Syndrome

Excerpt

Sunday, April 5

6:49 a.m.

Alexa Hampton was awakened by a sensation in her chest. The alarm wasn't set to go off for another eleven minutes, but she knew her sleep was finished.

Not again! She rolled over and slapped the blue pillowcase.

That little sound from her heart and the twinges of angina, that catchall for heart discomfort, was happening more and more now, just as Dr. Ekelman had warned her. But she wasn't going to let it stop her from living her life to the fullest as long as she could, and right now that meant having her morning run.

She curled her legs around, onto the floor, reached for a nitroglycerin tab, and slipped it under her tongue. Known as a vasodilator, the nitro lowered the workload on her heart by expanding her veins. It should get her through the workout ....

That was when she felt a warm presence rub against her leg.

"Hi, baby." Still sucking on the tab, she reached over and tousled Knickers' gray‑and‑white hair, then pushed it back from her dog's eyes. Her Old English sheepdog, a huge hirsute off‑road vehicle, turned and licked her hand. Knickers was ready to hit the trail.

She'd been dreaming of Steve when the chest tightness came, and maybe the emotion that stirred up had caused the angina. She still dreamed of him often, and it was always someplace where they had been together and loved, and they were ever on the brink of some disaster. That frequently caused her heart to race, waking her.

This time it was the vacation they took six years ago, in the spring. They were sailing off Norman's Cay in the Bahamas. She was raising the jib, the salt spray in her hair, but then she looked up and realized they were about to ram a reef.

She felt the dreams were her unconscious telling her to beware her current precarious condition. If, as is said, at the moment of your passing, your entire life flashes before your eyes, then the dreams were like that, only in slow motion. It was as though she were being prepared for something. The dreams were a premonition. She had a pretty good idea of what.

Ally had had rheumatic fever when she was five, which went undetected long enough to scar a valve in her heart. The formal name was rheumatoid aortic stenosis, a rare, almost freakish condition that had shaped her entire life. The pediatrician at Mount Sinaihad told her parents they should think twice about allowing her to engage in any vigorous activity. Her heart's function could be deceptively normal during childhood but when she got older . . . Well, why stress that organ now and hasten the inevitable day when it could no longer keep up with the rest of her body?

She had refused to listen. She'd played volleyball in grade school, basketball in high school, and she became a disciplined runner when she went to Columbia to study architecture. She wanted to prove that you could make your heart stronger if you believed hard enough and wanted to live hard enough.

Now, though, it was all catching up. She'd had a complete checkup two weeks ago Thursday, including a stress test and

Doppler echocardiogram, and Dr....