Heart Failure (4 page)

Carrie was still debating her next move when she pulled into the hospital parking lot.
Enough of that
. She plunged through the double doors of the Emergency Room, ready to immerse herself in the practice of medicine. Her personal life could go on hold for a bit.

The patient’s name was Gus Elsik. He lay propped on the gurney in a full sitting position, struggling to breathe despite the oxygen mask on his face. The sheet had slipped to expose one swollen ankle. Carrie noted the distended neck veins. The diagnosis was already pretty clear to her, but she’d go through the necessary steps to be certain.

The patient was obviously in no condition to talk, so Carrie addressed her questions to the woman in a blouse and jeans who stood beside the gurney, fresh lines of worry adding to the ones that creased her face already.

“I’m Dr. Markham. What happened?”

“My father’s having trouble breathing.”

“Is this a new thing?”

The woman shook her head. “No, I took him to the clinic last year when he was having the same kind of trouble, just not as severe. He saw Dr. Avery, who said it was some kind of
problem with his heart. The doctor gave him some pills, but after he started feeling better, Daddy stopped taking them.”

“And when did he start getting short of breath?”

“It’s been going on for a couple of weeks. Maybe more. When it got to where he couldn’t walk from his room—he stays with us—when he couldn’t walk from his bedroom to the dining room without resting to catch his breath, I insisted that we come here.”

Gus’s other symptoms confirmed Carrie’s diagnosis: swelling of the feet and ankles, moist cough, waking up at night short of breath, having to sit upright to breathe. “What you have,” she said to Gus, “is congestive heart failure. I’m going to admit you to the hospital, do some tests, and start treatment. I’ll contact Dr. Avery. He’ll see you tomorrow and follow up.”

Gus’s daughter asked, “Is it serious?”

“It’s serious, but I’ve seen worse. We should be able to get this under control with some medications to get rid of the excess fluid and improve the heart function.”

“What . . . did . . . you . . . call . . . it?” Gus asked, a gasp for air separating each word.

“Congestive heart failure. But don’t let the words scare you. We’re going to keep your heart going for a good while yet.” She encouraged him with a smile and a pat on his shoulder.

As she sat at the nurse’s station to write orders, Carrie thought about heart failure. There was the kind Gus developed, the kind that medications could help. Then there was what she was feeling right now: the heart pain, the anguish, the emotional turmoil that no amount of medicine would improve. That was the worst kind of heart failure.

A Scripture verse popped unbidden into her head. She
didn’t recall the source—somewhere in the Old Testament—and she wasn’t sure of the exact quotation, but the gist was that God promised to give a new heart.
You didn’t give my husband a new one, God, so that’s one strike. I don’t know about Adam’s heart. And I’m still waiting for my new heart
.

As soon as the clock in his kitchen showed eight a.m. on Monday, Adam dialed the law office where he worked. He hoped Brittany, the receptionist, wasn’t running late. He had a lot to do, but the first thing was to square his absence with his employers.

He was about to hang up when there was a click on the line and he heard, “Hartley and Evans, may I help you?”

“Brittany, this is Adam.”

“Where are you? Are you okay?”

“That’s why I’m calling,” Adam said. “Somebody decided to shoot up my car during the night. I’ve got to arrange to repair the damage, get a rental car, all that stuff. Would you tell . . . ?” Who? Bruce Hartley was the senior lawyer in the two-person firm. But it wasn’t always possible to predict how Bruce would react. The other partner, Janice Evans, was the better choice. “Would you tell Janice what’s happened? I’ll get there as soon as I can.”

Adam’s next call was to his insurance agent. He expected to leave a message, then waste most of the morning waiting for a call back. Instead, the agent was at his desk and proved both sympathetic and extremely helpful. When he found out Adam’s car was drivable, he told him where to take it to have the damage repaired. He even arranged for a rental car to be delivered there.

By mid-morning, Adam pulled into the lot that served the two-story building owned and occupied by Hartley and Evans, Attorneys at Law. He parked his black Toyota Corolla rental in his assigned slot, tugged his briefcase from the passenger seat, and headed for the front door.

