Mercy (16 page)

“Visual inspection of the heart shows normal size,” she said.

She removed the organ and placed it on the scale. The heart weighed 385 grams, 35 grams more than the normal range. She placed the heart on the stainless steel table. Lucy felt uneasy, unusual for her, but then again she did hold the heart of her friend’s fiancé in her hand. The moment for sentimentality was short; she had a job to complete.

“The circumference and appearance of the valves are normal,” Lucy said. “The ventricular wall appears normal in texture and width.” She searched hard for clues. A subtle scar could be a nidus for an arrhythmia, or an irregular heartbeat that would have caused his ultimate death.

She looked again and noticed something unusual this time. The left ventricle appeared to be dilated. She inspected the bulge more closely.

“There is some bulging noted of the septum into the left atrium,” Lucy said into the recording. The recording would pick up the excitement in her voice. “The right ventricular wall is normal in configuration, size, and thickness. The coronary arteries are patent with minimal atherosclerotic changes. Biopsy will be sent for chemical analysis, viral cx, and staining.”

Lucy turned the heart over in her hands and studied the ballooned ventricle with intense interest. The anatomy here was incredibly unusual, even for a doctor who had held plenty of hearts in her hand.

“No significant coronary artery stenosis,” Lucy said. “Nor is there significant fibrosis in the ventricular transverse sections near the apical or basal segment.”

This was in line with Sam’s medical history. If he had an underlying heart condition, Lucy would have expected to see abnormal narrowing in the arteries. Everything looked normal except for the apical ballooning of the lower part of the left vertical.

The bulging ventricle resembled a takotsubo, a pot with a bulbous base used by Japanese fishermen to trap octopuses. It was from this that the condition derived its name: takotsubo cardiomyopathy. It was a highly unusual coronary condition, one Lucy had never before seen in an autopsy. She might not have been able to identify its pathology were it not for her near-photographic memory. What made the discovery even more unusual was that takotsubo cardiomyopathy was almost always associated with older women, as much as 90 percent of the time.

Patients with takotsubo experienced a weakening of the left ventricle, the heart’s main pumping chamber, usually as the result of severe emotional or physical stress—or intense fear. More tests would have to be done for Lucy to make a conclusive diagnosis. But she believed Sam’s lab results would reveal that he had been literally scared to death.

CHAPTER 20

Julie arrived at Michelle Stevenson’s home in Shrewsbury at a quarter to seven. She came by car because her motorcycle was stored in a garage, where it would remain until it could be sold. Her riding days were done.

Motorcycle riding was not the only part of Julie’s life that had gone into hiatus. She had contacted the head of the Mass Coalition for Choices and Dignity to tender her resignation from the board of advisors. She could no longer in good faith advocate for death with dignity laws in Massachusetts—or anywhere else, for that matter. Not after she went from opposing the views of Very Much Alive to partnering with them.

Did it mean she no longer believed in death with dignity laws? Or did it mean she believed in them as long as she was not personally affected? Either way, Julie could no longer serve on any of the committees, and she had canceled all her speaking engagements, with no reschedule date offered.

Today marked two weeks since Sam’s death. Aside from funeral business, it was the first time Julie had been somewhere other than her home or the hospital. In that time, she had cried some, here and there, but mostly she walked through the days still with an impenetrable malaise, still numb to those who asked how she was doing. She had taken a week off, but welcomed the distraction she got from work. It was in the quiet moments that the guilt settled in and the gravity of the loss hit hard enough to take away her breath.

If only we had taken a different route. If only …

Trevor and Paul had shown true concern for Julie’s well-being. Paul was readily and consistently available. He helped with shopping, with school, with carpooling. He showed a level of maturity to which Julie was not accustomed.

Julie always said that Trevor followed Paul’s lead. In the wake of Sam’s death, the flame that had fed her son’s need for rebellion was extinguished, at least for the moment. His focus was on school, soccer, and not adding to his mother’s distress. Julie was grateful for that, and for the many e-mails and sympathy cards she received—including one with a return address in Dorchester from a Mr. Max Hartsock, who had made full recovery from his MRSA infection. In his thoughtful note, Max included VIP passes to an upcoming Eagles game, which Julie gave to Paul to share with Trevor.

