Heart Failure

by Richard L Mabry

  As Carrie drove out of the parking lot, something she’d heard in med school crossed her mind. Just because you’re paranoid doesn’t mean they aren’t out to get you. Maybe it wasn’t paranoid to be careful—not if someone was trying to kill Adam . . . and her.

  SIX

  ADAM JUMPED UP FROM HIS CHAIR WHEN HE HEARD THE TAP ON the door of Rancho Motel’s cabin six. “Adam?” a small voice called.

  He opened the door and waved Carrie inside. They exchanged an awkward hug, but when Adam made a motion to kiss her, Carrie pulled back, disguising the movement by tucking a strand of hair behind her ear. His heart sank.

  Carrie settled into the room’s only chair. “Do you think this is a safe place to meet?”

  Adam eased onto the bed and sat with his back against the headboard. He’d asked himself the same question. “It’s the safest place I could think of.”

  “Why didn’t your caller ID show up on my phone when you called?” Carrie asked. “What I got was ‘private call.’”

  “I went to Best Buy and bought a prepaid cell phone. People, especially those on the wrong side of the law, call them ‘throwaways.’ I’ll give you the number before you leave. From now on, use that when you call me.”

  “Why?”

  “I understand that it’s possible to locate a cell phone, even when it’s not being used, by triangulating the cell towers it accesses. I don’t know how sophisticated this guy who’s after me really is or how much technology he has available, but I decided there was no reason to give him a way to pinpoint my location.”

  Carrie said, “Well, I can see that you’re taking this seriously. But what’s your next move? That is, if you don’t mind telling me.”

  For maybe the hundredth time Adam regretted thinking he could get by without sharing his past with Carrie. But he couldn’t change that. He leaned back against the headboard and closed his eyes. “I’m not sure what to do. Ordinarily I’d pack up and run again. But that would mean leaving you, and I can’t do that.”

  “But if you stay, you’re not safe. Right?” she said.

  “You saw what’s happened already. Does that seem safe to you?”

  “What I can’t understand is, if DeLuca went to prison, why is this still happening?”

  “A connected mob guy can put out a hit whether or not he’s behind bars,” Adam said. “You can bet that’s exactly the message that went out before the prison door closed on Charlie DeLuca.”

  “So that’s why you were in the Witness Protection Program,” Carrie said.

  “Witness Security Program,” Adam corrected. “But, yes. No one knows where I am except my brother.”

  “Why Jameson? Why here?”

  Adam forced a smile. “My grandmother grew up here. She went north and married my grandfather, but as a child I heard lots of stories about Texas, and specifically about Jameson, which was just a wide place in the road when she left. I looked it up on the Internet and found it had changed. Like the story of the three bears—not too large, not too small, but just right.”

  “So you essentially slipped away from federal protection? Would they take you back?”

  “I left the program because there were too many ways DeLuca’s people could find me. I don’t see why it would be any safer for me to go back now.”

  “How did you get a job here?” Carrie asked.

  “All it took was a couple of forged references and an obvious good grasp of the practice of law. It’s not hard to be a paralegal when you’re already an attorney.” A faint smile crossed Adam’s face. “Besides, Bruce Hartley got me cheap, and that’s just his style.”

  “What about me—or maybe I should say, what about us? Was that all part of your cover?”

  Adam was shaking his head while she was still talking. “Absolutely not. My first week here, when I slipped into the Jameson Community Church and saw you in the congregation, I knew I had to meet you.”

  “So when we were introduced that Sunday morning after church, it wasn’t an accident?”

  “No. Until I saw you, I never put much stock in that ‘love at first sight’ stuff. You changed my mind, right then and there. And the more I got to know you, the more certain I was that love was real.” He took a deep breath, swallowed twice, and said, “Carrie, I loved you then. I still love you.”

  Carrie turned her head and wiped at her eyes. A long moment passed before she finally spoke, and when she did her voice was fragile, as though it was ready to crack. “When John died, I thought I’d never love anyone again. Life had lost its color. But I met you, and it didn’t take long for me to think you’d come into my life to fill the hole that was there. I started to live again.”

