Heart Failure Read online

  Jess frowned. Not exactly true in her case. She had managed to wind up on a gurney in the emergency department twice in four weeks.

  After Madison had closed the door, Diana swiveled back to Jess. Her gaze bored into Jess as if she wanted to read her thoughts. “Your colleagues thought the same as you did. Just a bit of dehydration and low blood pressure. They elevated your legs, but when you remained unconscious and they couldn’t find your pulse, they were clever enough to hook you up to the EKG.” Diana paused as if waiting for her reaction.

  Jess made a “go on” gesture. “Tell me. In medical, not in English.” She didn’t need to be coddled like a patient; she wanted to know the facts.

  “You had a VT, and they shocked you. They—”

  “VT?” Jess wasn’t sure she’d heard correctly. Maybe she needed the English version after all.

  “Yeah, a ventricular tachycardia. I saw the EKG printout myself. You had a heart rate around one eighty with wide ventricular complexes and…”

  The rest of Diana’s explanation got drowned out by a buzzing in Jess’s ears. Why? She was healthy, had never had any serious illnesses, not even as a child. Why would she develop a dangerous cardiac rhythm? So dangerous that they’d had to shock her? That made no sense. Maybe they’d gotten it wrong. Maybe Kayla and Scott had misjudged the rhythm. Maybe the cable had been faulty and transmitted extra signals. Maybe…

  “Dr. Riley?” Diana squeezed her forearm and pulled her out of her thoughts.

  “Call me Jess.” This was not the time to insist on decorum.

  “Jess, I guess this comes as a surprise, but the EKG left no doubt. You had a VT, and electric cardioversion was the right choice of treatment. Now we’ve got to find the cause. Any prior events? Known conditions? Anything in your medical history?”

  “Okay. Sounds like a plan.” Jess relaxed back as far as lying on a gurney with barely a cushion could be called relaxing. If she had to trust anyone at work, it might as well be Diana who had proven herself already. “Nothing. I’ve always been healthy, and I’ve had more than a few EKGs and echoes during my residency, as we practiced on each other. I’ve never had a problem with endurance training—I’m a long-distance runner.” She snorted and rolled her eyes. “Not so much in the last year. And since Ella’s birth, I haven’t been as fit as I wanted to be. But maybe I have unrealistic expectations.”

  “Maybe. But VTs are not an usual occurrence postpartum. And…” Diana ran her hand through her shoulder-length hair, tousling it even more than before. “Before the birth in the garden, you fainted too. Your pulse was racing. I had no way to time it, but it was way over the normal limit. As you recovered in seconds, I chalked it up to stress and pain. Maybe you had a VT then too, only self-limiting that time.”

  Her first instinct was to deny it and accuse Diana of a vivid imagination. Throw in a sarcastic comment or two, then jump up and stalk out. Only her bones were as heavy as the lead gown had been, and she was more tired than ever. She’d probably land on her face if she attempted to get up right now.

  Jess rubbed the upper right side of her chest, which was still tender after the electric shock. Something wasn’t okay. If she was honest with herself, it hadn’t been for a while. But still, a VT? She couldn’t believe it.

  Ding! Ding! Ding! The heart monitor came to life with a familiar alarm that drowned out the other sounds. Her breath froze. Beep-beep-beep. The sound of her own heartbeat wasn’t steady and reassuring anymore. She craned her neck to catch a glimpse of the monitor behind her left shoulder.

  The spikes of the EKG came much too fast, were much too wide. She couldn’t deny what she saw with her own eyes. Another VT. With each spike, fear stabbed her chest with razor-sharp icicles.

  The lines jiggled as her vision blurred. Dizziness and nausea rose as if she’d been too long on a roller coaster. “Fuck.” Her head fell back on the cushion, and she closed her eyes and waited for consciousness to fade.

  Only it didn’t.

  As if a magical button had been pressed, her heart rate switched from highly elevated to normal, and the wailing alarm of the monitor stopped. The sound of her pulse pounded in her ears, echoing the faint beeps that again reassured medical personnel that everything was all right.

