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The art of transplantation: Mend the Living
Perspectives
From literature to medicine The art of transplantation: Mend the Living Mend the Living begins with the steady beat of 20-year-old Simon Limbeau’s heart as he rouses himself before dawn for a surfing trip with friends. The early pages of this novel by French writer Maylis de Kerangal celebrate Simon’s physical vigour and his emotional exuberance—his heart, both literal and figurative. De Kerangal describes him slipping onto the back of his first wave: he is euphoric, able “to grasp the whole explosion of his own existence, and to conciliate himself with the elements, to integrate himself into the living”. Heading homeward with friends, this integration comes to a violent end. Their van crashes into a pole and Simon is propelled head first through the windshield. De Kerangal then narrates the 24 hours in which Simon’s life hangs, as his surname predicts, in limbo. His brain is dead but his heart continues to beat. Meanwhile the people around him—distraught parents, hospital administrators, doctors, and nurses— navigate a complex process that makes it possible for Simon’s heart, lungs, kidneys, and liver to be transplanted. One might expect a novel about organ transplantation to focus on the donor, the recipient, or both, but
MacLehose Press
For more on From literature to medicine see Comment Lancet 2015; 386: 1223, Perspectives Lancet 2015; 386: 1230, 1618, 2132, Perspectives Lancet 2016; 387: 330, 835, 1365, 1897, 2371, and Lancet 2016; 388: 19, 553, 1874, 2859, Lancet 2017; 389: 147, 897, 1599
1876
de Kerangal comes at the story from a different perspective. She is interested in the human element of the intricate medical and bureaucratic process. She describes the tightly choreographed actions of all the people who make donation and transplant possible— from the nurse who catheterises Simon when he arrives at the organ donation unit in Le Havre, to the administrator who arranges for the distribution of organs, to the man who cleans Simon’s corpse after his organs have been harvested. De Kerangal reveals how the healthcare workers involved in Simon’s case never let their work become routine and mechanical. Thomas Remige, a nurse specialist in the organ donation unit, “knows the steps and the mile stones of the process”, but “he also knows to what extent it differs from a well-oiled mechanism, a chain of set phrases and diagonal checkmarks on a checklist”. Any single case, he observes, “is terra incognita”. Who can predict, for instance, how parents will respond to the request for organ donation in the hours after their child’s sudden death? One of the pleasures of Mend the Living is how de Kerangal depicts the individual members of the ensemble cast as they take turns at the forefront of the story. Each one is uniquely insightful about the meaning of his or her work. Alice Harfang, for example, is a medical intern and the scion of a famous medical family. She remembers looking, as a child, at Rembrandt’s painting, The Anatomy Lesson of Dr Nicolaes Tulp, in which dissection signifies both scientific progress and the body’s violation. As Harfang watches the surgeon remove Simon’s heart, she recognises that, at this moment, she occupies a space where there is no separation between the living and the dead. The “absolute matter” of the body has transformed into “a substance of incredible potentiality”.
After Simon’s organs have been removed, Remige becomes similarly reflective. He transforms the routine task of preparing a body to be moved from the operating room to the morgue into a sacred ritual by singing a “song of a good death”. This private performance over Simon’s body is “not an elevation, the sacrificial offertory, not an exaltation of the soul…but an edification: this song reconstructs the singularity of Simon Limbeau”. De Kerangal’s account of the medical, legal, ethical, and existential complexity of organ transplantation has been praised by physicians for its accuracy, and the novel recently won the 2017 Wellcome Book Prize. There are, it should be noted, two quite different English translations. The more lyrical British version by Canadian translator Jennifer Moore won the Wellcome prize and is quoted in this review. The crisper American translation by Sam Taylor bears a different title, The Heart. Mend the Living fittingly concludes not by shifting attention to the woman who received Simon’s heart, but by maintaining its focus on the people who made the transplant possible. With lyrical descriptions of ritual and routine, de Kerangal depicts doctors and nurses re-emerging from limbo to rejoin the living. They clean the operating theatre and tally the instruments. They wash up, discard their scrubs, and put on their street clothes. They pause to flirt or they catch a homeward train. After mending the living, they mend themselves.