  “I wasn’t trying to—”

  Carrie shook her head. “You did exactly what was needed. You let me talk about John. You dried my tears and let me lean on your shoulder. You gave me your love. And the gray turned to a rainbow again.”

  Adam’s heart swelled.

  “You introduced yourself as Adam. Then I found out you’re really Keith. You may even have other names. But that doesn’t matter. I’ve decided that what matters is I’m not ready to lose you. I love you, and I want us to be together.”

  Hope rose in Adam’s chest. “Does that mean our engagement is on?” he asked. “Are you ready to wear the ring again?”

  Carrie rose and moved to the window. She stared into the night for a long time before speaking. “Let’s leave it at ‘I love you’ for now. We can talk about our future when all this is settled.”

  “So where do we go from here?” Adam asked. “You know the choices I have. What do you want me to do?”

  Carrie turned from the window and looked into Adam’s eyes. “I don’t know what to tell you. All I know is that we’re in this together.”

  Adam crossed the room and put his arms around her. They hugged and kissed, this time with the passion that had marked their relationship earlier.

  When Carrie finally pulled away she looked at her watch. “I need to go. Give me your new cell phone number. I’ll call you tomorrow.”

  Carrie entered the number into her phone, then moved toward the door, where she turned to face him. “Should I keep calling you Adam?”

  He nodded. “You have to, in order to keep my identity a secret. Is that going to be a problem?”

  “No. You’re still the man I fell in love with. That’s all that matters.” She kissed him once more. “Good night. Be careful.”

  All through a night marked by tossing, turning, and brief periods of fitful sleep, Carrie pondered her situation and weighed the choices facing her and Adam. Her dreams were filled with flashbacks of John’s death interspersed with vivid scenes of a gunman bursting into the church and shooting Adam dead during their wedding. She woke in a mass of tangled, sweat-soaked bedclothes.

  Over a quick breakfast of coffee and toast, she considered her options and found none of them good. Driving on automatic pilot to the clinic, her mind was a muddle. Now it was time to go to work, to put everything else aside. Her patients deserved her full attention, and that was what they’d get.

  She stood outside the exam room where her first patient waited when a familiar voice made her turn. Phil Rushton said, “Carrie, glad I ran into you. Do you have plans for lunch?”

  Carrie made a conscious effort not to show her surprise. What was going on? Phil Rushton didn’t ask colleagues to lunch. It was generally held that he didn’t ever stop for lunch. He went straight from the operating room to his clinic so he could see his post-ops, evaluate possible preoperative patients sent to him by his colleagues, and do the hundred and one things involved in a busy and successful specialty surgical practice.

  There was definitely something going on here—but she wasn’t sure what it was. One explanation was that Phil was interested in her as something other than a colleague. But that didn’t ring true with her. Phil rarely did anything that didn’t benefit him, directly or indirectly. Once more Carrie wondered if he was angling to get her out of
the clinic. She’d noticed some time ago that he favored the clinic’s other internist, Thad Avery. Maybe Phil or Thad wanted to replace her on the clinic staff with a friend of theirs. Whatever the reason, she’d better tread carefully.

  “I’m sorry, but I have a luncheon date.”

  “With that boyfriend of yours?”

  “Actually, no.” As though it’s any business of yours. “I’m meeting a woman who’s been my best friend for years.”

  “Can you cancel it?” Phil said. Was that a smile on his face? Unbelievable. “There’s a little hole-in-the-wall café down the street. The food is great, but it seems no one’s discovered it yet, so it’s quiet. Just the place for us to talk privately.”

  Talk privately, as in break bad news? Carrie liked this less and less. “Phil, I—”

  “Dr. Markham!”

  Carrie’s nurse, Lila, came speed walking down the hall toward her. Something was definitely wrong. Lila didn’t hurry for anything except the direst of emergencies. “What?” Carrie said.

  “The EMTs just brought Mrs. Lambert into the ER. Chest pain, syncope, shock—probably a coronary. The ER doc’s with her now, but they need you there stat!”

