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Nonfiction Feature: “Beneath The Surface” By Amy Butcher


Beneath The Surface

            The morning I realized the birds on the telephone line outside my apartment were cowbirds and not crows, a boy I knew was getting his heart stitched up.

            The boy was in a hospital and I was not in a hospital. I held the phone against my chin with my shoulder and hunched over, rubbed a cotton ball across my toe, and asked, “It’s going okay?”

            My boyfriend was on the other line, standing against a window on the seventeenth floor of Mass General in downtown Boston. He cleared his throat and took a sip of something. “Seems to be,” he said.

            I didn’t think then about the heart or what was happening to it—the idea that a thread was pulling something so fragile together. I dabbed the cotton ball into more of the acetone and wiped at the other toe and said, “Good.”

* * *

            I’d met the boy nine times before.

            Once we ate Brussels sprouts off china plates in a living room decorated with wallpaper of printed pink Colonial men and women. Another time we pulled on zip-up sweatshirts and walked along the Charles River, drinking marshmallow lattes with a disproportionate amount of marshmallow. On one occasion, he handed me a blanket that smelled like attic and made me watch forty minutes of loose footage he taped at his father’s lake house.

            “It’s going to be a thriller,” he said, “when I’m done with it.” This implied a vast amount of time spent in front of computers and monitors and boxy black equipment. But all I saw were ripples on water and geese taking off towards some definite treeline.

            “Okay,” I said.

            The night we watched the footage, the boy was seventeen. It was January. Even under the blanket, my feet were cold. I kept trying to tuck them up under me, rubbing my socks together beneath the fabric. His cousin Keith sat beside me quietly, watching the footage with fascination.

            “Can we go soon?” I whispered in his ear. I wanted to be some place else: a downtown sidewalk, a restaurant, a place where I wouldn’t have to pretend something ordinary was special.

            “In a minute,” he said. “I’m enjoying this.”

            The footage of the birds and the trees and the sandy embankments would be edited down, turned into a film, submitted at some point as part of a portfolio to film schools. This is what I assumed. I let my eyes slide over the footage and onto the boy. I tried to picture what he would look like under big, bulky headphones.

            When the footage finished playing, I folded the blanket and put it back on the couch. “Good to see you again,” I said to the boy, and then I pulled on my snow boots and trudged to the car, parked two streets away, the snow coming down softly, the man I loved following behind.

* * *

            The boy suffered from congenital heart failure. He wasn’t supposed to live past six months. This is what the doctors told his mother in the birthing room.

            “His heart is functioning at three-quarters capacity,” they said. “Two of the four chambers aren’t divided; they don’t work.”

            His mother held the child, still warm in his blankets. She looked at the doctor. She named the baby Charlie, after her father.

            In the hopes that he might exceed their expectations, she held Charlie against her body each day and sang hymns. An infection, doctors warned, could exacerbate his condition; her milk would be best. But the baby grew tired quickly, his small lips too weak. She bought special formulas to increase his caloric intake, held the bottles along her chest and prayed.

            Charlie turned six months and then twelve. On his first birthday, his mother baked a cake with real vanilla beans and rich white buttercream. She took his picture, his cheeks covered in icing. She put it on the refrigerator to remember.

            Two weeks later, the doctors performed open-heart surgery on the child. They lay the baby on a small padded table and wrapped him in a thin white sheet. They made an incision in the center of his chest, tucking wires around the organ. They divided the upper and lower chambers. They added a patch to the right ventricle to improve blood circulation.

            The surgery would let him see six, they said.

            Charlie turned four and then he turned five. His mother had him swallow pills with orange juice. She tucked the bitter ones in pancakes. The pills fought off infection. He turned seven, and then nine, and then eleven. His heart kept beating. The doctors wondered aloud if it might beat forever.

            On his twelfth birthday, his mother rented a pavilion along the river. His father grilled hamburgers and sweet peppers and Charlie rode a horse along the edge of the water.

* * *

            When I first met Keith, I didn’t know about Charlie. I knew only that my new boyfriend had a New England accent and said “pardon?” when he didn’t hear me right. I knew he was raised on a street with the name of a condiment and that he cooked his eggs with Brie. I liked to spend whole sunny afternoons in his bed in winter. His cold fingers touched me until they warmed. Later, he’d froth milk with a small whisk and pour it in mugs of espresso in the shape of a heart. We’d sit on his blue bed sheets or walk around our small Pennsylvanian town for hours, sipping the mugs slowly until the drink went cold.

