A Matter of Heart (8 page)

T
he colors in the cardiologist's office remind me of Thanksgiving—rust chairs, pumpkin walls, and cranberry planters. Spaced between the chairs are fake leafy plants—are they supposed to make us feel like we're alone? We are alone, except for an old couple with matching white hair.

Mom and Dad are both here. Mom has canceled her Wednesday after-school group. Dad coaches the cross-country team at his middle school, and he's missing a meet to be here. Not that they think anything is wrong.

I'm trying to stay focused and positive. I'm not big on praying, but God and I talk sometimes. It never made sense that I should ask God for something that I could work to get on my own. Even now, I'm not asking him for favors so much as explaining how it's going to be. I can't be sick now. In a month, fine, but not
now. I got slightly dizzy because I didn't drink enough. It happens to me every winter. The Phoenix temperatures drop down to normal human levels and I forget to drink enough. Mom is always on me to take vitamins. I silently vow to take my potassium every day even if it does make me burp.

Mom is sitting on my left, a clipboard with a stack of papers to fill out propped on her knee. Dad is on my right, trying to rearrange a plastic leaf that keeps poking his shoulder.

I've got my math spread out on my lap, but I can't concentrate. The air in here is musty. There are no windows, either. Why? So you can't jump when you get bad news?

I should be swimming right now. The back of my neck feels itchy just thinking about it. I know it's only been two days, and Coach is beginning to taper down the workouts anyway. But I still have this stupid fear that everyone else is getting fast while I'm getting slow. After I'm done here, I'll ask Connor to meet me at Lifeline for a swim. A swim will make everything right.

After Mom finishes the paperwork, a lady wearing a cranberry smock leads us down a hall to one of the rooms.

I sit on an examining table just like at Laney's office. Only this room has a cart next to the bed with a monitor attached to some kind of machine.

The assistant's name is Maggie, and she does all the same stuff they did to me at Laney's: takes my medical history, blood pressure, temperature, pulse rate. Then she hands me a pink folded-up thing. “If you could put that on, please.”

“What is it?” I ask.

“A dressing gown. It opens in the front.”

Dad clears his throat. “Maybe I ought to wait outside.”

I crumple the material as I realize why his cheeks are suddenly pink.

Mom squeezes his hand. “I'll come get you as soon as we're done.”

I put on the gown, and it doesn't take long for Maggie to attach the electrical leads to me. They're flat sticky bits of tape that are held by clips and attached by wire to the machine. I expected a few—not ten. They're on my chest, my arms, and my ankles.

“Just relax,” she says.

As if. I'm afraid to move so the lines don't shift around. Also, the gown is barely hanging to the curve of my right boob and I don't want it to slip and leave my nipple to the wind. Even worse, I have a nagging itch on the inside of my left ankle.

“Mom,” I say. “Scratch for me.”

She finds the spot and digs in with the tips of her short nails the way I like. In the meantime, I can see a line stretching across the computer monitor, spiking with every heartbeat. It's just like
Grey's Anatomy
. The screen looks like it's full of pointy witch hats. Good thing Jen isn't here. She'd get new ideas for Halloween.

A few minutes later, a printer starts up. “You can get dressed now,” Maggie says as she takes a sheet off the printer. “The doctor will be in shortly.”

I finish dressing and Dad comes back in. Nineteen minutes later we're waiting so quietly I can hear a rustle on the other side of the door. My chart being lifted. A quick knock follows and then he comes in.

“Hello,” he says. “I'm Dr. Danvers. And you must be the Lipmans.”

Dr. Danvers is a good-looking guy about twenty years past
hot. Dr. McDreamy for the parental crowd. His black hair is shot through with gray, but he has really nice blue eyes and an easy smile, and he even has a little beard-stubble thing going on.

He works his way from Dad to Mom and then gets to me. He shakes my hand. I can see that he'd be a good doctor to have if you needed one. Which I don't. I just need him to give the okay so I can get back in the pool.

“Laney told me you're a star swimmer,” he says.

“Just broke a school record in the hundred free this past weekend,” Dad says.

“Really?” His brows rise along with the edges of his smile. “And you're how old?”

