Ever since she was a little girl, Elizabeth had been fascinated by the human heart.
Her interest almost certainly stemmed from her twin brother, Patrick, who had been born with a congenital heart condition. All throughout her childhood, she had accompanied him to his doctor’s appointments. She would watch with wonder as they hooked him up to wires that could somehow take a recording of his heart’s rhythm and turn it into a graph of wavy lines, which printed out on a strip of paper. She marveled over the way they were able to display moving pictures of his heart beating on a monitor, simply by pressing a magic wand to his chest. She asked almost as many questions as her mother did, and the doctors and nurses were always willing to satisfy her curiosity with the answers she craved. “Looks like you may have a future doctor on your hands,” they would say to her mother with a wink and a smile. Elizabeth supposed that was when she had decided to become a cardiologist.
When their stay-at-home mother enrolled in nursing school so she could provide home care for Patrick herself, Elizabeth had helped her study and practice her procedural skills. She had learned right along with her mother, becoming quite proficient at checking a pulse, auscultating with a stethoscope, and taking a blood pressure. It was a way of trying to bond with her mother, who was usually too busy doting on her sickly son to pay much attention to her perfectly healthy daughter.
Despite being twins, Elizabeth and Patrick were as different as could be. She had always been the serious one, the responsible one: intelligent, ambitious, and wise beyond her years. Meanwhile, Patrick had struggled, both socially and academically. His chronic heart condition had prevented him from participating in activities or forming the kind of close friendships most kids make through sports and clubs. He had missed so much school, he’d been held back a year, which had only made things harder for him. Before his heart transplant, when he had been too sick to get out of bed, he had withdrawn into the imaginary worlds offered by books, television, and video games. After the transplant, he’d had a hard time adjusting to life in the real world from which he had been isolated for so long. The side effects from the steroids he took to prevent rejection - a puffy face, severe acne, and an insatiable appetite - made it even more difficult for him to be accepted by his peers, especially girls. Besides being overweight, he was shy and socially awkward. While his pretty sister was being asked out on dates and invited to school dances, Patrick stayed at home playing on his computer. While Elizabeth looked forward to college and her future career in cardiology, her brother dropped out of high school and became a sort of hermit who worked for their father in the family-owned funeral parlor in exchange for food and a place to stay.
Their father, a funeral director like his father before him, would have been best described as “distant.” Though he had worked from home - his family lived in the second floor apartment above the funeral parlor - the long and odd hours his job required meant that he was rarely around. During a busy week, when the number of deaths was higher than usual, Elizabeth and Patrick would go days without seeing their dad. Even though they knew he was working right under their feet, the twins were forbidden from interrupting him while he was preparing for a funeral. But that didn’t prevent Patrick from developing an unhealthy interest in dead bodies.
Perhaps it was because he had faced the prospect of dying himself that Patrick became fixated with death, or maybe it was simply that dead people had been kinder to him - or less cruel, at least - than the living. For whatever reason, while Elizabeth liked beating hearts, Patrick preferred them still. He enjoyed the company of the cadavers in their father’s care - sometimes a little too much.
Elizabeth would never forget the day their father found Patrick fondling one of the bodies he had just finished embalming. She was halfway through the first year of her electrophysiology fellowship at Emory University Hospital in Atlanta and had flown home to Key West to spend her hard-earned vacation days with her family. It was just Patrick and their father living there at that point; after their parents’ divorce, their mother had remarried and moved to Phoenix with her new husband. Elizabeth hardly ever heard from her. She had never been particularly close with either parent, but she maintained a tight bond with her twin. When their father flew off the handle and kicked Patrick out of the house, threatening to call the police if he didn’t leave, Elizabeth couldn’t help but sympathize with her brother.
“You don’t know what it’s like for me!” she had listened to him sob as she drove him up the Overseas Highway. She didn’t have a destination in mind. All she knew was that she had to get Patrick out of the house and give her dad time to cool down and reconsider. She was also trying to understand why Patrick would do what their father claimed to have caught him doing.
Patrick didn’t deny the accusation. Instead, he confided in his sister. “Every day since my transplant, I’ve woken up feeling like there’s a dead boy trapped inside my body. I don’t belong with the living. I belong with the dead!”
