Chapter 7
"Call me Charlie," the worried man remarked. "There are already way too many doctors around here."
"Do you want to wait until your brother gets here? It might be best to have an extra set of ears to…" Dr. Cosmos started to explain.
"No!" Charlie announced in a voice that to his own ears sounded an octave higher than normal. "Just tell me what you came in here to discuss."
Charlie swung his legs down. He was not about to have an important conversation looking totally helpless. Charlie teetered on the edge of the exam table. The sensation he had as he started walking towards Van Acker's office building was back: the suffocating feeling. It felt exactly the same. To make matters even worse, his heart had started beating double time in his chest. Charlie felt like he was drowning even as his brain was trying to tell him that was impossible.
Charlie panicked. He managed to get out a strangled warning, "I can't breathe!"
Andrew Cosmos swiftly maneuvered his frightened patient so that Charlie's back was once again resting against the raised portion of the exam table. Andrew forcibly told Charlie to pull his legs up. When Charlie did as he was told; the cardiologist pushed the young man's head down so that Charlie's forehead rested on his knees. He placed a warm comforting hand on the back of the young man's neck.
Andrew Cosmos issued another instruction. This time, however, knowing that he had the man's attention the physician used a more soothing tone. "Focus on the sound of my voice."
Charlie's hand shot out and he grabbed onto a handful of lab coat and held on to the life line.
Andrew Cosmos bent his head so that it was just inches from his patient's ear and calmly stated, "You are getting air in."
He continued to hold on to Charlie's neck, but now with a considerably lighter touch. Andrew Cosmos reassured a far less resistant Charlie Eppes.
"Take nice long even breaths." The cardiologist patiently instructed. He felt the death grip on his lab coat fall away. "Good. Charlie. Continue focusing on your breathing."
Andrew Cosmos checked the monitors.
"You've got this." Andrew Cosmos exclaimed as he kept his eyes on the latest readouts.
Charlie managed to get his breathing under control.
Andrew Cosmos, not known for his award-winning bedside manner, gave his patient a couple "that a boy" pat's on the back. He then gave instructions for Charlie to lower his legs and to place his head back against the raised pillow.
A tired Charlie did as he was instructed.
"Charlie, when you're ready, we'll start our discussion." Andrew Cosmos stated.
"I'm ready if we are going to discuss how I am going to go home tonight and get to leave for Cabo tomorrow." Charlie responded. He was still holding out hope that everything would fall into place.
"Charlie, I would love to be able to tell you that you have clearance for both those things." Andrew Cosmos replied. "Getting you back home is our ultimate goal. Cabo is not even under consideration."
"Okay," A crushed Charlie quietly answered. He blinked back tears.
Andrew Cosmos tried not to notice that he had just stomped the stuffing out of Bambi. Instead, he focused on the readouts.
"So there's a substantial age gap between you and your brother, Don." Andrew Cosmos pulled over a stool and sat down.
"Five years" Charlie replied warily.
"I heard from a colleague that you're some sort of super smart mathematician." Andrew Cosmos stated dryly. He had no idea who Charles Edward Eppes was or how important the young man was when they were first introduced. Then Andrew was informed of his patient's seemingly vast achievements via a colleague, Dr. Brain Cho, neurosurgeon extraordinaire, who went all fanboy after Charlie was wheeled past on his way to an exam room.
"I'm pretty good." Charlie replied with a straight face.
Andrew noted the small smile that had appeared on the drawn and tired man's face.
He liked the young man's unpretentious nature. Andrew Cosmos had treated some very powerful movers and shakers during his long distinguished career. He found that 97% of the time "movers and shakers" were pretentious human beings who lived to hear about their achievements and greatness. Charlie Eppes, however, appeared to be one of the rare 3% who were truly likable human beings.
"Is your brother also in the academic field?" The older man questioned.
"Hardly." Charlie replied. A smile returned to his face. "Don has a distinguished career with the FBI. He is a Special Agent In Charge. He's the go-to-guy when they encounter tough cases." Charlie boasted.
Andrew Cosmos noted the pride in his patient's voice when talking about his sibling. There was obviously a good bond between the two brothers.
"My dad, Alan, was a city planner but he chose to retire early after my mom's cancer recurrence." My mom, Margaret, died three and a half years ago."
Charlie knew his doctor was trying to find some common ground. He had watched Don use the same technique during interviews. However, Don was a lot more subtle.
"I'm sorry about your mother, Charlie." The doctor replied earnestly. Andrew mentally noted that in this case he would be dealing with not one, but three emotionally wounded men.
"My dad was really good at what he did." Charlie said proudly, "I think he is actively considering going back to work."
Charlie did not know why he kept volunteering information. It was not like he believed the physician was actually interested in his answers. Charlie just felt the need to keep talking.
"Good for him." Andrew Cosmos honestly responded. He was doing his best to keep a professional distance from the engaging man, but the longer Charlie Eppes talked the more difficult it was becoming. Any minute now the cardiologist was afraid his patient was going to reveal the names of his childhood pets.
