We do ten before lunch. We cut them. We tag them. We place them in a small pyramid so they don’t roll off the tray.

“Whoo,” says Charles, as he pulls off his mask. The top one is still beating, and I look at it a while before pulling off my own. The patient gets up, and he looks too, and we’re all just staring as the heart slows and then stops.

“Wow,” the patient says. His name is Thomas Farrar. He is forty years old, and there is a slow drop of blood winding its way down his chest, but otherwise, he is fine--better, in fact.

“It’s a shock, isn’t it?” asks Charles. “Like, hello, here’s this piece of you that up until a little while ago was keeping you alive.”

“Yeah,” says the patient, “I guess that’s it.”

“Do you want to keep it? We could clean it out, put it in alcohol for you. Some patients like that. A little memento.”

Thomas seems about to say yes, but then he shudders, perhaps thinking of the heart in a jar on his desk at work or his fireplace at home. “No,” he says, “you can get rid of it, I guess.” The nurse wipes off the drop of blood and hands Thomas a new paper gown.

Charles and I scrub out, and we place the tools in the insta-clean. Then we head down to the cafeteria, where they’re serving steak. I eat mine medium. Charles likes his rare, partly because it weirds me out to see blood on his tray. He is the old hand. I am the new boy, and he relishes in his imperturbable stomach.

For ten years now he’s been solely on heart removals. We’re the first hospital in the world with a dedicated team, even if it is just Charles and I, and we’ve gotten so fast we can usually knock out 25 a day.

“The human body is a breaking machine,” Charles told me when I was first interviewed for the job, “And you can’t stop that, not altogether. So what do you do? You keep the pieces that break first from breaking so early. And that’s the best you can hope for. Ninety-percent of the time, the thing that breaks first is the heart.”

The HeartPlus isn’t perfect, of course. But it’s better than the original as far as endurance is concerned. The titanium does wear down, and the fuel cells run out. “It won’t last til the end of time,” Charles likes to tell patients, “But it’ll sure outlast the rest of you.”

In some ways, the heart was a simple thing to replace. For as important as it is, it’s a pump with valves. Mechanics have made more complex ones for cars. So eventually, we got the pacemaker. And then, when they improved enough, we got the HeartPlus. But still we focused on fixing. And it was Charles who switched the dialogue to one of prevention.

“It just doesn’t make sense,” he told me, “to keep this thing in your body that is, for most people, a ticking time-bomb. What’s the number one killer of Americans? Heart disease. Well, there’s an easy solution: circumvent the heart from the get-go, and spend your time worrying over cancer or diabetes instead.”

At first, he was characterized in the journals as a loon. But then more and more doctors started to agree. And healthy patients came to him, and asked if he would do it, and he asked the hospital, and they said yes.

It’s simple now. Cool and clean and efficient. And other hospitals have their cardiologists doing the procedure too, even if they can’t handle as many as us.

I remember having my own done. It was Charles, of course, that I trusted with his instruments in my chest. I wanted to be awake, to feel the moment when the organic thumping was switched with a mechanical pulse. In truth, I was afraid. Centuries of poems and metaphors coursed through my mind. For a moment my humanity seemed to flicker and stammer and float away through the hole in my ribs. But then they were patched, and I sat up, and I looked at the piece of muscle, gasping like a caught fish.

And yes, I took it home. And I watched it the entire evening. I tested myself. I thought about my father, long dead, and was pleased to find the same ache in my chest where it had always been.

I laughed at myself for being so foolish, for knowing what the heart is and yet still expecting it to feel.

The next day I called Charles, and I said I would take the job.

After lunch, we scrub in, and there’s our next patient. He is ten years old, and his eyes are brown and big as platters. Normally we don’t go this young, but the boy’s a genetic risk, a father who had a heart attack at twenty-five, and an uncle who had one not long after. The boy sits on the edge of the operating table, swinging his legs nervously.

We greet the boy. Charles gives him a lolly-pop and then takes me out into the hallway. “You okay doing this?” he asks. Though I’ve been at it a year, I’ve never worked on a child.

“Yeah,” I say, “Just another body. No different, only smaller.”

“Geeze,” says Charles with a smile on his lips. I can see that he is still worried but also somewhat proud, “You’re heartless.” Then he chuckles. He loves these puns.

But even though I laugh, and even though I go in, and I help the kid lay down, and I hold the mask over his face to make him go to sleep, Charles is wrong. I have a heart. It’s sitting in a glass jar on my desk at home. And though I know it’s silly, and I will laugh at myself later, I swear I feel it hurting as I bring the saw down on the boy’s smooth chest. And I pray, in a way that I never did for myself, that nothing will be lost. Only saved.

Medgagdet recently announced the winner and runners up of the fourth annual Medical Sci-Fi Writing Contest. Evan Perriello is this year's winner of the Amazon Kindle reader for his short story "HeartPlus." Runners up were James H. Dawdy for "Mars Rescue" and Hans Patrick Griesser for "WHAT'S MORE AFFORDABLE THAN FREE?"

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