Heart Failure Read online

  Carrie nodded and left the room. She looked at her watch and decided that if she hurried, she could finish seeing her patients and still be on time for lunch with Julie. In the hallway, she heard someone calling her name. Carrie turned to see Rob Cole trotting toward her. “Dr. Markham, I’m glad I caught you.”

  “Rob, I really have to get back to the clinic. What’s so important?”

  “I wondered about Mrs. Lambert.”

  “Did you and your partner have that call?”

  “Right. Her EKG showed a massive MI. Did she make it?”

  “So far. And you were right—she had a myocardial infarction. Dr. Rushton is doing a CABG right now.”

  “Well, she’s in good hands,” Rob said. He ducked his head, and Carrie thought he looked about fourteen years old when he did. “Um, I know that you’re a doctor and I’m only an EMT, but I was wondering if you’d like to have a cup of coffee together sometime.”

  Carrie put her hand on his arm. “Rob, I’m flattered, but I’m involved with someone else. Thank you, though.”

  Rob was a good-looking young man who’d just asked her out. And Phil, despite his usual demeanor, had sent some signals of interest as well. Some women probably would be thrilled to have that much attention, but Carrie wasn’t one of them. No matter what had happened, she wanted to honor her commitment to Adam.

  She thought about the ring she’d given back. Did she regret that action? No. Although she was in love with Adam, Carrie didn’t think they could move forward until they were no longer in danger. She only wished she knew when that might be.

  Carrie and Julie had decided to meet at a restaurant in the Galleria, a large shopping center north of Dallas. Julie was already at a table toward the back, and the sight of her friend made Carrie’s face light up.

  Julie jumped up and met Carrie halfway to the table. The two friends hugged.

  “I’m sorry I’m late,” Carrie said. “Things were crazy this morning.” She took the chair next to Julie and tossed her purse onto the vacant one beside her.

  “No problem,” Julie said. “Catch your breath, get something to drink, and we can talk.” She sipped her iced tea. “Afterward, I have orders from Barry to check out the Nordstrom here. He agreed to pay for our lunch if I brought home something frilly.” She raised an eyebrow.

  Carrie grinned. In a few minutes the two friends were chatting as though no time had passed since they were last together.

  The waitress served salads, and for a moment the two women nibbled, although neither seemed as interested in eating as talking. Finally Julie said, “Now for the reason we’re here, I guess. The last time we talked, someone had taken a shot at you, after which you discovered your fiancé wasn’t who you thought.”

  “I’ve found out even more since then,” Carrie said. She leaned forward and laid out all she’d learned from Adam. “The real question isn’t whether I love him—despite everything, I still do—but what we’re going to do to get out of this mess.”

  “I don’t suppose you’ve talked with anyone else about the situation,” Julie said.

  “Who would I tell? My parents pretty much washed their hands of me when I became a Christian my first year in med school. I don’t have any siblings—you’re the sister I never had.” Carrie leaned across the table. “You’re my best friend.”

  “Even though we were both in love with Billy Kiker in the third grade?”

  “Even then,” Carrie said, and laughed for what seemed the first time in weeks.

  Julie took a forkful of salad. “Why didn’t Adam tell you all this before he asked you to marry him?”

  Carrie put down her fork. “He admits he probably should have, but he thought he’d made a clean start in Jameson and hoped he could get by without revealing his past.”

  “And you can forgive him for that?”

  “When I think about how supportive Adam’s been, when I realize how wonderful it’s been to have him in my life—yes. He taught me how to smile again, Julie. When he and I first met, I was a wreck, mainly because of what happened to John.”

  “Stop it! John had a cardiac problem that no one, not even a great diagnostician like you, could have noticed. And even though the odds of a complication like the one he experienced are slim, that doesn’t mean it can’t happen . . . even with the best possible medical care.” She reached to pat Carrie’s hand. “You have to accept that.”

  Carrie inhaled, taking a moment to compose herself. “I know. And I’m making progress there.” She took a swallow of tea. “The guilt about John’s death isn’t as bad as it was, although there are still triggers. But now I’m really frightened for Adam. The shooting, the firebomb, someone trying to kill him—and my life is in danger as well.”