“Sixteen,” I say.

“Just turned sixteen in September,” Dad adds.

“She's never had any heart issues,” Mom says. “She passes a physical every year in perfect condition.”

He nods and pulls out his stethoscope. “Mind if I have a listen?”

He listens to me lying down and then standing up. “Breathe normally,” he says, which I'm getting really tired of hearing. When he finishes, he wraps the stethoscope around his neck. “I'd like to do one more test.”

“What?” Dad blurts as Mom makes a noise like a dying bird.

“The EKG shows the heart muscle is a little thickened, but I can't determine the cause without also running an echocardiogram,” he explains. “It's basically an ultrasound of the heart. It doesn't hurt a bit. We can do it right now, if you like.”

A nervous feeling rolls through me like a wave of seasickness. I want to tell Dr. Danvers that no, I don't like. “I'm meeting Connor at the pool tonight. It's already after five.”

“Honey,” Mom says.

Dad's rubbing a hand over his mouth and chin. I can guess how he feels. The same way I do. Frustrated. Mad. Freaked out.

“Dad?” I say.

His eyes meet mine. “Let's do the test and get out of here, Ab.”

But it's another hour before I get taken to a different room, and a lady with hair on her chin smears blue gel on my chest and rubs a cold metal knob over it. I try to breathe normally.

When it's over, there are three texts from Jen and one from Connor.
STILL WAITING
I text them both. Tomorrow I can tell them about the EKG and the echo. When the scare is over.

But when Maggie leads us to Dr. Danvers's office, it doesn't feel like a false alarm.

It feels like a funeral march. I shake off the feeling, but Mom rubs my shoulder as if she feels it too.

Dr. Danvers's office is all desk and bookcases and framed medical degrees. I can't focus on anything except the file in front of him. My file. When we're sitting down, me in the middle, Dr. Danvers tilts his computer screen so it faces us. “I've reviewed Abby's echo,” he begins, “and I'm afraid there's a problem.”

A shiver ripples up my spine.

Dr. Danvers gestures to the screen. “This is Abby's echo. It measures the thickness of the chambers and walls of her heart. Abby has an asymmetrical, or irregular, thickening of the ventricular wall. This is indicative of a heart condition called hypertrophic cardiomyopathy.”

“Heart condition?”

“What?”

Mom's and Dad's words overlap and twist together in disbelief and fear. Dr. Danvers pulls out a piece of paper and carefully
writes out the words in block print as if we're five years old:
HYPERTROPHIC CARDIOMYOPATHY
. He lays the paper on the desk facing us. “It's sometimes called an enlarged heart.”

“But her heart is fine,” Dad says. “It's always been fine.”

“Hypertrophic cardiomyopathy, or HCM, often doesn't develop until adolescence,” Dr. Danvers says. “That's one of the reasons this can be so deadly. Teenagers die from this without ever knowing they have it.”

“Die?” Mom says with a gasp.

“When it's not discovered in time,” he adds quickly.

“Then we caught it in time?” Mom asks. “Before it gets too serious?”

“HCM is always serious, but Abby should be fine.” He pulls out another piece of paper and draws a picture of a heart. “These are the chambers of the heart, and this is the wall that separates them: the septal wall. With the measurements from Abby's echo, I'd say she has a mild to moderate case.”

I let out a breath at the same time Dad does. “So that's not bad,” I say.

“It's not,” Dr. Danvers agrees. “But even at mild levels, HCM results in a strain on the heart's function. Because of this thickened wall, the blood doesn't flow out of the chamber as easily. There's a great deal of pressure that builds up, which is why Abby experienced dizziness. Other typical symptoms include arrhythmia—an uneven heartbeat. This could lead to fainting and cardiac arrest.” He pauses, his gaze circling from Mom to Dad and then to me. “Unfortunately, when left untreated, HCM can result in death.”

Mom's fingers are white on the arm of her chair. Dad's hands
are fisted. I feel like I'm somewhere else. Like this is a movie and I'm watching from above.

“You just said it was a mild case,” Dad snaps.

