Nick nodded. “Yeah, but it’s better now.” He wished he could say the same about Brian, but nothing had changed since the morning.
“Let’s take a listen.” Dr. Elizabeth slid the end of the stethoscope down the front of his gown. “Deep breath in...” she instructed, pressing it lightly to the left side of his chest. He inhaled oxygen through the thin tubes in his nose, for which he had happily traded in the face mask as soon as Rob had let him, and held it until Elizabeth added, “...and out.”
As he exhaled, Nick started to cough uncontrollably. He doubled over, gripping the bed rail tightly with one hand while he clutched his chest with the other. His broken rib and bruised sternum both cried out in protest as his body was wracked with painful spasms.
Elizabeth repositioned her stethoscope, bringing it around to his back. “Get him a glass of water, please,” she told Dani, who had already begun to pour water from the plastic pitcher on Nick’s bedside table into his cup. She held it under his chin as she guided the straw to his lips. Grateful, he took a tiny sip, followed by longer swallows, letting the liquid soothe his irritated throat.
Gradually, the coughing fit subsided, leaving him completely exhausted. Elizabeth removed the stethoscope as, eyes streaming, Nick slumped back against his pillows. His chest heaved as he tried to catch his breath, his heart pounding harder than if he had just performed a full show.
“His pulse ox is down to eighty-nine,” he heard Dani say to Elizabeth, as an alarm went off on his monitor.
“Put him back on the mask,” the doctor replied. Nick didn’t even bother to argue before he felt Dani ease the cannula out of his nostrils and place the bulky face mask back over his mouth and nose. He took gasping breaths, feeling like a fish out of water as he greedily sucked oxygen from the mask. After a few moments, the monitor’s frantic beeping stopped, as Nick’s oxygen level returned to the normal range.
“Better?” Elizabeth asked. Nick nodded without speaking, wiping away the moisture that had leaked from his watering eyes. She lowered the front of his gown and listened to his chest for a few more minutes, a deep furrow appearing in her forehead as she moved her stethoscope from one side to the other. When she finally looked up, she was still frowning.
Nick’s heart sank with disappointment. “What now?” he wondered, dreading more bad news.
“I’m not liking what I’m hearing,” Elizabeth admitted. “The extra dose of diuretic Dr. Rob administered may have taken some excess fluid off the top, but your lungs still sound congested.”
“It didn’t even get rid of that much,” added Dani. “He’s still retaining fluid like crazy. Look...” Nick leaned forward as she pulled back his blankets to reveal his swollen legs, which had ballooned to twice their normal size. They looked like two fat sausages stuffed into the casing of the white compression socks Dani forced him to wear. If Lauren could see him now, she would be able to throw every snarky comment he’d ever made about her pregnancy cankles right back in his face. But she wouldn’t… because if she could see him now, she would be way too concerned to laugh. Even Nick knew there was nothing normal about this.
“Is that from lying in bed too long?” he asked, staring down at his legs in dismay.
Dr. Elizabeth shook her head. “I’d like to do another echocardiogram to see if there have been any changes in your heart function. Dani, will you please get him prepped for the procedure?”
Nick stared at her. “Now?”
She raised an eyebrow. “Why, did you have something else planned for this evening?” When his face reddened, she smirked. “I didn’t think so. Don’t worry - it’ll be painless, I promise.”
That’s what you said last time, thought Nick grudgingly, remembering the drugs she had given him to make his heart race. He had almost passed out. He was in no hurry to repeat that experience.
As if she had read his mind, Dani offered him a reassuring smile and added, “It won’t be like the last one. That was a stress echo, where we were trying to simulate exercise to see how your heart responded. This time we just want to see how well it’s pumping when you’re at rest.”
He nodded, feeling slightly less anxious. As Dr. Elizabeth rolled in the cart carrying the ultrasound equipment, Dani removed his hospital gown and helped him roll onto his left side, which was still somewhat sore from his ICD incision. He felt a rush of deja vu as Dani darkened the room, making the ultrasound monitor glow with a ghostly blue light.
Dr. Elizabeth applied a liberal amount of conductive gel to the transducer. “This may feel a little cold,” she warned, but Nick still winced when she touched his bare chest with it. Elizabeth laughed. “Sorry about that.”
“‘S’alright,” Nick muttered, his breath fogging up the oxygen mask.
“Try to lie still while I look for the best angle,” she added, as she moved the wand-like object slowly over his chest. It was more uncomfortable than he remembered it being before, mostly because of the black and blue contusions across his breastbone.
“Do you have to press so hard?” he asked, wincing again as Dr. Elizabeth dug the transducer into his tender skin. “You said this would be painless.”
“Sorry,” she apologized a second time. “It takes a good amount of pressure to get a decent picture, but I’ll try to be more gentle.”
“C’mon, tough guy, you’ve got this,” said Dani, clapping his shoulder encouragingly.
