“Let’s hope there aren’t any complications,” Dr. Harmon said with a sigh.

“Isn’t there anything we can do?” Alan knew enough not to set his hopes too high.

“Trying to stop this thing now is like trying to stop the potholes from showing up when the ice melts.”

The verdict was in. No one test alone proves rheumatic fever, but Eden’s symptoms and lab results combined were enough for a diagnosis. What Rick had said was old news; internists know the nature of rheumatic fever. Why had he even asked? Now he could spend weeks waiting to see how deep the potholes were. “At least she isn’t hurting anymore.”

“Typical aspirin response. Too bad it’s only the symptoms that go away, not the process.”

For Eden the symptoms were the process. “Hi, Daddy. I’m better. See?” she had announced, hopping into the kitchen the day before. To prove it she bent and straightened her arms, stood up and sat down. Alan smiled bravely and took her temperature.

“Ninety-nine four. You may as well stay for dinner, but then I want you back in bed.”

“Can’t I help with the dishes?”

“Well, now,” Karen said, eyes wide with astonishment. “Would you consider volunteering sometime when you don’t expect to be turned down?” The answer was a mischievous grin.

Karen waited till she was upstairs before asking Alan, “Please tell me what we’re in for. I know this miraculous cure’s too good to be true.”

“There are various diagnostic possibilities—”

She stamped her foot. “Please, Alan, don’t patronize me. She’s got rheumatic fever, right? Start from there. What’s going to happen to skating, running? Will her fingers be deformed? That’s what I want to know.”

“We assume she has rheumatic fever. But if she does, the heart’s what we have to worry about.”

“Heart! My God! What’s that got to do with her knee and her elbow?” Karen’s panic caught Alan off guard. It hadn’t occurred to him that she wouldn’t automatically make that association.

“I’m sorry, I should’ve led into that. Sit down, and let’s keep our voices low. I’ll explain.”

“This gets worse and worse,” Karen said in a despairing tone. Instead of sitting down, she tried to control her agitation by clearing the dishes. Alan sat at the table, fidgeting with a cup.

“I should get hold of myself,” Karen said. “I’ve been so on edge since this thing began.”

“It’s not your fault. Doctors need to be reminded once in a while how to talk to people. The term ‘rheumatic fever’ is graphic: fever and painful joints. Funny thing is, despite all the pain and swelling, there’s no damage to the joints. You don’t need to worry about her being a cripple. She’ll skate and do everything like before. But rheumatic fever affects the heart too, and it’s the exact opposite.  She can be in perfect health after the attack, and years later she comes up with murmurs.”

“I’ve never understood murmurs,” Karen said. “My cousin was turned down by the army because of one.  Aren’t people born with them?  If Edie had a murmur, wouldn’t Rick know about it?”

“Congenital murmurs are different. Rheumatic fever damages the valves.”

Karen was wiping the counter, her back to him. “Oh Alan,” she said wearily, “All the answers only raise more questions. I don’t think I can absorb any more. I need sleep.”

“Will Frank give you a hard time about staying home?”

Mention of her boss at the law office arrested her hand in mid-air. It was a moment before she answered. “He knows I have responsibilities at home. He expects no more than he’s getting.”

The last was said in such a flat tone that Alan feared more was to come. He got up and put his arm around her. She turned away, wiping her eyes with the hand towel. He knew they were at that point again, where neither words nor silence offered any comfort. She left the kitchen.

~~~~~~~~~~

Alan had a dream. He was walking with a little girl. In one hand she clutched a cage with a bird; with the other she held tightly onto his.  A cold wind came up and she became frightened.

“Scarlett’s after me!” she cried. “I want to take the bus.”

“No one’s after you, sweetheart. Don’t be scared,” Alan replied.

“But there’s other horrible things,” the child insisted. “Please let’s take the bus!”

“It’s only a wind. We can walk.”

A bus stopped and a woman motioned them aboard. Alan waved her off, but she persisted. He shook his head and the woman was angry as the bus drove off. Suddenly a storm broke, tearing the child from his hand and breaking her leg. Then her arm broke too. A heavy-set man glared at him, but the limbs healed right under his eyes. A blast of hail sprang open the cage and the bird escaped.

“Cordie’s gone! I want my Cordie!” The child cried.

Alan woke to the sound of rain pelting against the window.  Karen was asleep beside him.

