“Shake a leg!”

Rick stood at Eden’s bedside, his finger on her pulse. Strong, regular, eighty per minute ― at rest. How would her heart respond to physical activity? With stronger beats, or with an excessive increase in rate because the strength wasn’t there?

Eden knew nothing of such questions. To her, Rick’s command meant her sentence was over and life could resume where it had left off. She had no inkling what six weeks of enforced rest had done to her leg muscles ― never mind the unpredictable capacity of her heart.

“Which one?” she asked.

Rick hesitated a second. “Which one what?”

“Which leg do I shake?”

“The right one, of course. You always do the right one first. Didn’t you know that?”

With a gracious smile she shook her left leg. Rick took note of the pulse rate: Ninety-six.

“Now,” he said. “Sit and put your legs over the side.” Pulse one hundred.

Flanking her on opposite sides, Rick and a nurse helped Eden out of bed. As her feet reached the floor, her supporters loosened their grip. She almost collapsed. She tried again. With an effort she supported her weight. Pulse one hundred twenty and noticeably weaker. They let her stand for ten seconds, then helped her back onto the bed. Her mouth was agape. Rick’s hand was still on her wrist: One hundred twelve and stronger. He smiled and she felt better.

“That’s what happens when you don’t use your legs for over a month. How’s the breathing?”

“Breathing’s OK,” she replied, “but my legs! I can barely stand. What’s going to happen?”

“Your legs’ll be fine, but we don’t want to push the heart too fast. Be patient.”

Assisted by a physical therapist, she spent two weeks learning to walk the length of the hallway. When she finally went home, she found her bed in the recreation room on the first floor. For the first time in more than two months she ate at the kitchen table.

The weeks passed and her heart gained strength. With fanfare she tackled the stairs.  Alan reported the pulse rate. “Not bad,” Rick said. “Just once a day for now.”

By stages she was allowed more and more exercise.

It took another month to wean her from steroids, a slow process to allow her body to adjust to every decrease in dosage.  Spring came and Eden took walks outdoors, first up and down the block, then longer distances. She felt ready to toss aside all restrictions, but Rick insisted that every lab test be normal before giving her a clean bill of health.  That took two more months.

Debbie and Joshua knew about heart troubles. Uncle Milt had never worked again after his heart attack. No one needed to tell him to take it easy; breathlessness wouldn’t allow otherwise.  Within a year he was dead.  Witnessing Eden’s forced inactivity, not knowing how her illness differed from his, they saw her heading the same way. Mrs. Avery tried to calm their fears, but too much of her effort went into reassuring herself. The children sensed this and did not probe.

It was Eden herself, getting stronger by the week, who laid their anxiety to rest. Six months after inflammation had first ravaged her heart, the process fell silent. Eden put illness out of her mind, and her friends knew no better than to accept her recovery as complete.

“She still has a mitral systolic murmur,” Rick said that summer. “Not sure what it means.”

Six months later the murmur was gone. She had escaped intact.

The days in which Eden’s life had hung in the balance; the weeks of her recovery; the months of waiting to see how complete her recovery would be; all had taken their toll on Alan. His agony was more than that of a father trembling over the near-loss of his child; it was his self-blame for allowing it to happen. He also knew that absolution would forever be a mirage, for as surely as year upon year would pass before Eden’s valves showed their scars, so would his conscience lie in ambush year upon year to pounce on him again.

