“Imagine what it would be like to have a brand-new heart”: Biosentimentality and embodied-relationality in Change of Heart: A Novel

Abstract This paper discusses Jodi Picoult’s Change of Heart: A Novel in order to foreground how the received heart triggers anxiety and the narrative crisis in the heart recipient who develops an ambiguous relationship with the heart donated by a death row inmate. The paper foregrounds how the current culture of transplantation medicine evolution of kinship orders such as intercorporeal and intersubjective relationality has problematized the notion of the body as a discrete biological unit with a definite boundary. Interestingly in the novel, the fragments of the human body acquire a symbolic imagery that challenges the medical and commercial understanding of the human body as spare parts and therapeutic tools. The fictional frame of the literary narrative dramatizes how the residual presence of the donor’s subjectivity validates the notion of cellular memories that define memory as a distributive phenomenon not located to the brain alone. The paper highlights how development in the domain of organ transplantation has enabled us to reconceptualize the significance of body in the construction of human subjectivity and has allowed us to retrospect on the concept of the fluidity of the human bodily boundary that has problematized our traditional understanding of the body as an organic integrated whole.


PUBLIC INTEREST STATEMENT
In the domain of biomedicine, human body is metaphorically defined as a kind of machine. The body is considered to be an assemblage of interchangeable parts that can be repaired and replaced whenever it fails to function normatively. However, ethnographic study of the organ recipients has defied the notion of the body as an inanimate matter and has drawn scholars' attention to new forms of embodied subjectivities that are evolving in the process of transplantation surgery. This article discusses Jodi Picoult's (2008) Change of Heart: A Novel for the purpose of demonstrating how the fictional frame of the novel engages with the anxieties and experientialities of the organ recipients who narrate about their post-transplantation experiences. The article aims to foreground how the novel subverts the biomedical notion of the body as a processing machine through the fictional representation of the anxieties of the heart recipient.

Introduction
Anand Gandhi's (2013) national award-winning film Ship of Theseus throws light on the issues of medical tourism and the rise of the neo-cannibalistic 1 culture, while also, offers scope to speculate on the notions of embodied and hybridized orders of subjectivities that are evolving as a result of biotechnological intervention into the organic order of humanness. The title of the film alludes to the Ship of Theseus or Theseus Paradox a thought experiment that is recorded in Parallel Lives or Plutarch's Lives (1967) wherein the Greek historian and philosopher named Plutarch inquires whether the ship that is restored by replacing all its parts remains the same. Gandhi offers an interesting analogy between Ship of Theseus and the human body that in the era of technocratic biomedicine can be replenished by incorporating biomatter from anonymous sources. Ship of Theseus dramatizes the life of the eight organ recipients who meet at an NGO in order to watch a documentary made by the anonymous donor whose organs they have received. The film enables us to speculate on how the biomedical practices like organ transplantation have made it possible to share biological relatedness among people by effacing the discrimination related to race, class, age, and gender.
Louise Noble (2011) argues that in the European countries the use of human body parts for curing life-threatening diseases has been practiced since the Renaissance era. Although the notion of organ transplantation was not unfamiliar within the premise of biomedicine, it has achieved its present iconic status as a miraculous medical procedure with the evolution of technocratic biomedicine in the twentieth century. Organ transplantation has stimulated an unusual combination of anxiety, curiosity, and celebration that is aptly captured in the medical thrillers and science fiction. This article discusses Jodi Picoult's (2008) Change of Heart: A Novel that dramatizes the embodied experientiality of the organ recipient Claire Nealon whose notion of subjectivity is problematized by the residual presence of donor's selfhood. The novel captures the anxiety associated with the notion of hybridization of the human subjectivity. It portrays human subjectivity as an embodied phenomenon that is ontologically as well as functionally distributive in quality. Interestingly, in the novel, the fragments of the human body acquire a symbolic imagery that defies the medical and reified understanding of the human body as spare parts or therapeutic tools. The article argues that the fictional representation of the hybridized subjectivity as portrayed in the novel offers us scope to interrogate the notion of human subjectivity that we associate with rational, autonomous subject with a discrete biological embodiment and organic oneness. The article foregrounds how developments in the domain of organ transplantation have enabled us to reconceptualize the significance of the body in the (re)construction of human subjectivity. The fictional representations of the practice of cadaveric organ transplantation offer us scope to reflect on the new forms of entangled and "embodied-relationality" associated with biomedically intervened and bioengineered bodies (Shildrick, 2008, p. 35).

