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Plus, she carried herself with a grace she hadn’t possessed at seventeen.
Grace and confidence.
Because for the rest of the morning after they’d left his office, she’d been nothing but the smooth professional.
Even now she was in the cardiac lab, watching a CRT pacemaker placement performed by one of his partners, Dr. Gregory Jessup. Greg would be relocating to Nashville in a few weeks to take a cardiology position with Vanderbilt Hospital and would head up implementing CRT placement in Tennessee.
He guessed Kimberly opted to go with Greg to avoid more time with him, but he’d given her the choice.
“Dr. Travis?”
Daniel blinked.
“Dr. Travis?” The older woman wrinkled her nose and swatted him with the magazine she used to fan herself.
“Sorry, Mrs. Johnson.” He’d done it again, blanked out with thoughts of Kimberly. Never did anything come between him and his patients, but today he admitted he’d been distracted by a collision of his past with his present.
Pull yourself together, Daniel. You’re dealing with people’s lives.
He looked into Mrs. Johnson’s dark eyes and gave her his full attention. “You were saying?”
The woman gave him an odd look, then returned to fanning the magazine back and forth. “I was saying that I’ve not been able to catch my breath for at least two weeks. If I walk from one end of my apartment to the other, I have to sit down and I feel wheezy. My apartment ain’t much more than a speck on a breadcrumb so it ain’t that much of a walk, yet I can barely do it.”
Daniel made a few notes on the computerized notebook that contained Mrs. Johnson’s electronic chart. “Have your feet been swelling more?”
“Lord, yes.” She lifted a foot off the floor and waved it at him. “I can’t even wear real shoes anymore because these elephant trunks won’t fit in them before the day’s done.”
“What about your hands?”
She held up chubby fingers. “I haven’t worn my wedding band in weeks because the last time I did I had to take an extra fluid pill and use a stick of margarine to get it off.”
Daniel sat the computerized clipboard on the counter, then listened to the left and right sides of Mrs. Johnson’s neck. Her carotid arteries both sounded clear. No bruits, a tiny swishing sound that blockages made. Then he listened to her heart. She had a grade-two murmur with mitral valve regurgitation caused by her congestive heart failure. Ronchi could be heard in both lung bases.
“Cough,” he ordered her.
She did so. The wet rattle didn’t clear.
“I’m going to order a chest X-ray and an echocardiogram. You might recall that an echocardiogram is an ultrasound of your heart and isn’t painful.” He leaned back, watching her reactions to his words so he could fully address her concerns. “Your heart isn’t pumping blood efficiently enough and fluid is building up in your lungs. That’s why you have the rattling sounds in your chest called ronchi, and it’s why you feel so tired and out of breath all the time.”
Her dark eyes bore into him. “Can you fix me?”
“I want to look at the test results first but, regardless of what they show, we’re going to make some changes to your treatment program.”
She nodded.
“We’ll need to increase your fluid medications. You’ll have to have blood tests more frequently to watch your sodium and potassium levels. As with your current medicine, the new pill can cause your potassium levels to drop. This is dangerous for a variety of reasons, but one of the major ones is that it can cause muscle spasm. Your heart is a muscle and the electrolyte imbalance can throw it dangerously out of rhythm.”
Mrs. Johnson’s eyes widened.
“As long as you get your blood tests when you’re supposed to, we’ll be able to keep your potassium level close to where it’s supposed to be.”
She nodded.
“I’m going to give you some literature on a special type of pacemaker for congestive heart failure. It’s designed to correct your heart’s ability to contract, which will improve your ejection fraction—that’s the amount of blood the heart pumps out with each beat. With improved ejection fraction, it will improve your congestive heart failure.”
Her mouth twisted in confusion. “What does that mean?”
“It means that if you qualify for the pacemaker you’ll be able to walk from one end of your apartment to the other without getting so short of breath.” One of life’s little blessings one didn’t appreciate until the ability disappeared and exertion of any kind became a trial. “I think you qualify, but I want to see your echocardiogram before making a final decision.”
