{"id":193,"date":"2016-09-04T15:56:01","date_gmt":"2016-09-04T19:56:01","guid":{"rendered":"http:\/\/www.herbheineman.com\/?page_id=193"},"modified":"2024-07-25T16:41:42","modified_gmt":"2024-07-25T20:41:42","slug":"chapter-16","status":"publish","type":"page","link":"https:\/\/herbheineman.com\/Eden\/edensgarden\/chapter-16\/","title":{"rendered":"Chapter 16: The Heart"},"content":{"rendered":"\t\t
\n\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t

PART II<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t

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

For two years Rick Harmon\u2019s quarterly reports had been consistently negative. \u201cJust the usual flow murmur,\u201d he would tell Alan. The first omen of things to come appeared when she was fifteen, in the spring of 1986: \u201cSecond aortic sound a little soft, significance unclear.\u201d Alan allowed Rick\u2019s 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.<\/p>

In Rick\u2019s 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. \u201cThere\u2019s a short diastolic blow in the aortic area, and the second sound\u2019s getting softer. I\u2019d 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.\u201d<\/p>

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 \u2015 veteran of thousands of cardiac examinations \u2015 wasn\u2019t sure what he heard, and he was glad when she was dressed. Rick watched his performance with the faintest smile, as if saying, \u201cBetter get used to it.\u201d He sent Eden out to wait and asked Rita. \u201cWhat do you think?\u201d<\/p>

\u201cNo question about it. She\u2019ll need prophylaxis for endocarditis, on top of the Bicillin.\u201d<\/p>

\u201cAre you going to do an echo?\u201d Alan asked.<\/p>

\u201cI don\u2019t think we need it. We heard the murmur. Do you want one, Rick?\u201d<\/p>

\u201cIt\u2019s your call. Follow her with us. If you don\u2019t need an echo, we\u2019ll do without. How about you, Alan?\u201d<\/p>

\u201cWhatever you say.\u201d Maybe he too would hear the murmur eventually.<\/p>

Rita sensed his predicament. \u201cAlan, I know this is a personal thing for you, but don\u2019t let that get in your way.\u00a0 We\u2019re here to help you as well as Edie.\u201d<\/p>

\u201cI appreciate that. Do you hear anything in the mitral area?\u201d<\/p>

\u201cShe may have a degree of mitral insufficiency too. We\u2019ll have to keep listening.\u201d<\/p>

\u201cWhat are we going to tell Edie,\u201d Alan asked, \u201cand who\u2019s going to do the telling?\u201d<\/p>

\u201cWe\u2019ve got to be truthful,\u201d Rick answered, \u201cbut without making her an invalid. Activity won\u2019t hurt her near as much as restricting her. You agree, Rita?\u201d<\/p>

\u201cAbsolutely. I let my patients\u2019 symptoms speak for themselves. Anyway, we\u2019re still examining her every three months. We can change our minds anytime.\u201d<\/p>

\u201cOK,\u201d Rick continued, \u201cnow back to the explanations. This daughter of yours is sharp as a nail. And inquisitive. Remember, Alan?\u201d<\/p>

\u201cYou bet. She already knows all about heart valves.\u201d<\/p>

\u201cI\u2019m not surprised. You\u2019re the teacher, I assume?\u201d<\/p>

\u201cShe wanted to know why she had to keep on being checked years after she got better.\u201d<\/p>

\u201cJust as well,\u201d Rick said. \u201cHow much did you tell her?\u201d<\/p>

\u201cI had to tell her that a scarred valve may not work right.\u201d<\/p>

\u201cDid you mention heart failure?\u201d<\/p>

\u201cNo. But I did mention surgery, as casually as I could. She didn\u2019t buy the comparison with appendectomy, she knew it was open-heart, but I told her it wasn\u2019t that dangerous, and she might never need it. She didn\u2019t push it further, said she didn\u2019t know enough to worry.\u201d<\/p>

Rick took in a whistling breath. \u201cOK, you\u2019ve laid the groundwork, but now you have to go back a step. Not worrying didn\u2019t matter at the time, because you were only talking about a possibility. Now she\u2019s got it. Knowing her, I don\u2019t 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\u2019s quite a celebrity.\u201d<\/p>

\u201cDoes he carry a stethoscope for the use of his disciples?\u201d Alan asked.<\/p>

\u201cGracious, 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.\u201d<\/p>

\u201cWhat if she does bring up heart failure, not being able to skate, that sort of thing?\u201d<\/p>

\u201cI don\u2019t think she will. But if she does, punt. Tell her to ask Doctor Becker!\u201d<\/p>

\u201cI usually tell them,\u201d Rita said, \u201cthat nothing\u2019s 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\u2019t worry that far ahead. Sometimes I wish they would. We\u2019d have fewer of them smoking cigarettes.\u201d<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

\n\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t
<< Chapter 15<\/a><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t

Chapter 17 >><\/a><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

PART II 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\u2019s quarterly reports had been consistently negative. […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":21,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-193","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/pages\/193","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/comments?post=193"}],"version-history":[{"count":5,"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/pages\/193\/revisions"}],"predecessor-version":[{"id":782,"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/pages\/193\/revisions\/782"}],"up":[{"embeddable":true,"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/pages\/21"}],"wp:attachment":[{"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/media?parent=193"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}