Excellent Marie's illness continues Caduceus : Marie---Part Two by cardiodoug part two of Marie's illness

The stress test ramp’s incline gradually dropped to a flat level as it slowed and stopped. Marie was exhausted. Cindy assisted her off the machine to a nearby stretcher. Dr. Kawalski ran a resting EKG while Marie was lying down. He closely examined the findings. A specific portion of the electrocardiogram, known as the ST segment, had changed. The test was abnormal with definite evidence of myocardial ischemia. After Marie had rested for a few minutes, she was placed on a stretcher, a second EKG was obtained, showing some resolution of ichemia, and the stretcher was positioned with Marie's chest directly beneath a gamma ray scanner. The scanner would anylyze the flow of nuclear, radioactive tracer through her coronaries.  Dr. Kawalski entered the nuclear lab. “Are you okay, Mrs. Conti?” Marie was already feeling better. Her breathing had returned to normal and her leg weakness was gone. “Sure, Doctor. I’m okay now, but I was really getting weak on that thing!”  “Yes, I could see that. I’m glad we did the test today. I’m pretty sure we have a firm diagnosis.” “What’s wrong doctor?  What did the test show?” “Well, it is abnormal. It indicates that you likely have a problem with your heart.” “Oh no! Is it serious?” “As I said earlier, considering your symptoms, I think it’s better to find a problem like this, a problem we can fix, as opposed to other, more ominous conditions. Mrs. Conti, we discovered the source of your symptoms before anything bad happened. You’ve not had a heart attack and I’m confident we can make you feel better with some medication for now. Next week we can investigate further to determine what intervention may be needed." She anxiously asked, “What kind of investigation?” “You’re gonna  need a cardiac catheterization, an angiogram, to look at your coronary arteries. That’s the only sure way to see exactly what’s goin’ on and to determine what treatment needs to be done.” “A cath. What’s that?” “You probably know someone who’s had a coronary bypass or a coronary balloon treatment?” “Sure. I know a few people who’ve had a bypass operation and one of my husband’s friends had that balloon thing.” “Well, all of them had to have a cardiac catheterization to decide what needed to be done.” Marie looked overtly concerned. ”Will I have to have a bypass?” Dr. Kawalski could see his patient’s dread over the thought of heart surgery. “You’re getting ahead of yourself, Mrs. Conti. Let’s say there’s a remote possibility that you'll need surgery. It’s much more likely that the problem can be fixed with a balloon treatment and a stent, what we call a coronary angioplasty. You said your husband’s friend had that done. I assume he did well?” “Yes, he did very well.” “That’s good. The procedure has become very common and it’s getting safer all the time. The results are generally excellent. However, we’re gettin’ way ahead of ourselves. The first thing we need is an angiogram, a cath. Then the cardiologist can tell us what he recommends.” Marie was distraught, thinking of the expense, the hospital stay and Carlo. Mrs. Conti, I really think you'll do fine with this. You can have treatment and live a normal life. I’ll have you see a cardiologist right away. Hopefully, we can have you taken care of next week.” “That’s not the problem, Doctor. It’s my husband. I’m afraid to tell him. He’ll be very upset.” “I’ll be happy to talk with him if you'd like. I can reassure him. He’ll be fine.” “It’s not that he is worried about me. I mean, he will be worried, but that’s not what concerns me. He’ll be angry as well--angry that I came to see you in the first place. It’s a strange situation. It’s embarrassing."   “What situation is that, may I ask? Strange in what way?” “He hates doctors. It’s a long story. He blames doctors for our daughter’s death.” “Your daughter? What happened? When did she die?” “She was only five-years-old. I’d rather not talk about it right now. The problem is that if I need treatment, like one of those balloon things, or worse, bypass surgery, I’m going to have to tell Carlo. He won’t like it.” “Mrs. Conti, I have no idea of what’s goin’ on with your husband, but we have to put your well being ahead of his emotions. You know that.” “Yes, I do. I deal with it everyday. I’ll explain it to him this weekend, but I’m not looking forward to it.” “Please, don’t hesitate to call me if you have trouble with your husband. I’ll be glad to explain everything to him. I’m on call this weekend and I’ll be available if you call the hospital and page me. Here’s the number for the hospital.” He handed Marie a business card with the hospital's number written on the back. “Thank you. I really hope it's not going to be a problem, with my husband I mean."  "I'm sure he'll be fine once he understands how important this is. How long have you and he been married?"   "It will be fifty-three years this summer." "That's a long time, Marie. He must love very much. I think he'll be ok with this." "I'm sure he loves me, doctor. But still. . . . " Kawalski interrupted. We'll work it out, Marie. Please call if you need to talk." “I will. I promise.” “In the mean time, before you see a cardiologist, I' m going to give you some prescriptions. I want you to take one baby aspirin a day. This is very important, Mrs. Conti.  Most people don’t think of aspirin as a medication, but it's very effective at preventing heart attacks. One baby aspirin a day is the ideal dose. I’m also writing prescriptions for two medications. You’ll have a medication called Nitrovasc, that I want you to take every morning, and a second prescription for nitroglycerin. You probably know that nitro is used under your tongue if you have chest pain. You don’t need to take this unless you have symptoms of chest pressure or shortness of breath. Marie, my nurse will explain the details to you. She’ll make an appointment for you to see a cardiologist as soon as possible. Until then, I want you to take it easy. No exertion. Just become a couch potato for a few days. Okay? If your symptoms get worse, call me. Call me at anytime, Mrs. Conti, day or night. I always have my beeper. You simply need to call the hospital operator and ask her to page me.” “I understand, Doctor. I think I’ll be fine. I really want to thank you for being so helpful, Dr. Kawalski.” “That’s my job Mrs. Conti. It’s no problem. I think you'll do well. We’ll fix you up as soon as we can. I want you to return Monday morning for the resting portion of this test. We compare the resting nuclear scan with the exercise scan. That helps to determine the severity of the problem. Please don't eat anything for breakfast on Monday. We'll do some fasting blood work for cholesterol and a few other things when you come in. I’ll see you then.” “I’ll be here. Thanks again.” Marie talked with Kawalski's nurse before leaving the office. On her way home, she stopped at the pharmacy to fill her prescriptions. She was still frightened about telling Carlo of the days events. At least, she thought, I now know what the problem is. That's something good. But Carlo's going to be trouble, I know it. Marie decided to wait a day or so before talking to her husband. She thought it best to relax over the weekend and avoid confrontation. As instructed, she would be a couch potato. She took a dose of aspirin when she arrived home, waiting, as instructed, to start her other medication in the morning. She would have to hide her new medications from Carlo. She watched television that evening and went to bed early. As usual, Carlo stayed up late, doing paper work while watching the news. Marie kneeled at her bedside and prayed, as she did every night. “Dear God, please bless and protect Michael, Laura, and Carlo.” Her prayer continued, asking God to protect her loved ones, her sister, her friends. She never asked for personal help. God was busy enough helping others. She would feel guilty asking him to protect her or provide her with personal favors--she was more concerned about her family than herself. After twenty minutes of humble prayer, she ended, as always, for a request of God’s blessing on Cassandra. Asking God to protect her baby, to love her and hold her in His arms. Marie slipped into bed, pulled the covers up and caressed her pillow. She lie awake for what seemed  hours, thinking about Carlo, worrying about him—fretting over his anticipated reaction to her doctor visit and her health. What would he do if I were gone? He’d be alone and lost. She drifted off to sleep. A short while later she was awakened by Carlo as he crawled into bed. “Hi, honey,” said Marie  Carlo kissed her on the cheek. “Good night.”  Marie quickly returned to slumber. She was walking—strolling through their old neighborhood in North Detroit. A light rain was falling, a warm summer rain. She was wearing a sun dress. The rain turned cold. Marie felt a chill as she looked around the houses. Nothing was familiar. Where is Cassie? Cassie’s lost. I have to find her! Marie was lost. The houses were all run down, some were vacant, some boarded-up, some iin shambles. She felt terror. Th cold rain on her shoulders made her shiver. She screamed, Cassie, where are you?  