  “Why doesn’t he go to the police?”

  “He says there’s a possibility someone there might leak his true identity. I don’t think it matters anymore, but he won’t listen.” She drained the tea from her glass, but her throat remained dry. “It’s frustrating to feel so helpless. I don’t know what’s going to happen next.”

  Julie rattled the ice cubes in her glass, and the waitress appeared with a pitcher for refills. After she left, both women added sweetener to their glasses and drank. Then Julie said, “How would you like this to end?”

  Carrie didn’t answer at once. When she did, her voice was almost a whisper. “What do I want? I want all the danger to go away—right now, without our having to do anything. Just poof.” She opened her fist like a magician making a coin disappear.

  “Neither possible nor realistic,” Julie said. “What is both possible and realistic is that you give Adam your support and help him find out who is after him.”

  “Even if doing that puts me in danger?”

  “Crossing the street puts you in danger. Driving to the grocery puts you in danger. Eating in the hospital cafeteria puts you in danger. And the reward for any of those doesn’t approach what you’ll get from having Adam in your life. You love him. Period.”

  Carrie shoved her plate aside. “And that’s it? That’s all I can do? Julie, I feel so helpless. I need to do something.”

  “Isn’t that typical of a doctor? You always want to be in control.” Julie pointed her finger at her friend. “You can’t control this. You can brainstorm, you can do what Adam asks, but the main thing you can do is pray . . . for him, for you, for the whole situation.”

  “I . . .” Carrie’s throat tightened. She couldn’t get the words out.

  “I know, sometimes praying is hard, especially if you haven’t done it for a while. But there’s no magic formula. Just talk to God. He’s been listening all the time. All you have to do is make it a two-way conversation.”

  Adam could hear the argument in his head as clearly as if there were someone standing beside him making the case. “Leave town.” “Don’t go to work.” “Hide.” And to each suggestion, his answer was the same: a resounding, “No.” To this point, his response had been to run, but this time he’d stand and fight.

  He wasn’t going to run, because to do so would mean leaving Carrie behind. Yet, if he stayed, he needed this job—not just for the salary, although that was essential, but because to step away from it would invite the very questions he’d tried to avoid. “Why did Adam do that? Is there something strange about him?” If he simply kept doing what he’d been doing, surely he’d think of a way out of all this.

  Was it time to move past his principles and get a gun? No, he wasn’t ready to take that step. He’d figure a way out of this without resorting to violence. Of course, if it came to defending Carrie . . . For now he’d stick with the actions he’d already taken to avoid a would-be shooter.

  Adam was at his computer, scanning through LexisNexis for a legal opinion to back up some research, when he felt the buzz of his cell phone in his pocket. This was the new one, the one with a number only Carrie knew.

  Although Hartley and Evans provided Adam with his own office, they’d been careful to emphasize the fir
m’s open door policy. The attorneys would close their doors only when client privacy required it. Otherwise, everyone’s door was to remain open, to promote ease of interaction in the office. It was nice in principle, but Adam needed privacy for this call.

  He slid the phone out of his pocket, turned his chair away from the doorway, and whispered, “Carrie?”

  “Adam, why are you whispering?”

  “I don’t want anyone to hear this conversation.” He lowered the phone to his lap, effectively hiding it behind the edge of his desk as Janice Evans walked by and gave him a friendly finger wave. He waited until she was past to raise the phone to his ear once more in time to hear Carrie say, “So that’s what I’ve decided.”

  “I’m sorry. I had to put the phone down. One of the attorneys just walked by. What was that?”

  There was no mistaking the exasperation in Carrie’s voice. “Maybe we’d better talk another time.”

  “Carrie, I’m sorry. I can call you in a couple of hours from outside the office.”

  “By then I’ll be up to my eyebrows in patients.”

  “How about tonight?”

  An eternity passed before she replied. “Your motel. Seven o’clock. I’ll take the same precautions I did last night. Gotta go now.”