  “I’m on my way.” Carrie turned to Phil with an “I’m sorry” look, then hurried away, glad for the interruption, but worried about her elderly patient who appeared to be having her third coronary event in the past two years.

  As she walked briskly through the enclosed breezeway that connected the clinic with the hospital, Carrie thought about what lay ahead of her. She wondered if this was the heart attack that might be the final one for Mrs. Lambert. Well, not if Carrie could do something to prevent it.

  There had been a time when Carrie prayed for her patients. Then John died. She hadn’t offered up many prayers since then, but this seemed to be the time for one.

  God, I know the ultimate result isn’t in my hands, but in Yours. Please use me to restore Mrs. Lambert to health. The doors to the hospital were straight ahead of her. Time to see if she, or God, or the two of them together could keep her patient alive.

  Carrie pushed through the double swinging doors into the confusion of the Emergency Room. Her eyes swept left and right as she hurried to her patient’s side. If one ignored the sounds that formed a constant background—beeps and voices and the clatter of balky gurney wheels—and focused instead on all the moving parts, they’d see staff going about their business in an efficient manner, with no outward hint of the inward adrenaline rush some of them undoubtedly felt.

  “Dr. Markham, your patient is over there.” An ER nurse, whose name danced outside of Carrie’s memory, indicated a cubicle surrounded by drawn curtains that moved like sails in the wind from the activity going on behind them.

  “Thanks, Jane,” Carrie said, thankful that the right name had come to her just in time.

  She drew aside the curtains and saw what she’d expected. An ER doctor alternately focused on the green lines of a heart monitor and the lab slips in his hand. An elderly lady, thin and pale, lay motionless on the wheeled stretcher. Oxygen flowed into a clear plastic mask that covered her lower face. IVs dripped into both arms. Her vital signs, constantly displayed on yet another monitor, showed a blood pressure that was low but adequate.

  “I’m here,” Carrie said to the other doctor. “Fill me in.”

  He did so in a few sentences, using the medical-speak only a professional would understand. “If you don’t need me, I’ve got an ER full of patients. But call if I can help.” He slid through the curtains and was gone.

  As Carrie moved to her side, the woman on the stretcher opened her eyes, blinked, and squinted in recognition. “Dr. Markham. Am I dying?” Her voice was weak, and the effort of speaking seemed to exhaust her.

  Carrie patted her hand. “Mrs. Lambert, you’ve had another heart attack—a pretty big one, according to what I see. We need to do a cardiac angiogram to see how to handle this.”

  Mrs. Lambert breathed out through pursed lips, then took in a deep breath. “So, another stent?”

  “I’m—”

  “It depends on what the angiogram shows. You may need an operation to supply more blood to your heart.”

  Carrie whirled to identify the speaker. Actually, his voice was easily identifiable to her—she’d heard it only minutes ago—but she couldn’t believe Phil Rushton would try to claim the case without speaking to her first. “Phil, what—”

  At that moment a man and woman in hospital scrubs pushed into the already crowded space and positioned themselves at the head and foot of the gurney. The woman spoke to Mrs. Lambert. “We’re going to take you for an X-ray study of your heart.” They busied themselves with changing from the wall oxygen supply to a tank under the gurney. The male member of the team unplugged the monitors, and in a moment they wheeled Mrs. Lambert away.

  Carrie glared at Phil. “Can you tell me what’s going on? And why you’re taking over my patient without consulting me?”

  Phil made a palms-out gesture. “Carrie, this is Mrs. Lambert’s third infarction. I have no doubt that both her EKG and enzymes will confirm that it’s a major one. Her daughter called the clinic right after you left and asked if I’d take charge of her case if she needed surgery. She gave me most of the history I need. We’ll see what the angiogram shows, but I’m willing to bet that this time stents won’t do it. Your patient will need bypass surgery. Now, unless you want to try to talk her and her daughter into going somewhere else, I think you’ll agree I’m a good choice to do the operation. And the sooner we get to it, the better.”

