereoplane instead of airplane. Anyway, Aldousany didn't understand what he'd said, so Joe had to repeat it.

"Wow," said the doctor. "That's cool. Most boys just say fireman or cowboy or something like that."

Joe went out to look at the dinosaurs, and I closed the door as the doctor walked to his desk. I was nervous now: "You know Chang mentioned the possibility he might need surgery someday." Aldousany turned around and looked me in the eye without the slightest trace of doubt: "Oh, he needs surgery."

When he said it, a little yelp like a puppy's rose up in me. I was unable to suppress it.

I made a stiff-fingered vertical sign on my breast and said, "But they won't have to open him up, will they?"

He nodded. "Open heart, yes. That's the only way to do this."


We waited until six days before the operation to tell Joe. The Thursday before the big Wednesday, both Nico and I picked him up at school. Bruno doesn't get out until an hour later and takes the bus home, and we'd left Toby for after-school care at his preschool. So we had some time with Joe alone. It was drizzling. As we were going into the house I said, "Joe, let's sit down here on the porch for a minute, because Mommy and I have something to talk to you about."

"What?" he asked, in a slightly put-upon tone, as if he were anxious to get inside to do something he'd been thinking about doing, like look at his shark teeth.

He sat down. The leaves and fronds in the yard were wet and glistening and dripping, the bark black on trunks and branches. The temperature was perfect and the terra cotta tiles of the porch felt cool under our butts.

"Joe, you know that hole in your heart?"

"Yeah."

"Well, we've been talking with some doctors. And they say it has to be fixed."

"Fixed?"

"Yes. The hole has to be closed. 'Cause it's making your heart not work right, and that could give you a problem if it's not fixed."

His mother chimed in in Italian, which is the way she speaks to them, and what they speak to her: "Fixing it will make you even more healthy than you are now. Piu forte [More strong]."

Since we were sitting in a row on the same broad step, we were all looking out into the yard. But I was glancing at Joe from the side, trying to get an idea as to how this was going down.

He was very concentrated and intent on what we were saying, gazing out and not up at either of us. It looked to me like he was contemplating the drizzle, a boy sage, and that this sublime meteorological phenomenon was taking shape in his mind as a line of preternatural poetry. His hands were clasped and resting on his bare knees, and his fingers were working. Not frantically, but he had a good grip, twining around.

"What do you think about that?"

"Okay," he said. And we sat there silently for several seconds ...

"But how do they fix it?"

"They sew it up, I guess. Or put on a patch."

Another silence.

"But how?" he repeated. And it was clear from the perplexed and still-intent expression on his face that what he was asking was, "How do they get to my heart, which is inside me?"

"Remember when you got the stitches in your forehead," said Nicoletta. "They'll make a cut like that, on your chest. But you won't feel it at all. You'll be completely asleep and not feel a thing, then they'll sew you up again like they did with the cut on your head."

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