Herbert S. Heineman, M.D.

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PART II

Chapter 17: The Lesson

“I had my checkup the week before last. I have a murmur.”

Josh caught his breath. “Why did you wait so long to tell me?”

“Please don’t be mad.”

“I’m sorry. Ever since you explained, I’ve been scared that something would show up—”

“And I was getting more and more confident it wouldn’t. You were right. Doctor Harmon had Doctor Becker, the cardiologist, examine me just to be sure. I only saw her this Wednesday. That’s why I didn’t say anything. It could have turned out to be nothing.”

“So now it’s there,” Josh said despondently. “What’s going to happen?”

She looked at him silently for a few seconds. “It matters to you, doesn’t it?” She put a hand on his. “Am I being too sentimental?”

“There’s no such thing. And yes, I do care. Of course I care.”

“They even had Dad listen, because they wanted him to hear for himself. I felt kind of sorry for him.” She laughed at the recollection. “He has all kinds of qualms about seeing me undressed. I don’t understand why; he’s a doctor.”

“Father-daughter stuff, I guess. He must have done a thousand exams if he’s done one.”

“Maybe that’s it. Anyway, I think he heard the murmur too after a while ― if he wasn’t too flustered. I can hear it.”

“You can? Have you been listening to your heart all this time? I mean, to hear a murmur, don’t you have to know how the heart sounds without one?”

“I asked Dad what to listen for, and he explained that there was a normal comparison built right in. Come on, I’ll show you. We have to go some place real quiet, because if there’s any noise we can’t hear it. Dad’s study is good, it’s carpeted. I’d say my room, but in case Mom suddenly appears, you know . . . ” With a merry laugh, she reached for his hand, just as she had done in the kitchen that January afternoon.

Josh froze. Was she actually going to make him listen to her heart? When her own father, a doctor, had had a hard time?

She sensed his resistance, and it amused her. “Come on, it’s not catching!” She pushed him gently into the study and closed the door. He looked over his shoulder as if the last lifeboat had departed his sinking ship. The silence made his feeling of isolation total.

“Suppose your mother comes home.”

“I’ll be able to hear the door. And for God’s sake stop worrying! You’re not afraid to be alone in a room with me, are you? I’m a well-bred girl, you know!”

“It’s not that,” he said, wishing he could share her abandon. “I don’t want your parents to think they can’t trust us.”

“Nothing will happen. You’ll see. Now I want you to trust me.”

He had no choice. She perched on the edge of her father’s desk and told him to draw a chair up close. He sat facing her, about a foot lower. She was wearing a print cotton blouse buttoned up the front to an open collar. A gold pendant featuring a heart inside a circle rested on the blouse, its thin gold chain round her bare neck. His mouth was dry.

She turned to reach for a stethoscope lying on the desktop behind her. The movement had the same effect as her reach for the books, only enhanced by the thinner texture of her blouse. With a supreme effort he retained his presence as she turned back. Here it comes, he thought.

“First, a mini-lesson,” she said. “Like you said, you have to hear normal sounds before you can hear the murmur. I could have you listen to your own heart, but you can do that another time. There are two valves that sound alike, pulmonic and aortic—named after the arteries, of course. My pulmonic valve is normal, and we’ll do that first. Ready?”

“OK,” he barely whispered. What was he supposed to do? A vision of an irate Mrs. Avery flashed before him, bursting in on a scene of lewdness masquerading as medical education. Get out of this house, and don’t you ever come back! He wished the whole thing were over.

“You look as if you’ve seen a ghost,” Eden said. “It’s just me. Are you OK?” His look had betrayed him. And the worst was yet to come. And she was actually amused!

“I had this nightmare about your mother bursting in and throwing me out for good.”

Eden laughed. “Was that it? She’d never do that, she likes you too much.”

“Yeah, but—”

“There’s ― nothing ― to ― worry ― about. I keep telling you. Now let’s go.”

She slipped the head of the stethoscope into her blouse and held it against her chest. With her free hand she extended the earpieces to him. She did not open a single button.