~~~~~~~~~~

Rick Harmon came next evening carrying a box. “I don’t need to explain this, do I?” he asked, opening the portable electrocardiograph. “After I’ve checked her out, I’ll do an EKG ― for baseline. Then a shot of Bicillin in case there are still bugs hanging around. She’s not allergic, I hope?”

“Not as far as we know,” Alan said. “Don’t remember her ever getting any.”

“Neither do I,” Rick continued. “When I’m done, I’ll come down and we can talk.”

He knocked on Eden’s door and went in. “How’re you holding up, young lady?”

“Great. The other knee felt a bit stiff this morning, but it never got real bad.”

“Good! But don’t get any ideas of running around. Not until Simon says ‘Run.’ ”

“OK, Doctor Simon. A bedpan, if you please. I have to go. Maybe run.”

Make a child feel better, and instantly all is forgiven and forgotten. No questions about causes and meanings, no worries about the future. It was one reason Rick liked pediatrics.

“Now I have to listen to your chest,” he said after confirming that her joints were improved.

“My chest’s fine. I don’t hurt there.”

“Thank goodness for that. Still, I have to listen. Then I’ll explain.”

She held still while he examined her. “Find anything?”

“Not a thing. Sounds fine. I have to check because you might have rheumatic fever, which sometimes affects the heart. I also have to take an EKG.”

“I’m sure my heart’s OK. I can feel my pulse, see?” She demonstrated. “And if I close my eyes and concentrate real hard, I can feel my body shake a teeny bit every time my heart beats.”

“You’re quite an observer.”

“What do you need the KGE for?”

“EKG. It shows the electric currents in your heart.”

“Electric!”

“It’s not like your electric outlets. You can’t get a shock from your own body. When the heart beats, there’s something like a tiny flash of light, so tiny you can’t see it. The EKG picks it up.”

“That’s amazing. Wait till I tell Josh. How do you do it?”

“Who’s Josh?” He unfurled the wires and attached the electrodes to her wrists and ankles.

“Why there? I thought you said my heart. Josh is Debbie’s brother.”

“Your body conducts electricity, all the way to your hands and feet. Who’s Debbie?”

“Hey! I never knew that. Debbie’s my friend.”

Rick turned to plug in the machine. “Stop!” Eden shouted. “Now you are going to shock me!”

“No! This plug isn’t connected to you. You won’t feel a thing.  Why don’t you tell Debbie?”

“I don’t trust you. I don’t want to be zapped. Josh’s a wise guy. I’m going to get back at him.”

He sighed.  “I can see I’m going to have to prove it to you.  Tell Josh what a skeptic you are.” He took the electrodes from her limbs and put one on his own wrist.  He picked up the plug.

“Careful!” she shouted, starting to pull him back. With ostentatious nonchalance he plugged in the machine.  Nothing happened. “Do you want me to put on the others too?”

“I guess not,” she replied, still wary. “You’re sure I won’t feel anything?”

“Quite sure. These wires aren’t connected to the outlet, just your body. Now, can we proceed?”

“I’m still scared, but if you promise me it won’t hurt ― I guess so.”

He took the EKG. Now her anxiety was replaced by eagerness. “Can I see it?”

“Another triumph of curiosity over fear.” Rick showed her the tracing with its repeating pattern of blips and waves. “Each set goes with one heartbeat. See? How nice and regular they are?”

Karen had stolen upstairs on hearing Eden’s raised voice, but by the time she got there the alarm had subsided. She stepped inside to find doctor and patient engaged in a study of the EKG.

“I think I’m missing something.”

“Careful, Mommy, don’t touch me, I’m electric! Here, I’ll show you. This is P, this is QRS, and this is T. Isn’t that right, Doctor Harmon?”

“Right on the button. You learn fast. How come you’re not doing that well in school?”

“I haven’t been paying attention,” she answered sheepishly. “I know I should do better.”

“When you go back, you’ll be a heart expert, so flunking math won’t look so good, will it?”

“I promise I’ll try.” Karen smiled.  Another promise.  Eden considered the subject closed.

“Isn’t it great, Mommy? Every time my heart beats, you get these wiggles on the KGE ― I mean GEK. Doctor Harmon, do animals and birds have electricity in their hearts too?”

“They sure do. But that’s enough excitement for one day.” Rick returned the electrodes to the box. “See you tomorrow. And by the way, birds are animals.”

