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Recalcitrant Tissue:

Cadaveric Organ Transplant and the Struggle for Narrative Control

Sara Wasson (Lancaster University)

Published in Justin Edwards (ed.), Technologies of the Gothic in Literature and Culture:

Technogothics (London: Routledge, 2015), pp. pp. 99-112. ISBN 9781138797192

The Gothic has long been interested in failed communities, the snapping or violating of ties

between kin or neighbours. In earlier Gothic, dysfunctional families or religious communities

were settings for cruelty and exploitation. As the Gothic mutates into new forms today, it is

increasingly characterising texts which depict whole societies as wounded in their relational

capacity – in the ability to connect, to care. Human organ transfer gives copious opportunities

to rethink community and even kinship. From a positive perspective, Lesley Sharp has

written about the possibility of “biosentimentality” emerging from cadaveric donation, in

which recipient and donor kin may experience a profound bond (Harvest, 193). More

negatively, in anonymous living donation the donor is often represented as a mere

manufacturer of tissue, a move which elides their sacrifice and has facilitated brutal predation

on poor and vulnerable harvestees worldwide (Scheper-Hughes; Joralemon). This chapter

examines texts that complicate both those approaches by instead depicting the transferred

tissue as both alien and active, the alien tissue triggering a narrative crisis in the experience of

the recipient. Organ transfer technologies enable recipient survival, literally enabling a “self”

to endure, but in the process require imaginative labour in forming a new subjectivity. The

recipient must forge a new story of a self both enabled and undone by medical intervention.

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As such, this chapter discusses some of the narrative dimensions of organ transfer,

particularly in the light of recipient ambivalence over the “gift” of tissue. At their extreme,

fantasies of cadaveric organ receipt can make literal Gothic’s traditional preoccupation with

alienation from the body: as David Punter says, “Gothic tests what it might be like to be a

shell ... a shell which has been filled to the brim with something that looks like ourselves but

is irremediably other…. Thus it is we ourselves who are cast as the ghost, the spectre, the

‘revenant’” (Gothic Pathologies, 16). With such (admittedly extreme) alienation in mind, I

will briefly examine Jean-Luc Nancy’s autobiographical essay “The Intruder,” which

describes receiving a heart transplant, and Claire Denis’s film L’intrus (2004) inspired by

Nancy’s prose. These texts resist the dominant trend in medical transplant commentary to

downplay any sense of the received tissue as alien; instead, these texts actively dwell on the

strangeness of the transfer process and ultimately show their tissue recipients suffering a

narrative crisis.1

Elsewhere, I have discussed literary texts that represent organ transfer from living

“donors” or harvestees, in the process flagging up black- and grey-market living donation as

predation on vulnerable demographics (Wasson). By contrast this chapter focuses on

recipient experience of cadaveric organ transfer and potential anxieties about being changed

by the received tissue. The traditional Gothic tropes finding new forms here include

possession, paranoia, and the return of the dead hand of the past. Both recipient and “donor”

arguably become monstrous and spectral.

It must first be admitted that the very act of using such gothic imagery to describe

organ transfer is seen as pathological by transplant clinicians. Recipients are discouraged

from dwelling on thoughts of the donor’s death, the alien tissue, or their changed self. In fact,

this constellation of thoughts has been labelled “Frankenstein syndrome” (Sharp, Harvest,

23-4; Beidel). To prevent it, transplant professionals typically anonymise cadaveric donors,

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ban interaction between recipients and donor kin, and encourage recipients to see transferred

tissue as analogous to a machine’s spare parts (Bunzel et al; Sanner; Shildrick). This is well-

meaning: there is evidence that thinking about the donor can encourage biological tissue

rejection (Bunzel et al 252). To such professionals, a paper such as this, emphasizing morbid

imagery, must seem perverse. It must also be admitted that relatively few organ recipients

feel the extreme form of this distress: in one survey of 47 heart transplant recipients in

Vienna, for example, only 6% of heart recipients felt their personality had been changed by

the received tissue (Bunzel et al 251). Yet social scientists find that recipients’ emotions on

cadaveric transfer are often more complex than the current medical framework allows, and

that giving recipients the opportunity to have their ambivalence heard may be relevant to

“positive clinical outcomes” – i.e. to recipients’ survival (e.g. Shildrick et al). The gothic

framework of this paper is an invitation to explicitly examine that shadow side of recipient

experience. It can be argued that recognizing this distressing dimension is necessary in that it

respects the complex ambivalence of patient experience. That recognition draws close to

Arthur Frank’s call to clinicians to respect the darker modes of illness narrative (110).

This chapter is part of a wider project examining what Gothic studies may contribute

to contemporary medical humanities, and vice versa. The dominant theoretical frameworks

and affective outlook of these discourses are often diametrically different. For example, in the

latter, patients’ autobiographies of illness experience are rightly celebrated as giving some

writers a chance to reclaim a sense of their own agency. In this vein, Rita Charon argues that

writing illness narratives enables “patients to give voice to what they endure and to frame the

illness so as to escape dominion by it” (65-6). Similarly, Ann Hunsaker Hawkins suggests

that illness narratives:

show us the drastic interruption of a life of meaning and purpose by an illness

that often seems arbitrary, cruel, and senseless …. The task of an author … is

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not only to describe this disordering process but also to restore to reality its

lost coherence and to discover, or create, a meaning that can bind it together

again. (2-3).