Embodied and hybridized subjectivity
Jodi Picoult's Change of Heart: A Novel offers fictional representations of the estrangement and existential crisis of life narrative experienced by the organ recipient post-transplantation surgery. The novel dramatizes how the intercorporeal relationship between the organ donor and recipient problematizes our ontological understanding of the self and the other. The fictional narration of the emotional and existential anxieties of the organ recipients and their kin prior and posttransplantation surgery captures the epistemic schism between the biomedical explanation of the body as a machine and the phenomenal experiences of the recipients. Change of Heart: A Novel fictionally engages with the anxieties and dilemma of June Nealon and her daughter Claire waiting for a heart transplantation surgery. After years of waiting for a heart donor for Claire, the only suitable match for her daughter is obtained from the death row inmate Shay Bourne convicted of being the murderer of June's husband Kurt Nealon and her elder daughter Elizabeth. June is depicted as an apprehensive mother who is not able to decide whether to accept the only option she has to save her fatally ill child or to refuse it. June expresses her moral ambivalence thus: Shay Bourne wanted to donate his heart to Claire so that she'd live. What kind of mother I would be if I let that happen? And what kind of mother I would be if I turned him down? […] If I didn't take Bourne's heart, Claire would most likely die. If I did, it would be like saying I could somehow be compensated for the death of my husband and daughter. And I couldn't-not ever. (p. 158) Claire's heart surgeon, Dr. Wu explains to June, "it's just a muscle, June. Nothing more, and nothing less. What makes a heart worthy of transplant has nothing to do with the donor's personality" (p 210). However, Dr. Wu's biomedical explanation of the organ transplantation procedure does not reduce June's increasing anxiety about the effect of accepting a heart from a person convicted of being a murderer. She is not able to disregard the medical reports of the organ recipients whose personality traits are reported as being morphed with the donor's personality. The novel thus speculates on the moral and medical ambivalence about whether the self is distinct from the sum of the muscles and tissues or whether the biological materiality of the body is an essential, albeit synecdochic, carrier of self. In the novel, the conversation between June and her daughter foregrounds how the elimination of the donor-recipient's sex matching as one of the criteria for identifying suitable heart donor makes Claire anxious. In a state of anxiety, Claire inquires whether the new heart that will be implanted in her will lead to a change in her subjectivity. Claire asks: What do you think she's like? I blinked startled. Who?
The girl. The one who died Claire, I said. Let's not talk about this.
Why not? Don't you think we should know all about her if she's going to be a part of me?
… "Of course, it's a girl," Claire said, "It would be totally gross to have a boy's heart." I don't think that's a qualification for match She shuddered. It should be. Claire struggled to push herself upright so that she was sitting higher in the hospital bed. "Do you think I'll be different?" (p. 63) Lawrence Cohen (2001) discusses how the demystification of the immunological mechanism of the human body has reconfigured the binaristic understanding of the self and other. His study reveals how intercorporeal relatedness generated by the transplantation surgery has dissolved the apparent solidity of the biological configuration of the individual body and his/her family lineage. 2 Cohen further states that organ transplantation has reached an immunosuppression era where development in immunosuppressant drug cyclosporine has made it possible to create a group of possible organ donors by effacing the distinction related to race, class, age, and sex. Conversely, in Picoult's Change of Heart: A Novel, Claire's abhorrence about the notion of implanting a heart from a man and the anxiety of receiving it from the murderer of her father and elder sister throw light on the fact that the biomedical explanation of the human biomechanism has not diminished the existential emotional anxiety of the recipient about the donor's identity. Like her mother, Claire is not able to detach the donor's identity from the organ that is conceived as a reified entity by biomedical and pharmaceutical industries. Claire's narration of her anxiety about the donor's personality bears resonance with Margaret Lock's (2002) study of the organ transplantation cases that discusses how the gender, ethnicity, race, personality, and social status of the organ donors become the cause of anxieties among the recipients.
Unlike the heart recipient Paul River (played by Sean Penn) in Alejandro Gonzalez Inarritu's (2003) film 21 Grams who develops a biosentimental relationship with the widowed Christina Peck (played by Naomi Watts) whose husband's heart he has received, 3 Claire Nealon in Change of Heart: A Novel is apprehensive about meeting Shay Bourne's sister post-heart-transplant surgery. In her book Strange Harvest, Lesley Sharp (2006) coined the term biosentimentality to examine the emotional connectedness and intercorporeal kinship developed between the recipients and the donor's family during the process of transplantation (p. 193). Examining how the phenomena and phenomenal experience of organ transplantation cross mere medical boundaries, Sharp describes the same as a "socio-medical process" (p. 4). She states that the ethnographic study of the organ recipients has thrown light on the fact that in a few transplantation cases the donor's body is reanimated in minds of recipients. Many recipients acknowledge the fact that their life is dependent on the working of the organ derived from the donor. Sharp says, "in these cases, both the dead donor and once ailing recipient are rejuvenated through the melding of their bodies" (p. 24). Conversely, in Change of Heart: A Novel the received heart triggers a complex entanglement of anxiety and indebtedness in Claire that leads to a crisis in life narrative.