“Stick these in your ears and tell me what you hear.”

Because of the shortness of the connecting tubes, he had to pull up to the desk until his shoulder was level with her knee. He slid sideways to avoid contact. As he listened, his eyes grew wider as if controlled by a rheostat. “Incredible! This is marvelous. I can’t believe it.”

“I couldn’t either, at first.”

“Hey, don’t yell!” he protested, laughing despite himself. “I heard that through the stethoscope. Your voice coming out of your chest.” He removed the earpieces. “What a work of art! There’s that fabulous machine pumping away day and night in every living human being since time began, and I bet at least ninety-five percent have never heard it.”

“Ninety-nine point nine would be closer, if you ask me. But now you have to listen again and describe exactly what you hear.”

He reinserted the earpieces. “What d’you know! It’s faster now. And wait! When you breathe in it speeds up, and when you breathe out it slows down. Is that right? Whisper!”

“I didn’t know that, but if that’s what you hear it must be right. How about the sounds?”

“Sounds sort of like ‘boom-bip, boom-bip, boom-bip.’ ”

“Which is louder, the boom or the bip?”

“The bip.”

“You get an A. Keep up the good work. Now listen between the booms and the bips.”

He concentrated for a long time. “I hear you breathing. Funny, I hadn’t paid attention to that before. Amazing how you don’t hear things unless you focus on them. Fascinating! All that noise, and your brain can choose to tune in or out. Marvelous! But back to the valve.”

Another ten seconds. “I think I hear a soft sound, rushing-like, between the boom and the bip. I could be imagining it. There’s nothing between the bip and the next boom.”

“Excellent!” she whispered just a shade too loud for his comfort. He cringed. She cupped her mouth irrelevantly. “What you heard is a murmur. Dad says it’s normal, caused by blood rushing by every time the heart beats. Remember, you heard nothing after the bip. Now I’m going to switch to the aortic valve.” She moved the stethoscope. “Ready. Now listen again.”

This time he took even longer. “The ‘boom’ sounds the same. But the bip is not as loud. The murmur may be a shade louder, but I’m not sure.”

“Nothing between the bip and the next boom?”

He tried again. “I don’t hear anything. Should I?”

“Take out the ear pieces. I’m going to lean forward and breathe all the way out, and I want you to listen just for that one thing while I hold my breath out.”

“How does leaning forward and breathing out help?”

“Makes the heart flop forward against the sternum, so it’s closer to the stethoscope.”

Her heart rate slowed as she exhaled. Closing his eyes, he concentrated on every sound. On the third beat he heard it; after that it was there all the time. Then she had to take a breath.

“Absolutely amazing!” he said. “I heard a real soft sound, like blowing on your finger. It started right with the bip but it faded out before the next boom. Your heart was so slow, I could hear the silence. Wow! Now I know why we had to have a quiet room.”

Eden removed the stethoscope from her chest and replaced it on the desk.

“It’s called aortic insufficiency,” she said. “The pulmonic valve closes tight, so no blood flows back. The aortic valve leaks.”

“And that’s from the rheumatic fever?”

“Yes. Now you know as much as I do.”

She came down from the desk and opened the study door. “Come, let’s sit in the living room. We’ll be safer there.” She flashed him a wicked smile.

“I’m sorry I acted so scaredy-cat. I didn’t know it could be done without undressing at least a little, and how would that have looked if your mom had walked in?”

“I wouldn’t have let you listen if I’d had to undress. I told you I was a well-bred girl, but you didn’t trust me, did you?”

“I apologize, honestly. I got nervous when you started talking about listening to your heart. Also, if you really want to know, it wasn’t only your mother I was afraid of. I don’t want us to be in that situation ― for our own sakes. You know what I mean?”

“Yes, I do. And you’re right.”

“But just to complete my medical education, is that how they do heart exams in girls? I always have to strip off my shirt and the doctor listens lower down.”

“Oh no, girls’ hearts are the same. Doctor Harmon makes me undress. They listen for the other valves under the breast. The heart has four, you know. But my lower ones are OK.”