  “I really—” Adam heard a click. He had no idea what Carrie wanted to say, and he’d have to wait another five hours to find out. But surely she wouldn’t agree to a face-to-face meeting again if she wanted him out of her life. Or would she?

  “You’re sure a popular person.”

  Adam snapped out of his reverie to see Brittany standing in the doorway of his office, one hand poised on her hip. She probably didn’t realize her pose was provocative. Adam figured she’d been practicing those mannerisms for so long they were automatic by now. Brittany was an attractive young red-head who acknowledged that her life’s ambition was to latch onto a handsome lawyer with a great income and a bright future. Since, as far as she knew, Adam didn’t fit that description, she’d been pleasant but not seductive to him—thank goodness.

  “Why am I popular?” he asked.

  “Someone called for you this morning. You were out at the time. They asked if you were usually the one who closed up the office. I told them ‘sometimes.’”

  Adam’s heart raced, wondering if the hit would be in the parking lot this time. He’d have to figure out a way to avoid that. “Did they give a name? Say why they wanted to know?”

  “Nope. Just got the information, thanked me, and hung up.”

  Adam shrugged. “Probably nothing, but thanks.”

  “Well, I thought you’d like a heads-up.”

  “Thanks.” I’ll be watching for him . . . the same way you’d watch for a snake when you’re in the woods.

  Brittany swung away and headed for the coffee machine.

  Was this another way to let Adam know the stalker had found him? He’d heard that some killers got a perverse sort of pleasure out of letting their victims know they were about to die. Then again there could be a perfectly innocent explanation for the call. But Adam doubted it.

  In Adam’s mind there was no question of whether the stalker would strike again. The only unknown was when and where . . . and who would be harmed or killed in the process. Here at the office, he’d have to be constantly on his guard. But outside? What else could he do that might give him a bit of breathing room?

  He’d moved to a motel, mainly so he could get a good night’s sleep without worrying about another firebomb or bullet. He’d switched to a different vehicle, but he realized that the anonymity that gave him would be short-lived. How long would these advantages last? What was the reflex he studied in college biology? Fight or flight. Some animals did one or the other reflexively. Only man made a choice. But what was his?

  He needed wisdom that was beyond his own power. So he did the thing that had become as natural to him as breathing, the thing that had kept him sane during the last two years. He bowed his head and prayed.

  EIGHT

  CARRIE CHECKED HER WATCH—HALF PAST FIVE. IF SHE DIDN’T drag her feet on her hospital rounds, she should be able to get home, relax in a hot bath for a bit, then get ready to see Adam. The more she thought about it, the more she agreed with her best friend’s advice. How had Julie put it? There was risk to everything in life, even crossing the street. She had to consider not just the worst possible outcome, but the best.

  Carrie didn’t want to lose Adam—no matter what. She still loved him—that much was becoming increasingly clear to her—and whatever it took, she was going to help him find out who wanted to kill him, then neutralize them. Together they’d put a stop to it. The reward was worth the risk.

  She quickened her pace through the hospital corridors and soon was in the surgical ICU at Mrs. Lambert’s bedside. The figure lying there didn’t resemble the woman Carrie had seen so many times in her office. There she had been alert, animated, happy to be alive. Now she lay still as a wax mannequin, unmoving and pale. A ventilator controlled her breathing. IV lines and monitor wires were everywhere. But she’d survived the surgery, and that was important.

  A quick scan of the chart showed stable vital signs and initial lab values that were no cause for worry. Phil’s operative note, although brief, indicated that the procedure went off without a hitch, with the patient tolerating the surgery as well as could be expected for her age and condition. There was no need for Carrie to add either orders or a progress note. Her patient was unresponsive, so conversation was neither necessary nor possible. Moving on to the waiting room to face her family, on the other hand, took a bit of willpower.

  If Carrie had any doubt that she’d been replaced in the mind of Mrs. Lambert’s family as the primary caregiver, the reception she received in the waiting area removed it. Mrs. Stinson was polite, yet more distant than she’d been earlier. Yes, Dr. Rushton had been by. No, there was nothing Carrie could do, no questions she could answer. Almost as an afterthought, Mrs. Stinson added, “We’ve talked it over, and we’d like Dr. Avery to take over Mother’s care after she leaves the hospital. Dr. Rushton said that would be okay with you. I hope you don’t mind?”