Julie rang the doorbell. She tucked the bottle of wine she’d brought, a cabernet sauvignon from Chile, under her arm and waited.

The door opened. Michelle greeted Julie with a warm embrace, drawing her into the foyer of the ranch-style home. The aromas from the kitchen were intoxicating. For the first time since Sam’s death, Julie had an appetite.

Michelle took Julie’s coat and the bottle of wine. She smiled when she read the label. “This will go perfectly with our meal,” she said. “Speaking of which, we’re having beef and ginger stir-fry. Hope that’s all right with you.”

“That’s great. I’m glad you encouraged me to come. Whatever it is, your husband’s cooking smells amazing.”

“It’ll taste amazing, too,” a friendly voice called from the kitchen. “I’ll meet you in the living room with appetizers in just a moment.”

Michelle said, “Lucky for me, Keith loves to cook. Otherwise we’d probably starve. How are you holding up?”

Julie’s expression was a bit strained. “It’s been hard,” she said. “But I’m hanging in there.”

“Well, I’m glad you made the trek out west,” Michelle said as she hung Julie’s coat in the front hall closet.

“It’s good for me to get out.”

Michelle took the bottle of wine to the kitchen while Julie went to the living room. The furniture, mostly black leather and wood pieces, was tasteful, but not extravagant. Light from the fireplace warmed the room and cast a flickering glow across the beige walls.

It was harder to be in a couple’s home than Julie had anticipated. She and Sam had talked long into the night about decorating the place they would buy together. For inspiration, Julie had gotten into Pinterest, and had pinned plenty of images to boards to keep track of her ideas. It was what couples did. That, and cook, and help with homework, and binge-watch shows on Netflix.

Julie’s home was decorated with all the flair of a Pottery Barn catalogue. She was good at medicine, but lacked imagination when it came to interior design. That had been Paul’s bailiwick when they were married, and true to form, his current place was a hip, industrial loft space with a neo-bohemian vibe. Julie had figured she and Sam would take advantage of his considerable skill with the table saw, and have lots of wood throughout their home—wherever that was going to be.

Now Julie would stay with her tried-and-true approach: practical, affordable, and good enough. She had wanted to make home design decisions with Sam, and felt guilty for envying what Michelle and her husband shared.

Julie studied the art on the walls, which went well with the rest of the room’s décor. Her attention was drawn to a black-and-white photograph of a handsome young man with a friendly smile.

“That’s Andrew,” Michelle said, returning with two glasses of wine. “That’s my son who died.”

“I’m sorry. He looks like you,” Julie said.

Michelle’s husband Keith emerged from the kitchen carrying a plate of baked Brie with almonds and one of shrimp cocktail.

“There’s more where this came from,” Keith said.

Julie knew Keith from work, and he had come with Michelle to Sam’s funeral. The quick embrace they shared felt natural. Keith was a tall, handsome man, with neatly trimmed brown hair and eyes that sparkled when he flashed his brilliant smile.

An internist by training, Keith was part of a relatively new trend in health care. Hospitalists, which was Keith’s actual job title, specialized in the care of hospitalized patients. They could work on most any floor and deal with every aspect of the patient’s needs during their hospital stay. Like many hospitalists Julie knew, Keith moonlighted at other hospitals, which was a bit of a hush-hush practice, something not to be flaunted in the face of White’s powerful CEO, Roman Janowski.

Julie’s eyes went to something rather unusual hanging on the wall—two colorful beetles mounted with pins inside a wooden box frame.

Keith came over when he noticed Julie observing the specimens. “Lovely, aren’t they,” he said.

Julie grimaced slightly. “If anything with an orange body and green head landed on me, my first thought would be squish it, not frame it.”

“Actually it’s orange abdomen and green thorax, but I get your point.”

Michelle came over. “Keith’s first field of study, his first love really, was medical entomology,” she said.

“Diseases caused by insects have killed more people than bombs or bullets combined.” Keith said this with a sardonic grin.

“I was a research scientist,” he added, “traveled to exotic locales, collected specimens, tried to understand how these creatures potentially could harm or transmit diseases to humans.”

“What changed your career trajectory?”

“Money,” Keith said blandly. “Research just doesn’t pay like traditional medicine. I had a son and one on the way. I dropped out of research, went to medical school, and became a doc. These lovelies,
Calodema regale blairi,
the male being the smaller of the pair, are somewhat rare and a nice little reminder of that time in my life.”