There is understandable eagerness to see illness narrative representing illness in ways that can

make it bearable and useful, both for the patient and for the medical hearer who wishes to

empathise with the patient’s experience. Yet the darker side of illness experience – chaos,

pain, passivity in the grip of medical interventions – can fit uneasily with such confidence in

storymaking agency, and as I will show, several critics have argued that the act of being an

ethical witness of patient experience sometimes requires we resist reaching for such narrative

consolations.

The two texts I will discuss in this chapter do not offer such a sense of restored

|”coherence” or meaningful order. They do not match the most common forms of illness

narrative, as identified by Arthur Frank: the “quest narrative” in which a person’s experience

of illness becomes a meaningful journey, or the “restitution narrative,” in which a benevolent

medical system restores a patient’s health (115, 77). Rather, they invoke the most disturbing

strand within illness writing: chaos anti-narrative, in which illness is not vanquished,

suffering is overwhelming, and there is no sense of a valuable “journey” to reach valuable

wisdom or a sense of enrichment. Every illness narrative features all three strands, but when a

chaos mode predominates there is little appetite to hear such story: listeners feel aversion to

being “sucked into the undertow” of such distressing illness experience (115).

There are significant problems with identifying a chaos anti-narrative strand in

literature or film, because by definition, the latter are artistic forms, selecting and interpreting

experience. Chaos experience, by contrast, is by definition unspeakable; Frank even calls it

“Mute Illness” (Frank 97-8; cf. Scarry). In this mode, pain, disorientation and despair

annihilate the ability to formulate a coherent narrative structure to represent the experience.

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Yet there are ways in which the notion of a chaos anti-narrative strand may be useful in

approaching representations of illness, particularly insofar as the texts lack meaningful

sequence, “the untellable silence” alternating with urgent “and then” repetitions, but without

the comforts of clear chains of causality or a sense of progress (Frank 99-100). In chaos,

nobody is clearly in control, and the experience is one of profound emotional darkness.

In this regard, one of the things Gothic studies can offer medical humanities

scholarship is a range of strategies in examining literary and cinematic representations of

helplessness and confinement. Definitions of a Gothic mode tend to feature two characteristic

elements: a narrative voice soaked through with a sense of horror and distress (Andrew

Smith, “Rethinking,” 84; Punter, Terror 2: 184; Botting, Gothic 3), and a sense of

claustrophobic confinement, both literal and metaphorical. In practical terms, that means

scholars in our field may have the following: experience of the narrative structures and forms

of language that can express and/or tame harrowing experience; sensitivity to the way spaces

can construct human experience, particularly in terms of the way they can regulate, limit and

control (e.g. Foucault, par. 14; Botting, “Gothic Production,” 29) and most of all, perhaps, a

willingness to hear the language of fear, despair and terror. This latter willingness is no small

thing – research has shown significant lack of appetite to hear such story, including among

healthcare practitioners (e.g. Smith and Sparkes; Langer). Yet there is an ethical necessity to

be willing to hear chaos: such witness is necessary for the speaker’s healing, and a corrective

to the temptation to privilege survivors’ stories over those who do not survive (Frank 110,

135; Langer; Uehara et al; Smith and Sparkes).

I will now discuss some of the medical aspects of organ transfer that make it such a

peculiarly intense transformation, and will then examine how Nancy and Denis represent one

particular disturbing aspect of some organ recipients’ experience: the sense of being trapped

in an opaque narrative outside one’s own control or knowledge.

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Possession and estrangement: recipient experiences of organ transfer

Much work has been done documenting the strangeness of receiving another person’s organ,

both in the popular imagination and in recipient experience. A recurrent strand of this work

flags up the anxiety of being fundamentally changed by the received tissue. The mechanism

of this transformation is usually not clear: sometimes the fear is that genes may slip over and

rewire the recipient body (Sanner 11), but often the dread is a less specific sense that the

given tissue somehow retains qualities, or an essence, of the giver. In the case of cadaveric

organ donation, any such sense of lingering presence is particularly unnerving since the

“giver” is dead.

Cadaveric donation may seem to escape the ethical quandaries that can beset living

donation, particularly on the black market. But ethical controversies also feature in cadaveric

organ transfer - most obviously, in black market transfer, or in cases where state-sanctioned

murder allegedly facilitates organ procurement (see e.g. Kilgour and Matas). Ethical issues

are also raised by two other aspects of cadaveric donation: first, controversies over the

category of brainstem death itself and the reality of the role of procurement surgery in the

death process; and second, the medical protocols used to manage end-of-life care in patients

identified not as braindead but as potential “Non-Heartbeating” donors. I will discuss each

issue briefly.

