Heart Failure (14 page)

The first question came at noon.

Carrie was sitting at her desk thumbing through a professional journal and munching on a sandwich Lila brought her from the food court. What was it? Tuna? Ham? It might as well be cardboard. But she had to eat.

She had gone through the same thing after John’s death. She had no appetite. Food had no taste. Time dragged by, marked by painful memories of the past and fears of what the future might hold. Would Adam’s departure prove to be as hard as John’s death? Both almost killed her.

Phil Rushton, a white coat covering his dress shirt and muted tie, tapped on the frame of her open door. “Got a sec?”

Carrie washed down a bite of sandwich—it turned out to be grilled cheese—with a swallow of Diet Coke. She blotted her lips with a paper napkin. “Sure, come on in.”

Phil eased into one of the chairs across the desk from Carrie. “You shouldn’t gulp your food like that. You’ll get an ulcer.”

“I’ve been doing this since my second year of premed. If it hasn’t burned a hole in my duodenum by now, I don’t think it will.” She laid aside the remains of her sandwich. “What’s up?”

Phil sat down and crossed his legs, revealing navy over-the-calf socks above black wingtip shoes. “Just checking on how you’re doing. I don’t want you to burn yourself out. It seems that every time I look up, you’re in the office or ER, even when you’re not on call. You need some time away.”

Carrie decided to say what she was thinking. “Phil, how is that different from what you do? Both of us spend a lot of time practicing our profession, but I guess that’s our choice, isn’t it?”

Phil nodded. “Touché. And I must admit that you’re not burying yourself in your work as much since you began going out with Adam.” He looked down at her hand. “I hadn’t noticed until now. You’re not wearing your ring anymore. Is something going on?”

Carrie was acutely aware of her bare left hand. “I don’t want to discuss that.” She looked straight at Phil. “Adam’s left town. I don’t know whether he’s coming back or not.”

“Why did he leave? Where has he gone?”

“I don’t know,” Carrie said. She reached up to dab at the corner of her eyes, a gesture that wasn’t fake. Just the mention of Adam’s departure was enough to bring her to the verge of tears.

Phil rose. “Well, I’m sorry to hear that. You know you’re very special to everyone here. If there’s anything I can do . . .” He let the words hang for a moment, then turned and left the room.

Carrie leaned back and tried to ignore the urge to cry. She replayed Adam’s leaving once more. Was he in danger? Would he be back? Or had she lost the love of her life for yet a second time?

For reasons she couldn’t fully explain, Carrie swiveled her chair and reached into the bookcase behind her desk to retrieve a dusty, leather-bound volume. She laid it on top of the journal she’d been reading and opened it to the front page. The ink was fading, but the words were still clear: “To Carrie. Let this be a lamp unto your feet, a light unto your path. Corrine Nichols.”

Carrie hadn’t thought of that sweet lady in years. But maybe the gift she’d given to a medical student just starting on her Christian pilgrimage was what Carrie needed right now as she struggled to hold on to the spark of faith that flickered
within her. She let the book fall open and ran her finger down the pages, looking for direction in a life that was rapidly sinking into despair.

Adam squinted into the sun and reached into his pocket for his sunglasses. His journey took him eastward, and that meant each morning he had to drive into the sun. Couldn’t be helped. The quicker he reached his destination, the quicker he could start his search for the puzzle piece he needed. He planned to use every available hour of daylight.

He’d spent last night in a Holiday Inn just west of the Texas-Arkansas border. Their “free buffet breakfast” of juice, Danish, and coffee was about all he could tolerate—not because it was so bad, but because the butterflies that took up residence in his stomach when he started the journey were still fluttering furiously.

Adam intended to call Carrie last night, but by the time he arrived at the motel, he was too tired to do anything but shower and fall into bed. He didn’t want to try phoning her during the day—cell coverage was sometimes spotty where he was, and if he did get through, she was hard to reach between patients. Besides, leaving a message for her would be worse than no call at all. No, right now he’d concentrate on his driving. He’d phone her tonight for sure.

The eighteen-wheelers speeding eastward on Interstate 20 made using his cruise control impossible. Instead, Adam guided his little SUV along, speeding up and slowing down, passing and being passed, always careful to stay under the speed limit. The last thing he needed was a traffic stop.

As the driving became automatic, Adam let some of the thoughts he’d suppressed surface. Why had he thought this harebrained scheme would work anyway? The smart thing would have been to pack up and leave town for good, strike out for a new city and bury himself there. Leaving the relative security of the Witness Security Program had probably been a mistake. On the other hand, it had brought Carrie into his life. And for that, he was eternally grateful.

Would this work? Could he—? No matter. Adam had to set short-term goals and not look beyond them. First, leave Jameson. Make sure the story got out, one that was believable but left him an option to return. Then make this drive. When he reached his final destination, call Dave and ask for his help in the last stage of the plan. Despite the promise he’d made, Adam hadn’t called Dave. Why? Because if he revealed the final step of this scheme too soon, he knew his brother would surely try to talk him out of it.

And if this failed? He didn’t want to think about that possibility.

The plan had to work.

ELEVEN

CARRIE WAS IN HER KITCHEN, ABOUT TO MICROWAVE A TV DINNER, when her cell phone rang. Once she recognized the caller, all thoughts of food left her. She dropped into a chair and breathed a silent “thank You” to God.

“Adam, is that really you?”

“Yes. It’s so good to hear your voice. You’ll never know how much I miss you.”

