During a lifetime of eighty years, the heart beats as many as four billion times, propelling up to seventy-five million gallons of blood against pressure that increases with age. An organ charged with such a prodigious task cannot afford significant structural defects.

For two years Rick Harmon’s quarterly reports had been consistently negative. “Just the usual flow murmur,” he would tell Alan. The first omen of things to come appeared when she was fifteen, in the spring of 1986: “Second aortic sound a little soft, significance unclear.” Alan allowed Rick’s uncertainty to carry the weight of a negative report: Innocent till proven guilty. Within him lurked a fear that the subtle change presaged worse news.

In Rick’s mental image, the aortic valve, which controls blood flow from the left ventricle to the aorta, was not snapping shut at the beginning of diastole the way it should. Perhaps it was losing its pliability. He began to listen intently for the telltale murmur. Three months after Eden turned sixteen he heard it. He had to tell Alan. “There’s a short diastolic blow in the aortic area, and the second sound’s getting softer. I’d like to call Rita Becker in. She knows Edie from the hospital. We can all meet in my office. . . . And I want you to listen too.”

The meeting was arranged. After Rita had completed her examination, she passed the stethoscope to Alan. Gingerly he applied it to the left of the sternum between the second and third ribs. Unsure if he heard it, he asked Eden to lean forward, in the approved maneuver to bring out murmurs of this kind. He needed to listen, but his eyes pushed aside his ears. It had been hard enough when she was twelve and the sounds of heart failure leaped out at him; now she was sixteen, and the whisper of aortic regurgitation demanded utmost concentration. He wondered if Rita had been recruited expressly to help him feel easier. Despite his best efforts, he ― veteran of thousands of cardiac examinations ― wasn’t sure what he heard, and he was glad when she was dressed. Rick watched his performance with the faintest smile, as if saying, “Better get used to it.” He sent Eden out to wait and asked Rita. “What do you think?”

“No question about it. She’ll need prophylaxis for endocarditis, on top of the Bicillin.”

“Are you going to do an echo?” Alan asked.

“I don’t think we need it. We heard the murmur. Do you want one, Rick?”

“It’s your call. Follow her with us. If you don’t need an echo, we’ll do without. How about you, Alan?”

“Whatever you say.” Maybe he too would hear the murmur eventually.

Rita sensed his predicament. “Alan, I know this is a personal thing for you, but don’t let that get in your way.  We’re here to help you as well as Edie.”

“I appreciate that. Do you hear anything in the mitral area?”

“She may have a degree of mitral insufficiency too. We’ll have to keep listening.”

“What are we going to tell Edie,” Alan asked, “and who’s going to do the telling?”

“We’ve got to be truthful,” Rick answered, “but without making her an invalid. Activity won’t hurt her near as much as restricting her. You agree, Rita?”

“Absolutely. I let my patients’ symptoms speak for themselves. Anyway, we’re still examining her every three months. We can change our minds anytime.”

“OK,” Rick continued, “now back to the explanations. This daughter of yours is sharp as a nail. And inquisitive. Remember, Alan?”

“You bet. She already knows all about heart valves.”

“I’m not surprised. You’re the teacher, I assume?”

“She wanted to know why she had to keep on being checked years after she got better.”

“Just as well,” Rick said. “How much did you tell her?”

“I had to tell her that a scarred valve may not work right.”

“Did you mention heart failure?”

“No. But I did mention surgery, as casually as I could. She didn’t buy the comparison with appendectomy, she knew it was open-heart, but I told her it wasn’t that dangerous, and she might never need it. She didn’t push it further, said she didn’t know enough to worry.”

Rick took in a whistling breath. “OK, you’ve laid the groundwork, but now you have to go back a step. Not worrying didn’t matter at the time, because you were only talking about a possibility. Now she’s got it. Knowing her, I don’t expect her to settle for a pat on the back. Kids are curious about these things. One of my patients is a sixteen-year-old with atrial septal defect. He draws diagrams for his friends, then lifts his shirt and lets them listen. He’s quite a celebrity.”

“Does he carry a stethoscope for the use of his disciples?” Alan asked.

“Gracious, no! A stethoscope gets in the way of good listening. We doctors need them to impress our patients, and not to embarrass ourselves with women. The real benefit is that he capitalizes on his condition instead of worrying about it.”

“What if she does bring up heart failure, not being able to skate, that sort of thing?”

“I don’t think she will. But if she does, punt. Tell her to ask Doctor Becker!”

“I usually tell them,” Rita said, “that nothing’s happening now, which is true. But nobody can forecast ten or twenty years down the line, and I tell them that too. The questions usually stop there, because youth don’t worry that far ahead. Sometimes I wish they would. We’d have fewer of them smoking cigarettes.”