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nibbled and
considered. "To begin with, you have to understand how the heart
works." He took a gold pen out of his hospital white coat, clicked it
open, and started to draw on the paper place mat. "Your heart is shaped
like this." He drew a rough oval and divided it into four quadrants.
"The atria and the ventricles work together, alternately contracting and
relaxing to pump blood. The neuro-electrical system of our body is the power
source that makes this pumping action possible." He looked up and smiled.
He thought he had a killer smile—and he did. Susan smiled back. "This
electrical pulse is triggered in the sinus node, up here in your nasal
passage." He drew a small circle somewhere above theheart, then
traced a line down to the oval as he talked. "The impulse travels a
special pathway like this, down and through your heart, where it then triggers
the heartbeat. In your father's case, something—age, maybe diet or alcohol, or
even stress—has interfered with this delicate process, and when that happens
the heart fails to respond to the impulse and goes out of rhythm. It can then
start to beat erratically. It speeds up or goes way too slow, even sometimes
threatening to shut down, and this is the general condition we call
arrhythmia." He clicked his ballpoint closed for emphasis. "Lecture
over." He returned the pen to his pocket and smiled again.
          "Doctor,
I don't mean to be rude, but I know all of this. He's had four arrhythmias now.
I've had the condition explained to me three times. I'm not looking for a
description of his problem. I'm looking for a cure. Would you mind if we get to
the bottom line? I want facts. I want an actuarial prognosis. I want survival
percentages." A legal mind used to finding solutions jumped out from
behind that angelic mask and surprised him.
          Okay, Lance thought. Go for it. Give her what she wants. "Your
father has severe ventricular tachycardia fibrillation, which is one of the
life-threatening arrhythmias. It requires urgent treatment or death can occur.
Generally, we start with drug therapy and, often, as you know, this can correct
the problem for long periods of time. In your father's case we have seen that
option come and go. Failing that, we still have a range of other options
available to us. One is electrical shock cardioversion. It's basically paddles
and juice to the chest walls. The idea is to shock the heart back into a normal
rhythm."
          "Will that last, if you do it?"
          "It might. It's a case-by-case situation. Sometimes, yes.
Sometimes, no."
          "What else?"
          "We can install a pacemaker under the skin on the chest. It's a
battery unit that monitors the heart rhythm, and when it senses an arrhythmia
it gives the heart a little electric boost that gets it back in rhythm."
          "How long does that take?"
          "About two days. It's normally an outpatient procedure, but
speaking quite bluntly, your father is in pretty bad physical shape. I would
want him here for at least two days."
          "He's got a trial that begins tomorrow morning. He'll never go for
that."
          "Convince him."
          "Yeah, right," she said. "You don't know him. What
else?"
          "Surgery. We induce an arrhythmia, get his heart in fibrillation,
and then, using cameras and probes, we go in through the groin, snake our way up a vein to the heart,
and look for the offending spot—usually, it's a fatty growth of some kind. We
probe for it, watching his heart rate on the monitors and on the TV. When we
hit the problem spot his heart will stop fibrillating, and then we give that
place a little zap of radio frequency and burn it off. In ninety-five percent
of the patients it fixes the problem forever."
          "What are the risks?" Susan asked, prompting Lance to lean
back and lay down his fork.
          "With yours truly on the drums, almost none. I've done forty or
fifty of these radio frequency