Josh dwelled but a moment on that image. There was a more pressing issue to deal with.

“Other than knowing, how does this change your life?”

“Not at all. I can do whatever I like. But they’ll be watching me extra close now. Oh, there is one new thing. If I go to the dentist I have to get extra penicillin to keep the bacteria out of my blood. That’s to keep the valve from getting infected.”

The first part of her answer came as a relief. He didn’t know what to make of the second.

“I didn’t know bacteria got into the blood when the dentist pokes around in your mouth.”

“One more shot once in a while won’t bother me. I already get one every month.”

“Where do you get all those shots?”

“You mean, who gives them, at whose place — that way?”

“No, I meant, do you get them in the arm, like tetanus shots?”

“Oh, you mean which part of me. In my rear end.”

Again Josh had a disturbing mental image. “You must look like a pincushion.”

“Don’t worry, there’s lots of room, lots of it.”

It was time to change subjects. “By the way, I’ve been accepted at Cornell.”

Suddenly the life went out of Eden’s face. She held her breath, looked at him, swallowed, and tried to contain the twitch round her mouth. Then, too quietly, she said:

“That’s wonderful. Ivy League. Congratulations. Are you going?”

He felt he owed it to her to maintain eye contact, although he’d rather have looked away.

“If I don’t, my folks’ll want to know why. It’s the best place I applied to. They say it’s good to live on campus. Dad went to a commuter college. He missed out on the social life.”

“Is that how you feel too?” she asked.

“I don’t know. It’s an important decision and I want to make the right one. Six months ago I wouldn’t have hesitated for a moment.”

She took a deep breath. “Then don’t now.”

“Don’t go?”

“Don’t hesitate. Look, Josh, we don’t have to play games. I’m going to miss you, I can’t begin to tell you how much; and I know you’ll miss me. But when you think about it—”

“It’s hard.”

“—it’s straightforward. We’re both pretty young, especially me. We don’t know what’s going to happen. Imagine you settle for second best just so we can be in the same city. Years from now, if we’re still seeing each other, I’ll feel guilty for standing in your way. If we’re not, you’ll be mad at me for the same reason.”

“God, you make it sound so easy.”

“I didn’t say it was easy to do, it’s the decision that’s easy. Your education comes first.”

He looked at her admiringly. “Why is it that my brain’s all fogged up, and you see things so clearly?”

“Because,” she answered slowly, getting up and walking toward him, “I’m a girl.”

At that moment Karen entered the front door. Seeing Eden and Josh in the living room, she invited him to stay for dinner.

“I wish I could, but we’re having company and I have to put in a command appearance.”

Karen saw him out with a friendly smile. Turning to Eden after he had left, she asked:

“How was Death of a Salesman?”

“Good. I told Josh about the heart murmur. Now he’s more worried than I am.”

Karen averted her eyes for a moment. “I think he’s fond of you, Edie.”

“An old friend of the family.”

“He’s a good boy, but don’t get too involved.”

“What’s ‘too involved,’ Mom,” Eden asked with irritation. “Other girls my age have boyfriends. What do you think we do?”

“Knowing you both, I’m sure you’re not doing anything you shouldn’t. I just don’t want you to commit yourself so young. You have your whole life ahead of you, and you have your career to think about. Juggling that with a family isn’t as easy as it sounds.”

No sooner had she said this than she realized how silly she sounded. Eden’s only sixteen, she reminded herself, and not about to commit herself to anything. She still has two years of high school, and Josh’ll be off at college. However, Karen also knew the source of her exaggerated concern ― and she felt some justification. What if she was overreacting? The substance of her concern was valid. Her own history was proof.

Eden knew nothing about her mother’s inner struggle. “Don’t worry about my career, Mom. I don’t know what that’s going to be. And as regards a family, I sort of like the idea.”

She excused herself, went to her room, closed the door softly, and lay down on her bed. For half a minute or so she stared unseeing at the ceiling. Then she closed her eyes and wept angry tears.