“Oh, I know.” She waved dismissively. She recapitulated. With every heartbeat there’s a teeny flash of light. Maybe if I concentrate really hard I’ll see the flash, just like I feel my body shake. She closed her eyes and waited. Yes! There it is, right inside my eyes, the same steady beat. Fantastic! All those things going on. Plug in an . . . EKG and take a picture.  PQRST. Animals and birds have electric hearts too. How about maggots and caterpillars? They’re not really disgusting now that I think about them.  Josh is right. How would you take a maggot’s EKG? She laughed at the idea; she was happy.

Rick told Karen and Alan that all was in order. “She has a soft flow murmur.  I think that’s all it is.” Seeing Karen’s puzzled look, he explained: “Normal blood flow is audible. If you listen hard enough, you can hear it in anyone. The trick is to recognize the sounds that shouldn’t be there.”

“You really have a way with her. I was listening at the door.”

“I was having fun. If I had more time, I’d hang around just for the pleasure of talking with her.”

“She has real confidence in you—”

“You must have missed the part with the outlets!”

“Is that what she was yelling about?  Obviously you calmed her.  I wish I could be as calm.”

“The difference between grown-ups and children,” Rick answered. “She’s rooted in the present, and she feels good. Period. You’re worried about the future. Enjoy her naïveté while you can.”

~~~~~~~~~~

With time Eden became restless. Her joints no longer hurt, Rick’s visits had become a boring routine, and she had mastered electrocardiography. Then Rick heard a new murmur and, despite her wailing, forbade all strenuous activity. “She has mitral regurgitation,” he told Alan.

“You mean, the valve’s shot already?”

“More likely dilatation of the left ventricle. But cardiac dilatation means carditis, and you know the implications. Also, she must go on prophylaxis as soon as the shot of Bicillin I gave her wears off. Once a month, you know the routine.”

“She’ll want to know why she can’t just take a pill.”

“She can. But if you’ll take my advice, don’t try it. You’ll have to remember every single day. Then she goes away for a weekend, or off to camp, and you have to rely on someone else. Shoot her up once a month and you’ll have peace of mind.”

The murmur did not disappear; it became louder. Then Eden, her eye sharpened by experience, noticed a subtle change in her EKG which might have escaped some medical students twice her age.

“Look,” she said. “This line is longer than it was the other day.”

“You mean this?” Rick asked, pointing to the line between atrial and ventricular blips.

“It looks, like, stretched out.”

“You’re as sharp as ever. I agree. We’ll have to see how it looks next time. Remind me.”

Eden, pleased with her observation, asked to keep the tracing. He ran off an extra strip. The other would be analyzed with calipers, for the change she had noticed was measured in millimeters.

Downstairs, Rick cornered Alan. Karen was in the basement, out of earshot. “She’s got first-degree block,” he said quietly. “P-R interval 0.24 second. More evidence of carditis.”

“Does she know anything new’s happened?”

“Are you kidding? She saw it before I did. I’m glad she didn’t ask what it means. She obviously hasn’t stabilized. Be alert but don’t alarm her by asking pointed questions. Let her come to you.”

“How about Karen?”

“I suggest you say nothing. She’s been through enough. Maybe it’ll go away.”

Alan told Karen the physical exam was normal.

The storm broke two nights later. At one o’clock there was an insistent knocking on their door.

“Edie, what are you doing up? Is something wrong?” Karen asked, sitting bolt upright.

“My chest hurts and I can’t breathe. I’m scared.” Her wheezing was audible across the room the moment she opened the door.

“Alan, wake up!” Karen shook him with one hand while flicking on a light with the other.

In a single fluid motion he swung out of bed and walked toward the door. He took Eden’s hand, led her to the place he had just vacated, and said gently: “Sit here. I’ll be right back.”

He raced downstairs and returned with his stethoscope so fast that his own heart was pounding almost as fast as Eden’s.  Lifting her pajama top, he applied the instrument to her back.

“Ow, cold!” she said.

“I’m sorry, baby. I should’ve warmed it. Now don’t talk, just breathe as if I weren’t listening.”

But listening he was, and what he heard made him turn his face so Karen couldn’t see it. The rales and wheezes spelled heart failure. He had heard it hundreds of times ― in people five or six times as old as she. There was fluid in the air spaces of her lungs. That was why she couldn’t breathe.

He now needed to listen to the heart. Lately, out of respect for her modesty, he had avoided being present any time her torso was not covered. Evidently she didn’t have self-consciousness to match his scruples, for she lifted the front of her pajama top even while he was listening to her back.