“Mild to moderate,” Dr. Danvers says. “And I'm just trying to be clear about what we're dealing with.”

“Is it treatable?” Mom asks.

“Absolutely.” He reaches for a prescription pad. “I want to start Abby on beta-blockers immediately. They'll help control her heart rate.”

“What does that mean?” Dad asks.

“Beta-blockers will keep her heart rate low and in a safe range.”

I'm shaking my head. As if from above, I see my head moving. I hear the words come from my lips. “But I can't swim fast with my heart rate low.”

“No,” Dr. Danvers says. “You can't.”

You can't
.

I hear the words, but they don't reach me. I'm still watching from above. This isn't happening.

“You'll have to make some changes, Abby. You can still swim,” he says. “But not competitively. Not at the level you're accustomed to.”

My voice shakes. “For how long?”

“You don't understand,” Dr. Danvers answers, and his voice is so gentle, fear rises in my throat, squeezing until I can hardly breathe. “This condition is permanent, Abby.”

“How long?” Dad growls as if he hasn't heard this last bit.

Dr. Danvers blinks and looks from Dad back to me. “Forever.”

I
'm frozen. Numb, maybe. I heard Dr. Danvers, but it's like my ears just closed up shop and nothing's getting in or out. Then Mom gasps. Chokes on a sob. I feel her hand on my arm and something cracks inside me. A jagged crack like you see on the sidewalk, and if it spreads and deepens, then it will crumble. I'll crumble.

No!
I won't fall apart. I struggle for breath, needing to do the one thing I'm good at. Fight.

I look up, and Dad is standing now. His jaw pulses and the veins in his neck stand out. “How can you say that? How can you sit there and say that to us?”

“Please, Mr. Lipman, have a seat. Let's talk calmly about this.”

“I don't want to sit,” Dad bites out.

“David, please.” Mom's voice is a tremble of air.

I pull my arm from Mom's hand and sit forward. “This doesn't make sense. I just set a new school record on Saturday. How could I do that if my heart is as screwed up as you say?”

He folds his hands together. “That's a good question, Abby. But as I said, this condition develops over time. Up until now, your heart was able to withstand the pressures and do its job. But that's changed now. The dizziness and loss of consciousness are signs. A warning.”

“But I was dehydrated. Laney said that could have caused it.”

“It was almost certainly a factor,” Dr. Danvers agrees. “Dehydration is an added risk factor for HCM.”

“Then if I'm careful and drink more—”

“It might alleviate symptoms, but it won't change your condition.”

“How did this happen?” Mom asks. “Is it some kind of virus?”

“No, Mrs. Lipman. HCM is a genetic condition.”

“Genetic?” I blink, surprised. “I was born with it?”

“Technically,” Dr. Danvers says, “you were born with the genes to develop this. But HCM doesn't always appear right away. And in many cases, there are no symptoms, which is why it's often missed during school physicals. In fact, you're quite lucky, Abby. In many cases, the first time it presents itself is at death.”

Mom cries out and covers her mouth.

I want to laugh and be sick at the same time. Dr. Danvers has just called me lucky?

“The important thing to remember is that HCM is treatable, and Abby can live a full and active life. We'll start her on a low dose, twenty-five milligrams of a beta-blocker a day. That's
just one pill every morning. The goal is to keep her from overexertion. We want her peak heart rate around one hundred fifty beats per minute.”

One hundred fifty?

Dad is asking more questions but I can't listen.
One hundred fifty?
When I'm racing, my heart rate peaks between one eighty and one eighty-five. How can I jet through the water at that rate? How can I swim fast enough to make tidal waves?

I look at the desk and I see the words staring up at me from the piece of paper.

HYPERTROPHIC CARDIOMYOPATHY

I guess doctors can write neat enough when they want to. Anger swells up inside me, so bitter I can taste it at the back of my throat. The words are lying there, mocking me. I reach for the paper and wad it in my hands. It crinkles as I squash it into a ball, folding the words in on themselves, destroying them before they can destroy me. I shove the crumpled ball into my purse and stand up. “I've got to get out of here,” I say.

I'm drowning.

The doctor has told me I can't swim, and now I'm drowning.