With a neutral expression, Diana studied her for a moment.
Years of not only surviving but thriving in the hierarchical world of medicine had taught Jess to withstand even the most heated glare. Never had she needed to suppress the instinct to squirm the way she did now.
After a few seconds that felt like an hour, Diana stood and got the machine. She positioned herself on a stool next to the gurney as the machine’s computer booted up. “You know, I’ve no experience. But I’m willing to try.”
“Lucky for you, I’m a cardiologist. I’ll talk you through it.” Almost giddy with relief she didn’t have to face one of the techs or her colleagues, Jess pulled down the thin sheet that covered her.
She was naked underneath and didn’t want to know when and how that had happened. She slightly rolled onto her left side and repositioned the sticker of an EKG lead that dug into her skin as her left breast came to rest on the gurney. Jess suppressed a sigh. Even half a year ago, her breasts had still been the perky almost-but-not-quite-Bs she’d had since high school. During the pregnancy, they had become these bursting bags of milk. She directed her gaze to the monitor. This wasn’t the time to think about the price her body had paid for Ella. Anyway, her daughter was worth every pound she’d gained.
Diana shook the gel bottle with an ease that spoke of experience. Either she had done more than a few ultrasound examinations before, or she took ketchup to every meal. The gel glistened on the small ultrasound wand when Diana squirted a blob on it. “This might be cold.”
Jess rolled her eyes. How often had she said the same thing?
“Sorry, I said that on autopilot. Where do you want me to start? I know how to check for pericardial tamponade, but we’re not looking for a hematoma now, right?” Diana hovered with the wand at the swell of Jess’s left breast.
It was obvious Diana knew more than she let on, but Jess appreciated that she let her have at least a little control over the situation. “Left parasternal, third intercostal space, index mark pointing to my right shoulder.”
As the wand made contact with her skin, Jess flinched and held her breath. Hopefully Diana thought it was cold and not fear that produced the reaction.
She needn’t have worried. Diana’s gaze stayed on the monitor as she twisted and angled the wand. It wasn’t hard to guess the exact moment she produced a clear picture. A proud smile lit up her face. Just as fast, it vanished again, replaced by a frown. “Oh.” The sound that escaped Diana was the last thing a patient wanted to hear.
The monitor was filled with white lines on a black background showing barely any movement. For any other patient, the sight would mean nothing. But Jess had spent more years than she’d like to admit looking at similar pictures, and the diagnosis sprung to her mind: acute heart failure. Oh, fuck.
That couldn’t be true. That wasn’t her heart. No, no, no.
But the cold gel freezing her skin and the lines on the monitor moving in sync with her pounding heart left no doubt. Icy waves crashed over her head, and she fought to keep from drowning in fear.
She clenched her fists. Ella, think of Ella. Fight this!
“I’m not a cardiologist, but…” Diana looked at her with concern. “This isn’t normal. The heart is hardly moving.”
“Yes. Freeze that picture for a second.” Jess leaned up and brushed Diana’s hand away from the console of the ultrasound machine. “Let me measure the EF.” With practiced movements, she confirmed what her trained gaze had already guesstimated. An absurdly low number stared back at her. She hesitated over the save button but eventually pushed it. This was too serious to pretend it would go away on its own.
Jess let herself fall back on the gurney with a sigh. What had caused this? She tried to take a mental step back as if the lines and numbers on the screen belonged to another patient. “Myocarditis? Coronary ischemia? Both are unlikely.” What else? There was something, but she was so tired that her thoughts faded away as if shrouded by thick winter fog.
Diana studied her for a second. “I know it’s rare, but—”
“If it’s rare, you can forget about it. All residents want to capture the elusive zebra, but all we ever see are plain horses.” Jess grimaced. If she had a dollar for every suggestion of a rare disease from a student or resident that had turned out to be another routine case, she wouldn’t ever have to work another day.
“Indulge me for a second, just like I indulged in your secret examination here.” Diana’s tone was gently teasing, something Jess had never experienced at work.
Jess couldn’t summon the energy to protest. She nodded and gestured for Diana to go on.
“I recently read an article about peripartum cardiomyopathy and how it’s a severely underdiagnosed disease. Most women have a mild case, and the symptoms are similar to ordinary exhaustion and lack of sleep, but some develop an acute heart failure. What do you think?”
“PPCM?” The idea sliced through the fog in her mind like a signal fire. It was rare, but everything fit. She was a healthy woman without prior history of heart disease who had delivered a child not long ago. Maybe Diana was on to something. “We can’t test for it. We’d have to rule out everything else first. Let’s call a colleague of mine, and you present the facts. If he agrees with your conclusion, I’m willing to entertain the idea.”
“Who do you want me to call?” Diana