            We had been together for eight months when Keith brought me home to meet his family in Boston. The trip was for one week at Easter. I imagined a quiet church service and honeyed ham. I arrived to a dark house cluttered with clothing.

            Keith’s mother was a financial advisor who wore tight shirts and a bejeweled Blackberry holster. Her car had heated seats and eight cup-holders and the leather smelled musky, expensive and new. His brother rowed boats along the Charles and drove a Land Rover and flew to England for the Royal Regatta. Their father was a diagnosed schizophrenic and, after the divorce, moved to live alone in a cabin on Puget Sound. He called himself a monk of learning. A philosopher of thought.

            I could not relate to any of them.

            On Easter morning, I put on things I’d acquired in the eight months with Keith—pearl earrings and a Tiffany’s necklace with a charm shaped like a starfish—and we sat in silence at the breakfast table, drinking freshly squeezed orange juice from tumblers carved to resemble fish.

            “You’ll like Charlie,” he told me on our last night in town. “He’s more of a friend to me than family.”

            I nodded. I hoped to find something in common with Charlie. “Great,” I said.

            Charlie was sixteen then. We picked him up at dusk and drove into the city. We ate greasy chicken tacos on damp tortillas from a stand on Church Street, then drove down to the river to drink Sam Adams and watch the city sparkle.

            “Thank you for this,” Charlie said. He leaned back against the hood and lifted the glass to his lips.

            I liked him—the way I felt we could relate to a world increasingly concerned with status. Charlie’s only status was: Alive. I opened another bottle and clinked my glass against his. “It’s beautiful,” I said, motioning towards the blinking skyline.

            “Yes,” Charlie said.

            Later that night, Keith and I lay in his childhood bed, discussing the future: Charlie’s heart and its size.

            “Should we have given him beer?” I asked. I rolled over under the moonlight that poured in from open blinds. I worried aloud about complications and drug interaction.

            “I’m sure it’s fine,” Keith said. “He’s made it this long.”

            His fingers found mine, then other things.

* * *

            When Charlie turned eighteen, Keith and I called him on speakerphone, squeezing together to share the space above the receiver. We agreed we would start singing as soon as Charlie picked up. When he didn’t answer, we tried again. Then we tried the house. Then we tried his mother.

            That morning at breakfast, she told us, Charlie had fainted. His heart was too weak. “Really this time,” she said.

            She drove him to the hospital—the quickest route, because she’d mapped them all before. The doctors added his name to a heart transplant list. He was posted as their highest priority.

            “Normally patients don’t get this far,” the doctors told her. It was supposed to be an achievement. What they meant was that she should be grateful he had stayed alive this long.

            He had, only moments ago, turned eighteen.

            His father sold the lake house in preparation for the bills. Charlie would stay in the cardiovascular wing, hooked to bags and clear tubes, for days or weeks or months until the new heart came in.

            “How does a new heart come in?” I asked Keith after we hung up. I knew but wanted to hear it aloud.

            It was December then and this, we figured, was the best time to be on such a list. A heart would be salvaged from a car accident that would occur on the way to Christmas dinner or at some point on New Years Eve. The person would be drunk or not. The accident would be on a highway or not. The donor would be married or he wouldn’t. He would have kids or he wouldn’t. It didn’t matter. We couldn’t think about the person. He would be what the doctors called a “beating heart cadaver.” His heart would be removed. It would be flown by helicopter, swathed in ice. The helicopter would land on the roof of Mass General, the doctors would remove Charlie’s heart, and the new one would go inside the empty cavity in his chest.

            Keith and I spent Christmas Day sipping virgin pomegranate martinis—frothy juice and ice—from the plastic cups my mother served us. We waited. If the call came, we would drive up the coast to the hospital.

            It didn’t come.

            We spent New Years Eve in Boston. This, we were certain, would be the night. We drank with his brother in a Beacon Hill brownstone that overlooked Boston Commons. The townhouse cost twenty million, we were told. We drank Grande Siècle from crystal goblets and looked at the people in the park through expensive, narrow telescopes. At midnight, Keith pulled me onto the roof deck.

