Runaway Heart

FOUR

"He's not converting as fast as I'd like," the solemn-faced Dr. Lance Shiller said, slapping nervously the metal clipboard in his right hand against his thigh. He was looking at Susan Strockmire and she, not her father, was the one causing his nervousness. The woman was exquisite. He was determined to impress her with some medical wire-walking, maybe take her downstairs for a cup of mud and a little case consultation, get her away from the manic frenzy of the Cardiac Care Unit at Cedars.

It was hard to get any romantic traction with code blues going off all over the place, while crash carts whizzed by and cardiovascular post-ops rolled through on bloodstained sheets.

"If you want, we could explore some options," Shiller said. "Tell you what, I'm off in twenty minutes and I haven't eaten since this morning." He looked at his gold watch. "Holy Moley, that's almost eight-and-a-half hours ago. No wonder I'm starved. How 'bout we jump downstairs now and get a bite? I think we need to discuss getting your father a more permanent result. The drug therapy doesn't seem to be doing it."

"Okay," she said nervously. "Okay… sure… whatever you think is best, Dr. Shiller."

"Right. Well, that's what I think is best… and I prefer Lance."

The windowless cafeteria was overlit and bustling with medical people of all shapes and specialties, as well as a few civilians from the four o'clock visitors crowd. Most were carrying trays or hunched over processed meals at institutional tables, looking uncomfortable in straight-back metal chairs. Susan and Lance were in one of the few leather booths along the wall. Susan only ordered coffee and Lance was poking at something called "The California Plate" that was just an avocado and chicken salad with honey-mustard dressing. He really wasn't hungry because, truth be told, he had eaten only an hour ago.

"What other kinds of things are you suggesting?" Susan asked, leaning forward, her beautiful, delicate features porcelain and perfect even under the harsh neon glare. But her pale blue eyes, the color of reef water, were clouded with concern.

God… I am falling in love, Lance thought, as he nibbled and considered. "To begin with, you have to understand how the heart works." He took a gold pen out of his hospital white coat, clicked it open, and started to draw on the paper place mat. "Your heart is shaped like this." He drew a rough oval and divided it into four quadrants. "The atria and the ventricles work together, alternately contracting and relaxing to pump blood. The neuro-electrical system of our body is the power source that makes this pumping action possible." He looked up and smiled. He thought he had a killer smile-and he did. Susan smiled back. "This electrical pulse is triggered in the sinus node, up here in your nasal passage." He drew a small circle somewhere above the heart, then traced a line down to the oval as he talked. "The impulse travels a special pathway like this, down and through your heart, where it then triggers the heartbeat. In your father's case, something-age, maybe diet or alcohol, or even stress-has interfered with this delicate process, and when that happens the heart fails to respond to the impulse and goes out of rhythm. It can then start to beat erratically. It speeds up or goes way too slow, even sometimes threatening to shut down, and this is the general condition we call arrhythmia." He clicked his ballpoint closed for emphasis. "Lecture over." He returned the pen to his pocket and smiled again.

"Doctor, I don't mean to be rude, but I know all of this. He's had four arrhythmias now. I've had the condition explained to me three times. I'm not looking for a description of his problem. I'm looking for a cure. Would you mind if we get to the bottom line? I want facts. I want an actuarial prognosis. I want survival percentages." A legal mind used to finding solutions jumped out from behind that angelic mask and surprised him.

Okay, Lance thought. Go for it. Give her what she wants. "Your father has severe ventricular tachycardia fibrillation, which is one of the life-threatening arrhythmias. It requires urgent treatment or death can occur. Generally, we start with drug therapy and, often, as you know, this can correct the problem for long periods of time. In your father's case we have seen that option come and go. Failing that, we still have a range of other options available to us. One is electrical shock cardioversion. It's basically paddles and juice to the chest walls. The idea is to shock the heart back into a normal rhythm."

"Will that last, if you do it?"

"It might. It's a case-by-case situation. Sometimes, yes. Sometimes, no."

"What else?"

"We can install a pacemaker under the skin on the chest. It's a battery unit that monitors the heart rhythm, and when it senses an arrhythmia it gives the heart a little electric boost that gets it back in rhythm."

"How long does that take?"

"About two days. It's normally an outpatient procedure, but speaking quite bluntly, your father is in pretty bad physical shape. I would want him here for at least two days."

"He's got a trial that begins tomorrow morning. He'll never go for that."

"Convince him."

"Yeah, right," she said. "You don't know him. What else?"

"Surgery. We induce an arrhythmia, get his heart in fibrillation, and then, using cameras and probes, we go in through the groin, snake our way up a vein to the heart, and look for the offending spot-usually, it's a fatty growth of some kind. We probe for it, watching his heart rate on the monitors and on the TV. When we hit the problem spot his heart will stop fibrillating, and then we give that place a little zap of radio frequency and burn it off. In ninety-five percent of the patients it fixes the problem forever."