Her heart pounded, her chest and neck felt full. She screamed again, Cassie, where are you, honey? Please answer me, please baby, tell me where you are. Marie heard a racing engine. She turned, looking over her shoulder. A car was flying down the street. It was their old Ford Fairlane. She bolted, running down the sidewalk as the Ford swerved and jumped the curb, chasing her down. Horror struck as she shot another glance over her shoulder. No one’s driving. The car is empty! Looking ahead, she ran as fast as she could--heart racing, skin cold and clammy. She turned again to look at the approaching car. There was a driver after all; it was Carlo. He had a terrifying, wide eyed look and a toothy grin with huge, bizarre teeth. He screamed, I’ll get you. I’ll kill you for this. The front bumper struck her legs. Marie let out a horrifying shriek as she slid under the car. The Fairlane stopped. An incredible force was crushing her chest. She was pinned against the sidewalk with the full weight of the car on her body. Staring upward, she saw the engine. Grease and oil dripped down on her--her torso was compressed by a hot oil pan. A loud noise filled her head. The engine was roaring.  She felt a crushing pain in her upper left arm and shoulder. She was in tortured misery. The pain in her arm and burning pressure in her chest increased. She tried in vain to pull her arm to the side--forcibly turning her head to the left, scraping her jaw against a hot engine block. She could see her arm and shoulder, smashed against the sidewalk by the car's broken left front axle. Her jaw ached from being burned by hot steel. She was trapped in agonizing pain. She thought of Cassie. I have to find her. She cried out, God help me! God help me, please! To Marie’s amazement, the car disappeared. Her pain was gone: chest pressure, arm pain, shoulder pain, jaw pain, all gone. God is helping me. She was bathed in a glowing warmth--feeling incredibly safe and content. Marie sensed an exquisite taste in her mouth, a wonderful sensation that she had never before known. Her head was filled with beautiful music. All of her senses were pleasantly stimulated. She was caressed by a soft blanket of warmth.  Out of nowhere, came the most beautiful sound she had ever heard. “Hi, Mommy. I’ve been waiting for you. I love you, Mommy.” The alarm clock went off at seven a.m. Carlo jumped out of bed, wide awake as usual. He went to the master bath to get ready for the day. Marie remained in bed, lying silent, still caressing her pillow. It was Sunday. Carlo got ready for church as he had done for the past forty-seven years. For him, Sunday was no different from any day with regards to church. He went to mass seven days a week, a ritual he started years ago, shortly after Cassie’s death. Being obedient to the church and God was what he relied upon to spare him from further pain--the dreaded pain of loosing a child. However, despite attending mass every morning, he remained a Catholic recluse. He knew the parish priest superficially, but always left mass early without talking to anyone. For Carlo, it was personal--between him and God. “Marie, time to get up, honey. We have to get ready for church.”  Carlo shaved, showered and returned to the bedroom with a towel rapped around his waist. “Come on, Marie. We’ll be late.”  Marie was motionless. Carlo walked to the head of the bed and gave his wife a gentle shake. She didn’t move. He leaned down to kiss her on the cheek. Her face was ice cold. Springing upright, with a sense of horrid urgency, he yanked the blankets off his wife’s cold, lifeless body.                                                                  * * * On Monday morning, the phone rang. Carlo answered. “Hello, Mr Conti. This is Dr. Kawalski.” “Doctor who?” “Dr. Kawalski. I saw your wife Saturday.” “You what?’’ “I saw Mrs. Conti, Marie. She’s having some trouble.” “You must be mistaken. My wife never saw you.” “Actually, she did. I know you don’t approve of doctor’s, but she did see me for assessment of fatigue.” “You saw Marie two days ago?” “Yes sir, I did. She was supposed to return to my office today. Since she didn’t show I thought I’d call. How’s she doing?” Carlo was incensed. “What did you do to my wife?” “We did a stress test. I’m concerned about her heart. How is she?” “She’s dead, you asshole. Marie died in her sleep. What did you do to my wife, you son of a bitch?"   Kawalski was shocked. “Mr. Conti, I’m so terribly sorry. What happened?” “She went to bed and died. You killed her, you goddamn crook!” “Mr. Conti, please. . . .“ “Please what, you fuckin’ jerk. I hope you die a painful death, you bastard!” "Mr Conti, I hav. . . ."  "Click" Carlo slammed down the receiver.

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