  But it wasn’t. Having seen it with her own eyes, Jess was no longer able to deny it. Something was seriously wrong.

  She could have died.

  Ella! The idea of leaving her daughter was unimaginable.

  Bile rose in her throat. Jess swallowed it and pushed her fears to the back of her mind. She needed to function, not to feel.

  She caught Diana’s gaze and tried to project authority she didn’t feel at the moment. “I want you to do an echo.”

  Diana nodded. “I’ve already ordered one. The tech should be here any minute. And then we can—”

  “No, I don’t want any fucking tech to know my business.” Jess gestured to the portable ultrasound machine in the corner of the room. It wasn’t the most modern or best equipment the hospital had to offer, but it would be enough for a glimpse at her heart. “I want you to do it while I interpret the pictures. And I want whatever we see on the screen to remain between us.” It was bad enough that she had collapsed at work and that her colleagues had had to treat her arrhythmia in the cath lab. No way would she involve them further.

  With a neutral expression, Diana studied her for a moment.

  Years of not only surviving but thriving in the hierarchical world of medicine had taught Jess to withstand even the most heated glare. Never had she needed to suppress the instinct to squirm the way she did now.

  After a few seconds that felt like an hour, Diana stood and got the machine. She positioned herself on a stool next to the gurney as the machine’s computer booted up. “You know, I’ve no experience. But I’m willing to try.”

  “Lucky for you, I’m a cardiologist. I’ll talk you through it.” Almost giddy with relief she didn’t have to face one of the techs or her colleagues, Jess pulled down the thin sheet that covered her.

  She was naked underneath and didn’t want to know when and how that had happened. She slightly rolled onto her left side and repositioned the sticker of an EKG lead that dug into her skin as her left breast came to rest on the gurney. Jess suppressed a sigh. Even half a year ago, her breasts had still been the perky almost-but-not-quite-Bs she’d had since high school. During the pregnancy, they had become these bursting bags of milk. She directed her gaze to the monitor. This wasn’t the time to think about the price her body had paid for Ella. Anyway, her daughter was worth every pound she’d gained.

  Diana shook the gel bottle with an ease that spoke of experience. Either she had done more than a few ultrasound examinations before, or she took ketchup to every meal. The gel glistened on the small ultrasound wand when Diana squirted a blob on it. “This might be cold.”

  Jess rolled her eyes. How often had she said the same thing?

  “Sorry, I said that on autopilot. Where do you want me to start? I know how to check for pericardial tamponade, but we’re not looking for a hematoma now, right?” Diana hovered with the wand at the swell of Jess’s left breast.

  It was obvious Diana knew more than she let on, but Jess appreciated that she let her have at least a little control over the situation. “Left parasternal, third intercostal space, index mark pointing to my right shoulder.”

  As the wand made contact with her skin, Jess flinched and held her breath. Hopefully Diana thought it was cold and not fear that produced the reaction.

  She needn’t have worried. Diana’s gaze stayed on the monitor as she twisted and angled the wand. It wasn’t hard to guess the exact moment she produced a clear picture. A proud smile lit up her face. Just as fast, it vanished again, replaced by a frown. “Oh.” The sound that escaped Diana was the last thing a patient wanted to hear.

  The monitor was filled with white
lines on a black background showing barely any movement. For any other patient, the sight would mean nothing. But Jess had spent more years than she’d like to admit looking at similar pictures, and the diagnosis sprung to her mind: acute heart failure. Oh, fuck.

  That couldn’t be true. That wasn’t her heart. No, no, no.

  But the cold gel freezing her skin and the lines on the monitor moving in sync with her pounding heart left no doubt. Icy waves crashed over her head, and she fought to keep from drowning in fear.

  She clenched her fists. Ella, think of Ella. Fight this!

  “I’m not a cardiologist, but…” Diana looked at her with concern. “This isn’t normal. The heart is hardly moving.”

  “Yes. Freeze that picture for a second.” Jess leaned up and brushed Diana’s hand away from the console of the ultrasound machine. “Let me measure the EF.” With practiced movements, she confirmed what her trained gaze had already guesstimated. An absurdly low number stared back at her. She hesitated over the save button but eventually pushed it. This was too serious to pretend it would go away on its own.