"You know it's true what they say about idle minds." The doctor volunteered.
"I wouldn't know," Charlie dead panned. "Mine's been on overdrive going on three hundred forty-two months now.
Andrew Cosmos knew right then and there that this case was going to cause him to lose sleep. He snorted out a laugh.
Charlie, happy to see that his doctor appeared to have human emotions, smiled.
The young man's smile gave Andrew Cosmos a small sense of relief. Charlie obviously had coping mechanisms in place and a tight family unit.
Andrew had a sinking feeling that after further testing; the rug was going to be pulled out from under Charlie, his father and brother.
"Why am I still here." Charlie asked bluntly. He was finished with the "gain his trust" exercise.
Andrew Cosmos, held up one finger, and quickly checked his phone. A text from his head nurse stated that Don Eppes was stuck in traffic and his ETA was approximately 15 minutes. When Andrew looked up; he could tell by the set look on his patient's face that Charlie was not going to wait fifteen minutes for an answer.
Andrew tried anyway.
"I think it would be beneficial to have this discussion with the added support of…"
"No." Charlie decreed.
"Your brother is expected in fifteen minutes." The physician proposed.
"I'm not waiting fifteen minutes." Charlie declared forcibly.
Despite major reservations; the cardiologist proceeded. "A key measure of a heart's pumping ability is the ejection fraction of the left ventricle. What is considered a healthy level is 60 percent."
"Alright," Charlie said quietly.
"A healthy level is 60 percent." Andrew Cosmos repeated. "Charlie your level is 25." The doctor waited for the young man to digest the information.
When Charlie nodded; Andrew Cosmos continued.
"Also, taking into consideration your declining health and the occurrence of irregular heartbeats." Andrew Cosmos added.
Charlie got stuck on the phrase "declining health." He closed his eyes.
"Charlie?" The doctor inched his stool closer to the table. "Let's take a break and wait for…"
Charlie opened his eyes and looked directly at the cardiologist. "Continue."
"I will, " Andrew Cosmos conceded. "But at any point…"
"Continue," Charlie demanded. "Please."
The cardiologist followed his patient's instructions and continued. "Based on your current health status and irregular heart beats my next step would be to perform a catheterization in order to check for coronary disease." He watched the color drain from his young patient's face.
"Charlie, I think we should take a minute to regroup and then…"
"I don't need to regroup. Continue." Charlie directed the doctor. He wanted the discussion to continue even as his determination to remain resilient was beginning to waver.
"However, I don't feel that coronary disease is what I am seeing in your case. I strongly feel that we are dealing with a specific type of myocarditis." Andrew Cosmos felt himself come under a dark stare. "Myocarditis is an inflammation of the heart muscle."
"An inflammation is usually caused by a virus." Charlie helpfully volunteered. While he did not possess a medical degree; Charlie was certain that all that was needed was the right antibiotic to help knock the virus out of his system. A feeling of relief flooded Charlie.
"The causes are wide: anything from a virus to bacteria." Andrew Cosmos answered carefully. He saw the change in his patient's demeanor and knew where the young man's thoughts had gone.
Relief for Charlie was short-lived.
Andrew Cosmos concluded that due to his rapidly declining health (the physician watched as Charlie flinched) that a heart biopsy was now a priority.
Charlie's brain was flooded with words: rapidly, declining, inflammation, irregularities, myocarditis, heart biopsy.
He put out a hand and asked the doctor to stop talking. Charlie explained that he needed time to digest all the information presented.
Andrew Cosmos gave his patient the space Chalrie requested. He pushed his stool back a couple of inches and busied himself with entering notes; all the while keeping a careful watch on his rocked patient.
The cardiologist had a lengthy conference with his long-time partner, Ana Vaidya (a noteworthy cardiothoraric surgeon) which had left Charlie "stuck" in the exam room. They had both come to the conclusion that a diagnosis of heart disease was not an easy fit for Charlie. There was something more going on.
Andrew Cosmos revealed to his partner, Ana, that it was his belief that performing an angiogram on Charlie was not going to yield the answers that Andrew needed. It was decided (after conferring with Charlie's other treating physicians and going over test results) that a biopsy would be a more viable option.
He had been informed by Dr. Van Acker that the physician had taken one look at his new patient and knew Charlie needed ER intervention. Doctor Van Acker stated that he was alarmed when Charlie informed him that he had come to the office unaccompanied. After Charlie passed out; the physician felt an obligation to accompany Charlie to the ER so that the young man had someone with him who could provide medical history should Charlie not be able to do so on his own behalf.
"What does a biopsy entail?" Charlie asked. He needed to know what to expect.
Charlie listened intently as the cardiologist explained how he would be going in through a vein in his neck in order to extract small samples of heart tissue.
It was at that moment that Charlie came to the realization he should have waited for Don to arrive. He felt weighed down by every one of the doctor's words.
Charlie angrily swiped away some tears.
"Why is this is happening." Charlie questioned the man seated in front of him.
A light pat on his knee was of little comfort. In fact, it only made the moment worse for Charlie and his hands flew up to cover his eyes.