“It’s going to be all right,” her mother whispered into her hair. “It’ll be all right, baby.”
She was clutching her mother’s arm, hard, the slender bone a life raft.
“If—if anything happens—you’ll take care of the kids for me.” It wasn’t a question and her mother didn’t take it as one.
“Yes,” she said, without hesitation, and the quivering sensation eased in Bree’s chest. She was breathing hard, but there didn’t seem room for enough air.
“Okay,” she said. She could feel her fingers trembling on her mother’s arm, and with an effort let go. “Okay,” she said again, and sitting up straight, pushed her hair out of her face. “Okay. Now what?”
LUB-DUB, LUB-DUB … THE meaty sounds of a healthy heart were clear through my wooden Pinard stethoscope. Beating a little faster than normal—and no wonder—but healthy. I straightened up and Bree instantly clutched the neck of her blouse closed, her face tense.
“Your heart sounds perfect, darling,” I said. “I’m sure that it’s a bit of atrial fibrillation, but that’s just a matter of stray electrical impulses. You aren’t going to have a heart attack or anything of that sort.”
The tension in her face eased, and my own heart clenched a little.
“Well, thank God for that.” A thick lock of hair had come loose from its ribbon, and I saw that her hand was trembling as she brushed it back from her face. “But it—is it going to keep happening?”
“I don’t know.” Aside from bad news, “I don’t know” is the worst thing a doctor can say to a patient, but it’s unfortunately the most usual thing, too. I took a deep breath and turned to my medicine shelves.
“Oh, God,” Bree said, the genuine apprehension in her voice tinged with reluctant amusement. “You’re getting out more whisky. It must be serious.”
“Well, if you don’t want any, I do,” I said. I’d chosen the good stuff, the Jamie Fraser Special, rather than the strictly medicinal whisky I gave the patients, and the scent of it rose warm and lively, displacing the smells of turpentine, scorched metal, and pollen-laced dust.
“Oh, I’m pretty sure I do.” She took the tin cup and inhaled the comforting fumes, her eyes closing involuntarily and her face relaxing.
“So,” she said, raising an eyebrow. “What do you know?”
I rolled my own whisky slowly round my tongue, then swallowed, too.
“Well, as I said, atrial fibrillation is a matter of irregular electrical impulses. Your heart muscle is sound, but it’s—once in a while—getting its signals crossed, so to speak. Normally, all the muscle fibers in your atria contract at once; when they don’t get a synchronized message from the electrical node in your heart that supplies them, they contract more or less at random.”
Brianna swallowed another sip, nodding.
“That’s pretty much what it feels like, all right. But you said it’s not dangerous? It’s freaking scary.”
I hesitated, a fraction of a second too long. No one but Jamie was more sensitive to the transparency of my face, and I saw the alarm rise again at the back of her eyes.
“It’s not very dangerous,” I said hastily. “And you’re young and very fit; it’s much less likely.”
“What’s less likely?” She put down the cup, agitated, and glanced involuntarily up at the ceiling; Mandy was back in the children’s room just overhead, loudly singing “Frère Jacques” to her doll Esmeralda.
“Well … stroke. If the atria don’t contract properly for too long—they’re meant to squeeze blood down into the ventricles; the right ventricle pumps blood to the lungs, the left to the rest of the body—” Seeing her ruddy brows draw together, I cut to the chase. “Blood can pool in the atria long enough that it forms a clot. And if so, it might dissolve before it gets out into the body, but if not …”
“Curtains?” She took a much bigger gulp of her drink. She’d been pale as a fish belly after the attack, and looked much the same way now. “Or just being disabled, so I drool and can’t talk and people have to feed me and drag me around and wipe my butt?”
“It’s not likely to happen,” I said, as reassuringly as possible, which under the circumstances was not all that reassuring. I could visualize the hideous possible outcomes as well as she was obviously doing. Somewhat better, in fact, as I’d actually seen a good many people suffering the aftereffects of stroke, including death. I had a momentary absurd impulse to tell her a fascinating fact about men who die of stroke, but this wasn’t the time.
“So what can you do about it?” she asked, straightening up and firming her lips. I saw her eyes turn toward the bulk of the new Merck Manual, and I handed it to her.
“I’m not sure,” I said. “Have a look.” I wasn’t hopeful, given what atrial fibrillation actually was—an intermittent derangement of the heart’s electrical system.
“I mean,” I said, watching her thumb through the book, brows furrowed, “you can stop a severe attack—one that goes on for days—”
“For days?” she blurted, looking up wide-eyed. I patted the air.
“You don’t have that sort of fibrillation,” I assured her. Mind, you can always develop it … “You just have the minor, paroxysmal kind that comes and goes and may just disappear altogether one day.” And God, please, please let it do just that …
“But for a severe attack, the normal treatment in the 1960s was to administer an electric shock to the heart with paddles applied to the chest. That makes the fibrillating stop and the heart start working normally again.” Most of the time …
“Which we plainly can’t do here,” Bree said, looking round the surgery as though estimating its resources.
“No. But I repeat—you don’t have anything as severe as that. You won’t need it.” My mouth had dried at the remembered visions of cardioversion. Even when it worked, I’d seen a patient shocked repeatedly, the poor body seized by electricity and jerked high into the air, to fall back limp and tortured onto the table, only to face another round when the EKG pen fluttered like a seismograph. I gulped the rest of my whisky, coughed, and set down the cup.
“Does it say anything helpful?”
“No,” she said, closing the book. Her tone was deliberately casual, but I could see clearly how shaken she was. “It’s just the same as you said—administration of electric shock. I mean—they do have a medicine that they say works sometimes on some patients, but I’m sure that isn’t anything we can manage here, either. Digitalis?”
I shook my head. Penicillin was one thing—and even that was by no means dependable; I still had no way of producing a standard dosage, or of telling whether a given batch of the stuff was even potent.
“No,” I said regretfully. “I mean—you can extract digitalin from foxglove leaves, and people do. But it’s dreadfully dangerous, because you can’t predict the dosage, and even a bit too much will kill you. And we do have a few things to hand.” I tried to sound brightly helpful. “We’ll make sure to keep a good stock of the white willow tea on hand—it’s the most powerful.” White willow didn’t grow in North Carolina but was reasonably available from city apothecaries, and I had a good stock that Jamie had brought me from Salisbury.