  He was right, of course. Mrs. Lambert was a prime candidate for what medical professionals called a “cabbage.” Not the leafy vegetable. She needed a coronary artery bypass graft, a procedure that bore the acronym CABG. Carrie had to admit the probable need for such surgery crossed her mind as she hurried to the ER. Mrs. Lambert shouldn’t suffer because Carrie had her feelings ruffled. She shrugged. “Let’s head for the angiography suite. I want to see what the angio shows.”

  “Are you sure you want to go back there?” Phil said. “After what happened to John—”

  “I’ll be fine,” Carrie snapped. “I’ve been going to the angio suite since two weeks after John died. I’ll be the first to admit it wasn’t easy at first, but I did it.” She turned on her heel and said over her shoulder, “I promise I won’t break down, if that’s what’s bothering you. Now, are you coming?”

  As Carrie hurried down the corridor, she wondered about the man matching her stride for stride. Professionally he was as competent as they came. She’d trust her life to Phil. Actually she’d trusted her husband’s life to him. She might have assigned some blame to Phil in John’s death, but now that some time had passed she realized he’d done all he could. The question that continued to plague her was whether she had done all she could as well.

  SEVEN

  PHIL WAS RIGHT, OF COURSE. THE ANGIOGRAM SHOWED ALMOST total blockage of Mrs. Lambert’s left anterior descending and left circumflex coronary arteries. In layman’s terms, blood flow to the major portion of the heart muscle was cut off. “I’ll talk with Mrs. Lambert and her daughter,” Phil said.

  Carrie knew she’d been dismissed, but she couldn’t simply disappear. She’d cared for Mrs. Lambert through two other heart attacks and thought she’d formed a bond with the woman. Even if the daughter asked Phil Rushton to take over the case, Carrie felt an obligation to be there. “I want to go with you when you talk with them. She’s my patient too.” At least for now.

  She stood by as Phil explained the procedure to Mrs. Lambert and obtained her permission for the surgery. No problem, the woman said. She knew how close to death she’d come—how close she still was. If surgery was what was needed, she was ready.

  Carrie’s heart melted when Mrs. Lambert looked at her and said, “Dr. Markham, would you pray for me?” Carrie nodded her assent, afraid to speak. I’ll try, but my prayers haven’t been too successful lately. She squeezed Mrs. Lambert’s hand and
followed Phil out of the room.

  They found the daughter, Mrs. Stinson, in the waiting room. Despite her earlier frustration about the call to Phil Rushton, Carrie sympathized with this harried, middle-aged woman who wore worry lines on her face like a combat badge. Mildred Lambert had lived with her daughter and son-in-law since her husband died over a year ago.

  Carrie and Phil took two vacant chairs that flanked Mrs. Stinson. There was no one else within earshot, so this was as good a place as any to have the talk. “Your mother has had another heart attack,” Carrie began. “And this was a big one—almost fatal. So Dr. Rushton needs to perform surgery.”

  Phil explained that Mrs. Lambert needed more blood flow to the heart, so he’d take a vein from her leg and hook it up to take the place of the clogged arteries. “We call it a bypass graft.”

  “Is it risky?” Mrs. Stinson’s voice was weak, and now tears flowed freely.

  “Of course,” Phil said, and went on to explain the potential risks. “But it’s necessary surgery. Without it, your mother would almost certainly die.”

  Mrs. Stinson turned for the first time to Carrie, an unspoken question in her eyes.

  Carrie nodded. “I agree.”

  A secretary came over to the group and handed Phil a clipboard. He glanced at it. “We have the op permit signed. Now I have to get ready.” He rose and hurried away.

  “Is Mother strong enough . . . ?” Mrs. Stinson let the words trail off.

  “We believe so. The anesthesiologist is excellent. Dr. Rushton is the best heart surgeon around. The whole team is extremely competent. Your mother is in good hands.” Carrie found herself reaching for Mrs. Stinson’s hand. “I have to get back to the clinic. Dr. Rushton will see you as soon as the surgery is over, and I’ll be back this evening. Is there anything I can do for you now?”

  Mrs. Stinson blinked away tears. “Just keep us in your prayers.”