Moonlight Over Manhattan(18)

CHAPTER FIVE


THE SNOW CONTINUED to fall.

In the emergency room, Ethan was busier than ever.

Before he’d left for work, his sister had arrived at his apartment with Madi. He’d been surprised by how calm and well behaved the dog was. Over Thanksgiving her behavior had been close to manic but his sister assured him she’d been overexcited because of the number of people in the house.

It was certainly true that today she seemed like a different dog.

If she carried on like this, they just might make it through.

“So the dog walker—”

“Her name is Harriet, Ethan. Why are you so bad with names?”

“Because people move through my department so quickly I don’t need to remember them. I don’t care about their names or their ambitions. I fix them. That’s it. So Harriet—” Harriet, Harriet, he repeated to himself “—will be coming twice a day? What about snow? Is that going to keep her away?”

“She has never let me down in two years. She’ll be here. I stopped by her apartment on the way here and gave her your key.”

“You gave my key to a stranger. Thanks.”

“She’s not a stranger. She’s a lifesaver—yours. Make sure you’re home to meet her later.”

Satisfied that Madi’s needs were going to be met by someone, if not by him, Ethan focused on his work.

His first patient was a forty-five-year-old male who had suffered chest pains while shoveling snow.

The first responders at the scene had already transmitted the twelve-lead EKG. Someone showed it to Ethan and he instructed them to page the on-call interventional cardiologist.

Moments later the man arrived in the department.

“I was clearing the snow from the steps and I started to feel funny,” he told Ethan. “My chest was kind of tight, like someone was squeezing it. And I thought I was being a wimp, so I carried on. But then my wife appears at the top of the steps and she says, ‘Mike, you’re whiter than the damn snow.’ She called 911.”

“Good decision. I’ve already checked the EKG the first responders sent through and it shows that you’re having a heart attack.” Ethan saw the fear in the man’s eyes and placed a hand on his shoulder. “You’re in good hands, Michael. We’re going to take good care of you and I’ve called the cardiologists.” He turned to the team. “Can we get a repeat EKG? We need two large-bore IVs and let’s get him on a nitro drip. We need to prepare him for the cath lab.” He turned back to his patient, explained what was happening and questioned him carefully.

“I can’t believe it’s my heart. I feel pathetic. It was just a bit of snow. How the hell can this happen?”

“You’re underestimating the physical demands of shoveling snow, especially heavy snow like the storm we had last night.” Ethan slotted his stethoscope into his ears and listened to the man’s chest. “It can be as demanding as a sprint, except that clearing snow usually lasts longer. Maybe a better comparison would be a heavy session on the treadmill. And the combination of cold and physical exertion increases the load on your heart. You probably had a spike in your blood pressure. At least you had the good sense to stop and call 911. We see plenty of folks who keep going, who think they’re being weak and don’t stop. You stopped. That was smart.”

“You’re sure it’s a heart attack?”

Ethan showed him the EKG. “This shows that you’re having what we call a STEMI. That stands for an ST Elevation Myocardial Infarction. We’re going to keep you attached to a heart monitor for now and send you for an angiogram.”

They prepared him for transfer to the cardiac catheterization lab, placing a portable monitor and oxygen tank on the bed.

One of the less experienced interns looked stunned. “Shoveling snow? If he’d been a walk-in I would have assumed he’d pulled a muscle.”

“If someone comes in with chest pains after they’ve been shoveling snow, assume it’s a heart attack. He needs PCI in the cardiac catheterization lab. We aim for a door-to-balloon time of ninety minutes or less.”

“Ethan? Could you take a look at this?” The triage nurse called him over and Ethan moved on to the next patient.

It was a busy day. His mind was taken up by the demands of his job. His patients.

He didn’t give his sister or her dog a single thought.

HARRIET TUGGED HER wool hat further over her ears and checked the address twice. Normally she picked Madi up from Debra’s house, but her client was flying to the West Coast for a couple of weeks to deal with a family emergency and had left Madi with her brother. He lived in the West Village, which was technically out of the area the Bark Rangers covered, but Harriet told herself this was an exception. She went where her clients went, and if Madi was staying in the west side of lower Manhattan then that was where Harriet would go. It would require some redesigning of her schedule because she wouldn’t be able to handle the walks on the Upper East Side, but they had enough dog walkers in that area to ensure that she should be able to accommodate this latest change of plan.

The temperature had plummeted and an icy wind bit through her clothing. The promised snow had finally started falling.

Harriet was wearing her weatherproof coat and her weatherproof trousers, but still she was shivering.