            “This is it,” he told me. “Any minute.”

            We watched the buzzing static of cars brake and go. The roads were slick and wet. Any minute, we would take the Red Line one stop north to the hospital.

            At three, we drove home through the ice and grit, the only sound the salt along the undercarriage, like BBs hitting pie plates.

* * *

            In the morning, we drove to the hospital to again stand beside him.

            “You know what this means,” Keith said as he drove.

            “Sure,” I said, but didn’t. My head ached. It was only later I realized what he meant: that a heart might not come in time.

            In the hospital room, Charlie sat in his bed between two pieces of boxy recording equipment. The wires and cables looped alongside his own cables, his own wires.

            “I’m making a film,” he said.

            I thought of the night my feet had been cold. His whole face was blue now. His lips were purple where the skin plumped.

            We walked beside him as he wheeled the machines and bags down the hall. “Eight and a half loops make a mile,” he told us. He’d measured it with the help of a nurse. He walked four miles—thirty-four laps—a day.

            “I made a porch, too,” he said, pointing to three folding chairs propped outside his room. “The night janitors told me to take it all down, but I put it back out during the day.”

            We stopped in rooms that smelled like instant potatoes and he introduced me to the people—people hooked to monitors, breathing into tubes, breathing into machines. Most of them were older—forty, fifty—but one was eight. Eight or seventy, it didn’t matter. Charlie had made friends with everyone and all of the nurses.

            “When visiting hours end, they let me shoot the movie,” he said. He directed other patients, other people hooked to monitors and cords. “Most of them want to be in it,” he said, “but not all of them are mobile.”

            The film was about a man who woke on the seventeenth floor of an abandoned hospital. A doctor had helped him film a scene with an echocardiograph.

            “It’s shot in black and white, too,” he said, “so we can use Hershey’s syrup for blood, cause you can’t tell. It’s more accurate than Grey’s Anatomy.”

            He told us the Needham Times had heard about it, that they planned to air a segment on him as part of the next night’s evening news.

            “Will you be able to see it?” he asked.

            “Not in Pennsylvania,” we said.

            Back in his room, Charlie reached for his laptop on the bedside table. He loaded the URL of the clip they sent him for review. “Well, at least here’s proof,” he said, pointing.

            On the drive back down the coast, Keith heaved beside me in the passenger seat. His cries were animal. I held his hand and kept the heat on high.

* * *

            Back in Pennsylvania, there were rainy afternoons. There were fried eggs and whole albums listened to in silence on shag rugs.

            We ate cheese on toast because neither one of us felt like cooking.

            I made pots of tea and sat beside Keith in his living room. I read to him from books, highlighted passages I saw as significant to what he was experiencing. I copied lyrics from songs and pasted them in a Word file I titled Relevant. I emailed the file to him with the subject line, “Helpful?” I thought what he needed was language. I thought what we needed was a vocabulary for the things we were experiencing.

            He didn’t respond. We didn’t talk about what I’d done or what was happening. We carved our meat at dinner in silence, watching the flames on the candles flicker.

* * *

            On Charlie’s fifth week in the cardiovascular center, a heart came in. We didn’t ask questions. It was deliverance, plain and simple.

            The procedure took twelve hours. Surgeons sliced into the body, dissected the great vessels, performed a cardiopulmonary bypass. They attached Charlie to a heart-lung machine, whose pumping simulated a real heart. Surgeons removed the left atrium, removed what was broken, and trimmed the donor organ so that it would fit inside Charlie. Then they put it inside. They sutured it closed. They restarted the heart, and slowly, they weaned Charlie off the machine.

            “It went well,” his mother called us to say. We’d spent the day sitting on couches and beds and futons and floors. Days earlier, she called to tell us she didn’t want us making the trip to Boston “He isn’t able to have visitors, anyway,” she said. “Save your time for a time when he can spend it with you.”

            The new heart was a new start for all of us. I set a table with linen cloth. Keith cooked lamb and pan-fried potatoes. We raised our glasses, toasting to all the things we felt we could sense then but not yet see.

* * *

            Charlie stayed in the hospital for three more weeks. On the day he left, doctors assigned him a daily regimen of twenty-two pills—pills would suppress his immune system, that would keep his body from rejecting his body: the foreign entity, that new heart and all its beating.