“Oh, but I do, because I miss you even more.” Carrie had a million questions, but they all fled her brain like dandelion fluff in a strong wind. She asked the one that remained topmost in her thoughts. “Are you all right?”

“Fine. Just tired. But only a few more days to go.”

“Where are you?”

“I’m just east of—” Static filled the line, then everything went quiet.

Carrie looked at her phone display. “Call failed.” Was it the
fault of her phone? No, she had good reception. The problem must be with Adam’s phone. Maybe a battery, perhaps poor cell phone reception where he was. She waited a couple of minutes for him to call back. When he didn’t, she dialed his number—first his regular cell phone, then the throwaway phone he’d bought—but all she got was a mechanical voice saying, “Your call cannot be completed.”

At that moment, what Carried wanted most was to throw something, to vent her frustration with cell phones, cell phone towers, cell phone service providers, and everyone associated with the mass communication industry. Instead, she took a deep breath. It had been good to hear his voice and know he was doing well. That would have to be enough for now.

Before she returned to her food preparation, she murmured a brief prayer.
God, please keep him safe. Bring him back. Please . . .

“Lila, I’ll be ready to start seeing patients in a few minutes.” Carrie scanned the list of morning appointments. Nothing unusual there. She decided that she might have time to finish reading the medical journal article that had caught her eye yesterday.

She started digging through the stack on her desk, but before she could put her hands on the right one, her phone rang—not the primary number, but her back line. She didn’t give that number out to a lot of people, but one of them was Adam. Maybe . . .

She lifted the receiver. “Hello?”

“Dr. Markham?”

The voice wasn’t Adam’s. It wasn’t even a man calling. Disappointment replaced hope in Carrie’s mind. “Yes. Who’s this?”

“This is Doris, in the ER. Your patient, Mrs. Cartwright, is here, complaining of weakness, nausea, sweating. May be the flu—lot of that going around—but I thought I should give you a call. Do you want me to have the ER doctor look at her, or do you want to come over?”

The fact that Shelly Cartwright had come to the ER in the first place worried Carrie. The woman wasn’t a complainer. Her husband was in Afghanistan. The couple had a three-year-old son, an unexpected blessing that came while they were in their late thirties, but as far as Carrie could tell, Shelly was doing a good job of handling the stress of being both mother and father during Todd’s deployment. This must be something bad if it sent her to the ER.

“Dr. Markham?” Doris’s voice carried a hint of impatience.

“I’ll come over to see her. In the meantime, let’s get some labs going.” She rattled off the tests she needed, including a blood count to look for anemia and a blood sugar to check for low or high values. She added potassium, since a deficiency could contribute to weakness. “I’m on my way.”

When Carrie pulled back the curtains around the ER cubicle, she was taken aback by what she saw. The woman on the gurney looked nothing like the vivacious brunette with whom Carrie spoke at church only a few weeks ago.

Doris moved to the other side of the gurney and reached down to pat Shelly’s hand. The nurse might have a gruff exterior, but Carrie knew better.

“Shelly, what’s wrong?” Carrie asked.

“I feel so silly being here, but I kept getting weaker and weaker.”

The history Carrie obtained was of the fairly sudden onset of weakness, sweating, slight nausea. “When did this start?”

“About an hour . . . maybe an hour and a half ago.”

“Did you do anything for it?”

“I lay down, drank some Coke, but nothing helped.”

“Any pain?”

“No, nothing. I just felt like I was going to pass out . . . still do.”

Carrie looked across the gurney and checked the monitor again. Blood pressure had dropped a bit, pulse had gotten a little faster in the past few minutes. Cardiogram complex on the monitor didn’t look quite right—maybe hypokalemia?

“Labs back yet?” Carrie asked.

“Not yet,” Doris said. “I’ll see what’s holding them up.”

“Just a sec.”

Doris turned, a puzzled look on her face.

“Let’s hook her up and do a full EKG.”

Without question, Doris grabbed the apparatus and began attaching the leads.

In a moment Carrie was looking at the paper strip spewing from the EKG machine. “That explains it.”

“What?” Shelly asked.

Carrie held up the wide strip with the full EKG tracing. “You were hooked up to a cardiac monitor that only gives a partial picture of your heart’s activity. This is a complete one, and it confirms my suspicion. You’re having a heart attack.”

“But I don’t have chest pain,” Shelly said in a “this can’t be happening” tone.

“Almost half of women who have heart attacks don’t have chest pain,” Carrie said. “But we know what the problem is, and we’ll take care of you.”

And that’s what they did. Oxygen. Aspirin under the tongue. Amiodarone. A beta-blocker. A call to the interventional radiologist, and soon Shelly was on her way to the X-ray suite for a coronary angiogram.

While Carrie waited for the results, she asked Doris if she knew who was caring for Shelly’s son. “Sorry, I don’t know. Why don’t you ask the EMTs who brought her in. Rob and Bill are still here. They’re on break in the cafeteria.”

Carrie found the two EMTs in a corner, sipping coffee and swapping stories. She didn’t make the connection between name and person until the one with his back to her turned, and she saw it was Rob Cole. This might be awkward. Well, she needed the information.

“Dr. Markham, come join us,” Rob called.

Bill slapped Rob on the shoulder and grinned. “Yeah, I’m tired of this guy’s company.”

Carrie pulled up a chair, declined their offer of something to drink, and got right to the reason for her visit. “You guys did the pickup on Shelly Cartwright?”