He wished he were a religious man. Prayer might help. ­­­­­­

~~~~~~~~~~

To prevent another attack of rheumatic fever, Eden had to be protected against strep throat. Karen learned to give the monthly Bicillin injections.  A checkup every three months would reveal valve damage at the earliest stage.

“Why do I have to keep going back?” Eden asked her father. “Isn’t that over and healed up?”

“Just to be sure,” Alan said.

“Sure of what? What could he find next year that isn’t there now?”

Alan tried to balance simplicity with truthfulness.

“He listens to the heart valves open and close. If they get scars, they’ll sound different.”

“How can a scar take that long?”

“It does. It’s not like skinning your knee.”

“What if there is a scar?” she asked. “Won’t it fall off after a while.”

“You’re thinking ‘scab.’ A scar can keep the valve from working right.”

“How bad is that?”

“A person can get along fine with a little scar,” he answered as off-handedly as he could.

“And if there’s a big scar? Would I have to take medicine to get rid of it?”

Alan sighed. She was not going to take her foot out of the door he had opened. “There isn’t any medicine. If a valve is scarred so bad that—”

“Badly.” Her face was the very picture of smugness.

“Yes, miss. If a valve’s scarred so badly that it strains the heart, it may have to be replaced.”

“You mean an operation?”

“Yes, like having your appendix out.”

“But the valves are inside the heart, aren’t they? So they’d have to cut the heart open. I think I’d rather have my appendix out.”

“OK, it’s not the same. But they do it all the time; it’s not that big a deal. So don’t worry. Let Doctor Harmon do the worrying.”

“I guess I’m not really worried. Can you teach me about the heart and the valves sometime?”

Alan saw an opportunity to score a few points as parent. Seizing his first free evening, he sat down with Eden to explain the heart chambers and valves, using an atlas of anatomy and his own impromptu drawings. Her teachers would have been amazed at her power of concentration.

“How do they get pictures like that, Daddy? They look like photos.”

“They are. At least, they started out that way, but they’ve been touched up.”

“What do they photograph?”

“The heart, of course!”

She looked puzzled.

“The inside? Where do they put the camera?”

“Do you know what an autopsy is?” Alan asked her.

“Is that cutting people up after they die?”

“You don’t mince words, do you?” he answered, putting his arm around her shoulder.

“Just so they can take pictures for books?”

“Not only for that. Autopsies are done so that doctors can learn about diseases. People get sick, and sometimes they die. Then a special doctor, a pathologist, takes out all the organs, opens them up, and figures out what went wrong. Sometimes you can’t tell from just looking, so you cut out tiny pieces, slice them ever so thin, and put them under a microscope.”

All this she took in without a hint of disgust. Her eyes were bright with fascination.

He remembered the first autopsy he had attended as a medical student. A classmate had had to be carried out. With a feeling of pride he imagined his daughter ten years from now, lapping it up without effort. He almost missed her next question.

“If I died, would you let them cut me up?”

“That’s a horrible question! Parents shouldn’t even have to think of their children dying.”

“Well, it happens sometimes, doesn’t it?”

“Yes, it does, and I can’t think of anything sadder. You should be thinking the opposite. Someday I’m going to die, and they’ll ask for permission to cut me up, as you so tactfully put it. And I want you to say yes. Because if a doctor can learn something that could help another living person, that’s worth a whole lot more than letting me rot six feet under without a mark. OK?”

“Gruesome, Daddy. But I’ll think about it.”

Eden had begun to leaf through the atlas. With each page, her curiosity grew.

“Look,” she said, “here’s the uterus. Look how small it is. And it gets so big when a woman’s pregnant. How come it doesn’t burst?”

“Made of special tissue. Designed for stretching without breaking. Interesting, isn’t it?”

“And this is how the babies come out, right?” she said, pointing to the birth canal.

“Right again.”

“This is fascinating.” She turned more pages. “Much better than what we get at school, especially in sex ed.”

On that subject Alan wondered just what they were getting, but before he could ask, Eden had returned to the heart.

“What was wrong with this heart?” she asked.

“Nothing.”

“Then why did it stop?”

“Stop? What do you mean?”

“Well, when a person dies, doesn’t the heart stop?”

“Of course.”

“Why stop if there’s nothing wrong with it? Mine was plenty sick and it didn’t stop.”

Alan scratched his head. More than fifteen years’ experience as a doctor, and he had to improvise an answer to the simplest of questions.

“The organs depend on each other. A perfectly good heart may stop because another organ is too sick to work right. Not enough nutrition, maybe. Those details you learn at medical school.”

Eden appeared content to defer the mastery of medicine. “Can I look some more at this?”

“Yes, you may, and I’m sure you can, too.”

Without looking at him, she smiled and settled down to study anatomy. He went to the kitchen to report to Karen on their daughter’s obvious calling.

The experience put Alan in a wistful mood. He gave himself low marks for his performance both as father and as physician. Yet Eden, the victim of both shortcomings, was obviously focused in another place altogether. Two partners in one relationship, yet with such a different sense of its power and its failings. Here was he, brooding over the past and fearful of the future; there was she, all in the present, delighting in the opportunity to enroll him as her tutor, oblivious of his role in the very illness that kindled her interest. Where was her anxiety? Where was her accusing finger? Why, instead, was she so full of optimism and enthusiasm—and yes, affection?

It was his obsession, of course, that blinded him to the obvious. She had no reason to behave otherwise than she did. Not knowing the link between her heart disease and her sore throat, not knowing how much difference a shot of penicillin would have made, she thought of herself as a girl who had recovered from a serious illness — and that was cause for rejoicing.

In any case, she evidently held him blameless. And it did nothing to assuage his guilt. On the contrary, his daughter’s forgiveness ― he could see it no other way ― made his burden that much harder to bear. He sank into a depression, detailing all the ways he had failed her. He even toyed with the idea that he deserved to have his daughter, rather than one of his patients, be the victim, so as to place him face to face daily with his greatest failure. But his self-immolation did not do Eden a whit of good, and he chided himself for the thought. Add one more to his list of sins.

He pulled himself together. The past could not be recalled, and there was a future to take care of. He shook his head. One of these days, he told himself, he might need psychiatric help.