  Jess let herself fall back on the gurney with a sigh. What had caused this? She tried to take a mental step back as if the lines and numbers on the screen belonged to another patient. “Myocarditis? Coronary ischemia? Both are unlikely.” What else? There was something, but she was so tired that her thoughts faded away as if shrouded by thick winter fog.

  Diana studied her for a second. “I know it’s rare, but—”

  “If it’s rare, you can forget about it. All residents want to capture the elusive zebra, but all we ever see are plain horses.” Jess grimaced. If she had a dollar for every suggestion of a rare disease from a student or resident that had turned out to be another routine case, she wouldn’t ever have to work another day.

  “Indulge me for a second, just like I indulged in your secret examination here.” Diana’s tone was gently teasing, something Jess had never experienced at work.

  Jess couldn’t summon the energy to protest. She nodded and gestured for Diana to go on.

  “I recently read an article about peripartum cardiomyopathy and how it’s a severely underdiagnosed disease. Most women have a mild case, and the symptoms are similar to ordinary exhaustion and lack of sleep, but some develop an acute heart failure. What do you think?”

  “PPCM?” The idea sliced through the fog in her mind like a signal fire. It was rare, but everything fit. She was a healthy woman without prior history of heart disease who had delivered a child not long ago. Maybe Diana was on to something. “We can’t test for it. We’d have to rule out everything else first. Let’s call a colleague of mine, and you present the facts. If he agrees with your conclusion, I’m willing to entertain the idea.”

  “Who do you want me to call?” Diana fished her phone from her scrub pocket.

  Jess considered this for a second. Whoever she called, the news would spread faster than a wildfire. If she had to face her department, she might as well start from the top and involve her boss right away. “Call Dr. Huong.”

  The angry vibration of her phone woke Jess from the first deep sleep she’d had in weeks. She reached for it, going more by feel than sight in the dark and unfamiliar hospital room that was illuminated by the monitor next to her bed.

  Two past nine. Shit. She had intended to close her eyes for half an hour before calling her mom to let her know she’d have to stay the night, but that had been more than four hours ago.

  She swiped to answer. “Hi, Mom.”

  “Jess, are you still at work? I don’t know if I should be angry or concerned.” Her mom didn’t sound angry, so maybe she hadn’t fucked up too much.

  “Yeah, but…” How could she tell her mom on the phone that everything had changed this afternoon and her life had come tumbling down like a house of cards? “Something happened.”

  “Are you okay?” The concern in her mom’s voice nearly broke her.

  Jess swallowed and balled her hands into fists. The pain of the nails digging into the soft flesh kept the tears at bay. Barely. “Yes. No, not really. But I will be. It turns out I have PPCM and have to stay here. Can you watch Ella overnight?”

  “Of course I’ll take care of her, don’t worry. But what is PPCM? Is this a kind of overnight shift?”

  Oh, right. Her mom had her own PhD and had been married to a cardiologist for over forty years, but how could she expect her to know what this acronym meant? “No, It’s a medical condition. Peripartum cardiomyopathy. It means my heart is temporarily damaged and I have to be careful for the next few weeks.” Or months. But that wasn’t something she wanted to think about or admit out loud. “The recovery rate is very good. It’ll sort itself out when I take some medication.” Or not, but she didn’t want to think about that either.

  “Oh my God, honey. What happened? Do you want me to come to the hospital?”

  Yes. Her inner child she thought she’d outgrown over twenty years ago wanted her mom to come and hold her while they cried together. But that would be selfish. Her mom shouldn’t have to drive here in the evening, lugging Ella around. They both needed their sleep. “No. I’m fine. If you take care of Ella, I can get a bit of sleep and come and get her in the morning.” It took all the acting skills she had learned during med school to keep the neediness from her voice.

  “Are you sure? But let me at least come and get you. Let me take care of you. I can stay with you in your condo, or you can come home with me.”

  The way her mom insisted would have been annoying any other day. It reminded Jess that she was weak and helpless like Ella. She sighed. “Can we talk about it tomorrow? I’m too tired to think.”