Defining the moment of death is taxing because different parts of the body cease

functioning at different stages; definitions of death thus necessitate hard questions about the

ontological status of certain organs and the “location” of human consciousness and spirit

within the body (Lock 78-129). While brainstem death has become widely accepted as indeed

“death” in Western media and medical discourse, there are as yet no standard criteria for

brainstem death internationally. As Basil Matta notes, “Defining a moment at which death

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occurs within the dying process is necessary but arbitrary, and differs across societies. A

brain might be defined as dead in the United Kingdom, yet the same brain would not be dead

in Europe and vice-versa” (696). Regardless of nuances in national criteria, several decades

of reliable evidence do seem to reliably indicate that patients diagnosed as brainstem dead do

not recover (See e.g.Young and Matta 106). But while brainstem death is widely recognised

to be irreversible, this form of death is nonetheless distinct from cardiac death, after which

the entire body rapidly begins degeneration. After brain death, the donor/patient body can

still breathe if on a ventilator, has warm skin, may move, and must be anaesthetized before

procurement surgery to prevent cardiac shock at the surgical incision and organ removal. A

donor/patient body categorized as “brainstem dead” remains in what one anaesthesiologist

calls a “warm, pink, pulsating, breathing (albeit by machine), reactive state” (Hill 493).

In the case of donation after such brain death, it is procurement surgery – the cross-

clamping of the heart artery, and then the removal of organs – which directly triggers the

cardiac death (although that would eventually have followed brain death if ventilator were

disconnected). In addition, there is concern even among some procurement surgical staff and

neurointensivists that, rarely, some donor/patient bodies may feel pain: rarely, EEG scans

show lingering traces of cellular brain activity in some patients diagnosed as brainstem dead,

something which Basil Matta, an anaesthesiologist supportive of transplant, admits is “data

suggesting organized brain activity and perfusion in a minority of brainstem dead [and] is

unsettling” ( 696). Also, unusual cases in which the donor body shows hemodynamic and

tachycardic responses to unanaesthetised procurement surgery incision might suggest an

organism in distress (Young and Matta 106; Hogle 16-5; but contrast Poulton and Garfield).

These are rare situations, but even in general cases, some researchers have suggested that if

death is recognised as a process - and indeed it must be so recognised, given the widely

varying national criteria for recognizing death – and if brainstem death is recognised as a sign

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of futility in treatment rather than the final stage of death, then procurement surgery might be

more accurately described as a kind of semi-euthanasia, in that it hastens the final stages of

death in a patient who has already begun an irreversible death process, a semi-euthanasia in

the service of a great social good (Sharp, Harvest; Lock). For these and other reasons, there

continue to be lingering debates over the status of those categorized as brainstem-dead, and

the degree to which they move through a zone between life and death. Language struggles to

capture their liminal status -- “neomorts,” “cadaveric patients,” “living cadavers” (Matta 696;

Young and Matta 105; Sharp, Harvest 45, 59; Hogle 164-5; Lock).

Ethical questions also accompany the second kind of organ donation, Non-Heart-

Beating Donation, after cardiac failure (NHBD). This takes two forms: “uncontrolled”

NHBD, where procurement surgery occurs after a heart attack occurs and resuscitation fails,

and “controlled” NHBD, where a patient already on life support but with a “do not

resuscitate” order has their end of life care optimized to maximize the success of organ

procurement (Zamperetti 182). Controlled NHBD can radically impact end-of-life care

decisions; in the US, for example, care for such potential donors is passed to the organ

procurement staff who work under economic imperatives to maximize donation, which

inevitably introduces the risk of bias in their counselling to donor kin, and NHBD protocols

deviate from guidelines for end of life care, potentially harming the interests of both the

prospective donor and the bereaved (Rady et al 328-332). Controlled NHBD includes

medications and invasive ante-mortem and perimortem procedures to carefully control the

body’s reactions to the gradual death process, and some critics argue that certain drugs that

may later facilitate donation may make it hard to discern ongoing pulse or even speed death;

another concern is the painful removal of lymph nodes for recipient compatibility testing

while the potential donor is still alive (Fox; Sharp, Harvest 70). In summary, then, the

process of death changes radically once a donor is marked out for controlled NHBD.

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Yet even without knowledge of these ethical debates, the language of “gift” is not in

itself necessarily soothing for an organ recipient. Marcel Mauss’s anthropological research

suggests societies are structured by an obligation to reciprocate any gift – an obligation which

stems from the way that gifts are perceived to retain something of those who gave them.

Mauss uses the Maori term “hau” to describe this essence, and argues that “the thing received

is not inactive ... the hau follows after anyone possessing the thing” (11-12). The receiver

must reciprocate in kind, but even if she does, she can never equal the fact that the original

gift inaugurated the exchange network. Gift theory emphasies that it is the giver who has

control (e.g. Derrida; Bercovitch; Bataille; Carrier; Nemoianu).

In the case of human tissue transfer, the language of “gift” is inevitably highly

charged. In a real sense the tissue does retain markers of the “giver” – immunological

markers, genetic material – and also evokes the sense of a costly sacrifice having been made.

