Робин Кук - Mortal Fear

“But his father was seventy-four when he died. Cedric is only fifty-six! What’s the point of a physical if my husband dies just three weeks later?”

“I’m sorry,” Jason said softly. “Our predictive abilities are limited. We know that. We can only do the best we can.”

Mrs. Harring sighed, letting her breath out. Her narrow shoulders sagged forward. Jason could see the anger fading. In its place came the crushing sadness. When she spoke, her voice was shaking. “I know you do the best you can. I’m sorry.”

Jason leaned forward and put his hand on her shoulder. She felt delicate under her thin silk dress. “I know how hard this is for you.”

“Can I see him?” she asked through her tears.

“Of course.” Jason got to his feet and offered her a hand.

“Did you know Cedric had made an appointment to see you?” Mrs. Harring said as they walked into the corridor. She wiped her eyes with a tissue she’d taken from her purse.

“No, I didn’t,” Jason admitted.

“Next week. It was the first available appointment. He wasn’t feeling well.”

Jason felt the uncomfortable stirring of defensive concern. Although he was certain no malpractice had been committed, that was no guarantee against a suit.

“Did he complain of chest pain when he called?” Jason asked. He stopped Mrs. Harring in front of the CCU door.

“No, no. Just a lot of unrelated symptoms. Mostly exhaustion.”

Jason breathed a sigh of relief.

“His joints ached,” Mrs. Harring continued. “And his eyes were bothering him. He was having trouble driving at night.”

Trouble driving at night? Although such a symptom did not relate to a heart attack, it rang some kind of a bell in Jason’s mind.

“And his skin got very dry. And he had lost a great deal of hair—”

“Hair naturally replaces itself,” Jason said mechanically. It was obvious that this litany of nonspecific complaints had nothing to do with the man’s massive heart attack. He pushed open the heavy door to the unit and motioned Mrs. Harring to follow him. He guided her into the appropriate cubicle.

Cedric had been covered with a clean white sheet. Mrs. Harring put her thin, bony hand on her husband’s head.

“Would you like to see his face?” Jason asked.

Mrs. Harring nodded, tears reappearing and streaming down her face. Jason folded back the sheet and stepped back.

“Oh, God!” she cried. “He looks like his father did before he died!” She turned away and murmured, “I didn’t realize how death aged a person.”

It doesn’t usually, Jason thought. Now that he wasn’t concentrating on Cedric’s heart, he noticed the changes in his face. His hair had thinned. And his eyes appeared to have receded deep into their orbits, giving the dead man’s face a hollow, gaunt look, a far cry from the appearance Jason remembered when he’d done Cedric’s physical three weeks earlier. Jason replaced the sheet and led Mrs. Harring back to the small sitting room. He sat her back down and took a seat across from her.

“I know it’s not a good time to bring this up,” he said, “but we would like permission to examine your husband’s body. Maybe we can learn something that will help someone in the future.”

“I suppose if it could help others...” Mrs. Harring bit her lip. It was hard for her to think, much less make a decision.

“It will. And we really appreciate your generosity. If you’d just wait here, I’ll have someone bring out the forms.”

“All right,” Mrs. Harring said, with resignation.

“I’m sorry,” Jason told her again. “Please call me if there is anything I can do.”

Jason found Judith and told her that Mrs. Harring had agreed to an autopsy.

“We called the medical examiner’s office and spoke to a Dr. Danforth. She said they want the case,” Judith told him.

“Well, make sure they send us all the results.”

Jason hesitated. “Did you notice anything odd about Mr. Harring? I mean, did he appear unusually old for a man of fifty-six?”

“I didn’t notice,” Judith said, hurrying away. In a unit with eleven patients, she was already involved in another crisis.

Jason knew that Cedric’s emergency was putting him behind schedule, but Cedric’s unexpected death continued to disturb him. Making up his mind, he called Dr. Danforth, who had a deep resonant voice, and convinced her to let the postmortem be done in house, saying death was due to a long family history of heart disease and that he wanted to compare the heart pathology with the stress EKGs that had been done. The medical examiner graciously released the case.

Before leaving the unit, Jason used the opportunity to check another of his patients who was not doing well.

Sixty-one-year-old Brian Lennox was another heart attack victim. He had been admitted three days previously, and although he’d done well initially, his course had taken a sudden turn for the worse. That morning when Jason had made rounds he had planned to move Lennox from CCU, but the man was in the early throes of congestive heart failure. It was an acute disappointment for Jason, since Brian Lennox had to be added to the list of Jason’s inpatients who had recently gone sour. Instead of transferring the patient, Jason had instituted aggressive treatment for the heart failure.

Any hope of a rapid return by Mr. Lennox to his previous state was dashed when Jason saw him. He was sitting up, breathing rapidly and shallowly in an oxygen mask. His face had an evil grayness that Jason had learned to fear. A nurse attending him straightened up from adjusting the IV.

“How are things going?” Jason asked, forcing a smile. But he didn’t have to ask. Lennox lifted a limp hand. He couldn’t talk. All his attention was directed toward his breathing efforts.

The nurse pulled Jason from the cubicle into the center of the room. Her name tag said Miss Levay, RN. “Nothing seems to be working,” she said, concernedly. “The pulmonary wedge pressure has gone up despite everything. He’s had the diuretic, the hydralazine and the nitroprusside. I don’t know what to do.”

Jason glanced over Miss Levay’s shoulder into the room. Mr. Lennox was breathing like a miniature locomotive. Jason didn’t have any ideas save for a transplant, and of course, that was out of the question. The man was a heavy smoker and undoubtedly had emphysema as well as heart trouble. But Mr. Lennox should have responded to the medication. The only thing Jason could imagine was the area of the heart involved with the heart attack was extending.

“Let’s get a cardiology consult stat,” Jason said. “Maybe they’ll be able to see if the coronary vessels are more involved. It’s the only thing I can think of. Maybe he’s a candidate for bypass.”

“Well at least it’s something,” said Miss Levay. Without hesitation, she went to the central desk to call.

Jason returned to the cubicle to dispense some compassion to Brian Lennox. He wished he had more to give but the diuretic was supposed to reduce fluid while the hydralazine and nitroprusside were supposed to reduce pre-load and after-load on the heart. All of this was geared to lower the effort the heart had to expend to pump the blood. This would allow the heart to heal after the insult of the heart attack. But it wasn’t working. Lennox was slipping downhill despite all the efforts and all the technology. His eyes now had a sunken, glazed appearance.

Jason put his hand on Brian’s forehead and pushed the hair back from his perspiring brow. To Jason’s surprise, some of the hair came out in his hand. Momentarily confused, Jason stared at it, then he carefully pulled on a few other strands. They came out as well with almost no resistance. Checking the pillow behind Brian’s head, Jason noticed more hair. Not an enormous amount but more than he would suspect. It made him wonder if any of the medications he’d ordered had hair loss as a potential side effect. He made a mental note to look that up in the evening. Obviously hair loss was not a major concern at the time. But it reminded him of Mrs. Harring’s comment. Curious!