at the top of the steps and she says, ‘Mike, you’re whiter than the damn snow.’ She called 911.”
“Good decision. I’ve already checked the EKG the first responders sent through and it shows that you’re having a heart attack.” Ethan saw the fear in the man’s eyes and placed a hand on his shoulder. “You’re in good hands, Michael. We’re going to take good care of you and I’ve called the cardiologists.” He turned to the team. “Can we get a repeat EKG? We need two large-bore IVs and let’s get him on a nitro drip. We need to prepare him for the cath lab.” He turned back to his patient, explained what was happening and questioned him carefully.
“I can’t believe it’s my heart. I feel pathetic. It was just a bit of snow. How the hell can this happen?”
“You’re underestimating the physical demands of shoveling snow, especially heavy snow like the storm we had last night.” Ethan slotted his stethoscope into his ears and listened to the man’s chest. “It can be as demanding as a sprint, except that clearing snow usually lasts longer. Maybe a better comparison would be a heavy session on the treadmill. And the combination of cold and physical exertion increases the load on your heart. You probably had a spike in your blood pressure. At least you had the good sense to stop and call 911. We see plenty of folks who keep going, who think they’re being weak and don’t stop. You stopped. That was smart.”
“You’re sure it’s a heart attack?”
Ethan showed him the EKG. “This shows that you’re having what we call a STEMI. That stands for an ST Elevation Myocardial Infarction. We’re going to keep you attached to a heart monitor for now and send you for an angiogram.”
They prepared him for transfer to the cardiac catheterization lab, placing a portable monitor and oxygen tank on the bed.
One of the less experienced interns looked stunned. “Shoveling snow? If he’d been a walk-in I would have assumed he’d pulled a muscle.”
“If someone comes in with chest pains after they’ve been shoveling snow, assume it’s a heart attack. He needs PCI in the cardiac catheterization lab. We aim for a door-to-balloon time of ninety minutes or less.”
“Ethan? Could you take a look at this?” The triage nurse called him over and Ethan moved on to the next patient.
It was a busy day. His mind was taken up by the demands of his job. His patients.
He didn’t give his sister or her dog a single thought.
HARRIET TUGGED HER wool hat further over her ears and checked the address twice. Normally she picked Madi up from Debra’s house, but her client was flying to the West Coast for a couple of weeks to deal with a family emergency and had left Madi with her brother. He lived in the West Village, which was technically out of the area the Bark Rangers covered, but Harriet told herself this was an exception. She went where her clients went, and if Madi was staying in the west side of lower Manhattan then that was where Harriet would go. It would require some redesigning of her schedule because she wouldn’t be able to handle the walks on the Upper East Side, but they had enough dog walkers in that area to ensure that she should be able to accommodate this latest change of plan.
The temperature had plummeted and an icy wind bit through her clothing. The promised snow had finally started falling.
Harriet was wearing her weatherproof coat and her weatherproof trousers, but still she was shivering.
Debra wanted Harriet to walk Madi twice a day, every day.
“My brother is wonderful and I adore him, but he has no clue about dogs. I’ve promised him you will walk Madi and do whatever is needed. He’s a doctor. Busy. I don’t want Madi to be a bother.”
Knowing Madi as well as she did, Harriet didn’t hold out much hope in that direction.
It wasn’t that Madi was a bother exactly, more that she was acting in a way representative of the breed. Madi was a spaniel, a working dog, intelligent and inquisitive. Harriet adored her, but she hadn’t found her particularly adaptable. She wasn’t convinced she would respond to a change of environment as smoothly as Debra was anticipating.
It was probably a good thing Debra’s brother was a doctor. Presumably he’d be patient and caring and adept at handling difficult situations.
Someone patient and kind was exactly what Madi needed to help her settle into her new home.
She checked the address again. This part of Manhattan was a maze of winding streets. There were bookstores and bistros, bars and coffee houses. It was an area rich in history, with cobblestone streets lined with brownstones and beautiful town houses. It was also an easy place to get lost.
According to Debra, her brother lived in a two-bedroom, two-bathroom duplex loft apartment.
By the time Harriet found the apartment block, the light was fading and the tips of her fingers were numb.
She planned to take Madi for a half-hour walk, although she wasn’t particularly looking forward to it. Not only was her ankle throbbing, but it was never great for the dogs when it had been snowing. The streets were mucky and winter was always hard on the dogs’ paws. She constantly thought about the dogs, about their welfare and what she could do to make their lives the best they could be.
Fliss said it was the reason they had a thriving client base, but Harriet never thought about that side of it. She didn’t do it for the owners, she did it for the animals. Their comfort and happiness was what mattered to her and if that led to a happy owner, then that was a bonus.
Snow or no snow, Madi needed the exercise. Debra had given her the key, and the moment she opened the door to the apartment she knew something was wrong.
She’d fostered enough pets to sense disaster when it was close by.
She had no idea what the apartment looked like normally, but she guessed it was nothing like this.
Cushions lay scattered on the floor, their stuffing surrounding them like clouds. Toilet paper was festooned over the furniture like giant ribbons.
Staring at the mess in dismay and disbelief, Harriet walked through to the kitchen.
There, on top of a mound of dried pasta sat Madi, looking guilty.
“Oh dear. Did you do this? All by yourself? Boy, are you in trouble, young lady. And a bag of flour too. You’ve been busy.” Harriet eyed the snow-like substance covering everything in sight. She dropped her bag, dragged off her hat and her coat and tried to work out where to start. Take the dog out first? Clear up?
She decided that Madi had to be her priority. She’d never known the animal to behave badly before, which had to mean she was distressed. Clearing up could wait. “Poor Madi. What happened? Were you bored? Scared? Is this a very strange place?” She stooped to make a fuss over the dog. She pulled her onto her lap and removed pieces of pasta from her fur. “Don’t worry. I’m here now and everything is going to be fine.”
“I don’t think so. In fact I’d say everything is far from fine.” An icy voice came from the doorway and Harriet turned her head quickly. She hadn’t heard anyone else enter the apartment, and neither had Madi, who wriggled off her lap and bolted for safety, scattering pasta and rice.
The man in the doorway topped six foot, the collar of his long coat turned up against the
