‘A little better,’ I admit. Although that isn’t taking into account the fact that I’m still in pain from the C-section or that my body feels as if it’s been hollowed out like a pumpkin.
‘I know Nick has probably explained to you what’s been going on, but now that you’re on the mend, I wanted to give you a proper explanation of what we were dealing with when you came in as well as give you a chance to ask any questions and discuss your most recent test results.’
‘Okay,’ I reply, not exactly sure that I’m ready for the details. I’d asked Nick to keep the information vague for now. My voice is small. I can’t bear to think about that night. All I want is to be able to forget.
‘As you know, when you came into the ED our tests showed that you were experiencing heart failure, and in your case, more specifically, PPCM or peripartum cardiomyopathy, which we were able to conclude after running tests in ICU and ruling out all the other possible causes for your heart failure.’
‘What caused it?’
‘We don’t know why some women develop this. It’s not like other forms of heart failure, where we know the cause and can treat that. And that’s why we call it PPCM. This can usually manifest in the last month of pregnancy or in the first five months or so post-partum. Or it can occur sooner, as in your case.’ She pauses to open the folder in her hands. ‘Paige, when we did the first echo, we found that your heart was abnormally enlarged.’ She points to a laminated A4 poster she’s brought with her. ‘Like this,’ she says, holding it up. ‘As you know, the heart is a muscle, and what happens in cardiomyopathy is that the heart is unable to pump blood as effectively as it should. Now, when you came in, your left ventricular ejection fraction, or your EF, was twenty per cent. That is to say the amount of blood pumped out of the ventricles with each contraction was extremely low.’ She points out the ventricles on the diagram to show me. ‘You still with me?’
I nod. It’s raining outside and it has been all morning.
‘Okay, so to give you an idea, the normal EF range is around fifty-five per cent or above. That’s why I was so concerned with you having a C-section. Due to the weakness of your heart, emergency surgery with a general anaesthesia was very risky to perform, and even the epidural posed a lot of risks for you.’
A bird – one I can’t name, with a lapis-blue forehead and brown wings – perches on the windowsill before taking flight into the unrelenting drizzle. It’s early summer. It shouldn’t be raining. Cars are banked up in bumper to bumper traffic, their red brake lights flicking on and off as they inch forward slowly. Victoria is still talking, her voice like white noise.
‘Paige, did you hear that?’ asks Nick softly.
The bird returns to the sill, carrying a tuft of dry grass in its beak. ‘Yes, I understand.’
Victoria takes her glasses off and folds them. She drops them into a case and clamps it shut. ‘I want to let you know, as I’m sure Nick has already told you, that PPCM symptoms, especially given the fact they often appear in late pregnancy, can often be confused with late trimester symptoms…’ Victoria is prettier without the glasses, I decide. Her eyes are large and deep-set. Her eyelashes most certainly false. Her brows – they are perfectly shaped. I have an appointment booked for mine for this afternoon.
‘… from what you described, it seems your condition deteriorated fairly rapidly after the onset of those early warning signs. The promising news is that your echo showed a very slight improvement in your EF.’
I need to call Marcia, my beauty therapist. She hates last-minute cancellations, and if I miss this one, I won’t be able to get in for another week at the very least. I’m not supposed to be here. I’m supposed to be getting my eyebrows done today.
‘Paige?’ says Victoria finally.
‘Yes.’
‘I’m recommending a few more days in hospital to make sure we properly establish the correct amount of medication your body can tolerate.’
‘Sure thing,’ replies Nick, when I don’t.
‘Do you have any questions at this point, Paige?’
What kind of bird is that?
‘Um, no, I don’t think so.’
Nick interjects with questions about the anticoagulants, diuretics and beta blockers she’s prescribed, along with things like the size of my left ventricle, and my BNP levels. And is there a need for an implantable defibrillator? She patiently answers all of his questions and then redirects her attention back to me.
‘Now, there’s one more thing I’d like to discuss with you both. I mentioned before that PPCM is usually reversible with the right treatment, although I want to stress that there’s never a 100 per cent guarantee of full recovery. There is a chance your condition may worsen, remain stable or, as we all hope, improve. Generally, you can expect to be on the medication I’ve prescribed you for at least twelve months.’
Nick reaches for my hand then, signalling that he knows what’s coming next.
‘I know things are very raw for you both right now, but since you were about to become parents, we should talk about the fact that a future pregnancy would be contraindicated as long as your EF levels are under fifty-five per cent. Currently, your heart simply isn’t strong enough to supply blood to you and a baby. Research tells us that a pregnancy with an EF under fifty-five per cent would pose significant threat to your life, so I’d recommend thinking about what method of contraception would suit you – an IUD could be a good option, or I can have Dr Sanders prescribe a low-dosage progesterone pill if you’d prefer that.’
‘The pill will be fine,’ I manage, nauseated by the very thought. Pregnancy is contraindicated.
Victoria pats my leg. ‘I know this must be tough to hear, but you’re an otherwise healthy woman – you exercise regularly and have a good diet. I’m optimistic about your recovery.’
I muster a quiet, ‘Thank you,’ and Nick does the same, closing the door behind her.
‘I need to call Marcia, from Lush, the beauty therapist. I have an appointment at five thirty. Eyebrows.’
Nick sits back down beside me and pulls me into his arms. ‘Oh, Paige.’
‘It’s not fair,’ I say, my words muffled against his chest.
He holds me tighter. ‘I know, baby. I know.’
‘I want to hold Max,’ I manage, pulling away gently. ‘Could you bring him to me?’
‘Knock, knock.’ Caitlin is standing at the door of my hospital room with a bright Cath Kidston tote hanging off one arm and a small brown paper carry bag in her free hand. Nick has gone home to shower and get some rest, and Mum’s at home preparing some cooked meals we’ll be able to freeze. ‘Up for a visitor?’ she asks quietly. She’s wearing a long yellow dress with cream polka dots and a scarf belt cinched at the waist, and it radiates sunshine.
‘Sure. What’s in the bag?’
She hands it to me and I tip it upside down. A few bottles of essential oils, a vial of Rescue Remedy and a crossword puzzle fall out onto the bed.
‘The crossword is from Frank. Nick was in touch with Bette, she told Elsie, she told Frank and he wanted to send these along.’ She shows me a small stack of newspaper cuttings from the Herald Sun crosswords section. Frank is a resident at Windsor Lakes, and he and Elsie, Nick’s grandmother, are inseparable. When he was sick in hospital last year, it was my job to make sure he had an endless supply of crosswords, and now he’s doing the same for me.