Research on heart transplant recipients, in particular, has uncovered the guilt that can accrue

for a prospective recipient even while they wait for an organ to become available, in that they

are, in effect, eagerly awaiting an advantage from the death of another (Bunzel et al, 251-2).

For an organ recipient, direct and equivalent reciprocation is, of course, not possible, so it is

not surprising that transplant professionals take steps to reduce the demand of the gift,

depersonalising and even dehumanising the donor through symbolic substitutions such as

comparing transplant to the growth of plants (Sharp, “Commodified Kin”), or to replacing a

machine’s parts (Sanner 10, Shildrick et al). 2

Despite such defences, there remain cases where recipients felt that received tissue

changed them (eg Sylvia and Novak; Muslin; Pearsall et al; Castelnuovo-Tedesco, p. 219;

Bunzel et al; Basch; Adler). For example, Margareta Sanner describes rare cases where “a

few heart and kidney recipients experienced periods when they were [temporarily] convinced

that they were being influenced by their donors because they found their behaviours ego-

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alien” (10). These challenges to identity can involve a narrative crisis. In cadaveric donation

the continuation of the receiver’s story is literally dependent on the ending of another's, but

there is also a sense in which the receiver may fear that the donor’s story may shadow or

shape their own. When this anxiety occurs it is often around new behaviours or desires that

the receiver perceives to be ego-alien: new desires, new preferences, which shape their

actions differently: they change what the recipient will do. Some even try to tame this fear by

living like the donor’s presumed way of life (Sanner 11). The tissue transferred can feel to be

soaked in story, in a script, as much as in blood. There are other ways, too, in which organ

receipt can entail narrative crisis, and I will briefly examine some of the ways Nancy and

Denis imagine that happening.

First, however, it must be said that these are very different texts, one an

autobiographical narrative of a transplant recipient’s experience and the other a fictional film.

It can be argued that it is inappropriate to consider the two forms alongside each other as

even loosely equivalent modes. Such objections assume that autobiographical narrative is

intrinsically more “authentic” than fiction, the former giving access to a patient’s lived

reality, helping the reader/viewer “experience something of what it is to be ill, in pain, in

anguish, or dying” (Pellegrino 21). In the early days of literature’s use in pedagogies of

medicine, there was a particular temptation to see autobiography as offering direct access to a

“reality” of patient experience, in what Kathryn Montgomery Hunter critiques as a “a

materialist view of literature as a mirror of social reality” (2). But particularly since the early

1990s (and indeed in earlier work), the critical trend has been to recognise that all

representations of illness are inevitably mediated. Both the texts I examine are constructions,

since even autobiography must re-present and re-imagine experience to manifest it in a prose

or visual form. My argument is that both these representations of transplant experience resist

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conventional narrative satisfactions, and that this lack of narrative coherence is itself a valid

representation of a potential reality (even if temporary) for some transplant recipients.

Nancy’s essay “L’intrus” describes the received tissue as “the intruder” who “enters

by force” (1), and he figures this invasion in terms of a narrative clash. His own heart, he was

told, was genetically programmed to survive only to age fifty, but that genetically inscribed

story is altered by the donor tissue and the medical technologies that envelop them:

what other program was to cross … my own, physiological, program? Less

than twenty years before, transplants were not done, and certainly not with

recourse to cyclosporine, which protects against rejection …. Twenty years

hence, it is certain to be a matter of another kind of transplant, by other means.

(2).

The estrangement inherent in receiving an organ transplant is not solely a function of

receiving the tissue of another, dramatic though that may be. There are three potential

narrative pressures on any recipient of organ transplant. First, the sense that the received

tissue retains something of the giver that will usurp and change one’s own story – indeed,

something that must change one’s story, since without it one would die. Second, a sense that

one’s story is controlled by a web of external medical apparatus –the abstractions of waiting

lists, permissions, medical categories, the visceral materialities of medical intervention

(Nancy 5). Third, the recipient has a sense that, as in all illness or even natural aging, their

own body has become the stranger. For many people (though notably never Nancy himself)

one’s body usually feels continuous with one’s “self”; illness interrupts that confidence

(Charon 91). Catherine Waldby notes that people in end-stage illness, in particular, typically

experience a dramatic change in their psychological representation of their body’s interior:

For the healthy person … the interior is not physically mapped in any degree

of detail. …. For the patient awaiting transplant, the body’s interior is

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psychically reorganized, divided into a threatened self and the degenerate

organ that threatens self (246).