“I’m afraid I have to listen to the front, too.” He felt silly saying it, but he was not ready for the change in her body since he’d last seen it. Did respect for her modesty justify not knowing how his twelve-year-old daughter was maturing? Good Lord! He didn’t even know if she was menstruating. What if someone asked and he couldn’t answer? As if he hadn’t been embarrassed enough forgetting what grade she was in. He brushed those questions aside so he could concentrate on the examination. Careful not to touch, he listened to both sides of the sternum. Then, pushing up her tiny left breast with the stethoscope, he listened to the apex of the heart. The murmur and the gallop rhythm ― a triple beat instead of the normal double, typical of heart failure ― were so compelling, even at her heart rate of one hundred twenty, that all other thoughts were crowded out. With deliberate calm, he withdrew the stethoscope, wiped from his face anything that might be construed as concern, and said, “Just sit here. This is the kind of thing Doctor Harmon wants to know about right away.”

“Now? You only get called in the night for emergencies. I can wait till morning.”

Karen and Alan looked with wonder at their child who, even as she fought for her every breath, didn’t want to wake the doctor. But Alan knew what had to be done. “He made me promise to call. He may groan now, but if I don’t call he’ll have my head in the morning. I’ll settle for the groan.”

He went to his study and dialed. He could never understand why a doctor’s spouse would pick up the phone in the middle of the night. Karen didn’t. The call was always for the doctor.

“I’ll get Rick right away.” Rick came on the line. “Let me guess. It’s the heart, isn’t it?”

“Yes, she’s about to go into pulmonary edema, if she isn’t there already.”

“Say no more. Meet me at the emergency room as soon as you can get her there. Carry her if she has trouble walking. If she objects, tell her I insist. Poor girl.”

Eden didn’t resist. Clad in pajamas, a robe, and slippers, she let herself be led to the car. Alan was registering her when Rick walked through the emergency room door.

“We must stop meeting like this!” he growled, making Eden laugh in spite of her distress.

He took her to a cubicle. “Do you hurt anywhere?”

“Here,” she answered, pointing to the lower part of the sternum.

“Lean forward. Now breathe all the way out and wait before taking the next breath, if you can.” He then felt her abdomen. As he pressed gently just under the rib cage on the right, she winced.

“I’ll explain when you’re better. Right now you’re getting an injection. There’s fluid in your lungs and it gets in the way of breathing. You’ve never peed the way you’re going to pee in the next couple of hours. The more you pee, the easier you’ll breathe. You didn’t know breathing and peeing go together, did you? Then we’ll give you pure oxygen through a little tube, which we’ll put right under your nose. And you’ll stay in our guesthouse overnight, second floor. The nurses will be at your beck and call with bedpan, pillow fluffing, and good food without a grain of salt. We like to pamper our guests.”

“I’m flattered. When can I go home?”

“What? You just got here. I’m offended! Let’s talk about it in the morning.”

“OK.” The diuretic injection was ready even before Rick wrote the order. Eden was wheeled to the elevator, leaving the three adults by themselves.

“Friction rub, too,” Rick said to Alan. “Did you hear it?”

“No, I missed it.” He had been too flustered to listen for it, but there was no need to say so.

“You had to get her to lean forward and exhale. Maybe you were squeamish examining your pubescent daughter? It’s natural. Right now, just be a parent. I’ll be the doctor. Liver’s congested too. Your diagnosis was right on the button. I’m starting her on steroids.”

“Can you give us any idea how long she has to stay,” Karen asked.

“It’ll be a day-to-day thing, but she’ll be laid up for a while, that much I can tell you. Her heart’s inflamed, if you can picture that.  And all the while it has to keep working as hard as ever. Quite an imposition on an organ that sick. Imagine! You sprain your ankle and I say stay off it, do without ankle motion for a while. Upset stomach? Go easy on eating. But the heart, no rest, ever. And the work it does, unbelievable. . . . But Alan can tell you. He treats lots of cardiac patients.”

“My God, the idea of Edie being a cardiac patient—”

“Her heart muscle will recover, which is more than you can say for most of Alan’s cardiacs.”

Karen got the double message. “Is there a part that doesn’t recover?”

“For some reason the valves develop scars years later. The scars may be inconsequential or so bad that the valves don’t work. The best we can do is keep her from getting rheumatic fever again.”

“How do you do that?” Karen asked, expecting there’d be no way.

Rick’s answer was a pleasant surprise.  “That’s the easy part.  Keep her from getting another strep throat. A shot of Bicillin once a month’ll do it.”  He smiled at them.  “One of you will give it.”

Karen was silent for a while.  “Thanks again for everything, Rick. I’m so ignorant.”

“That’s what I get paid for. Go get some sleep.”

Karen leaned back against the seat of the car and closed her eyes. “Poor child. Fighting to breathe. Her heart’s failing. I’m so afraid she’s going to die.” Alan reached out and she grasped his hand with the desperation of one falling into the abyss. He knew Eden’s prognosis was not as grim as the events of the last few hours suggested. Still, he knew that trying to reassure Karen with statistics would only isolate her in her fear. Better share her anxiety even if his was partly feigned.

“Thank God for Rick,” he said. “She couldn’t be in better hands. I know she’ll make it.”