“Don’t talk that way,” Elizabeth had pleaded, picking up on the suicidal tone to what he had said. “You have so much to live for, Patrick. You were given a precious gift. You don’t want to let it go to waste, do you?”
“No, I was given a curse,” Patrick corrected bitterly. “You don’t understand, Lizzie. I can’t stop. I can’t prevent myself from having these thoughts, and it’s getting harder and harder to control my impulses when I’m surrounded by corpses all day long. I can’t live like this anymore.”
“Well, then maybe you should move out,” she said. “Maybe this is the kick in the pants you need to get your own place and find a different job.”
“Doing what?” Patrick scoffed. “I don’t have a degree or any marketable skills. Who the hell would hire me?”
“You know a lot about computers,” Elizabeth pointed out. “You could work in web design or tech support, something like that.”
Patrick shook his head hopelessly. “I’m a thirty-three-year-old man with no previous work experience, except for an unpaid position at a funeral parlor that I’ll never be able to put on a resume - what if a potential employer called Dad to ask for a reference? And I’ll never find a place to live with no credit and no way to pay rent. Face it, Lizzie - I’m totally fucked.”
“You can come stay with me in Atlanta,” she offered. “I’m sure I can help you get hired at Emory. They’re always looking for custodians, orderlies, cafeteria workers, and that kind of thing.”
It seemed like the perfect solution, and at first, it was. She put in a good word for Patrick at the hospital where she was finishing her medical training, and they took him on as an overnight custodian. He spent five nights a week mopping floors covered in blood and other bodily fluids and taking out trash bins filled with biohazardous waste. During the day, he slept on Elizabeth’s couch in her studio apartment while he saved up for a place of his own.
But it only lasted a few months before Patrick was discovered down in the hospital morgue, molesting a female patient who had been pronounced dead earlier that day. Elizabeth didn’t blame his supervisor for firing him. He was lucky the hospital kept the incident quiet; if the patient’s family had found out, there surely would have been a lawsuit, possibly even a prison sentence. Instead, Patrick got to stay on her couch, free as a bird, and eat all the food in her fridge while she worked endless hours to keep it full.
After a year of living like this, Elizabeth was beginning to resent her brother. She was almost finished with her fellowship and would soon be looking for an attending position. If she brought Patrick to another city and allowed him to continue living with her, she knew he would never leave. As much as she loved her brother, she couldn’t bear the thought of supporting him forever. She had worked hard to further her career, but one day she wanted to settle down, find a husband, and start a family. There had to be another way to help Patrick without sacrificing her own happiness.
The solution came to her shortly after she’d accepted a position at Lower Keys Medical Center in her hometown of Key West. Moving back meant it would be almost impossible for Patrick to avoid their father, who was still running the funeral parlor there. She was sure he would have retired by now if he’d had someone to take over the family business, but Patrick had been written out of his will. As their father’s only remaining heir, Elizabeth stood to inherit the property, but had no interest in becoming a funeral director herself. Her passion was for hearts that were still beating - but she knew how to make them stop.
Her father had already been prescribed a particularly potent cardiac drug to treat his atrial fibrillation, a type of irregular heartbeat that was fairly common in older men. All she had to do was crush up a few extra pills and dissolve the powder into his drink while she was over for dinner. When she left that night, there was no doubt in her mind that the toxic level of the drug building up in her father’s system would be more than enough to trigger a lethal arrhythmia.
Sure enough, she got a call from the police the next day to notify her that her father had been found dead by one of his employees early that morning. She pretended to mourn, but in truth, she didn’t feel much at all. She and her father had never been close.
After an autopsy, it was determined that Henry Gravel had died of cardiac arrest caused by an accidental overdose of his prescribed medication. No foul play was suspected, and Elizabeth became the sole beneficiary of both the funeral home and a substantial life insurance payout, which she was happy to share with her brother. Finally, Patrick had a place to live and enough money to support himself, at least until he found a way of earning his own income.
It was the perfect solution to their problem - and it had been all too easy to pull off.
***
Brian wished he could have warned Nick.
At first, everything had seemed relatively normal. Brian’s day had started out the same as every other morning since the accident. He woke up in his hospital bed, grateful to be alive but disappointed to find he could no longer move his finger, nor open his eyes. Completely helpless once more, he endured the daily humiliation of having his broken body bathed by Dani and examined by Dr. Elizabeth.