Similarly, as soon as Nancy is told his heart is failing, he feels “the physical sensation of a

void already open in my chest … If my heart was giving up … to what degree was it an organ

of “mine,” my “own”?.... I was already no longer in me” (3-4). As the transplant process

continues, this gaping openness intensifies both literally and symbolically:

there is nothing that is not foreign. The means of survival themselves, these,

first of all, are completely strange: what can it mean to replace a heart? The

thing exceeds my capacity to represent it. (Opening the entire thorax,

maintaining the organ to be grafted in the proper state, circulating the blood

outside of the body, suturing the vessels . . . organ transplant imposes the

image of a passage through nothingness, of an entry into a space emptied of all

property, all intimacy — or, on the contrary, the image of this space intruding

in me: of tubes, clamps, sutures, and probes.) (Nancy 7)

In the oddest twist, the ensuing immunosuppressant drug regimen makes his own body the

stranger: the drug cyclosporine stops his immune system recognising the transplant tissue as

alien and killing it, but the drug achieves this by weakening his immune system, and as a

result, all the hidden viruses and other scripts until now safely contained within his body are

unleashed. Shingles and other potential illnesses that lurked safely tamed are now let free: “In

me there is the intrus, and I become foreign to myself …. [T]he most vigorous enemies are

inside: the old viruses that have always been lurking in the shadow of my immune system—

life-long intrus, as they have always been there” (8-9).

The gaping open-ness, béance, intensifies as time continues. Nancy’s text does not

end like a conventional quest narrative – rather it is a catalogue of the annihilation of a self, a

self consumed by a story outside itself. He contracts cancer as a side-effect of the

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immunosuppressant drug regimen, and his description of the stem cell treatment for his

cancer is a haunting echo of a chaos experience, albeit mediated and tamed through prose:

“One emerges from this adventure lost. One no longer knows or recognizes oneself: but here

these words no longer have meaning. Very quickly, one is no more than a slackening, floating

strangeness, suspended between poorly identified states, between sufferings, incapacities,

lapses” (11). This is now a self defined in terms of fracture:

It is not that they opened me wide [béant] in order to change my heart.

It is rather that this gaping open [béance] cannot be closed. (Each x-ray

moreover shows this: the sternum is sewn through with twisted pieces of

wire.) I am closed open. There is in fact an opening through which passes a

stream of unremitting strangeness: the immuno-depressive medication, and

others … (10).

The impregnable recess wherefrom I say “I,” but that I know to be as gaping

[béant] as this chest opened upon emptiness... I am the illness and the medical

intervention, I am the cancerous cell and the grafted organ, I am the immuno-

depressive agents and their palliatives, I am the bits of wire that hold together

my sternum, and I am this injection site permanently stitched in below my

clavicle (12-13).

This is a self now defined in its openness to intrusion, both enabled and undone by physical

fracture.

Claire Denis’s film is loosely inspired by Nancy’s essay, and is similarly rich in

images of emotional strain and physical degeneration after organ transfer. A disorienting,

meandering work, it relies on odd juxtapositions of scenes and striking visual textures. The

film describes Louis, a cold, elderly man, seemingly an ex-mercenary, living alone in a cabin

in a forest near the Franco-Swiss border. He obtains a black market heart transplant, and with

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his new lease on life sets off to the South Seas yearning to reconnect with an estranged son he

fathered when there as a sailor years before. Eventually, he suspects that one of his own sons

was killed for his transplant heart. But this bald summary misses the point of the film, for

reality and guiltridden fantasy are blurred throughout. As Nick Schager notes:

Alternately coexisting in the physical world and its protagonist's angst-ridden

subconscious, The Intruder sinuously marries Louis's heart-related

disintegration with his mental deterioration, neither of which is alleviated by

his acquisition of a new black-market ticker from a mysterious organ-dealer

… who haunts him like a materialized manifestation of his inescapable guilt.

The border between the real and unreal is as insecure as the Franco-Swiss

boundary line. (para. 2).

The film is preoccupied by the policing of thresholds and boundaries. The opening scenes

depict border control guards halting smugglers, and illegal immigrants chased through woods

and – if they encounter Louis – being brutally killed. After Louis leaves his cabin in the

woods, it continues to be a strangely violent site. The empty cabin somehow expels any

intruder with violence: when a Bohemian girl makes it a temporary residence, she seems to

be slaughtered by Louis’s dogs. But ultimately, despite this aggressive policing of

boundaries, the film shows the deepest threat to self can be the way one’s own greed can

destroy those one most needs and loves. In this, it echoes the Nancy essay in arguing that the

greatest threat to one’s peace dwells within, though Nancy emphasises the physical rather

than emotional threats within.

The entire film is told from Louis Trebor’s perspective. Denis recalls that “I wanted

each image to convey a sense that it was generated by his mind. … everything is his” (Damon

Smith para. 84-6). As time passes, Louis’s guilt makes his whole world strangely fantastical.

When he orders his heart by email, the black market dealer types back, “The surcharge is to

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be paid upon arrival,” but we gradually become aware that Louis can never repay this debt. In

a vivid reverie he imagines being rope-dragged behind horses through snow by his Russian

dealer: when she leaves him for dead he gasps, “I have already paid,” and she replies “No.

You’ll never pay enough.” In another lurid vision he imagines an intact heart lying in the

snow, then devoured by dogs, and he keeps seeing his black market dealer at odd moments,

in different countries, tormenting him.

Like Nancy’s essay, the film can be approached as representing the organ recipient in

narrative crisis in multiple ways. First, it describes competing narratives, the protagonist’s

attempts to forge his own future narrative thwarted by multiple external and internal forces.