“They actually are quite beautiful,” Julie said, studying them closely.

“I’ve always been drawn to uncommon beauty, until I met Michelle.”

Keith gave his wife a gentle kiss on the forehead, and though the moment was sweet, Julie found it painful. Reminders of all she had lost would be everywhere now. With time, she hoped, they would be easier to accept, though she doubted they could ever be ignored.

“He’s still drawn to uncommon beauty,” Michelle said, a hint of disapproval in her voice. “Now he has rats. A cage of them he keeps downstairs. What are there, six?”

Keith looked a little annoyed.

“About,” he said. “They’re actually wonderful pets, and much easier to take care of than dogs.”

“But less cuddly than cats,” Michelle felt inclined to add.

Keith rolled his eyes. “I think rats are marvelously intelligent and trainable,” he said. “I breed them, it’s a hobby. Happy to show you.”

Winston had made Julie a little uneasy at first. She could not imagine how she would respond to a cage of rats, but she was not about to find out.

“I think I’ll pass,” Julie said.

Keith’s expression took a serious turn. “I know you and Michelle have talked since the funeral,” he said. “But I wanted you to know that the service was very moving. Your eulogy brought tears to my eyes.”

“And he doesn’t cry easily,” Michelle said in a way that suggested some exasperation with her husband’s stoicism.

“Thank you,” said Julie.

The service had been well attended and utterly heartbreaking. Sam’s parents flew back from Michigan, and other relatives and friends traveled even greater distances to pay their respects. Julie’s father had died five years ago, but her seventy-nine-year-old mother was there, supportive as always.

Julie had managed to get through her speech. In it, she talked about Sam: his heart, his compassion, his love for his students, many of whom had come. Many of them were in tears.

“Ever since the funeral, I’ve been letting people turn in front of me,” Keith said. “Your eulogy really made me think.”

It had made a lot of people think, from what Julie heard afterwards.

“Sam loved to ride. It brought him tremendous joy,” Julie had said at the service. “One thing I noticed on our long rides together was that Sam would always slow down and let another driver make a turn, or go in front of him. It wasn’t simply a kind gesture on his part. He was saying something else. He was saying to the other driver, ‘Where you are going is just as important as where I am going.’ This was a theme of his life—your journey is just as important as my journey. He genuinely cared about the lives of other people, and wanted to know everything he could about their journey. And it was this that drew people to Sam’s side.”

“I had the same reaction as Keith,” Michelle said. “It’s like I have a whole new awareness.”

“I’m glad to know that. I just spoke the truth. That was who Sam was.”

“You must still be reeling,” Michelle said.

“Well, to be honest,” Julie said, “I’ve been a bit obsessed.”

“Obsessed? How so?” Michelle asked.

Keith excused himself to fetch another bottle of wine from the cellar. “Don’t get lost down there,” Michelle said. Then to Julie, “I swear, that basement is like his own beetle burrow. He’ll vanish for hours, fiddling away on different projects. Anyway, you were saying.”

“Right, my obsession. The lab results from pathology came back and supported my friend Lucy’s conclusion. Sam died of takotsubo cardiomyopathy.”

Michelle gave a slight shrug. “Is that unusual?”

“Highly,” Julie said. “It’s atypical in men. Usually it’s women over fifty who get it, but it’s rare for them as well. It’s sometimes referred to as ‘broken heart syndrome.’ It’s a stress phenomenon that may be caused by a sudden surge of stress-related hormones, so it could also be triggered by fear.”

“Is it always fatal?” Michelle asked.

“No,” Julie said. “Often the condition reverses itself within a week. It feels like a heart attack, but it’s extremely rare for it to be a fatal one.”

“So it’s different than a heart attack,” Michelle said.

“It is a heart attack, but an unusual one. The EKG read is very distinct. It’s typically not trigged by heart disease, because it’s stress-based, and the autopsy confirmed Sam’s arteries weren’t blocked. Other than that ballooning, Sam’s heart was perfectly healthy. I’ve never seen a case of it, and neither have any of the cardiologists at White I spoke with. It’s very rare—two percent of heart attacks, maybe less.”