~~~~~~~~~~

Eden made it, but not before her parents and Rick had passed many anxious days. First the heart ballooned alarmingly because its muscle was so weakened.  Then the electrical conducting system was blocked, causing the ventricles to contract irregularly and ineffectively. Eden was transferred to intensive care and treated with steroids to control the inflammation. Doctors were in and out and conferred in huddles. EKG tracings littered the floor. Eden, heavily sedated, paid no attention to the bustle surrounding her. Her parents barely slept.

Slowly the steroids exerted their anti-inflammatory effect, and after many days of fearful waiting electrical connection was restored between the atria and the ventricles. The heartbeat again became regular and the x-ray showed a decrease in heart size. The crisis had passed.

It was her birthday. A white-coated gathering greeted her as she awoke. She gasped, believing for an instant that she was before a celestial welcoming committee. Then she saw the familiar faces. At a signal, oxygen was shut off and a nurse entered pushing a cart. On top of it stood a cake with a single lit candle.

“Happy Birthday!” sang her visitors.

“Is it really my birthday? I must be thirteen. That’s an unlucky number.”

Rick Harmon stepped forward. “If you really want to know, Edie, this is the luckiest birthday you ever had. Now that you’re better, I can tell you, you came close to not having one.”

“I didn’t know I was that sick. But having a birthday in the hospital is sort of weird. And a cake! Thank you.”

The nurse wheeled the cart over and asked Eden to blow out the candle. She was too weak.

“You do it, Mommy,” she said to Karen. Karen obliged and cut the cake.

“First piece for you,” she said to Eden. “It’s salt free. Right, Rick?”

Rick nodded. After the ceremony all except the Averys and Rick left the room.

“Am I going to be OK now?” Eden asked.

“Things are looking up,” Rick answered. “It’ll take a while to get your strength back, so we’ll leave now. Just a little oxygen for the next few days. We had it shut off because of the candle.”

As they turned to the door, Eden asked: “Why only one candle?”

The others looked to Alan to give the agreed-on answer.

“A new lease on life; first birthday. Just symbolic. Next year you’ll be fourteen.”

Eden laughed and asked for a second piece.

~~~~~~~~~~

Karen and Alan did not allow themselves to believe that Eden’s problems were over. They had been too close to the edge to turn their backs on anxiety. To Karen the future looked ominous, for she lacked the medical education against which to measure her fears. Caught between the need to know and the pain that knowledge inflicted on her, she kept on asking for details and then wondering why she tortured herself.

Alan did know enough medicine to put Eden’s future in perspective, but he had his own demons to deal with. Rick had never said another word about not treating Eden’s sore throat, but the thought pursued Alan relentlessly. Lying awake in bed, he saw images of her heart fluttering helplessly in its ribcage, her brain pale for lack of blood, arms and legs convulsing, eyes rolling up in sightless stare. Knowing that the present reality was otherwise availed him nothing; his emotions were already tuned to the imagined future. The next attack would kill her for sure; and even without another attack, things could only get worse with time. Alan the prisoner cowered before Alan the accuser, hearing yet again the indictment: You brought this on her.

Medical judgment. Doctors do it all the time. He had made a judgment, and even in Eden’s case he could argue that the odds were on his side. The outcome didn’t imply his reasoning was faulty, any more than if he had passed up a winning lottery ticket; it was just bad luck.

His defense fell short. Guilty. Sentenced to perpetual confrontation with his forgiving victim.