Physical therapy usually came next. Brian had learned to look forward to these sessions, for the passive range of motion exercises Dani did with him each day were the only way he was able to stretch and work out his arms and legs. As an athlete, he appreciated her efforts to prevent his muscles from atrophying, even though they sometimes seemed pointless - he didn’t know if he would ever be able to use those parts of his body again. Still, he wanted to maintain as much muscle tone and flexibility as he could.
But that morning, Dr. Elizabeth disrupted his routine. “We’re going to take Brian down the hall for some tests,” he heard her tell Nick, as she and Dani bustled around his bed, getting the equipment ready to be moved. “After last night, we need to reassess his level of neurological function. It shouldn’t take too long.”
“Just promise me you won’t let that nurse Patrick anywhere near him,” Nick replied none-too-politely. Brian didn’t know all of the details, but he had heard enough of Nick’s rant to realize how close he had come to dying the previous night.
“Don’t worry,” the doctor assured him, as she unlocked the wheels of Brian’s bed and began rolling it toward the door. “I’ll be doing the testing myself. Patrick’s not even working today.”
But this turned out to be a lie. When she wheeled Brian into another room, it was Patrick who helped her transfer him from his bed onto a hard table.
“Glad to see you put your girlfriend back in the fridge,” Brian heard her tell him in an undertone. “She’s not going to stay fresh much longer, you know.”
“I know,” said Patrick, sounding annoyed. “All the more reason to start planning for the next one. When are you gonna let these guys go?”
“When I’m finished with them,” Elizabeth replied waspishly. “You’ve had your fun; now let me have mine. A little privacy, please?”
Brian had no idea what they were talking about, but it made him feel uncomfortable. He heard the door close as Patrick walked out, leaving him alone with Elizabeth.
His apprehension only grew when she took off his gown. He expected her to put a blanket over his body, but she did not. Lying naked under the bright fluorescent light that filtered through his eyelids, Brian had never felt so exposed. He longed to be able to cover himself up or at least cross his legs to maintain some level of modesty, but he still couldn’t move a muscle. Goosebumps rose on his bare skin - for a hospital running on back-up power, the room was surprisingly chilly.
If Elizabeth noticed his discomfort, she didn’t do anything about it. She only made it worse when she started sticking additional electrodes to his body; the adhesive gel on the back of each was cool, and her hands were even colder. Having endured an electrocardiogram at each of his annual heart check-ups as a child, Brian recognized the pattern of the lead placement: a cluster of them along the left side of his chest, another on the right side, one on each of his arms, and one on each leg. He wondered why she was checking his heart when the problem seemed to be with his brain and spinal cord. Being a cardiologist, she wanted to cover all her bases, he supposed.
Dr. Elizabeth connected the leads, and Brian heard the EKG machine beep as it began to print out a recording of his heart rhythm. It was quick and painless, but he still felt anxious.
Afterwards, she peeled off the electrodes, painfully pulling out hair from his chest, arms, and legs along with them. He hoped she would cover him back up, but she didn’t. Instead, she began slathering his chest with something cold and slimy. It felt like the gel used during an ultrasound, but the way her hands rubbed it almost sensually over his skin made it seem more like massage lotion. Brian’s uneasiness grew. What was going on? He wished she would at least talk to him and tell him what she was doing, the way Dani always did. But Dr. Elizabeth didn’t say a word until halfway through the exam.
As he had inferred from the copious amount of conductive gel, the next test was an echocardiogram. Like the EKG, Brian had had enough echoes done back in the day to know the drill. The most difficult part for him had always been lying still enough for the doctor to get a good look at his heart. This time, that wasn’t a problem. He had no other choice but to lie perfectly motionless as Dr. Elizabeth moved the transducer over his chest. It didn’t hurt, but it did bring back bad memories of being told by his old cardiologist that he needed open-heart surgery.
“Beautiful,” he heard Elizabeth whisper, as she held the transducer in place.
Brian’s blood ran cold, as it suddenly dawned on him why she was really running all these diagnostic tests. It wasn’t about making sure he was okay. It was about seeing if he was a match for Nick. Nick desperately needed a new heart, and Dr. Elizabeth wanted to know if Brian’s heart was healthy enough to be donated.