  Carrie swallowed the retort that was on her lips. “Of course not. The records are already at the clinic, so it’s just a matter of your making future appointments with Dr. Avery.” She shook hands with the woman, although it was the last thing she wanted to do, then beat what she hoped was a dignified retreat.

  As she stepped out of the elevator, Carrie’s first thought, born of habit, was to retrace her steps back to the clinic. But she needed to save time, so she turned in the opposite direction, intending to reach her car by exiting through the Emergency Room. The door there emptied into the common parking area close to where she’d left her car that morning. As she hurried through the ER, her thoughts turned to her meeting with Adam. He would probably—

  “Dr. Markham.” Doris, the ER charge nurse, bustled up to Carrie and touched her sleeve. “I know you’re not on call, but we need your help.”

  Carrie fought the urge to pull away. She didn’t want to get caught, not now. “I’m in sort of a hurry to leave.”

  “This should only take a minute,” Doris said. “The EMTs just brought in an elderly black man who collapsed on the street downtown. Erin thought she’d seen you with him in the ER a few weeks ago.”

  Carrie looked at her watch. She really needed to go. Then again . . .

  “The man’s comatose,” Doris said. “He has no ID. There’s no one with him. We don’t even know how to contact his family, so if you recognize him that would really help.”

  Carrie took a deep breath. “Where is he?”

  In a few moments Carrie looked down at a familiar face. She knew Garvin Burnett, knew him well. Mr. Burnett’s visits to her office had always turned into prolonged sessions where he talked and she listened. Apparently she was the only person who would sit still long enough to do that for him.

  Mr. Burnett was in his early eighties. H
e had lived at Meadowbrook Acres for some years, clinging fiercely to his independence. He never called it a retirement home, never referred to it as anything but a place where the population all happened to be well up in years.

  She’d asked him once about his family, but he shook his head. “No family. But I don’t need anyone. I’m fine on my own.” When she broached the subject of moving to a section in Meadowbrook where he could get help if he needed it, Burnett bristled. “When I can’t take care of myself, that’ll be the time to pull the plug on me.”

  Two EMTs stood beside Mr. Burnett’s stretcher. One scribbled on a clipboard, the other adjusted the man’s oxygen mask. Carrie turned to Doris, who had taken up station at the foot of the stretcher. “You were right. He is a patient of mine. His name is Garvin Burnett,” she said. “How did he end up here?”

  The first EMT spoke up. “Got a call that a man had been acting crazy, then collapsed on the sidewalk at Fourth and Mizell. Witnesses told us he had a convulsion right before we got there. Nobody knew him, nobody saw anything else.”

  Carrie gazed down at the unconscious man. An IV was running, oxygen flowed into a mask over Mr. Burnett’s face. The monitor showed his blood pressure to be low, although not at shock levels. Quickly, she ran through the differential diagnosis. Then her memory dredged up the most important fact. The reason she’d seen Burnett in the Emergency Room previously was his diabetes. He had labile, type I diabetes, controlled with some difficulty by daily insulin injections.

  Carrie turned to the lead EMT. “He’s diabetic. When you picked him up, did you check his blood sugar with your meter?”

  “Part of the routine. His blood glucose was so low it was almost off the chart. We gave him glucagon and followed it with 50 percent dextrose, but he never came around.”

  “Labs back yet?” Carrie asked.

  Doris spoke up. “Ordered them stat when he hit the ER, but they aren’t back yet. We catheterized him but there was hardly any urine in the bladder.”

  Carrie nodded. The bladder probably emptied with his convulsion—so much for a urine glucose and ketone. “Okay. My first thought was that his blood sugar plummeted—too much insulin, no food, whatever—and it caused his convulsion and loss of consciousness. But that should respond to the treatment he got from the EMTs. There has to be something else. Let’s start looking.”