An analogy may be drawn between Sara Wasson's (2015) study of the fictional narrative of the phenomenal experiences of the organ recipients and Claire Nealon's ontological and existential experiences post-heart-transplant surgery in Picoult's novel. Wasson argues that although in a few organ transplant cases organ recipients experience a profound bond with the donor's family, an examination of the life narrative of the recipients has foregrounded the fact that in the context of cadaveric organ donation the recipients might develop an ambiguous relationship with the received tissue. Biotechnological intervention has enabled us to expand the life span of the organ recipient but it has also led to the reconfiguration of a new notion of self enmeshed with the donor's subjectivity. Wasson draws on the fictional narratives of the lived bodily 4 experiences of the organ recipients and explains how, "tissue transferred can feel to be soaked in story, in a script, as much as in blood" (p. 105). Thus, highlighting the relationship between biological materiality and existential intersubjectivity, between embodiment as purely neural event and embodiment as phenomenal experiential event. Claire's narration of her existential crisis posttransplantation surgery bears resonance with the psychological condition biomedically termed as Frankenstein's syndrome. The term was first used in the year 1979 in order to explain the psychological state of organ recipients who narrates about their body being hybridized and reterritorialized by the received organ. 5 As opposed to the biomedical explanation of the "organ as foreign, the recipient identifies deeply on a psychological level with the donor" (Millo, 2017, p. 49). Lesley Sharp states: Within the highly medicalized realm of organ transfer, talk of a multiple, disparate, or fragmented self is evidence of pathological thinking that requires therapeutic intervention. Transplant recipient who openly expresses the sense that another person dwells within them may well acquire a medical label that draw on monstrous imagery, such as Frankenstein syndrome. (p. 23) In Change of Heart: A Novel, Claire states that post-transplantation her notion of subjectivity is reconfigured by the residual presence of the donor whose hauntological identity she shares. 6 Claire addresses the received heart as an "alien inside her" (Picoult,p. 459). She experiences an epistemic crisis as her life narrative is being gradually morphed by the memories and the emotions of the heart donor Shay Bourne. In contrast to the hauntological experientiality of the patients who continue to feel the presence of the phantom limb, 7 the epistemic crisis in the context of the organ recipients evolves as a result of the presence of the donor's selfhood post-transplantation surgery. Claire narrates her anxiety thus: I have been some one different now for three weeks. It's not something you can tell by looking at me; it's not even something I can tell by looking at myself in the mirror. The only way I can describe it, and it's weird, so get ready, is like wave; they just crash over me and suddenly, even if I'm surrounded by a dozen people, I'm lonely. Even I'm doing everything I want to, I start to cry. My mother says that emotion doesn't get transplanted along with the heart, that I should stop referring to it as his and start calling it mine. But it's pretty hard to do, especially when you add up all the stuff I have to take just to keep my cells from recognizing the intruder in my chest…. My Sister's Keeper reflects on the notion of hybridization of the human subjectivity by foregrounding the post-transplantation experiences of Kate who receives the kidney of her sister Anna medically declared as brain dead after a fatal car injury. Kate reanimates Anna by imagining herself being an extension of her sister's subjectivity. She acknowledges herself being hybridized and says, "I remember how, at first, I thought the stiches seemed to spell her name. I think about her kidney working inside me and her blood running through my veins. I take her with me wherever I go" (p. 407). The phenomenal experiences of the organ recipients like Claire and Kate throw light on how the change in the physiological structure of the human body reconfigures our understanding of the self. The fictional representation of the problematized and reterritorialized life narratives of the recipients by the received tissue correlates to Antonio Damasio's (1994) explanation of how our notion of self is repeatedly reconfigured by our emotional and embodied states.