"What are the risks?" Susan asked, prompting Lance to lean back and lay down his fork.

"With yours truly on the drums, almost none. I've done forty or fifty of these radio frequency ablations-never one mishap."

"How long will he be in here?"

"One day of pre-op, a day of post-op, and a week of bed rest."

"Too long," she said. "He won't go for it."

"Make him."

"Listen-you think I haven't tried? He's a warrior. He fights for causes he views as more important than himself. He won't do it, and he's in charge of his life, not me. If it's going to take that long he's not going to sign a consent for surgery."

"Then we should try and convert him with the paddles. That's the next best option. If it works, he should be able to leave first thing in the morning. But he's nuts if he tries a case in his condition. He's very sick. The man needs rest. Christ, he must feel like hell."

She sat absolutely still, and for a moment Lance Shiller didn't think she was going to respond. Then she looked up at him and in her eyes he now saw something else. It was resolve. No, not quite resolve-it was more like fierce pride.

"He told me once that most of the important work being done in the world is being done by people who don't feel very well," she said.

"How much of it is being done by dead people?" Dr. Shiller said angrily. He saw her eyes go cold and knew instantly he had blown it with her, but, damn it, even though he wanted to connect with Susan Strockmire he was still a doctor, a brilliant chest-cutter, and a fine fucking surgeon. He hated it when his patients chose the wrong option.

Susan left Dr. Lance Shiller in the cafeteria still picking at his California plate. She wandered out onto the patio where the sun was just going down. She couldn't believe that L.A. was this hot in April. She thought of her apartment in Washington, D.C., and of her father's cramped little house where she grew up after her mother split, leaving them to take care of each other. Now that little bungalow located two blocks off the beltway housed Herman and the Institute for Planetary Justice.

It was still cold in D.C. at this time of year-blustery. L.A. had it all: beaches, mountains, deserts, and bright sunshine twelve months a year. And yet there seemed something prefab and superficial about it. A town designed for tourists. The fringe celebrity commerce of Tinseltown seemed absurd to her: maps to the stars' homes, a tour of famous actors' gravesites in a twenty-year-old black Cadillac hearse, plus the tacky Hollywood sign. In L.A. fame towered over accomplishment. That was a concept that didn't fit the heroic proportions of Herman Strockmire Jr., a man she fought daily to protect and whom she adored.

Susan had grown up watching her beloved father run headlong into legal and political brick walls, often badly damaging himself. "No, Daddy, don't!" she would yell, feeling helpless to stop him, even as an adult. Then she'd watch in awe as her battered father would pick himself up, shake it off, back up, and do it all over again. Always in pursuit of an idea, a principle, an underdog. He became her hero early in life and had never once disappointed her. She never saw him do one thing she couldn't respect.

Not that he didn't have his shortcomings. Hell, he wore them like plates of tarnished armor-and he had plenty. He didn't seem to know that sometimes discretion was the better part of valor. He couldn't distinguish between causes, taking on an important lawsuit against the Pentagon for illegally developing bio-weapons at Fort Detrick with the same fervor that he chased after the silly Area 51 alien thing. But, to Herman they were equally important, because to him it was always about morality, honor, and integrity.

Herman was the last defender of justice in a world that no longer cared, because life in America now seemed to be only about celebrity, money, and success. The core values her father stood for had been left in the vapor trail of a seesawing Dow Jones Average.

Sometimes she cried for her father as she watched him standing alone against huge corporate bullies and government tyrants, sick and bloodied, but unbowed. A squat little warrior with a runaway heart who wouldn't back down no matter what; not when he was protecting the weak, not when the cause was just. And yet somehow, despite all of his courage, she knew that to most people who bothered to look, he came off as old-fashioned, silly, and more than a little bit corny.

Susan sat on the stone bench in the courtyard and watched the windows of Cedars-Sinai Hospital turn orange with the reflected sunset. She couldn't let her father die. She couldn't let him risk his life, but she didn't know how to stop him. When he was committed there was no turning him back. She had tried everything in the past: tears, begging, prayers, but he would just hold her hand and smile sadly, because he wanted her, above all others, to understand. He wanted her to get it.

"Honey," he would say. "Some people are unlucky, and you know why?"

"Why, Daddy?" But she knew.

"Because they have second sight. Or maybe it's just that they have a better view. They can really see what's going on, while the rest of society is out buying a new, hip wardrobe. But if you've been given this gift of sight you must use it. It's bigger than any one life, certainly bigger than mine." That was what he would tell her. If she went up there now and pleaded with him to ask the court for a continuance so he could get the radio frequency ablation, he would just smile sadly-mildly disappointed that she didn't understand. Then he would tell her all over again.

Herman Strockmire Jr. is the last great knight, she thought proudly.

She turned and trudged to the elevator for the ride back up to the cardio unit, thinking that if she lost her father she would just as soon die herself.