            “Take this seriously,” they told him. They worried the boy who fashioned a porch outside his hospital room—a boy who squirted Hershey’s chocolate in strangers’ noses—might not.

            “Okay,” he said, “jeez.”

            To cope with his new life, Charlie was assigned a physical therapist. He was assigned a massage therapist. He received instructions for sleeping and instructions for travel—no flying, because oxygen levels in planes were too low. He received catheterizations and bone scans and supplements. He was warned against raw meat and cigarettes and Red Bull and sushi. Doctors monitored his fluid levels and sodium levels and blood pressure. To cope with living with someone else’s heart, he was assigned a psychologist.

            “How does it feel,” the woman asked, “to live with this new heart?”

            She expected guilt in a patient so young.

            Instead Charlie looked at her. What better a thing to do with a heart, he wanted to know, than use it?

            For months he played basketball and swam laps. He tried Vietnamese food for the first time. He went wind boarding off Nantucket. He liked a girl, and then he kissed the girl, and then he was dating the girl, whom he called “babe.”

            He told us these things on the phone when we’d call.

            “And I’m finalizing editing,” he said. “The Seventeenth Floor—it’s almost done.”

            He told us to drive up and see it. We promised the next holiday, the next break, the next lull.

            We would be there, we said, we will come.

* * *

            When Charlie came down with mono, Keith bought a one-way plane ticket.

            “He has to keep taking the pills so his body doesn’t reject the heart,” he said as he packed. “But the pills suppress his immune system, you see?”

            I did but didn’t want to. I packed him a thermos of hot tea. I drove him two hours through the night to Baltimore-Washington International. On the dark drive home alone, I tried to think about what this meant for him and not us. There was a life on the line, I reminded myself. There were things going on that were bigger than our love.

            In Boston, Keith spent whole days in the intensive care unit outside Charlie’s room. Because he was not immediate family, he could not stay in the patient care guest rooms the hospital kept tucked in the corners of the wing. He slept on small chairs in the cramped lobby. He ate meals from vending machines and drank cheap coffee from cylindrical drums. Once a day, he phoned me from a sidewalk that bordered the hospital.

            “When will you be coming home?” I asked after it had been a week.

            “I don’t know that I will,” he said.

            I let one week turn into two and then three.

            Meanwhile the mono spread. The pus and mucus collected in Charlie’s lungs.

            When the doctors described it, they used the word “pooling.”

* * *

            I didn’t know what to do for the people in pain. I bought cards of cats sticking out their tongues. I bought sunflowers. I bought a crate of Hershey’s Cookies ‘n Cream candy-bars, Charlie’s favorite, and had them shipped to the hospital room. Get fat at least, I wrote on the gift card. I didn’t know what else to say.

            Charlie kept getting sicker. Keith’s calls got less frequent.

            I stopped going to work. I sat around in my pajamas and ate soup from the pot. I read books and stopped highlighting. I lit candles that made everything smell like peach. At night, I drew back the curtains and cooked flavored rice from boxes. I drew baths, lay in the hot water, watched ripples form from what was going on beneath the surface of everything.

            “What about me?” I asked Keith one night on the phone, my voice like a whisper. It had been weeks.

            “Are you kidding?” Keith asked. “Are you kidding me right now?”

            I convinced myself I was. I convinced myself that if I gave it enough time, Charlie would heal and Keith would come back. The things I knew would return to the way I knew them.

            “Are you tired?” I asked. I asked about the weather.

            The crows appeared the next morning. The sky was pink. I drew back the curtains and there they were, huddled together on the telephone lines that bordered my apartment.

            I took it as a sign, their presence in my life. They meant what was bad would stay bad. What was broken would continue breaking.

            At night I thought about driving up the coast to stand beside the men, each fighting something I could not see. Instead I let the leaves turn brown in their dying. I woke up each morning to draw back the curtains and curse.

* * *

            In Boston, the doctors made an incision in Charlie’s trachea. They needed to stop the pooling. They gave him anesthesia to put him under, then pushed tubes down his throat to sop up the fluid. They drained the lungs, then stitched the hole.

            The hole was supposed to stay stitched ten days. They removed the stitches after seven, assuming the wound had healed, but it hadn’t.