The briefcase was a constant reminder of Adam’s journey. Along the way he’d parted with his expensive Halliburton case, a gift from his ex-wife. He couldn’t recall into which river he’d tossed the brushed aluminum status symbol, a gesture to further separate himself from a life he could no longer live. Then, after Bruce Hartley suggested that the grocery bag in which he carried his lunch and a few files wasn’t appropriate for a member of their staff, Adam found a scuffed leather briefcase in a pawnshop in town. It was this case that he now parked next to his desk before he slipped into his chair.

Bruce Hartley paused opposite Adam’s open doorway. Adam had heard Brittany describe Hartley as “sixty-one, going on forty.” The lawyer had a receding hairline that he tried to disguise with an expensive haircut, and a bulging waistline that custom-tailored suits did little to hide. Hartley was just out of marriage number two or three—Adam couldn’t recall which—and rumor had it he was already looking for the next Mrs. Hartley, although why anyone would put up with the man’s unpredictable moods was hard to imagine.

Hartley looked pointedly at his watch, then hurried on down the hall. Adam didn’t know whether Janice Evans had passed on his reason for being late, but evidently Hartley didn’t consider his employee’s tardiness worthy of comment.

Adam was going through the phone message slips on his desk when Evans stopped by. Janice Evans was a decade
younger than Hartley, and to Adam’s way of thinking, the more level-headed, intelligent, and talented of the two lawyers.

She wore a tasteful wedding and engagement ring set on the appropriate finger. Tiny pearl earrings were Evans’s only other jewelry. Her perfectly styled ash-blond hair fell short of her shoulders. She wore designer glasses over gray eyes that seemed to see everything. He was no expert on women’s clothes, but Adam was willing to bet that Evans’s pants suit had a well-known label and cost several times more than his off-the-rack suit.

“Sorry to hear about your car,” she said. “Get things wrapped up?”

Adam smiled up at her. “Yep. It’s in the shop getting a new windshield and having the headrests redone.”

“What did the police say?”

“Not much, actually. My own theory is that it was some high school kids with a gun, deciding to use my car for target practice.”
How many more times am I going to have to tell this?

“Well, be careful.” Evans nodded once and retreated to her office.

A few minutes later Brittany eased up to Adam’s desk and handed him several file folders.

“Anything urgent?” Adam asked as she shuffled through the stack.

“No. Usual stuff. But we missed you. The coffee you make is so much better than what I brew.”

“Glad you like my touch,” Adam said. “And unless someone shoots out my windshield again, I’ll be in tomorrow to brew it for you.”
That is, unless I’m dead
.

FOUR

CARRIE STOOD BEHIND HER DESK AND RAMMED HER ARMS INTO the sleeves of a fresh white coat. Why did the laundry think so much starch was needed for a professional look? Sometimes she thought the deliveryman should just stand her coats in a corner of her office instead of hanging them in her closet.

Carrie was trying to open the side pocket to admit her stethoscope when her nurse, Lila, stuck her head in the office door.

“And a very happy Monday to us all.” Lila was a middle-aged divorcee, a bottle blonde, who still acted as if she were in her twenties. Today she looked as though she’d bitten the lime, only to reach for the tequila and find someone had hidden it.

“Party a bit too much over the weekend?” Carrie asked.

“Nope, didn’t party enough. I had at least another day’s worth of fun planned, but I turned around and it was time to start another week.” Lila eased into a chair, crossed her legs,
and looked up at Carrie, who now struggled to button her white coat. “How about you?”

There were two ways to get news spread throughout the twelve-doctor, multispecialty clinic where Carrie worked: put a notice on the bulletin board or tell Lila. Carrie chose not to go either route. “Pretty routine.” She checked her pockets, lifted her gaze to Lila, and smiled. “Let’s get on with it.”

Lila stood and gave a mock cheer. “Once more the Rushton Clinic moves into high gear.”

The clinic’s official name was Jameson Medical Associates, but everyone called it the Rushton Clinic after Dr. Phil Rushton, the managing partner. He’d put together the group of physicians, helped work out a system for dividing profits and sharing expenses, made the administrative decisions most doctors were happy to avoid, and still found time to be the foremost cardiac surgeon in the region.