Nick knew he shouldn’t complain - this was nothing compared to the pain he’d already endured - but he was tired of being poked and prodded, tired of having his heart’s every impulse examined and analyzed. What could Dr. Elizabeth possibly be looking for that she hadn’t already found? His heart was failing, plain and simple. He didn’t need another test to confirm what they’d told him time and time again.
Elizabeth eased up a little before she finally settled over a spot on the left side of his chest. While she held the transducer firmly in place, he heard the faint whoosh of blood being pumped by his heart as it appeared on the screen. He was hit with another wave of deja vu as, just like before, the sound brought back memories of hearing his baby’s heartbeat during each of Lauren’s sonograms.
Except the last one.
A lump rose in Nick’s throat as flashbacks of that horrible appointment played in his head. He swallowed hard, fighting to hold himself together. He had to stay strong; he couldn’t afford to fall apart now.
“Try to relax, Nick,” said Dani, rubbing his shoulder. “Relax and breathe normally.” Only then did Nick realize he’d been holding his breath. He released it slowly and took another deep breath, relieving the tension in his body. “There you go. That’s better.” Her voice was soft and soothing in his ear, her hand warm and reassuring on his arm.
Not only was she a good nurse, but she would also make a wonderful mother, Nick realized. He suddenly pictured their roles reversed: she was in his place, lying on her back with her shirt pushed up, her little pregnant belly being probed by the ultrasound wand. He was standing beside the bed, his hand on her shoulder, as they both stared at the screen, mesmerized by the flickering motion of their baby’s heartbeat. It was such a beautiful sight, it almost brought tears to his eyes, though it existed only in his mind. But it could become a reality in a matter of months, if Dani decided to keep the baby.
That was when Nick knew what he wanted - and didn’t want - to happen. After losing Arya like he and Lauren had, he couldn’t imagine making the choice to stop a healthy baby’s heart, a baby who had the chance to be born alive. The next time Dani brought it up, he would tell her how he felt about it and hope she felt the same way.
When Dr. Elizabeth finished the exam, she set her equipment aside and turned to face him, her expression grim. “Well, Nick… I wish I had better news for you, but the echocardiogram confirmed what I was worried about,” she said with a sigh, causing his stomach to lurch. “Your heart function has gotten considerably worse since your last echo a couple of weeks ago.”
He swallowed hard, feeling like he could throw up.
Elizabeth kept talking, turning the ultrasound monitor toward him so he could see the blurry, black-and-white image of his heart frozen on its screen. “I used the ultrasound pictures to calculate your ejection fraction, which is the percentage of blood being pumped by the left ventricle per heartbeat,” she explained, using her finger to trace the path of the blood flow. “A healthy heart has an ejection fraction of anywhere from fifty to seventy percent. Yours was around twenty percent last time, putting you in the low range - a common finding in patients with cardiomyopathy and congestive heart failure. It’s since dropped to fifteen percent, meaning your heart is only pumping about a quarter of the blood it should be each time it beats.”
Nick didn’t understand how that was possible with as hard as his heart was pounding. Rolling over onto his back, he pressed his hand to the same part of his chest where Dr. Elizabeth had placed the transducer until he could feel his heart hammering against his palm.
“Are you okay, Nick?” Dani asked softly, looking down at him with concern.
He hesitated at first, not sure of how to answer. Finally, he nodded to indicate he wasn’t in pain or any immediate danger, even though Dr. Elizabeth had made it clear that he was decidedly not okay.
Dani put her hand on top of his, rubbing it reassuringly as Elizabeth continued, “The edema you’ve been experiencing was caused by decompensated heart failure. Your heart has weakened to the point where it’s not able to pump blood to the rest of your body fast enough, and it’s beginning to affect the way your other organs are working. The lack of blood flow to your kidneys has lowered your urine output and led them to overcompensate by boosting the production of a protein that causes fluid accumulation in order to increase your blood volume. This creates a vicious cycle: the blood gets backed up because your heart can’t pump effectively, which raises the pressure in your veins and weakens the heart muscle even more, making the problem worse.”
Nick lay back against his pillows, feeling light-headed. His enlarged heart was still pounding heavily in his ears. He pictured it like a water balloon, bloated with blood, being slowly squeezed by an invisible fist. Its walls would continue to weaken as they were forced to stretch thinner and thinner. At some point, the balloon would get too big and burst from the pressure. He wondered how long his poor heart could keep laboring the way it was before it, too, reached its breaking point and simply stopped pumping.
He took a shaky breath and let it out before he looked up at Elizabeth. “Is there anything you can do about it?”
“I’ll have to make some more adjustments to your medication regimen,” she replied, absently playing with the end of her long braid as she thought through her answer. “It’s all about finding the right balance. You’re already taking quite a few different drugs to reduce your heart’s workload, lower your risk of arrhythmias, control your blood pressure, and prevent fluid retention. I’m going to prescribe another cardiac drug called digoxin, which will help your heart pump more blood in fewer beats by strengthening the force of its contractions. I’d also like to add a different diuretic to increase your urine output.”
“Awesome,” said Nick sarcastically, sighing. He already hated having to piss into a portable urinal and hand it to Dani to empty for him. Now he would have to do it even more often. But he supposed it was a small price to pay if it prevented him from drowning in his own fluid.