He heard the faint whoosh of his heartbeat on the ultrasound machine get faster and louder as his heart began to hammer inside his chest. Surely, Dr. Elizabeth would hear it, too, and realize he wasn’t in a coma, that he could comprehend what was happening. But if she did, she didn’t react.
His mind was racing as rapidly as his heart. Did he and Nick even have the same blood type? He knew his own type, but not Nick’s. He wasn’t sure if Nick even knew - not that it mattered; a simple test could tell the hospital both their blood types. He figured Dr. Elizabeth must have already found out that he and Nick did, in fact, share the same type, or she wouldn’t have felt the need to test him any further.
But did she know about the holes in his heart? If she hadn’t before, he supposed she would find out by looking at it from different angles. Both holes had been repaired during his surgery over twenty-one years earlier, and he’d had no problems since, but he wondered if the defects would prevent his heart from being suitable for donation.
Brian felt deeply conflicted. On one hand, he wanted to help Nick. Nick was his best friend, the little brother he’d never had. He would do anything for Nick, or so he had thought. But would he die so that Nick could live? If saving Nick’s life meant sacrificing his own, Brian wasn’t so sure. It may have seemed selfish, but he wasn’t just thinking about himself. What would his family do without him? He couldn’t bear the thought of leaving Leighanne and Baylee behind.
But then, Nick had a wife and son, too, not to mention another child on the way. Were Lauren, Odin, and the baby any less important? Nick was not even forty years old yet; he had so much life left to live. Brian was only five years older; he still had a lot of life ahead of him, too, but did he want to spend it like this? He wasn’t sure about that, either.
He didn’t know whether to be relieved or disturbed by the fact that it wasn’t his decision to make. At the end of the day, Dr. Elizabeth and his family would be the ones deciding his fate. His heart, his whole life, was in their hands. God, please guide them in the right direction, he prayed. He didn’t know which direction that was - but he knew his Heavenly Father would. If it was God’s will for him to die in order to save Nick, just as His son Jesus had died to save the world, then Brian would do it. Because of his Savior, he didn’t fear death, for he knew his soul would go on to a better place when he passed away. He was just afraid of what it would do to his family here on Earth.
As Brian’s mind wandered with increasingly dark thoughts, Dr. Elizabeth continued the echocardiogram. It seemed routine at first, just like the ones he’d become accustomed to as a little kid. But then, as the doctor held the probe in place with one hand, her other hand drifted down his body, below his waist.
Brian’s heart skipped a beat as he felt her fingers close firmly around his flaccid penis. If he had been in control of his breathing, he would have gasped, but he couldn’t do anything to indicate his shock or displeasure as she began to pull and squeeze. In fact, his body reacted the opposite way, the organ stiffening in response to the stimulation. As it rose to its full length, the rest of him remained limp and still, unable to resist. Only his heart reacted, skipping around inside his chest as it raced.
He could tell she was watching it on the screen by the way she pushed the transducer deeper into his sternum, as if she wanted a better picture. Was this part of the test? Somehow, he didn’t think so.
He felt betrayed - betrayed by the doctor who was doing this to him, betrayed by his body for letting it happen. Tears filled his eyes as she went on tugging, working him almost to the point of release. But before he reached his climax, he heard the table rattle, creaking beneath their combined weight as she climbed on top of him.
No! he wanted to cry, as she lowered herself onto his erection. Against his will, he felt himself enter her. She was warm and wet, but he experienced no pleasure from penetrating her, only shame and horror. As she began to grind against him, thrusting her hips to drive him deeper inside her, his stomach churned with nausea. He desperately wanted to push her off him, but he was utterly powerless to stop what was happening.
The pressure on his chest was lifted as she let go of the ultrasound probe. Seconds later, he felt the familiar round disc of her stethoscope sliding over his skin. What the hell? he thought, his heart beating frantically beneath it. Was she getting off on hearing it pound while she humped his paralyzed body? Judging by the sound of her ragged breathing, it was a pretty safe bet. Brian felt sick.
The tears leaked out from under his eyelids, trickling unchecked down his cheeks as she went on assaulting him. His only way of escaping the pain and humiliation was to try to go somewhere else in his mind. Leighanne, he thought, forcing himself to focus on his wife’s face. I love you so much, baby. There ain’t no place like you.