            Back in his hospital room, past the porch and measured tiles, Charlie coughed. His mother turned to get a glass of water, and Charlie coughed again, bursting his aorta. The wound tore open. His head jerked back—his neck a hole—and the incision doubled. His throat pooled.

            The hospital went under code red. The nurses grabbed a gurney, wheeled Charlie down the hall, stood silent as on-staff doctors performed an emergency tracheostomy, shoving a scalpel through his throat.

            It took somewhere, doctors would later estimate, between seven and ten minutes to close the hole and drain the blood from his throat and lungs.

            Patients are brain-dead after five.

            “He’s in a coma,” Keith called me to say.

            I drove up the coast to stand beside them. I held Charlie’s mother’s hand in mine. I didn’t flinch when she hugged me to her chest, her body heaving. She told me she was grateful her nephew had someone like me.

            I had a strength, she said, something inside me that carried us both.

            I didn’t tell her I didn’t. I knew enough to know to look strong. I stood in the crowded room between her and Keith, held their hands while the two sang hymns. An atheist by birth, I tried my best to lip-sync. My body ached for words. A reverend rubbed holy oil on the parts of Charlie that were warm, and I watched the oil disappear into his thin, purple skin.

            When we left, Charlie’s mother slipped earphones into his ears.

            “He’s in there somewhere,” she said.

            I didn’t want to believe he was. I didn’t want to believe that his mind was alive—that it was processing, panicking, but couldn’t send the signals to move his hands or tongue or lips. I didn’t want to believe anyone could be trapped inside himself. I told myself Charlie was asleep, that his mind had gone to some new place, a noisy place, not unlike a subway stop or bus terminal. It was a place where people were talking, phones were ringing, a voice was sounding from a loudspeaker mounted to a pole. Everyone was coming. Nobody was going. The place had birds in the rafters, maybe it smelled like popcorn, maybe hot dogs turned in grease. Still everyone was hugging; no one had to stand alone.

            I turned and looked at Charlie, at his white body still in the white room under white blankets. Charlie’s mother blew a kiss, then turned on a playlist that played Christian music and church services on loop.

            “The Lord is with him,” she said.

            I couldn’t see how He possibly could be.

            In the parking garage, Keith and I stood against the hood of the car not speaking.

            “You should eat something,” I finally said.

            I drove us to a nearby Japanese restaurant with chopsticks whose tips resembled cats. The place smelled expensive and clean, the walls lined with murals of women tying back thick, black hair. We ate tempura and seaweed salad.

            “Isn’t this getting expensive?” I asked. “What happens when the money runs out?”

            “Then it’s the end,” Keith said. “Even with it, he might never come out it.” He reminded me of the lake house, then told me about the equipment. Charlie’s parents had sold it to help pay the bills.

            “All his stuff?” I asked. “His video camera? everything?”

            “All of it,” Keith said. “We have to give it our all.”

            We sat in silence until the silence felt hard. I told him about Pennsylvania and about the crows—how they were noisy, how they woke as I fell asleep, how their sounds felt like my world.

            “That sounds awful,” he said.

            When we finished, I sucked the orange slice and paid the tab. I dropped him off at his crowded, dark house, then drove six hours south in time for sunrise.

* * *

            Charlie stayed in the coma for ten months. Keith stayed in Boston.

            The crows woke me up daily with their squawking. They pooped in the alley when I walked through it. I hated their nose, their mass, their bodies big and black and alive.

            I threw shoes at them. When that didn’t work, I got up and got dressed. I went to the gym, still quiet and deserted in the early morning hours. I focused on what was inside of me, the things I had that were healthy, what was beating warm beneath my chest. I was proud of my heart’s function, the way that it moved. I put my hands on the metal heartbeat sensors and watched as the numbers climbed.

            We have to fight to stay strong, I told myself, sweating and panting in the echoing room.

            I knew even then: there are very different kinds of strong.

* * *

            In Boston, the doctors tried to break Charlie’s coma, performing surgery on his throat and brain and heart. They drugged him and injected him and drained him. They operated, time and time again. Keith called in December to tell me about the stitching. They were trying, once more, to repair what was torn.

            “He’s in surgery now,” he said. “They think if they can get the heart to pump a little more efficiently, maybe he’ll wake up.”