Damasio explains that the information that is transmitted from the body through the neural pathways plays a significant role in forming the concept of self. In contrast to Descartes who states that the self is a disembodied and purely cerebral phenomenon, Damasio argues that any change in the biomechanism of the human body will profoundly affect the central nervous system neurally and chemically that will lead to a change in our notion of subjectivity. Damasio argues that human beings as an integrated and agentic organism is formed as a result of the interaction between the brain and the body through neurochemical pathway. Damasio states that there is no doubt that mind is special because of its immense ability to feel pleasure and pain. Mind has the ability to form language that enables humans to express their thoughts to the world but the mind is embedded in the complex physiological mechanism of the body. So, any attempt to disassociate the two discursively, medically, or philosophically is erroneous. Damasio further argues that mind emanates from the activation of the biological tissues and nerve cells and thus shares the same characteristics that define the other living tissues of the human body. In Embodiment and Cognitive Science, Raymond Gibbs (2005) draws on Damasio's three-layered theory consciousness (proto self, core self, and autobiographical self) in order to critique the notion of human self that is biomedically explained as a monolithic and static phenomenon. Gibbs argues that the complexities of the human biomechanism and bodily experiences contribute to the creation of a distributive notion of human self. A systematic examination of the phenomenological experiences of the organ recipients resonates with Gibbs' argument that our notion of self-identity is intricately related to our body, body parts, and the changes in the same.
An intertextual relationship may be established between Picoult's Change of Heart: A Novel and Claire Sylvia and William Novak's (1997) memoir A Change of Heart. In her memoir, Sylvia states that post-transplantation she realizes that it is not merely the new organ she inherits from the donor. The heart embodies the memories, emotions, and characteristics of the person that haunt her in her dream. Sylvia discovers change in her food preferences and life style which compel her to hunt for the anonymous donor whose hauntological identity she shares. This is articulated thus: All my life I have been told that despite the protests of poets and the murmurings of mystics, the human heart is just a pump. An incredibly important pump, but only a pump, a monotonous, mandatory machine. According to this view, which is accepted one in contemporary Western medicine, the heart contains no feelings and carries no wisdom, no knowledge, and no memories […] I used to believe these things, but today I know differently. (p. 6) The psychosomatic confusion experienced by the organ recipient as dramatized in the memoir Change of Heart conforms to Paul Pearsall's (1999) argument that the notion of human self is a distributive phenomenon that cannot be localized to the brain alone. The problematization of the year ontological life narrative of the recipient with the donor's subjectivity correlates to Pearsall's study of the info-energetic nature of the heart and the concept of the cellular memory explained in The Heart's Code. The cellular memory is based on the hypothesis that memories can also be stored outside the brain within the cells of the human body. Pearsall states: All living things are made up of cells. Every cell is literally a mini-heart humming with the energy. The ultimate biological illusion has been the view that the body is made up of solid matter with fluid pumped through it by an unconscious heart and a powerful conscious brain that is the primary controller of the entire system. Energy cardiology suggests that the heart and not just the brain is what holds this system together by a form of info-energy in the temporary and ever-changing set of cellular memories we refer to as self. (p. 101) Pearsall argues that the concept of the self is a dynamic phenomenon that evolves as a result of the informational energy shared and exchanged by the different systems of the human body. He refers to the scientific studies of Dr. Gray E. Schwartz and Linda Russek that have revealed new possibilities about the way human beings think, feel, and find meaning in life. Their study has shown that heart can think and cells can remember. Memory is thus embodied as well as embedded and this embeddedness may thus be extended through the process of transplantation. Pearsall opines that because of our evolved dependence on the brain as the store house of our experiences we are seldom able to realize that heart is an informational and energetic cornerstone that integrates the brain with the body. Pearsall argues that if we are able to step out of the dualistic understanding of the human body and acknowledge the concept of the cells containing info-energetic memory in distributive networks then we will be able to understand the embodied experiences of the organ recipients who tell stories about their morphed intercorporeal memories. Such stories will offer fresh light on the relationship between intercorporeality, intersubjectivity, and renewed understanding of human identities.