He wished he could click his heels and wake up in his own bed with his wife on top of him instead. But like Nick before him, Brian knew there was no easy way out.
If only he could have warned Nick of what was to come.
***
Elizabeth had lost count of how many hearts she had listened to over the years. Healthy hearts, diseased hearts, dying hearts. Hearts that fluttered and hearts that stuttered. Hearts that raced and hearts being paced. Galloping hearts, ambling hearts, and every kind of heart in between. But none had brought her as much excitement as listening to Brian Littrell’s heart beat.
It had long been a dream of hers, ever since her college days, when his poster had hung on the wall of her dorm room. She had become a fan of the Backstreet Boys just a few months before the start of her freshman year. From the beginning, Brian had been her favorite. It was hearing the news of his need for open-heart surgery that had first drawn her to him, and the more she learned about his medical history - from the heart defect he’d been born with to the endocarditis that had almost killed him when he was five - the more she fell in love with him. She liked his music, but more than anything, she wanted to listen to his heart and hear it murmur through her stethoscope… then lay her head on his chest and listen to it thrum in her ear as she felt it throb beneath her cheek. She would even practice on his poster when her roommate wasn’t around, playing heartbeat sound clips on her computer and pretending they had come from him. The human heart made the most beautiful music she had ever heard.
It had taken her twenty-one years to turn her fantasy into a reality, but finally, she found herself living out her dream. The EKG had given her a striking piece of art, a priceless souvenir - perhaps she’d even frame the rhythm strip and put it on her wall so she could gaze at the perfect waveform of Brian’s heartbeat whenever she wanted. The echo had been mere foreplay, a way to get herself aroused as she watched his heart pump with tantalizing force on the ultrasound screen. Then came the main event. Her own heart hammered erratically as she writhed on top of him, feeling his pulse between her legs as his heart pounded through the earpieces of her stethoscope.
She paused to watch the waveform on the monitor, satisfied to see that she had brought his heart rate up to one hundred beat per minute - pretty impressive considering he was just lying there passively while she did all the work. She wondered if he was getting as much pleasure out of it as she was.
She paused to wipe the ultrasound gel off his chest so she could see the thin sternotomy scar running down its center more clearly. His surgeon had obviously taken great care to suture his incision neatly, and the scar had healed well over the years. It was hardly noticeable now, yet Elizabeth could not take her eyes off it. She had been waiting so long for this opportunity. Her breath caught in her throat as she traced her fingers lightly along the faint, white line, her body trembling with desire.
Pulling the stethoscope out of her ears, she set it aside and changed positions. Still straddling his hips, she leaned forward until she was lying on his stomach. She lowered her chin and touched the tip of her tongue to the top of his scar. She let it linger there for a few seconds, savoring the taste of him, before she slowly licked the length of the incision. Then she laid her head on his chest, turning it to one side so she could feel the warmth of his skin against her cheek and hear the beat of his heart in her ear. It was enough to take her breath away, bringing her to the point of orgasm. She tried to stifle her moans of pleasure, not wanting them to overpower the most beautiful sound she had ever heard.
She could have stayed that way all day, feeling Brian’s chest rise and fall steadily beneath her as the ventilator breathed air into his lungs, listening to his heartbeat slow back down to its resting rate. But long before that happened, she felt his stomach lurch and heard a horrible retching sound.
Realizing he was about to vomit, she sat bolt upright and regretfully hoisted herself off of him. She hurriedly pulled her scrub pants back on as she stumbled over to the aspirator, knowing she needed to suction out his esophagus before his stomach contents went into his airway. As long as he was paralyzed, he lacked the protective reflexes necessary to prevent himself from aspirating. Thankfully, Brian hadn’t been fed solid food in two-and-a-half weeks, so there wasn’t anything for him to throw up but bile.
“If you were trying to turn me off, you got your wish,” she sighed, as she stuck the suction tip down his throat and sucked his vomit up into the tube. She supposed it had been presumptuous of her to think he would experience the same level of pleasure as she had.
But no matter. It was almost time for her to take Brian back to his room and break the news to Nick that he was brain dead. In another day or two, she would have him all to herself again.
Had she known Nick would go wandering that night, she might have done things differently.
***
