"You said I'd probably start getting better in a couple of weeks, that I'd be better in a few months. It's been five months," Annie says, sitting in Dr. Cohen's office facing him across his desk in Philadelphia. "Lisa" had made an appointment with him as quickly as possible after getting home.
Dr. Cohen is going over her test results, explaining where they're at. "Lisa, your left ejection fraction is down to 31%. All your tests are more abnormal than the first day you came to my office. You remember how we discussed that some patients don't get better?"
"But you said that was unlikely," Annie replies, wanting to shut down, wanting to run away.
"It was unlikely. But I think we have to accept that's where things are going now. When your heart tried to heal itself, it built scar tissue. This has made your heart less able to function and enlarged as it works harder to pump your blood. This is called dilated cardiomyopathy. Your heart is failing."
Annie's mind spins. "What does that mean for me?"
Dr. Cohen looks uncomfortable when he answers. "It means that we can work on managing this condition, but that it isn't going to go away. I will be prescribing you several new medications to help your heart today. You need to take it easier than you have been. Your electrophysiologist, Dr. Hayner, recommended that we start to seriously think about you getting an implanted biventricular pacemaker and defibrillator to help your heart function and reduce the risk of sudden death. This can give you time and may even improve your heart function until the time comes when we have to think about other treatments. You have some time to think about that and I'll provide you literature to help you learn about your options there."
Annie just sits there for what seems like forever. She thinks about the fact that her career is over, of letting go of everything she loves, of becoming sick and useless. "How bad is this? What are my odds here, exactly?"
"I can't put a number on your life, Lisa. Statistics don't tell us what will happen to you in particular. Statistically, based on your tests, I would estimate a forty to fifty percent chance of you surviving another five years without a heart transplant."
Annie can't take it. She grabs her purse off the floor, pushes herself out of the chair in Dr. Cohen's office, and bolts. He chases after her for a moment, hands her the literature and prescriptions, tells her to call.