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Macmillan Childrens Publishing Group


A Novel

Michael Palmer and Daniel Palmer; read by Hillary Huber

Macmillan Audio




You really don’t know what you’ve got till it’s gone.

On nights like this, when Walter McKenna could barely get air into his lungs, and each breath came ragged and raw, the lyrics from the Joni Mitchell tune popped into his head and he’d grimace, thinking she was right. Damn right. In Walter’s case, it was heart disease that had paved over the paradise of his good health. It zapped most of Walter’s remaining strength and left him perpetually exhausted.

With great effort, Walter managed to sit up in his hospital bed. He had to do something to take the pressure off his bedsores—decubitus ulcers, his doctors called them—that had again formed on his buttocks and back.

Even in this new position, Walter felt them rubbing on the bedsheets. The pain brought him to tears. To keep new ulcers from forming, Walter endured daily chemical debridement. But that was better than the hives that had broken out a few weeks ago. Those were brutal little suckers. The pale red bumps came on like a speeding train, coating his entire body, and causing horrible itching that antihistamines could barely subdue.

If he were back home, Walter could at least enjoy some familiar comforts, but he was long past that possibility. Walter cursed softly. The hospital was his home now, and had been for months. Tomorrow’s debridement was just another bit of suffering to add to his growing list of miseries.

He shifted position again, but it was impossible to get comfortable. His legs and arms were weighted with so much fluid he felt like a human water balloon. He also felt intense pressure on his bladder, and relieved himself into his catheter. Peeing into a tube, shitting into a bedpan: this was life with end-stage heart disease.

In the morning, Melinda, Walter’s wife of twenty-five years, would show up and they would watch television together and talk pleasantly during the commercials. She would bring him updates from the high school track team where he ran as a boy and coached as a man, and this would make him feel both happy and sad. She would try to hold his hand, but his fingers were stiff and achy, grotesquely engorged, and it hurt to be touched.

Now, just the thought of Melinda tightened Walter’s chest, squeezing his heart. He made a loud sucking sound through his oxygen cannula, like the last gasp of a dying breath. But it was not his last gasp. Even though Walter’s arteries were clogged with plaque, the surrounding muscles starved for oxygen, and his ventricular function had downshifted from a sprint to a limp, he was still very much alive. A permanent resident in what he morbidly referred to as God’s waiting room.

When the figure appeared in the doorway, Walter wondered for a second if he were dreaming. But the pain was present as always, and thank goodness his dreams were not that cruel. Still, doctors rarely stopped in at night unless they had good reason. Walter listened to the beeps, hums, and buzzes—the white noise of all the monitors attached to him—without a sense that anything was abnormal.

But the doctor was here, so Walter figured he had to have a good reason. This doc wore a waist-length white lab coat, a crisply pressed shirt, and a bold red tie. He was Walter’s hospitalist, a specialist in administering general medical care to hospitalized patients. Lots of different hospitalists looked after Walter—so many, in fact, that he had taken to calling all of them Doc.

“What’s up, Doc?” Walter croaked. He needed a sip of water, but was too weak to reach the glass himself. Doc noticed and gave Walter a drink.

“Just making rounds,” Doc said.

“This late?”

Doc said nothing. From a black leather medical bag, Doc removed a bag of medicine, some clear liquid, and hooked it up to Walter’s IV.

“Hey, I’ve got more bags hanging on that IV tree than a luggage carousel at Logan. What’s with the new meds?”

Doc returned a half smile. “Just a refresh of your ACE inhibitor,” he said.

Walter, who’d taught high school physics for more than two decades, had little trouble absorbing all the medical jargon tossed his way. The angiotensin-converting-enzyme inhibitor would lower his blood pressure by decreasing oxygen demand from the heart. It was all duct tape and glue to keep a leaky vessel afloat another day longer, but Walter preferred that to the alternative.

Doc titrated the new IV medication and did a quick check of Walter’s vitals.

“How you feeling, Walt?” Doc asked.

“Like I’m dying,” Walt said.

“Everyone is dying, Walt. We’re just moving at different rates of speed, is all.”

Walter could not argue there.

“Any unusual discomfort?” Doc asked.

Walter paused, as if he could have a new pain to which he was not yet attuned, but, no, nothing was out of the ordinary. He said as much.

“So, any big plans for tomorrow?” Doc’s tone was a bit too sardonic, but Walter appreciated any hint of levity, even if it was gallows humor.

Several loud beeps rang out, and Walter’s EKG burst into an erratic series of peaks and valleys.

“Just the meds kicking in,” Doc said as he adjusted something on Walter’s EKG monitor. “I gave you a big dose, so it will take effect right away.” Walter’s heartbeat revved up several notches. His lungs, already thick with fluid, felt as if they’d been put in a vise.

The evening nurse popped her head in. “Oh—hi, Doctor. I was just checking on him because his monitor is alarming.”

“Thank you, Judy. We’re all set here. With his paperwork, I mean.”

The nurse returned a look of grim acknowledgment that set Walter on edge. Paperwork. Walter thought he understood the reference. Alarms were a constant on this floor, and he had a signed DNR that meant caregivers were not to perform CPR if his breathing should stop or his heart stop beating.

I’m having a reaction to the meds, Walter thought in a panic. Got to relax. Take it easy. I’m not ready.

“What’d you give me, Doc?” Walter asked. A stab of chest pain took his breath away.

“Just a little something to take care of people who have no business living,” Doc said.

Walter waited for a hint of a smile, some indication this was Doc’s tasteless humor on display once more, but his expression was cold as stone. Walter glanced toward the doorway, hopeful the nurse would reappear, but she had already left, probably headed back to the nurses station. No rush. No urgency. Damn that DNR.

Walter found himself gasping for breath. His body grew hot, and sweat blanketed his forehead. Gripping the bedsheets like a horse’s reins, Walter tried to slow the canter of his heart.

“I feel kind of funny, Doc,” Walter wheezed.

Stinging drops of perspiration rolled into Walter’s eyes. The pressure on his chest intensified. Walter took in several sharp, short breaths, but could not seem to fill his lungs.

A sharp, crushing pain took away what little breath remained. Unable to speak, Walter pawed the air, trying to get Doc’s attention. A wave of nausea overtook him, and a strange pressure built up at the base of his neck. Walter’s fingers turned a horrifying shade of dark violet. The gurgling in his lungs bubbled up to his throat. His heart skittered with irregular beats. A spasm of coughing shook Walter’s ribs so violently he thought they would break. His arms began to ache, and Walter felt an overwhelming sense of dread, of impending doom. Something was terribly wrong with him.

“Doc … Doc,” Walter coughed in breathless sputters. “I think … I’m … having … heart attack.”

Doc titrated the IV once more. “You are, Walt. A big one. The big one, in fact.”

Walter’s eyes rolled into the back of his head. His heart seemed to bounce freely around his chest. From somewhere in the whiteness and the blackness of this strange place where Walter now found himself, he heard a familiar sound. A melody. Some song. A tune he once loved. Yes, there it was, echoing softly in his mind. The words came to him, as did the angelic glow of Melinda’s face.

You don’t know what you’ve got till it’s gone …


Copyright © 2016 by Daniel Palmer