With his new heart Louis tries to create a new life. He imagines returning to Tahiti, where he

sailed as a young man, to reunite with his lost son. Louis’s love for this estranged son is

intense: we hear a letter he wrote to this son, saying that, “Every lost day that has kept us

apart weighs on my heart like an entire year.” Ironically, Louis cruelly neglects a French son

who lives nearby, who is a loving father to his own young sons; it transpires Louis did not

even visit after the birth of his newest grandson. This French son eventually finds the

aforementioned letter and weeps for the fatherly love he never knew himself. Yet though a

failed and callous father to this son, Louis does yearn passionately for his unknown Tahitian

son, and plans to use his new lease on life to return to Tahiti and reconnect with him. Louis

sends money and an expensive ship to Tahiti for him as extravagant gifts. We have hints of

how Louis intends this new life to play out: we are shown, in silence, a painting by Paul

Gauguin of a ship serenely sailing in the South Seas, followed by a shot from a ship moving

through Southern waters, water lapping.

But Denis’s haunting film shows Louis’s intended story come under repeated

fracturing pressures, ultimately yielding to a darker, incoherent sketch of disjointed grief and

unbearable guilt. She deliberately offers no coherent story, describing the film as “like a boat

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lost in the ocean drifting” (Damon Smith para.19). Louis travels to Tahiti but finds his son

has disappeared, and the money and ship are uncollected. His family refuse to help Louis

locate him, and we see them holding a funeral for a loved one – it is unclear whether it might

be his son. Louis perseveres, staying to continue the search and rebuilding an island shack. In

bizarre scenes he and his friend carry provisions and materials through the sea to restore the

flimsy dwelling. He plans to guard the shack; in an action reminiscent of his violent policing

of his forest cabin in earlier scenes, he shows pleasure when unearthing a rifle from beneath

the shack’s boards where he hid it years before. He still intends to police his own boundaries.

But this dilapidated dwelling is not destined to be a secure retreat. In a disturbing

foreshadowing, as he rebuilds we see a small sea creature approach a rusted tin for shelter in

lieu of a shell. Louis’s shack fails to protect him from his greatest threat, which is now

within: his alien heart is being rejected by his own immune system. Felled by organ rejection,

he is unable to finish the rebuilding, ultimately lying supine in the inadequate shelter, and

returning to a hospital.

After a partial recovery, a weakened Louis seems to discover his French son in a

Tahitian morgue, with an incision showing his heart has removed. In this final bitter piece in

his journey of guilt the quiet soundtrack, with minimal nondiegetic music, gives no cues to

differentiate between real scenes and vivid fantasy. After finding the young man, we see

Louis wearing a white funeral lei and overseeing the coffin carried out for burial. Denis’s

brutally effective filming dwells on the coffin being transported as freight, a motorised lifter

grinding up to the ship alongside other lifters bearing goods. The beloved’s body is now dead

weight. We watch it lifted aboard in agonizing, cruciform slowness, and the ship sails into the

dark for several minutes, the film score deploying the rare, poignant musical motif for “the

intruder,” denoting invader or heart transplant – a musical motif rarely used in this largely

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silent film. The film presents a kind of fantastic closure in the sense of a fantasy of a source

of the organ, yet this narrative was far from the one Louis consciously scripted.

The second way in which the film resists the typical consolations of illness narrative

is its use of deft camerawork, frame composition and editing. The film presents Trebor’s

body itself as becoming progressively alien. Initially he is presented as blending into his

environment of the French countryside, but as the film progresses and he moves to Tahiti his

figure increasingly becomes a dark silhouette on the screen, “a black hole on the surface of

the image” (Beugnet 37), itself intrusive and alien. Denis makes the materiality of the film

photography into a metaphor for the grafting and estrangement process in a second way, too:

she incorporates clips from an incomplete 1965 film directed by Gégauff, featuring Michel

Subor (who acts her protagonist Trebor) as a young man in Polynesia. Martine Beugnet notes

these clips “are like pieces of tissue transplanted onto a strange body and, in spite of their

similarities, only imperfectly integrated” (45). The music and frame composition, too, implies

Trebor’s “progress” is one of disintegration:

From active body in control of the space and dominating the frame, Trébor

increasingly withdraws into a reclining figure, an object of medical care,

handled and examined by others. …in fragmented sequences accompanied by

syncopated drum beats and the outlandish, lingering sound of electronic sound

waves and single guitar chords, images then offer themselves as the evocation

of a physical and mental process of self-estrangement (Beugnet 40).

Both illness and medical intervention can trigger crises of narrative, a sense of being

in the grip of a knowing and hostile environment that controls a story that one cannot know

oneself until its bitter close. These representations are precious in that they speak to a

necessary ambivalence at the heart of some organ recipients’ experience. Like other

protagonists of medical gothic, Nancy and the fictional Louis traverse the carceral sterility of

18

medical spaces, the opacity of medical discourse, and an illness and a treatment whose

trajectories resist neat prediction and whose dark workings within the body are a mystery.

