Part 33

Monica and David were back in Zander's room again, showing him his EKG. Brenda looked at it, too, leaning on Zander's shoulder, and Donna sat on his other side.

"Each of these is a heartbeat," Monica said, pointing to the squiggly and spikey lines on the EKG, which occurred over and over in the same pattern. "Each of these waves is broken down into parts, with the points designated by the letters - P, Q, R, S and T. A heartbeat starts here at P, the two upper chambers, the atrium, contract, then the electric current passes to the lower chambers, the ventricles, which are bigger, and make this spike, from Q to R to S, and then the ventricles contract, and then the electric current makes the T wave, and then it starts over again. From Q to T represents the time for the electrical activation and inactivation of the ventricles. The EKG measures the time it takes for this whole thing from Q to T to take. If it takes longer than normal, it can cause an abnormality of the heartbeat, very rapid, or fluttering, which can bring on sudden fainting, like you experienced. Even sudden death. Some people are so unfortunate that cardiac arrest and sudden death is their first symptom."

So," he said, looking at one, then the other, "I could just reel off any time."

"No, in fact deaths are preventable where the condition is recognized and treated," Monica said. "That makes this a lucky event, really, if you look at it the right way. Sometimes people have fainting spells, but this gets overlooked, because people think it is a simple passing out."

"I see. What is the treatment?"

"There are medications called beta-blockers are effective in about 90 of patients," Monica said. "In the rest we can implant a pacemaker or use an automatic defibrillator, but we don't usually resort to those unless the patient continued to faint even while on the medications, or went into cardiac arrest as the first symptom. Your father didn't find you to be in a full arrest."

"He's going around saying I could have died."

"Maybe, but you may not have. It was a good thing he was right there, though. People have had these attacks and died or went into a coma for days or weeks, or even just fainted and recovered and never realized the problem. Really you couldn't get luckier than to have this attack right in front of a cardiologist."

"Though he was the one bringing it on," Brenda said.

"True," Monica replied, "but then it could have been from playing sports hard, or from any stressful event. Cameron saying you could have died is Cameron being under the influence of parental worry."

"Speaking of that," Zander said. "What about the baby?"

"We'll check her and keep checking her," David said reassuringly. "We know to be on the lookout. With you, that wasn't so. Something happened before we discovered it."

Zander sighed. "Can she be tested for it?"

"Yes, and all of her check-ups include your history. Which is more than could have been said for yours."

"I'm trying to be upbeat about this," Zander said. "But all I can do is worry."

"You'll be educated about this," David said. "Well all make sure you know all there is to know about it."

"I'm going to decide on a medication and then write you a prescription," Monica said. "And you take it every day. Don't quit because you feel all right. It protects you but it doesn't cure you. OK?"

"How come it works?"

"It slows down the harmful effects of stress hormones on your heart. This medicine also slows your heart rate."

"That makes the interval of Q and T shorter?"

"Not specifically. But that lack of rhythm is less likely to be upset under an overall slower rate and with less effect from stress hormones."

"I see," Zander said. "Thank you."

"I'll go and start working on deciding which one to use," Monica said, leaving them.

"Thanks," Zander said, after her.

"How did you decide on your specialty?" Zander asked David. "Was it your Dad's death?"

"A lot of things, but my Dad's death was one."

"I read that in the write-up you gave me," Zander said. "I thought how he was young to die, but it just didn't hit me. Didn't occur to me at all it might mean something."

"Me neither," David said. "And I should even have thought about it. If a patient came in my office and said that about their grandfather, I might well had ordered an EKG of them even if they had no symptoms at all. I've seen mine and it's normal. The context distracted me away from making that connection."

"You think I'm any less likely to drop dead if I take these pills Dr. Quartermaine talks about?"

"You won't drop dead. You can even teach tennis. You can't be the next Bjorn Borg, but you can play anything recreationally."

"And Ginny?"

"She'll be fine. She can be tested long before she can even think about competitive sports."

"Thank you, David. It's a good thing we did the paternity test."

David smiled, and patted Zander's arm. "Of course it is," he said.