“All right, buddy, you ready to get that tube out of your throat?” asked Rob, as Dani helped him set up for the procedure.
Nick blinked an eager yes. He hadn’t been able to eat or drink anything since waking up, and his mouth had never felt so dry. His thirst was so bad, he had actually been dreaming of water as he dozed in and out. He imagined himself floating in a vast lake, where all he had to do was lower his head to drink his fill of fresh, cold water. He couldn’t wait to chug a whole bottle of it once the tube was out.
“He looks ready to me,” Rob said, shooting Dani a grin. “Go ahead and suction him.”
“Okay, Nick, just gonna suck out some spit here,” said Dani, as she stuck a suction wand into his mouth. He couldn’t imagine he had any saliva left, but in spite of how dry his mouth felt, he still heard some rattle through the thin hose as the tip reached the back of his throat, triggering his gag reflex. It was like being in the dentist’s chair, but even more unpleasant. He wanted to cough, but couldn’t because of the tube that was blocking his windpipe.
“Now there’s a balloon inflated around the tube,” Rob explained, as he peeled off the tape that had helped to hold it in place, “and when I let the air out of it, it’s gonna make you cough. Go ahead and cough while I pull out the tube.”
No problem, thought Nick eagerly.
“Ready? Take a deep breath, and here… we… go.” When Rob pulled the tube, it felt like he was ripping Nick’s lungs out right along with it. Nick coughed and gagged, his throat burning as he struggled to catch his breath.
“Good job, Nick,” Dani said, suctioning out more of the mucus that was clogging his throat. “Keep breathing. That’s it.”
“We’re gonna give you some oxygen through a nasal cannula,” Rob added, holding up a length of clear, narrow tubing. He placed the prongs of the cannula in Nick’s nostrils and tucked the tubes behind his ears, tightening the piece that held them together beneath his chin. “This’ll help you breathe easier, and it should be a lot more comfortable.”
Nick could already feel the oxygen flowing into his nose. He nodded, grateful to be able to move his head and neck freely again.
“How do you feel?” Dani asked.
“Thirsty,” Nick rasped, surprised at how rough his voice sounded.
She nodded. “I’ll get you some ice chips.”
While she was gone, Rob listened to Nick’s chest with his stethoscope. “Your lungs sound clear,” he said. “Oxygen saturation level looks good.”
“How ‘bout my heart?” Nick asked, although he was afraid to hear the answer. He knew there was something they weren’t telling him. Healthy hearts didn’t just stop for no reason. Hearts that were damaged sometimes did. He remembered Dr. Polakoff using the words “sudden cardiac death” when he’d diagnosed Nick’s heart condition, warning him that if he didn’t change his lifestyle, he would be at risk of dying young. Now Nick felt sick to his stomach, realizing how much he’d let himself slip back into his old ways over the past few weeks.
“Well, right now you have a normal sinus rhythm, which is good,” Rob replied, draping the stethoscope over his shoulders. “I’m gonna get the cardiologist in here to go over the rest.”
Nick swallowed hard, his throat still sore. Before he could ask any more questions, Dani came back with a styrofoam cup filled with ice. “Here you go,” she said, handing it to him. “Take it easy with those. You haven’t had anything to eat or drink in two days, so your stomach could be sensitive.”
“No wonder I’m so thirsty,” Nick whispered, as he popped one of the ice chips into his mouth. It felt wonderfully wet and cold, soothing on his dry tongue. He sucked on it gratefully, swishing it around in his mouth and swallowing the water as it melted.
“We’ve been keeping you hydrated with IV fluids. This is just dry mouth,” Dani said, sliding his bedside tray table in front of him so he had a place to set the cup down. “Your throat may be sore for a few days from the breathing tube, but that will go away soon.”
“What about my voice?” he wanted to know. It sounded a little stronger each time he spoke, but it was still very hoarse.
“Don’t worry,” said Dani, with a reassuring smile. “I made sure the paramedics used a smaller size endotracheal tube when they intubated you, to minimize the risk of damaging your vocal cords. I told them you were a singer. You’ll be back to belting out BSB songs in no time.”
Nick didn’t feel much like smiling, but he managed to curve one corner of his mouth upwards into a crooked grin. “Thanks.”
“You’re welcome.” She gave him a sympathetic look. “It was the least I could do.”
He raised his eyebrows, giving her a significant glance in return. “Sounds like you did a lot more than that. Seriously… thank you.” The simple words didn’t seem like enough to convey the overwhelming mix of emotions he felt, but Nick didn’t know how to express them any other way. What else was there to say to someone who had literally saved his life?