Similar to the character Claire in Picoult's Change of Heart: A Novel, Casey Schillinge in Dean Mayes's (2016) The Recipient narrates about her morphed intercorporeal subjectivity. The novel dramatizes the experience of an optimistic and confident woman Casey Schillinge who turns agoraphobic post-heart-transplant surgery. Post-transplantation Casey is haunted by nightmares that unsettle her notion of an autonomous and integrated self. Casey narrates about her psychosomatic confusion to her psychiatrist thus: It's not me […] Casey began to shake. It's as though I' m there and experiencing it. But at the same time, I'm watching as though it's not me […] There's someone else. A third person. I'm watching someone else being attacked. I don't know who it is. Every time I get close seeing it, I wake up. (p. 131) Casey's nightmares sensitize her to the fact that it is not merely a new organ she inherits from her donor. The received heart embodies the spectral presence of the donor's identity that has profoundly affected her autobiographical self. The corporeal relatedness experienced by the organ recipients like Claire and Casey throws light on how the received heart triggers embodied-relationality between the donor and the recipient. In an essay titled "The Critical Turn in Feminist Bioethicists" Margrit Shildrick (2008) defines embodied-relationality as a process of acknowledging the significance of corporeal relatedness with other individuals that informs and reconfigures our notion of human subjectivity. In Change of Heart: A Novel, the received heart may be interpreted as a symbolic extension of the organ recipient's identity. The literal blurring of the self and the other dramatized in Picoult's novel correlates to Catherine Waldby's (2002) explanation of the phenomenon termed as "biotechnologically-mediated intercorporeality." 8 The concept of intercorporeality is explained by feminist theorist Gail Weiss (1999) in her thoughtprovoking book Body Images: Embodiment and Intercorporeality. Waldby adopts and appropriates the term in order to explain how biotechnological intervention denaturalizes the boundary between the self and the other. In the current culture of organ transplantation, the process of organ donation involves a complex order of intercorporeality that produces identification and dis-identification among the donors and the recipients. Waldby says, "to receive and incorporate another's organs and tissues involve a complex modification of the recipients embodied identity as the habitual equation between the limits of the body and the contours of I is shown into question" (p. 251). The notion of intercorporeality explains the process of donation and incorporation of biomaterial among the biomedicalized subjects that throws light on the way we all are indebted and mutually associated with each other. Sharing of biomatter among individuals dramatizes intercorporeality as a phenomenon that often extends to an intersubjective experience.

Conclusion
This article is concluded by stating that fictional narratives such as Change of Heart: A Novel enable us to restructure our understanding of the Cartesian mind-body dualism that is embedded in the narrative of biomedicine. The novel throws light on the fact that human subjectivity is a distributed phenomenon that cannot be localized in the brain alone and the embodied understanding of the human subjectivity is further validated by the notion of cellular memories that influence the subjectivity of an individual. Picoult in her literary work focuses on the experiential emotional anxieties of the organ recipients in order to draw readers' attention to the alternative notion of the human subjectivity that defies the understanding of the body as an inanimate matter. The fictional representation of the corporeal relatedness between the donor and the recipient as dramatized in the literary text interpreted in this article offers us scope to reconceptualize the significance of the body in the construction of our subjectivity. The phenomenological insight of the organ recipients like Claire alludes to Gibb's argument that a systematic examination of one's experience of the self and its relation to the body throws light on the fact that the notion of self-identity is intricately related to the body.
construction of human subjectivity. Merleau-Ponty discusses consciousness as an embodied phenomenon that evolves as a result of the dialogic relationship between mind, body, and the world. He emphasizes on the subjective experiences and the corporeal dimension of the human self and defies the notion of human body as a processing machine. Merleau-Ponty argues that it is through our body that we are aware of our self and hence the focus should be laid on the living body. Drawing on the concept of lived body, medical anthropologists and sociologists like Lesley A. Sharp and Margaret Lock have recently started studying the lived bodily experiences of the organ recipients which defy the dominant biomedical understanding of the body as a machinic entity. 5. See Millo's, "Considering Counter Narratives: An Exploration of Gothic Representations of Organ Transplantation in Literature." MA diss., University of North Carolina, 2017. 6. The concept of hauntology is associated with the notion of non-presence that defies the ontological binary between pure presence and absence. I use this term drawing on Jacques Derrida's (1994) notion of hauntology as essayed in Specters of Marx. In this chapter, the concept of hauntology is adopted and appropriated within a phenomenological framework in order to discuss the existential and emotional anxieties of the organ recipients who share their experience of being haunted by the spectral presence of the donor's subjectivity post-transplant surgery. 7. The term phantom limb was first coined by Philadelphia physician Silas Wier Mitchell after Civil War. The concept of phantom limb is explained by V.S Ramachandran (1998) in Phantoms in the Brain: Human Nature and the Architecture of Mind. Ramachandran explains that in a few medical cases amputees feel the "ghostly" presence of the arm or the leg that they have lost in an accident or is removed during a surgery (p. 22). He states that in a few cases patients, "wake up from anesthesia and are incredulous when told that their arm had to be sacrificed, because they still vividly feel its presence … Moreover, some of these patients experience excruciating pain in the phantom arm, hand, or the finger, so much so that they contemplate suicide" (p. 22). 8. In Strange Harvest, Sharp (2006) states that the embodied intimacy experienced by the recipients unsettle the binary between the self and the other. "Organ transfer's uniqueness lies in the ability to transcend normative (or natural) forms of human coupling where the notion of sameness is at once about shared human fragments and about the sentimental kinship structure" (p. 193).