These particular representations resist narrative’s typical consolations; this new way of being

can best be represented by breaking story.

Notes

1 I will use the term “organ transfer” rather than “transplant” throughout, in recognition of

Lesley Sharp’s warning that the latter term tends to emphasise the recipient and elide

attention to the equally important elements of the donor, donor kin, and the wider organ

procurement milieu (Strange Harvest, 3).

2 There are alternative ways for a recipient to relate to donor in ways that do not reduce the

donor to inorganic spare parts or “greened” vegetation. Sharp speaks of a “wondrous”

alternative where a sense of kinship can be formed between recipient and donor kin

(Harvest), and from a different perspective, Shildrick et al argue that phenomenological

insights may help recipients embrace the transferred tissue as simultaneously alien and non-

alien.

Works Cited

Adler, M. L. “Kidney Transplantation and Coping Mechanisms.” Psychosomatics 13 (1972): 337-

341. Print.

Basch, S. H. “The Intrapsychic Integration of a New Organ.” Psychoanalytic Quarterly 42 (1972):

364-384. Print.

Bataille, Georges. Theory of Religion. New York: Zone, 1989. Print.

Bercovitch, Eytan. “The Agent in the Gift: Hidden Exchange in Inner New Guinea.” Cultural

Anthropology 9 (1994): 498-536. Print.

Beidel, Deborah C. “Psychological Factors in Organ Transplantation.” Clinical Psychology Review

7.6 (2987): 677-94. Print.

2

Beugnet, Martine. “The Practice of Strangeness.” Film Philosophy 12.1 (2008): 31-48. Print.

Botting, Fred. “The Gothic Production of the Unconscious.” Spectral Readings: Towards a Gothic

Geography. Eds. David Punter and Glennis Byron. London: Palgrave Macmillan, 1999. 11-

36. Print.

---. Gothic. London: Routledge, 1996. Print.

Bunzel, B., B. Schmidt-Mohl, A. Grundbock and G. Wolleneck. “Does Changing the Heart Mean

Changing Personality? A Retrospective Inquiry on 47 Heart Transplant Patients.” Quality of

Life Research 1.4 (August 1992): 251-256. Web. 12 Oct. 2012.

Carrier, James. “Reconciling Commodities and Personal Relations in Industrial Society.” Theory

and Society 19.5 (Oct. 1990): 579-598. Print.

Castelnuovo-Tedesco, P. “Transplantation: Psychological Implications of Changes in Body Image.”

Psychonephrology. Ed. N. Levy. New York: Plenum Press, 1981. Print.

Charon, Rita. Narrative Medicine: Honoring the Stories of Illness. Oxford: Oxford UP, 2008. Print.

Derrida, Jacques. Given Time: I. Counterfeit Money. Chicago: U of Chicago P, 1994. Print.

Foucault, Michel. “Of Other Spaces.” 1984. Repository of Texts Written by Michel Foucault. Trans.

Jay Miskowiec. Web. 10 Sep. 2007.

Fox, Renée. “An Ignoble Form of Cannibalism: Reflections on the Pittsburgh Protocol for

Procuring Organs from Non-Heart-beating Donors.” Kennedy Institute of Ethics Journal 3

(1993): 231-39. Web. 10 Oct. 2012.

Frank, Arthur, The Wounded Storyteller: Body, Illness and Ethics. 1995. Chicago: U of Chicago P,

1997. Print.

Hawkins, Anne Hunsaker. Reconstructing Illness: Studies in Pathography, 2nd ed. (West Lafayette:

Purdue UP, 1999). Print.

Hill, David. “Issues in Organ Donation and Transplantation.” Correspondence. Journal of the Royal

Society of Medicine 92.9 (September 1999): 493-4. Web. 12 Jun. 2012.

3

Hogle, Linda. Recovering the Nation’s Body: Cultural Memory, Medicine and the Politics of

Redemption. New Brunswick, NJ: Rutgers UP, 1999. Print.

Joralemon, Donald. “Organ Wars: The Battle for Body Parts.” Medical Anthropology Quarterly 9.3

(1995): 335-56. Print.

Kilgour, David and David Matas. “Bloody Harvest: An Independent Investigation into Allegations

of Organ Harvesting of Falun Gong Practitioners in China.” 31 Jan. 2007. Web. 15 Jul.

2009.

L’intrus. Dir. Claire Denis. Ognon Pictures. 2004. Film.

Langer, Lawrence. Holocaust Testimonies: The Ruins of Memory. New Haven: Yale UP, 1991.

Print.

Lock, Margaret. Twice Dead: Organ Transplants and the Reinvention of Death. Berkeley: U of

California P, 2002. Print.

Matta, Basil. “The Implications of Anaesthetising the Brainstem Dead: A Reply.” Correspondence.

Anaesthesia 55.7 (July 2000): 695-6. Web. 12 Jun. 2012.

Mauss, Marcel. The Gift: The Form and Reason for Exchange in Archaic Societies. 1950. Trans. W.

