heart.

"So as long as he has oxygen, his heart will function on its own? He doesn't need a pacemaker?"

"Right," my instructor responded. "The brain tells the lungs to breathe, but it doesn't tell the heart to beat. Remember the heart has its own electrical conduction system."

I nodded. I did remember, as we were knee-deep in cardiology at school. 6 students, our instructor, and two nurses were crowded around a patient's bed. His chest rose and fell rhythmically, and his telemetry monitor showed a steady, healthy heartbeat. His skin was warm and even-toned, exactly what nurses want to see, since this indicates good blood circulation, which means the heart is doing its job, which means it's getting the oxygen it needs. We took turns listening to his heart sounds with our stethoscopes--a strong, healthy pattern of lub dub lub dub lub dub. 

He'd been declared brain dead a couple days before, his breathing the work of a ventilator next to his bed. The goal was now to keep his organs healthy and strong so they could eventually bring life to others.

The patient had been found unconscious, rushed in, and treated, but an overdose is a powerful opponent. I slid his ankle ID band around so I could see his name. He was a few years younger than I am, around the age I was when I gave birth to my daughter, expectantly looking at all that life had yet to offer.

We talked about some of the clinical signs of brain death--lack of a gag response (tested by inserting a suction tube down the ventilator tube, to which a brain-alive person would automatically gag); pupils dilated, fixed, and unresponsive (we took turns lifting his eyelids, shining a light at his dilated pupils back and forth, noting the absolute lack of response). We learned about the Lazarus effect, spontaneous movements in a brain dead person that are the result of spinal cord reflexes (those that do not travel to the brain).

The brain runs the show, because it is sophisticated, each cell packed with experiences and connections. It is a well-intended parent, or teacher, or coach, or mentor. But like any of these, its charges can still operate independently. We reflex without checking in first. Our hearts excite and conduct and pump. We say we want to "turn off our brains" for a while, to do something "mindless." We say we want to "veg out", we say we are listening to our hearts instead of our brains. We strongly perceive our brain's instructions against a particular action, or feeling, or response; we decide instead to do something else.

Of course, like many well-intended parents, teachers, coaches, or mentors, the brain is subject to misfire. It floods with chemicals that disrupt the delicate balance required for proper, healthy functioning. It remaps its connections after trauma. It swells with fluid, it bleeds, it sustains injury. It is our most precious organ, protected so carefully by layers of tissue and a hard skull, and yet it can fail us, and we it.

I don't know anything about this young man's life, the years he lived with an active, living, responsive brain. I know he had a sister, a father, and a girlfriend. I know that an overdose of cocaine--his first overdose--abruptly ended everything in front of him. I will never forget his name.

Another student and I helped our instructor re-position him (to avoid blood pooling and pressure ulcers). With my hands on his upper right leg, I pulled him towards me, struck again by how warm, soft, and utterly alive his skin felt. My instructor placed two fresh pillows on the bed and we rolled him back over, pulling the hospital sheet and a soft crocheted blanket back up to his chest. Somebody must have brought that blanket in.

I stared at his face, rested my hand on his ankle, and gave a little squeeze. This young man was no longer alive, though it did not seem possible, or fair, or right. His assigned nurse came in to tell us that his girlfriend had arrived to visit, so we filed out of the room to collect our backpacks and coats and head to our next assignment.

The monitor continued to display a normal sinus rhythm, the pattern of a healthy beating heart, its vital oxygen supply not coming from lungs responding to an active, guiding brain, but from a machine artificially inflating the lungs. The heart did not know, nor did it care. It would keep on supplying oxygenated blood to the body, unaware that the brain was gone, and would not come back.

His girlfriend walked into the now-empty room, sat in the chair beside the bed, and held his hand.