Dani blushed. “I was just doing my job,” she said, shrugging. “I mean, I don’t know if it was fate or just a fortunate coincidence that we both happened to be in the right place at the right time. I can’t say you’re lucky, but hey... if you’re going to have a cardiac arrest, you might as well do it when there’s an off-duty critical care nurse around. Good thing you didn’t let me get too drunk.” She shot him a wry smile.
Nick snorted. “No kidding.”
All jokes aside, he was still having a hard time wrapping his head around what she’d told him had happened. He had watched documentaries on near-death experiences, in which survivors had talked about looking down on their own bodies while they floated somewhere above, seeing themselves lying on hospital beds or operating tables. But Nick hadn’t seen anything - not a bright light, not a long tunnel or a tall staircase, and certainly not his own resuscitation. He had no memory of what had happened between the moment he’d closed his eyes in the car and the instant he’d opened them in the hospital.
A part of him was disappointed to have been denied one of the powerful out-of-body experiences others had described, but maybe it was better that way. He couldn’t imagine what it would have been like to look down and watch Dani giving him CPR. The mental image of her hunched over his lifeless body in her little while dress and red heels, pumping his chest with her hands, was disturbing enough. It made him thankful for the black hole in his memory.
As it was, just knowing he had been on the brink of death made Nick feel more vulnerable than he’d ever felt before. He was grateful to Dani for bringing him back to life, but also embarrassed by the turn of events. In the blink of an eye - or so it seemed to Nick - he’d gone from the bar to a hospital bed, where the same hot girl he’d been having drinks with one minute was sucking the snot out of his lungs the next. He didn’t even want to think about what else Dani might have done for him as he’d lain there unconscious over the last two days. It was awkward enough without wondering who had put him in the hospital gown or placed the catheter he could feel poking out from underneath it. He wanted to know when that particular tube could come out, but decided he would wait and ask Dr. Rob.
When Rob returned, he was accompanied by an attractive woman in a white coat. What is this, Grey’s Anatomy? Nick wondered, admiring her tall, slim figure as she approached his bed, her heels clicking against the tiled floor. Does this hospital only hire beautiful people?
“Nick, this is Dr. Elizabeth, one of our best cardiology attendings,” Rob introduced his colleague. Noticing the way he kept using first names, Nick decided that, like the rest of the Keys, the hospital must also be pretty casual. “We called her in to consult on your case.”
“Nice to meet you, Mr. Carter,” said Dr. Elizabeth, offering a polite nod. With her pale, blue eyes and long, brown hair, she reminded Nick a little of Lauren. He wondered if his estranged wife even knew he was in the hospital.
“You can call me Nick,” he replied, licking his lips nervously. Whatever news this doctor had been brought in to deliver, it couldn’t have been good. What if he was dying? Dude, you already died, he reminded himself. It doesn’t get any worse than that. “So… do you know what happened to my heart?”
Dr. Elizabeth nodded again. “You were diagnosed with alcoholic cardiomyopathy about eleven years ago, correct?”
“Yeah, that’s right,” said Nick. His mouth felt as dry as Death Valley again. He popped another ice chip into it, then added, “But, you know, the last time I saw my cardiologist, he said there were no signs of damage, that my heart had healed.”
“How long ago was that?” she asked.
Nick thought for a few seconds. “I don’t remember. I guess it’s been awhile,” he admitted.
Dr. Elizabeth pursed her lips. “I only ask because, unfortunately, that isn’t the case anymore. We ran some tests while you were unconscious, and the results are cause for concern. Your condition seems to have worsened significantly since your last checkup. The chest X-rays that were taken after your admission show that your heart is grossly enlarged. Let me show you.”
She slid a pair of X-ray films out of a manila envelope and set them on his tray. “The one on the left shows the normal heart of an average-sized adult male,” she explained, pointing to a white blob in the center of the black film. “The one on the right is your heart.”
Nick’s breath caught in his throat as his eyes shifted from one film to the other. The difference between the two was undeniable; the second heart was huge, leaving little room for a healthy pair of lungs. He pressed his hand against the left side of his chest until he could feel his heart beating again, his rib cage expanding as his lungs inflated beneath it. His chest was still sore from the CPR, and it hurt to take a deep breath, but otherwise, he felt normal. Not at all like he’d felt on the Unbreakable tour all those years ago, when he had first suspected something was wrong with him.
“Why haven’t I had any symptoms?” he wondered aloud. “We were just on a world tour. I spent the past six months performing two-hour shows almost every night, and I never felt any chest pain, shortness of breath… nothing. How could that be?”