D. Halls. New York: Norton, 1990. Print.

Montgomery Hunter, Kathryn. “Toward the Cultural Interpretation of Medicine.” Literature and

Medicine 10 (1991): 1-17. Web. 3 Jan. 2012.

Muslin, Hyman L. “On Acquiring a Kidney.” The American Journal of Psychiatry 127 (1971):

1185-1188. Web. 12 Jun. 2012.

Nancy, Jean-Luc. “L’intrus.” 2000. Transl. Susan Hanson 2002. New Centennial Review 2.3 (Fall

2002): 1-14. Print.

Nemoianu, Virgil. “From Gifts to Alienation and Back.” A Theory of the Secondary: Literature,

Progress, and Reaction. Baltimore: Johns Hopkins UP, 1989. 135-152. Print.

4

Pearsall, Paul, Gary Schwartz and Linda Russek. “Changes in Heart Transplant Recipients that

Parallel the Personalities of their Donors.” Journal of Near-Death Studies 20 (2002): 191–

206. Web. 12 Jun. 2012.

Pellegrino, Edmund D. “To Look Feelingly - the Affinities of Medicine and Literature.” Literature

and Medicine 1 (1982): 18-23. Web. 11 Oct. 2011.

Poulton, B. and M. Garfield. “The Implications of Anaesthetising the Brainstem Dead: 1.”

Correspondence. Anaesthesia 55.7 (July 2000): 695. Web. 12 Jun. 2012.

Punter, David. Gothic Pathologies: The Text, the Body and the Law. Basingstoke: Macmillan, 1998.

Print.

---. The Literature of Terror. 2nd ed. 2 vols. Edinburgh: Pearson, 1996. Print.

Rady, Mohamed Y., Joseph Verheijde, Joan McGregor. “‘Non-Heart-Beating,’ or ‘Cardiac Death’

Organ Donation: Why We Should Care.” Journal of Hospital Medicine 2.5 (Sept-Oct 2007):

324-34. 10 Dec. 2013.

Scarry, Elaine. The Body in Pain. New York: Oxford UP, 1985. Print.

Schager, Nick. “Review of The Intruder (L'Intrus). Dir. Claire Denis (2004).” 6 Dec. 2005. Web. 4

Jun. 2013.

Scheper-Hughes, Nancy. “Commodity Fetishism in Organs Trafficking.” Commodifying Bodies.

Eds. N. Scheper-Hughes and L. Wacquant. London: Sage, 2002. 31-62. Print.

Sanner, Margareta. “Living with a Stranger’s Organ: Views of the Public and Transplant

Recipients.” Annals of Transplantation 10.9 (2005): 9–12. Print.

Sharp, Lesley A. Strange Harvest: Organ Transplants, Denatured Bodies, and the Transformed

Self. London: U of California P, 2006. Print.

---. “Commodified Kin: Death, Mourning, and Competing Claims on the Bodies of Organ Donors

in the United States.” American Anthropologist 103.1 (March 2001): 112-133. Print.

Shildrick, Margrit, P. McKeever, S. Abbey, J. Poole and H. Ross. “Troubling Dimensions of Heart

Transplantation.” Medical Humanities 35.1 (June 2009): 35-38. Web. 12 Jun. 2012.

5

Smith, Andrew. “Rethinking the Gothic: What Do We Mean?” Gothic Studies 4.1 (May 2002): 79-

85. Print.

Smith, Brett and Andrew C. Sparkes. “Exploring Multiple Responses to a Chaos Narrative.” Health

15.1 (2011): 38-53. Web. 10 Dec 2011.

Smith, Damon. “L'Intrus: An Interview with Claire Denis.” Senses of Cinema 35 (April-June 2005).

Web. 10 Jun. 2012.

Sylvia, Claire and William Novak. A Change of Heart: A Memoir. New York: Warner Books, 1997.

Print.

Uehara, Edwina S. Martha Farris, Paula T. Morelli, and Anthony Ishisaka. “‘Eloquent Chaos’ in the

Oral Discourse of Killing Fields Survivors: An Exploration of Atrocity and Narrativization.”

Culture, Medicine and Psychiatry 25.1 (2001): 29-61. Web. 10 Dec 2011.

Waldby, Catherine. “Biomedicine, Tissue Transfer and Intercorporeality.” Feminist Theory 3

(2002): 235-50. Print.

Wasson, Sara. “‘A Butcher’s Shop where the Meat Still Moved’: Gothic Doubles, Organ Harvesting

and Human Cloning.” Gothic Science Fiction 1980-2010. Eds. Sara Wasson and Emily

Alder. Liverpool: Liverpool UP, 2011. 73-86. Print.

Young, P. J. and B. F. Matta. “Anesthesia for Organ Donation in the Brainstem Dead: Why

Bother?” Anaesthesia 55.2 (February 2000): 105-6. Web. 12 Jun. 2012.

Zamperetti, N., R. Bellomo and C. Ronco. “Defining Death in Non-Heart Beating Organ Donors.”

Journal of Medical Ethics 29 (2003): 182–185. Web. 10 Dec. 2013.