“They actually are quite beautiful,” Julie said, studying them closely.
“I’ve always been drawn to uncommon beauty, until I met Michelle.”
Keith gave his wife a gentle kiss on the forehead, and though the moment was sweet, Julie found it painful. Reminders of all she had lost would be everywhere now. With time, she hoped, they would be easier to accept, though she doubted they could ever be ignored.
“He’s still drawn to uncommon beauty,” Michelle said, a hint of disapproval in her voice. “Now he has rats. A cage of them he keeps downstairs. What are there, six?”
Keith looked a little annoyed.
“About,” he said. “They’re actually wonderful pets, and much easier to take care of than dogs.”
“But less cuddly than cats,” Michelle felt inclined to add.
Keith rolled his eyes. “I think rats are marvelously intelligent and trainable,” he said. “I breed them, it’s a hobby. Happy to show you.”
Winston had made Julie a little uneasy at first. She could not imagine how she would respond to a cage of rats, but she was not about to find out.
“I think I’ll pass,” Julie said.
Keith’s expression took a serious turn. “I know you and Michelle have talked since the funeral,” he said. “But I wanted you to know that the service was very moving. Your eulogy brought tears to my eyes.”
“And he doesn’t cry easily,” Michelle said in a way that suggested some exasperation with her husband’s stoicism.
“Thank you,” said Julie.
The service had been well attended and utterly heartbreaking. Sam’s parents flew back from Michigan, and other relatives and friends traveled even greater distances to pay their respects. Julie’s father had died five years ago, but her seventy-nine-year-old mother was there, supportive as always.
Julie had managed to get through her speech. In it, she talked about Sam: his heart, his compassion, his love for his students, many of whom had come. Many of them were in tears.
“Ever since the funeral, I’ve been letting people turn in front of me,” Keith said. “Your eulogy really made me think.”
It had made a lot of people think, from what Julie heard afterwards.
“Sam loved to ride. It brought him tremendous joy,” Julie had said at the service. “One thing I noticed on our long rides together was that Sam would always slow down and let another driver make a turn, or go in front of him. It wasn’t simply a kind gesture on his part. He was saying something else. He was saying to the other driver, ‘Where you are going is just as important as where I am going.’ This was a theme of his life-your journey is just as important as my journey. He genuinely cared about the lives of other people, and wanted to know everything he could about their journey. And it was this that drew people to Sam’s side.”
“I had the same reaction as Keith,” Michelle said. “It’s like I have a whole new awareness.”
“I’m glad to know that. I just spoke the truth. That was who Sam was.”
“You must still be reeling,” Michelle said.
“Well, to be honest,” Julie said, “I’ve been a bit obsessed.”
“Obsessed? How so?” Michelle asked.
Keith excused himself to fetch another bottle of wine from the cellar. “Don’t get lost down there,” Michelle said. Then to Julie, “I swear, that basement is like his own beetle burrow. He’ll vanish for hours, fiddling away on different projects. Anyway, you were saying.”
“Right, my obsession. The lab results from pathology came back and supported my friend Lucy’s conclusion. Sam died of takotsubo cardiomyopathy.”
Michelle gave a slight shrug. “Is that unusual?”
“Highly,” Julie said. “It’s atypical in men. Usually it’s women over fifty who get it, but it’s rare for them as well. It’s sometimes referred to as ‘broken heart syndrome.’ It’s a stress phenomenon that may be caused by a sudden surge of stress-related hormones, so it could also be triggered by fear.”
“Is it always fatal?” Michelle asked.
“No,” Julie said. “Often the condition reverses itself within a week. It feels like a heart attack, but it’s extremely rare for it to be a fatal one.”
“So it’s different than a heart attack,” Michelle said.
“It is a heart attack, but an unusual one. The EKG read is very distinct. It’s typically not trigged by heart disease, because it’s stress-based, and the autopsy confirmed Sam’s arteries weren’t blocked. Other than that ballooning, Sam’s heart was perfectly healthy. I’ve never seen a case of it, and neither have any of the cardiologists at White I spoke with. It’s very rare-two percent of heart attacks, maybe less.”
“And you said it’s mostly found in women.”
“Menopausal women, to be precise, and yes, ninety percent of the time.”
“So that makes Sam’s case even more unusual,” Michelle said, taking a sip of her wine.
“I’m looking for an expert on takotsubo,” Julie said. “Someone who could review the slides.”
“There’s nobody at White?”
“Not the foremost expert that I’m looking for,” Julie said. “You’d think with my contacts, I’d be able to find the right person, but it’s not that easy.”
“Not that easy for what?” Keith asked, returning to the room with a dusty bottle of red wine.
“Julie is looking for a medical expert who knows about cardio-something,” Michelle said.
“Takotsubo cardiomyopathy,” Julie said.
Keith thought hard a moment. “Ah yeah, I’ve heard of it. Ballooned ventricle. Very unusual.”
He opened the wine, but left it on the table to breathe.
“It’s how Sam died,” Michelle said.
“We think,” Julie clarified. “It’s not definitive. But the markers are there. I’m trying to figure out why it showed up in a healthy, male heart when there wasn’t any associated stress event.”
“Nobody at White could help?” Keith asked.
Julie shook her head, looking defeated. Never before had she spent more time in White Memorial’s sizable research library than she had over these past few days. Her obsessive nature had gotten Julie through medical school, and it kicked in again to fuel her research into this rare heart ailment. Over the course of several days she had nearly drained a bottle of saline drops to keep moisture in eyes dried from hours spent gazing at the computer screen.
“Lots of dead ends and not a lot of leads. I got some names, but so far not a lot of callbacks. Look up ‘busy’ in the dictionary, and you’ll find a picture of a cardiologist.”
Julie was being kind. She had knocked on the doors of almost every cardiologist at White. Badgered them with questions until they stole glances at the clock or their pager. Most were polite, most respected her motivation, but all could give her only a smidge more than what she’d gleaned from her own research. The disease was too unusual for any of them to have more than a cursory understanding of it.
Every ailment had its guru to whom other docs turned for counsel, to whom their patients were referred. Julie needed to find that person for takotsubo cardiomyopathy, but he or she was as elusive as the reason Sam had suddenly presented with the condition.
“We deal with that callback challenge all the time,” Michelle said. “Very Much Alive is always on the hunt for doctors who support our mission.”
Julie’s expression brightened. “You know, I should have asked you sooner,” she said.
“Asked me what?”
“Very Much Alive-you guys are a global organization, right?”
“That’s right. A lot of our focus is on US law, but there are international implications to what we do, sure.”