The two doctors and Dani exchanged glances. “The symptoms of cardiomyopathy can be quite insidious,” said Dr. Elizabeth. “They come on gradually and slowly worsen over time. The warning signs are often so subtle, people don’t pay any attention to them until something catastrophic happens, like a sudden cardiac arrest. The human body is an amazing machine: it finds ways to keep functioning with failing parts for far longer than you would think. But eventually, even the strongest bodies start to break down.” She gave him a grim smile. “It sounds like yours worked around a weakening heart as well as it could, for as long as it could, until it just couldn’t anymore.”
Nick shook his head in disbelief. It still didn’t make sense to him that he could feel perfectly fine one day and be on the brink of death the next. There was only one thing he could think of that would explain his sudden collapse. “I never should have started drinking again,” he said with a sigh. “That’s what caused this, right?”
“It could have been a contributing factor,” Dr. Elizabeth confirmed.
Nick nodded. He already knew what she would say next: that he needed to abstain from alcohol completely to keep it from happening again. This wasn’t news to him; he’d heard the same advice eleven years earlier. It had helped him then: his heart condition had improved when he’d stopped drinking and doing drugs and started eating right and working out instead. The healthy lifestyle he’d adopted had helped him lose weight and stay clean and sober, and he’d felt better - both physically and emotionally - than ever before. But the heartbreak he’d suffered over the past year had taken its toll on him, and he had let himself go. He had been battling depression, gaining weight, and drinking heavily again. And although he’d tried to tell himself he was still in control, that he could stop any time and get back on track, this was a lie. The truth was, he had been in the midst of a downward spiral for months, and it seemed he’d finally hit rock bottom. Maybe this was his body’s way of giving him the wake-up call he so desperately needed.
“Okay… so once I get back on the wagon, I’ll get better, right?” Nick said, still trying to rationalize the situation to himself. “I just need to stay sober from now on.”
When he saw the three of them exchange glances again, he knew it wouldn’t be that simple. “Nick, your condition is very serious,” Dr. Elizabeth said. “The cardiomyopathy has progressed to Stage C heart failure. That means your heart has suffered structural damage and is no longer functioning properly.”
Nick frowned and swallowed hard, his throat tightening painfully. He was suddenly hyper-aware of his apparently sick heart pounding in his chest. The sensation was starting to make him feel light-headed. He lay back, letting his head rest against the thin pillow, and shut his eyes, hoping that when he opened them again, he would find himself in his own bed and realize it had all been a bad dream. He wanted nothing more than to wake from this nightmare.
“Nick? Are you still with me?” Dr. Elizabeth asked, squeezing his shoulder. Nick nodded, though he kept his eyes closed. “It’s a lot to process, I know,” she said sympathetically. “But I need you to understand your prognosis.”
“Prognosis?” he repeated, his eyes flying open. The word felt foreign on his tongue; he had only heard it used on TV, usually in the sort of dramatic scenes where doctors were diagnosing people with fatal diseases. All of a sudden, he understood. “Are you trying to tell me I’m dying or something?”
Dr. Elizabeth kept her hand on his shoulder. “The sudden cardiac arrest you suffered was caused by an irregular heart rhythm, which resulted from the weakening of your left ventricle. Unfortunately, once heart failure has progressed to this stage, it can’t be reversed.” She fixed her gaze firmly upon him, her light blue eyes locked onto his like a pair of tractor beams. Try as he might, Nick couldn’t bring himself to look away.
“Our best bet is to try to preserve what function you have left for as long as possible,” she explained. “We can manage your symptoms with medications to control your heartbeat and blood pressure, put in a pacemaker or internal defibrillator to hopefully prevent another episode of sudden cardiac arrest, and possibly even implant a device to help your heart pump more effectively. That would be down the road a ways… but it’s the road you’re traveling on now, and there’s no turning back.”
She paused to take a deep breath before dropping the bombshell: “If and when we run out of other treatment options, your only hope for long-term survival would be a heart transplant. Without one, yes, you will eventually die.”
Nick blinked, finally breaking eye contact as he tried to absorb all that she had said. A part of him was still in denial. After all, it seemed unbelievable that he had been brought back to life only to be given a death sentence. But if Dr. Elizabeth was right, his days were indeed numbered.
As if it could sense its impending demise, his heart started racing, determined to get in as many beats as possible before it stopped for good. It sure didn’t feel weak, hard as it was hammering against his tender rib cage. This time, Nick welcomed the sensation. At least it meant he was still alive.
***