Dr. Elizabeth left Dani with instructions on how much of each medication to administer. As Dani prepared the first dose, she looked down at Nick. “How are you doing?” she asked quietly.
He snorted, fogging up the oxygen mask again. “I’m pretty sure you just heard how I’m doing.”
She offered him a sympathetic smile. “No, I meant how are you doing emotionally? How are you dealing with everything Dr. Elizabeth told you?”
“Oh.” He shrugged and shook his head. “I dunno. I’m not, really… not yet. How does anyone deal with that kind of news?”
“Usually they’re in denial at first,” said Dani. “Then they get sad… and sometimes angry.”
Nick raised his eyebrows. He hadn’t expected an actual answer to what he’d intended to be a rhetorical question, but she had just described exactly what he’d felt since waking up in the hospital: denial, followed by depression. “Yeah,” he said, nodding. “I guess that’s pretty much how I’m dealing with it.”
“You’re normal then,” she said with a smile, squeezing his shoulder. “If you feel like talking about it, you know I’m here for you.”
“I know.” He forced a smile back from beneath his face mask. “Thanks.”
“You bet.” She went back to what she’d been doing before, drawing up a syringeful of the new drug Dr. Elizabeth had prescribed.
Watching her work, Nick thought about the decision he’d made during the echo. “Actually, I do want to talk,” he said, taking the mask off so his voice wouldn’t be muffled. “But not about that.”
Dani set down the syringe and looked up. “Better leave that on for now,” she said, gently lowering the mask back over his mouth. “Your oxygen level is still on the low side.”
“But I’m not coughing anymore. Can’t I try the cannula again?” he begged, giving her his best puppy dog eyes.
She rolled her eyes and grinned. Nick recognized the look of a woman who found him irresistible. He smiled triumphantly to himself as she reluctantly replaced the face mask with a nasal cannula. “Only as long as your sats stay in the nineties,” she said with a warning tone.
He nodded, taking a deep breath through the thin tubes. “Much better. Thanks.”
“Don’t mention it,” Dani replied, winking. “So… what did you want to talk about?”
“Well… I’ve been thinking. About the baby.”
She raised her eyebrows. “And?”
He swallowed hard. “Look, I know I might not be around nine months from now, so it almost seems selfish to ask this of you, but… I hope you decide to have it.” He held his breath while he waited for her reaction, watching her forehead wrinkle as her brown eyes widened and began to fill with tears. He let out his breath in a low sigh, feeling deflated. “I’m sorry,” he said quickly, before she could speak. “I don’t want to put any pressure on you. Like I said, it’s a lot to ask. If you don’t want this baby-”
“But I do!” Dani blurted, interrupting him. Her face broke into a tearful smile. “I do want this baby! I was worried you wouldn’t.”
Nick’s heart lifted. “After losing Arya, I would never wish another baby’s life away,” he said quietly, a lump forming in his throat. “As long as you’re okay with it, I want this one to be born. I may not be there to see it, but I’ll do whatever I can to support you both.”
Dani nodded. “Thank you,” she whispered, wiping away her tears. “Now if I could just figure out a way to tell Rob…”
Nick’s stomach lurched as he imagined how his wife would react when she found out he’d gotten another woman pregnant. Lauren put up with a lot, but she’d made it clear before she married him that infidelity was where she drew the line. Now that Nick had crossed that line, she would probably file for divorce. His indiscretion would destroy what was left of their marriage. Their little family would be fractured, their relationship ruined forever - and Rob and Dani’s right along with it.
“I don’t think it matters how I tell Lauren,” he said, shaking his head. “She’s never gonna forgive me for this.”
“Her loss,” replied Dani with a shrug. “You’re a good guy, Nick. And a great dad.”
He sighed. “Yeah, but I’m a shitty husband.”
“You’re human. You made a mistake. We both did. But it’s done. We can’t go back and change it. We have to keep moving forward,” Dani said frankly, her voice firm. “If Lauren won’t give you a second chance, then find someone who will. Any woman would be lucky to marry you.”
Nick snorted. “Yeah, right. The only kind of woman I could get to marry me now would be a golddigger looking for a nice, fat life insurance payout after I kick the bucket. I’d just be a burden to anyone else. Who would want to deal with all this?” he asked, waving his hand around the hospital room.
Dani raised her eyebrows. “You’d be surprised,” she replied with a smile. “Don’t be such a downer. Like I told you before, we’re not going to let you die - and once you’ve had your heart transplant, all this will be in the past.” She picked up the syringe she had filled earlier and injected it into his IV line. “You just have to hang on until then.”
Easier said than done, thought Nick, feeling his heart flutter. According to Dr. Elizabeth, it was barely functioning now. How long could he be expected to hang on before it stopped working altogether? He had no control over his own fate. His heart could falter again at any time, causing the defibrillator inside his chest to fire. When that happened, his life would be left in someone else’s hands - though whether God’s or Dani’s, Nick did not know.
***