*Ann Jurecic, Daniel Marchalik Department of English, Rutgers University, New Brunswick, NJ 08901, USA (AJ); and Department of Urology and Literature and Medicine Track, Georgetown University School of Medicine, Washington, DC, USA (DM) [email protected]
www.thelancet.com Vol 389 May 13, 2017
From literature to medicine The art of transplantation: Mend the Living Mend the Living begins with the steady beat of 20-year-old Simon Limbeau’s heart as he rouses himself before dawn for a surfing trip with friends. The early pages of this novel by French writer Maylis de Kerangal celebrate Simon’s physical vigour and his emotional exuberance—his heart, both literal and figurative. De Kerangal describes him slipping onto the back of his first wave: he is euphoric, able “to grasp the whole explosion of his own existence, and to conciliate himself with the elements, to integrate himself into the living”. Heading homeward with friends, this integration comes to a violent end. Their van crashes into a pole and Simon is propelled head first through the windshield. De Kerangal then narrates the 24 hours in which Simon’s life hangs, as his surname predicts, in limbo. His brain is dead but his heart continues to beat. Meanwhile the people around him—distraught parents, hospital administrators, doctors, and nurses— navigate a complex process that makes it possible for Simon’s heart, lungs, kidneys, and liver to be transplanted. One might expect a novel about organ transplantation to focus on the donor, the recipient, or both, but
MacLehose Press
For more on From literature to medicine see Comment Lancet 2015; 386: 1223, Perspectives Lancet 2015; 386: 1230, 1618, 2132, Perspectives Lancet 2016; 387: 330, 835, 1365, 1897, 2371, and Lancet 2016; 388: 19, 553, 1874, 2859, Lancet 2017; 389: 147, 897, 1599
1876
de Kerangal comes at the story from a different perspective. She is interested in the human element of the intricate medical and bureaucratic process. She describes the tightly choreographed actions of all the people who make donation and transplant possible— from the nurse who catheterises Simon when he arrives at the organ donation unit in Le Havre, to the administrator who arranges for the distribution of organs, to the man who cleans Simon’s corpse after his organs have been harvested. De Kerangal reveals how the healthcare workers involved in Simon’s case never let their work become routine and mechanical. Thomas Remige, a nurse specialist in the organ donation unit, “knows the steps and the mile stones of the process”, but “he also knows to what extent it differs from a well-oiled mechanism, a chain of set phrases and diagonal checkmarks on a checklist”. Any single case, he observes, “is terra incognita”. Who can predict, for instance, how parents will respond to the request for organ donation in the hours after their child’s sudden death? One of the pleasures of Mend the Living is how de Kerangal depicts the individual members of the ensemble cast as they take turns at the forefront of the story. Each one is uniquely insightful about the meaning of his or her work. Alice Harfang, for example, is a medical intern and the scion of a famous medical family. She remembers looking, as a child, at Rembrandt’s painting, The Anatomy Lesson of Dr Nicolaes Tulp, in which dissection signifies both scientific progress and the body’s violation. As Harfang watches the surgeon remove Simon’s heart, she recognises that, at this moment, she occupies a space where there is no separation between the living and the dead. The “absolute matter” of the body has transformed into “a substance of incredible potentiality”.
After Simon’s organs have been removed, Remige becomes similarly reflective. He transforms the routine task of preparing a body to be moved from the operating room to the morgue into a sacred ritual by singing a “song of a good death”. This private performance over Simon’s body is “not an elevation, the sacrificial offertory, not an exaltation of the soul…but an edification: this song reconstructs the singularity of Simon Limbeau”. De Kerangal’s account of the medical, legal, ethical, and existential complexity of organ transplantation has been praised by physicians for its accuracy, and the novel recently won the 2017 Wellcome Book Prize. There are, it should be noted, two quite different English translations. The more lyrical British version by Canadian translator Jennifer Moore won the Wellcome prize and is quoted in this review. The crisper American translation by Sam Taylor bears a different title, The Heart. Mend the Living fittingly concludes not by shifting attention to the woman who received Simon’s heart, but by maintaining its focus on the people who made the transplant possible. With lyrical descriptions of ritual and routine, de Kerangal depicts doctors and nurses re-emerging from limbo to rejoin the living. They clean the operating theatre and tally the instruments. They wash up, discard their scrubs, and put on their street clothes. They pause to flirt or they catch a homeward train. After mending the living, they mend themselves.
*Ann Jurecic, Daniel Marchalik Department of English, Rutgers University, New Brunswick, NJ 08901, USA (AJ); and Department of Urology and Literature and Medicine Track, Georgetown University School of Medicine, Washington, DC, USA (DM) [email protected]
www.thelancet.com Vol 389 May 13, 2017