Jim looked pointedly at his boss. “You’re not talking about the cola, right?”
“Fuck no,” Matt said. “Cocaine. I’m gonna need some to get me through this shit.”
Jim closed his eyes tightly and then slowly reopened them. “Matt,” he said softly, “putting aside the fact that I would never deliver cocaine to someone admitted to a hospital for a cardiac workup, I would not even know where to find cocaine, how to buy it, how much to pay for it, or whether or not it is real cocaine. And even if I did, if I were to be caught buying or possessing cocaine, my license to practice as a paramedic would be permanently forfeited.”
Matt looked at him. “You’re not going to do it then?”
“No, I’m not going to do it.”
“What a rip,” Matt grumbled. “Maybe I should’ve let the fuckin’ Mormon stay after all. He would’ve scored for me—especially if I told him he could pinch a little.”
“I’m going to leave now, Matt. I’ll come check on you in the morning.”
“Fine,” Matt said with a sigh.
As Jim reached the door of the ER room, Matt called his name one more time. Jim turned around and looked at him.
“Thanks for saving my ass,” Matt told him.
“It’s what I do,” Jim said with a smile.
Dr. Rostami did a very thorough workup of Matt the next day. He did the nuclear echo test twice, once under resting conditions and once under stress. Both tests indicated that there might be some areas of Matt’s cardiac muscle that were not receiving adequate blood flow. He then got him to the cardiac catheterization lab and inserted a catheter into the femoral artery in Matt’s groin.
“My schlong is usually a lot bigger than that,” Matt told the nurses during this procedure (after being floored with a combination of fentanyl and Versed in his IV line). “You should see it when it’s ready for action.”
“I’m sure it’s impressive,” replied the cute brunette nurse who was monitoring the medications and the IV. “Now hold still.”
“Have you ladies ever heard of a two by four?” he asked them.
They had not, but before he could explain it, they put a little more Versed in his IV and he drifted off into a twilight sleep.
After the procedure, Matt had to lay still on his back for three hours to make sure the artery in his leg had closed up properly. He was then taken back to his room, where Jim was now waiting for him, freshly shaved and showered (and with no fucking cocaine!).
Matt ate his tasteless dinner of some kind of pressed chicken breast with vegetables and longed for a Jack and coke. Just after the dinner dishes were taken away, Dr. Rostami came into the room to discuss the results of the day’s testing.
“The first thing,” he explained, “is that you have significant arteriosclerotic plaque occluding most of your major coronary arteries, including the left anterior descending artery, which provides blood flow to the majority of the left ventricle. It’s actually quite remarkable for the buildup to be that significant in someone your age—even with your stimulant use, diet, and cigarette smoking taken into account.”
“When I do shit, I do it right,” Matt said with a frown.
“Apparently so,” Rostami agreed. “The second thing is that you have significant cardiomegaly, or enlargement of your heart. Only a change in lifestyle is going to make that situation any better.”
“I’ll take that into consideration,” Matt promised. “What about the fucking SVT episodes? Did you figure out why that shit is happening?”
“Well ... again, the underlying cause is undoubtedly your habitual cocaine use, but I was able to identify an area in the atrioventricular node of your heart where the tissue has been damaged due to the stretching of the myocardium.”
“What the fuck does that mean?” Matt asked.
“It means that as your heart stretched and grew in size, an area of the AV node, which is where the electrical signal that makes your heart beat is regulated, became damaged due to a small loss of blood flow to the region. This created an area of non-conduction that causes the signal from your sinus node to occasionally bypass the AV node, which creates what we call a reentry loop, which is what causes your heart to beat so rapidly.”
“Oh ... well, now that you explained it,” Matt said sarcastically, “is there anything I can do about it?”
“The standard first-line of treatment for PSVT episodes is pharmacological,” Rostami said. “We can put you on Verapamil or perhaps another of the calcium channel blockers and hopefully that will...”
“I tried that shit before, doc,” Matt interrupted. “I couldn’t perform on stage when I was taking that shit. I’d get out of breath.”
“I see,” Rostami said. “Well ... there is also a new procedure, something developed at Stanford that we’ve been working on here at this facility. It’s called cardiac ablation.”
“What’s that?” Matt asked.
“It is still kind of experimental at this stage,” Rostami said, “although it is receiving more and more acceptance across the country. The idea is to insert a catheter inside of you, much like we did in the Cath lab earlier today, but the goal is to advance the tip to the area of damage in your AV node and then ablate that region, restoring the signal path.”
“Ablate? What exactly is ablating?”
“Ablation,” Rostami corrected, “and it means to burn away.”
“You want to burn my heart?” Matt asked, just to be clear.
“That is the idea,” Rostami told him. “The problem is that the insurance companies are reluctant to cover the procedure at this point in time. It is still considered experimental and they won’t authorize it until a year’s worth of pharmaceutical therapy has been completed and determined to have failed. That is why it would be in your best interest to start back on the medications and give them a chance. If you take the calcium channel blockers for a year and continue to have these episodes, then the argument for ablation becomes much more compelling and harder for the insurance company to reject.”
“You’re telling me that the insurance company is the one who gets to say whether nor not I get this ablation?” Matt asked.
“Unfortunately, that is the way the system works in the United States,” Rostami said.
“Fuck that shit,” Matt said. “How about if I just paid for this thing myself? Can you do it then?”
Rostami seemed taken aback by this suggestion. “Pay for it yourself? I don’t think that is feasible, Mr. Tisdale. A cardiac ablation is quite expensive.”
“How expensive?” Matt wanted to know.
“Uh ... I don’t have the exact figures in front of me,” he said, “but I would think that the use of the Cath lab, the procedure itself, the two-day stay in the CICU after ... that would have to run pretty close to a hundred thousand dollars.”
“Shit,” Matt scoffed. “Is that all?”
“Is that all?” Rostami asked, astounded.
“I’m a rich motherfucker, doc,” Matt told him. “I just paid more than that to fly the roadies and the rest of the crew home and back for Christmas. Have your people shoot me an estimate and I’ll have my accountant wire the money in. Let’s get this thing booked.”
“Are you serious?” Rostami asked.
“Dead serious,” Matt assured him. “Let’s do this thing.”
Meanwhile, in Los Angeles, Laura Kingsley was on her way to a hospital as well. In this case, the facility was Cedars-Sinai Medical Center, but Laura herself was not the one who needed medical attention. She was going in response to a phone call she had received on her cellular phone from Eric Pale, Celia’s violinist. The young musical prodigy had gone to the emergency room by ambulance six hours before after suffering a severe panic attack. He was doing better now and was being discharged, but, since they had given him medications to chill him out, and since he had no car with him anyway, he needed someone to drive him home.