Carrie was one of two internal medicine specialists in the group. Her training was as good or better than that of the other internist, Thad Avery, and their practice sizes were about equal. She had no quarrel with the arrangement except for occasions when Phil Rushton’s actions made her grit her teeth. She was ready to see her first patient when a secretary hurried up. “The Emergency Room called. Mr. Berringer was brought in earlier by ambulance. Heart problems. The ER doc wants to know if you’d like to see him.”

Lila, now quite professional, said, “I’ll let patients know you’ve had an emergency. They can wait or we’ll reschedule. Go ahead.”

Carrie walked through the breezeway that connected the clinic with the hospital, then made her way to the ER. The
charge nurse handed her a chart and pointed to a curtained cubicle.

Carrie flipped through the pages, noting the history of weakness, blurred vision, and a sense of palpitations, culminating in a fainting spell. The ER doctor had already ordered blood work, and the report was on the chart. Carrie scanned the figures, stopping when her eyes lit on the potassium level: 2.6 mEq/ml—definitely a contributory factor, and something that should be corrected as quickly as possible.

She pulled aside the curtains and took in the scene. “Mr. Berringer, what’s going on?”

The older man, pale and sweating, turned his head slightly toward her. The oxygen mask on his face added a hollow timbre to his voice. “I wish I knew, Doctor.” He opened his lips to say more, but instead closed his eyes, apparently spent by the effort.

Carrie turned to Berringer’s wife, who stood beside the gurney, alternately blotting beads of perspiration from her husband’s forehead and stroking his hand. “Mrs. Berringer, is your husband taking any medications other than the ones you told the emergency room doctor about?”

“Dr. Markham, they’re all medicines you prescribed. Don’t you have the list there?”

Carrie smiled at her and said gently, “Let’s pretend I don’t.”

The woman frowned. “You know about the heart pills and the cholesterol medicine. And, of course, there are those little tiny pink pills, but I don’t think they count. They’re just water pills of some kind.”

Carrie tried not to grind her teeth. “Do those little pink pills have a long name that’s shortened to some letters?”

“Oh, yes.” The woman’s face brightened. “I remember. HCZT or HTCZ or something like that.”

Hydrochlorothiazide, or HCTZ, was a diuretic given to patients with high blood pressure, but it also could deplete potassium levels in the body. And when this occurred in patients who’d taken an overdose of digitalis, the combination had the potential to be lethal.

Soon Carrie was able to put together the story. Henry Berringer refused to be “one of those people who use little pillboxes” to tell him if he’d taken his medicine on that particular day, choosing instead to rely on his memory. Apparently, for the past several days he’d taken his pills two or three times a day. The resulting digitalis overdose at first manifested itself as nausea and lack of appetite. He complained of seeing a yellow halo around lights, something he blamed on his early cataracts. But when he fainted in the living room, his wife called 911. His pulse was fifty and irregular when the paramedics arrived.

“You’ve taken too much of some of your medicine,” Carrie said to Mr. Berringer. “We need to make sure that doesn’t happen again. In the meantime we’re going to do some things to reverse the effects of that overdose.”

Mrs. Berringer looked so relieved that Carrie thought she might burst into tears. “Thank you, Doctor,” she mouthed as Carried slipped through the curtains with a promise to be back as soon as she could.

Carrie spent the next several hours shuttling between the clinic and the ER. Finally, thanks to atropine, Digibind, and intravenous potassium, Mr. Berringer’s heart rate and rhythm were approaching normal levels. Carrie thought it would be
best to watch him for a bit longer, and since he had a disturbance of cardiac rhythm and might have sustained heart muscle damage, there was no problem getting approval for his admission to the hospital’s medicine floor. If serial EKGs and cardiac enzymes showed no further problems, she’d let him go home—but with a lecture about his need to become “one of those people who uses pillboxes.” That was far better than becoming “one of those people who didn’t take their medicine properly and died as a result.”