  “Oh, Jess, I’m so sorry, honey. What do you need right now?” The compassion was worse than the concern, and it tugged at Jess’s composure until it threatened to unravel.

  I won’t cry. I won’t cry in a fucking hospital bed. In my own fucking department. Where anyone can come and see me and blab about it to the whole fucking staff. “Just…nothing. Please.” She choked on the last word.

  “Okay. We’ll sort it all out later. Tomorrow morning I’ll pick you up, and we’ll plan the next steps together. When do you want me to come?” Here was the mom she needed. No fussing, just practical reassurance.

  “Thanks.” The paperwork should be ready early, even if Jess had to do it herself. If she set her alarm to six, she could even get a couple of hours of paperwork in. “Could you come around eight?”

  “I’ll be there. Sleep well. I love you.”

  “Love you too.” Jess voice shook. When had she said this last to her mom?

  She rubbed her eyes. Sleep. She needed to get back to sleep.

  As if she could with all the problems looming ahead like the ascent of a mountain. She’d have to plan every step and handhold carefully so she wouldn’t fall.

  Chapter Four

  Lena plucked the mint leaves from her tea and stirred a dollop of honey into it. She cradled her favorite ceramic mug against her chest and breathed in deeply. Nothing was as good as fresh herbs. Some days she couldn’t believe how lucky she was to live in Maggie’s garden.

  The door swung open and nearly hit her in the face.

  Lena jumped back, and tea splashed all over her front and soaked her top. Hot, burning tea. Ouch. She pulled the thin cotton from her skin and looked up.

  The disheveled woman with dark circles beneath her eyes looked familiar. She glared at Lena from beneath unkempt hair. “What are you doing in my house?”

  Wait? Her house? Oh. Was that Jess? Nothing of the beautiful afterglow of giving birth remained.

  “Shouldn’t I ask you that?” The skin on Lena’s chest burned, and she tried to cool it by flapping her top, but it was too tight to give real comfort.

  “I don’t have to explain anything to you. This is my family’s house. What are you doing here?” Jess stepped
closer and towered over Lena by at least a couple of inches.

  “I live here.” Lena snarled right back. She wanted to kick the intruder out, but then it clicked. Jess obviously didn’t know she had been living in the garden house for the last ten months. Lena’s anger deflated. “You’re Jess, right? I’m Lena. Maggie rented the house to me.” She held out her hand.

  “Dr. Riley.” Jess ignored her hand and stepped past Lena, looking around the room with a frown. “My name is Dr. Riley, as is my mother’s.”

  “Um…come in.” Lena didn’t know how to react, so she went with her default setting: politeness. Even if Jess had already entered the house. “If you insist, I’ll call you by your last name, but how I address Maggie is between her and me. Can I help you?”

  “I don’t remember the furniture, so it must be yours. It’ll take a bit of time to move all that, so you can take until the end of tomorrow to remove everything.”

  Lena blinked. Was she joking? But the tone didn’t hold even a trace of humor. “There must be a misunderstanding. Let’s go talk to Maggie and clear everything up. I’ll change my top, and then we can go to the main house.”

  Jess’s icy blue eyes moved up and down as she studied her. “What are you doing with your top?”

  “I burned myself when you stormed inside.” Lena held up the empty mug.

  “Oh, um, I’m sorry.” Red spots bloomed on Jess’s cheeks. “You don’t need to come. You can start packing.” Without waiting for Lena’s reply, Jess stalked off.

  Lena followed her to the door. “Hey, wait a minute…”

  Either Jess didn’t hear or didn’t care as she stormed away. The dramatic effect of her exit was diminished by the fact that she stopped halfway to the house, clutched her side, and gasped for air.

  Shaking her head, Lena closed the door and went into her bathroom to change. As she peeled off her bra, the cotton brushed her skin, and she winced. A glance in the mirror confirmed what she had suspected. An angry stripe ran down her chest, as if she’d smeared herself with raspberries, from the valley between her breasts to her navel. Fortunately, she didn’t detect any blisters. She rinsed the stained top, then pressed the cold, wet cloth to her skin.