            By then I didn’t care or couldn’t. Charlie had been in the coma for ten months, and Keith had been in Boston, and I was tired of all that was broken. I cradled the phone against my shoulder, ordered them a giant cookie in the shape of a heart, and hung up.

            Outside, the birds made their noises. I felt nauseous with their noise, sick of the curse they’d put on my life. Their calls felt like a soundtrack to sadness. I typed their description into a search engine. I wanted to learn how they functioned. I wanted to learn how they lived. Above all, I wanted to learn to make them leave.

            Black, I typed. Noisy, whistling, chatter calls.

            The birds, I learned, were not crows but cowbirds. They ate the insects stirred up by hooves. Why they were on my telephone wire, I didn’t know.

            Hours later, Keith would call to tell me Charlie passed away. He had been resuscitated twice in ten months, and when surgery that morning failed, his mother decided not to put him through a third.

            “I thought you should know,” he said.

* * *

            I thought after the funeral, Keith might come back but he didn’t. He stayed in Boston with his family. He helped Charlie’s mother establish a charity fund in her son’s name. He joined a church and sang hymns on Sunday.

            I threw shoes, screamed, sweat until I felt dizzy.

            The birds stayed until they didn’t. One morning I woke up and they were gone. I watched from my bed the empty line swing. It shook without weight, miraculous.

            I ran my fingers along the bulge of my collarbone, felt my skin dip in the swells below. It was warm there and soft. The heart pumped underneath. It was working inside of me, pumping to some indeterminate end.

            From far enough away, I told myself, anything can look like anything.

            But even then I knew: the birds were not crows. They were not a bad omen. There are no bad omens.

* * *

            Nine months later, on what would be Charlie’s twentieth birthday, I found Charlie’s film, The Seventeenth Floor, on Youtube. I watched it in its entirety, and then I watched it again.

            The man in the film—he wakes in the abandoned hospital and walks the deserted hallways in a thin, translucent paper gown. He descends an empty staircase; the stairs go down, but they don’t lead anywhere. Every time he opens the stairway door, he is still on the seventeenth floor.

            Death appears as a figure in a black robe. Death trails him.

            The man runs through the empty corridors, the hallways white and shining. In the corner, against a wall, he comes across his own bloody heart. It is wrapped in a Ziplock bag and beats, covered in syrup ,through thick plastic.

            The man puts his heart in his pocket and runs. Death runs after him. The heart falls out and onto the floor, but Death reaches it first. He lifts his cloaked leg and stomps down on the organ.

            The man is jolted awake by a defibrillator, two nurses and a doctor. He is still in a hospital, only this one has people.

            I watched the film alone in my empty bed, my feet tucked under blankets, my skin white and flesh-like, alive and soft and warm.


Gionni Ponce (Nonfiction Editor): In “Beneath the Surface,” Amy Butcher explores how the death of a family member can mean the end of a relationship for a couple. Butcher makes no attempt to sketch herself as the perfect girlfriend in this difficult time for her partner. She fumbles with the wrong words and resigns herself to witnessing as they drift apart. The piece can only be described as “quietly intense” with particular attention paid to striking visual details.


This piece appeared in Indiana Review 33.2 Winter 2011

Amy Butcher is an award-winning essayist and author of the forthcoming Mothertrucker (Little A/Amazon, 2020) and Visiting Hours (Blue Rider Press/Penguin-Random House), a 2015 memoir that earned starred reviews and praise from The New York Times Sunday Review of Books, NPR, The Star Tribune, Kirkus Reviews, Glamour, Cosmopolitan, and others. More recently, her December 2018 essay “Flight Path” was the grand prize recipient of The Sonora Review’s Flash Essay Contest and her May 2018 essay, “Women These Days,” was named Best Essay of 2018 by Entropy and nominated for a Pushcart Prize and inclusion in the Best American Essays series by the editors at Brevity. Additional work has been featured on National Public Radio and the BBC, anthologized in Best Travel Writing 2016, and earned notable distinctions in Best American Essays 2015, 2016, 2017 and 2018. Her work has appeared in Granta, Harper’s, The New York Times “Modern Love,” The New York Times Sunday Review, The Washington Post, The Iowa Review, Lit Hub, Guernica, Gulf Coast, Fourth Genre, and Brevity, among others. She lives in Columbus, Ohio with her two rescue dogs, beautiful beasts.