Clash Of Cultures

46. I Have A Confession

Salman

There were two days left for Noor's wedding. 

Damn it, I shouldn't even have looked at that stupid evite. Now that date is etched in mind forever.

I was grateful however, that I had switched my primary care clinical rotation with the cardiology one. The quick pace of the cardiology service and my interest in this field had helped keep me focused on work instead of her. 

Even my sister and mom had moved back to Kentucky this week. Mustafa's heart was functioning a lot better than it had just a few weeks ago. And while he would still need surgical correction of the anatomy, the surgeons felt it best to let him grow a bit so that the surgery becomes a safer procedure. Cutting up tiny little hearts is never an easy job.

So work and the hospital had become my refuge! And the patient we were rounding on right now, was probably the sickest one I had seen on the cardiology service. 

"What's the ejection fraction of this patient?", asked Jason, the senior cardiology fellow I was working with this week.

"It's down to 30% now", I replied. 

Ejection fraction is the percent of blood that the heart pumps to the rest of the body. In a normal 11 year old that should be about 60-75%, so a 30% was dangerously low. 

"Ok, let's put him on the maximum dose of epinephrine and vasopressin, that are helping his heart pump and see if it helps. If it doesn't the only other option would be to put him on the heart-lung bypass machine", Jason said to the bedside nurse. 

"This is such a strange case...11 year old completely healthy kid, with one day of congestion and then he drops dead in the middle of his school's basketball game", I recalled how this child had presented. 

But thanks to the coaches who were trained in CPR and the defibrillator the school had in their gym, they were able to shock his heart and revive him even before the ambulance came. In terms of preserving brain function, his quick revival had given him the best chance to live a relatively normal life. That is, if we could figure out why his heart had stopped in the first place. 

"What is on your list of possible causes?", Jason asked.

I smiled at myself, since I was usually the one asking my junior residents that question.

Guess, I better get used to being at the bottom of the totem pole again as a first year cardiology fellow. 

"Since he was a previously health child, highest on my list would be some sort of an infection, likely a virus, but I would think of other things as well such as a inherited conditions that would affect his heart muscle or the heart's electrical system. And then lastly, since tweens are known to do stupid things, I would think of a toxin or drug ingestion as well. Maybe look at what the latest TikTok trend was"

Jason nodded and said, "Yeah I am going to guess a viral infection too, but we'll know more once we have the biopsy results" 

We stepped out of that patient's room and continued to the next, which was being presented by the intern on our team. I felt my phone buzz in my pocket, and pulled it out. It was a message by Kim. 

'Dummy...when are you going to contact Noor?'

Ugh...why does her name keep coming up?

Can't the world understand that I am trying to get over her?

'Contact her for what? I already asked Sam how Noor's arm was doing and she said it was healing well' I texted her back.

Almost immediately Kim replied, 'Idiot...she called her wedding off'