“Bessie, you’re making me blush-”
“In ’seventy-four you did nothing less than give me the second half of my life. The residents back then would have done me in, too, if you hadn’t stopped them. I’d never have seen my grandchildren. So give credit where credit is due, I say.”
“It was nothing.”
“There you go again. Nothing? My heart racing. Unable to get my breath. And everybody shouting, grabbing at the ECG tracing. I remember everything like yesterday.”
“Well, you know how it is in a precode when only residents are around.”
“But you measured out the rhythm and saw it for what it was.”
As part of developing the lore of her own sickness, Bessie had never stopped extolling to anyone who would listen how someone so young had maintained the presence of mind to pick out such a subtle distinction on a cardiogram in the midst of all that wild confusion. As she told and retold the story, she recalled seeing everything as if from the wrong end of a telescope, feeling desperate for air despite wearing an oxygen mask, and being about to pass out. The chief resident kept yelling for intravenous digoxin while others stuck her with IV needles and shouted a flurry of other orders:
“Furosemide!”
“Nitro!”
“Morphine!”
Like happy hour at a bar, she’d thought, watching the darkness close in on her.
A nurse had brought the syringe of digoxin up to the rubber injection port on a small intravenous bag.
Then that lone clear voice. “No! This is dig toxicity.” And a dark-haired girl with a plain face had grabbed the needle away before it could be injected. “The rhythm strip shows atrial flutter with block,” she added, speaking firmly and loudly enough to cut through the melee without resorting to panicky shouting like everyone else.
The rest of the team had immediately turned to give her their attention. “Look,” she said, running the long strip of paper upon which the ECG had been printed through her fingers, handling it like a ticker tape and pointing out the salient features.
Yes, yes, yes, the doctor in Bessie McDonald had thought, her hearing intact enough to pick up sufficient snatches of the quick-fire explanation to know it was correct even as her vision narrowed to mere pinpoints of light.
Atrial flutter with block, a hallmark of digoxin toxicity, meant a far too rapid heartbeat where the upper chambers, the atria, pounded along at 300 a minute, and the lower chambers, the ventricles, contracted at exactly half that rate, 150 a minute. The trick? To recognize it from the other arrhythmias where the atria and ventricles raced ahead at the same speed and the drug of choice was more digoxin. Had the chief resident succeeded in giving an additional dose to Bessie, however, he would have entrenched the problem, rendering her myocardium twice as resistant to treatment, and she could have died. Pumping at that speed, the chambers weren’t emptying properly, and her lungs were filling up with fluid. While the other drugs they’d ordered would help empty it out, the definitive step to solve the problem – slowing down her heart – had to be done by a synchronized countershock of electricity.
Melanie had come through for her on that count as well. Bessie felt the paddles lathering up her chest with lubricant, then “Pow!” A huge white light ripped up the inside of her skull. Yes! Despite the sensation of being kicked by a horse, the jolt of direct current, she knew, would stun the atria, render their conduction pathways refractory to the fast impulses, and allow her own natural pacemaker time to reassert itself. Within minutes she began to feel better, opened her eyes, and saw Melanie smiling at her.
“Quite a feat for a fourth-year student,” Bessie said. “You know, up until that point, I got the impression nobody on staff appreciated your skills.”
Melanie chuckled. “Hey, that’s the job of teachers with medical students. Keep ‘em tired and feeling stupid. Makes it easier to stuff them with knowledge. But to what do I owe this trip down memory lane?”
Bessie reached for the paper with her good arm. “This got me going,” she said, tapping the article about Kelly McShane. “It all happened that same year. I remember her. She was so pretty and pleasant around patients. I thought then she’d make a great doctor. And if you recall, Chaz Braden had been my cardiologist. Come to think of it, he kept ignoring my complaints of being nauseated. That should have tipped him off my digoxin level was rising.”
“You’ve got a pretty good memory for something so long ago.”
“What do you expect? I nearly died. As for the time when Kelly McShane disappeared, I figure just about everyone remembers that, at least where they were.”
“How do you mean?”
“Thursday, August 8, 1974. That was the night Nixon resigned. He gave a TV speech at nine P.M, announcing he’d be gone by noon the next day. I was glued to my TV at home. And in my office, Friday, the patients and I watched his departure from the White House. I’ll bet you can tell me where you were, too.”
Melanie frowned a few seconds, as if trying to recall her whereabouts, then shrugged. “Not really. I remember it happening, but not where I was. Must have been busy days on the floors. Say, the nurses told me you’re going to your son’s home to live.” She got up and walked over to the family photos on the bureau, leaning over to get a better look at them.
Bessie immediately felt excited. The mere mention of what lay ahead brought her to life again. “That’s right. Me on the Big Sur. Fred Junior and his wife have built their dream house, including a cottage for me, plus arranged for private nurses, all thanks to the dot-coms. The kid had the smarts to sell before they went bust, and I’m going out in style.”
“Hey, I think you should take a doctor along with you.” She delicately fingered the frames as she looked at the pictures one by one.
“Come along. That would be the dream team, having you in charge. You’ve always been there for me, when you’ve been there at all.”
Melanie laughed and moved to inspect the figurines near the head of the bed. “Will you listen to yourself? You can’t blame gibberish like that on the stroke.”
“You know what I mean. You saved my life twice. Why not a third time? I’ll bet there are lots of opportunities for someone like you in California.”
“Be careful. I might take you up on it.” She carefully picked up the piece depicting Bessie examining an old man. “This is beautiful. Is that you?”
“A long time ago-” She stopped short at the sight of Tanya standing at the door. How long the young nurse had been there she couldn’t say. “Yes, Tanya?”
“I’m sorry to interrupt, Bessie, but it’s time for your shot.”
“Oh!” Melanie said, peeking at her watch, “Well, guess I better be off, then.” She quickly replaced the porcelain figure.
Bessie flashed an annoyed look at Tanya for interrupting them. She’d been enjoying the company. “Oh, Melanie, please don’t go.”
“I really have to. Sorry it took me so long to stop by, yet better late than never, eh? Have a good sleep, and I’ll try to see you before you leave.”
Obviously their visit was over. Contemplating the striking woman Melanie had become in middle age, Bessie reached for her hand and took it in hers. “All the best.”
“To you as well,” Melanie said, returning the gesture with a warm squeeze.
Out of nowhere an insolent little question popped into Bessie’s mind. How come such a good-looking woman had never married?
Once she’d left, Tanya walked over to a stand where a small, multidose bottle of heparin and packets of needles were kept.
Low molecular weight heparin was another anticoagulant, this one used in small injected doses to prevent blood clots from forming in the limbs of patients who were bedridden. She wouldn’t normally have needed it, being on warfarin and the baby aspirin already, but having thrown two emboli from her heart so far, the doctors were taking no chances.