Day 288 – Writing exercise – the prologue
…
The fluorescent lights of the cardiology suite buzzed with the sterile hum of a greenhouse kept at absolute zero. Agatha sat on the examination table, her posture straight, wrapped in a pale blue paper gown that felt entirely too thin for the weight settling into her chest.
Across from her, Dr Harrison—a man whose salt-and-pepper hair and rimless glasses screamed “academic tenure”—swivelled a heavy monitor toward her. The screen was a chaotic scribble of green neon peaks and valleys, looking less like human biology and more like the visualizer from an illegal warehouse rave in 1996.
“Well, Agatha,” Dr Harrison said, tapping a stylus against the desk. “The mystery of your palpitations is solved. Though I suspect you aren’t going to like the answer.”
Agatha offered a practised, reassuring smile—the same one she used when she had to deal with her more recalcitrant charities seeking more funds. “Try me. I have to deal with very difficult people daily. I’ve survived worse than medical jargon.”
“You have Hypertrophic Obstructive Cardiomyopathy, or HOCM,” Dr Harrison said, his tone shifting into clinical precision. “It’s a genetic condition. The muscular wall—the septum—between your left and right ventricles has grown abnormally thick. On top of that structural bottleneck, your telemetry shows intermittent Atrial Fibrillation. Your upper heart chambers are essentially quivering instead of beating effectively, and your thickened muscle is blocking the outflow of blood to the rest of your body.”
Agatha blinked. “Thickened. Like… a muscle getting stronger at the gym?”
“Not quite,” Dr Harrison said gently. “Think of it like a highway where the lanes have suddenly narrowed, and the engine is misfiring. Your heart is working overtime just to maintain basic output. That pressure, that fatigue you’ve been feeling—it’s your heart screaming for backup.”
Agatha looked down at her hands, resting in her lap. For nineteen years, she had traded neon mesh and strobe lights for cashmere cardigans and beige throw pillows. She had raised twins on her own in a hostile environment, earned a corner office, and mastered the art of quiet, predictable suburban grace. She had buried the girl who danced on speaker stacks until dawn so deep she almost forgot she ever existed.
And now, her own biology was staging a rebellion.
“Okay,” Agatha said, her voice remarkably steady. “What does the fix look like?”
Dr Harrison leaned forward, folding his hands. “First, we adjust your lifestyle. High-intensity cardio is out. Dehydration is your enemy. But pharmacologically, we need to slow your heart rate, allow those stiff ventricles time to fill properly, and strengthen the actual force of the contraction so you don’t pass out walking to your car.”
He tapped a few keys on his keyboard and printed out a prescription sheet, sliding it across the desk.
“We’re going to start you on Digoxin, commonly known as Digitalis,” Dr Harrison instructed, his eyes locking onto hers. “Your maintenance dose will be 0.25 mg taken orally, once daily.”
Agatha committed the numbers to memory. “Digitalis. Isn’t that derived from foxglove?”
“It is,” Dr Harrison nodded, looking mildly impressed. “A potent botanical turned pharmaceutical marvel. It works by inhibiting the sodium-potassium ATPase pump in your myocardial cells, which increases intracellular calcium. The result? Your heart beats slower, but with significantly more authority. It calms the erratic electrical chaos of the AFib and forces your thick heart muscle to coordinate its rhythm.”
“Sounds delicate,” Agatha murmured.
“It is a narrow-therapeutic-index drug, Agatha. Which means the line between helpful and toxic is razor thin. You cannot afford to be casual with this.” Dr Harrison’s voice dropped an octave, turning severe. “You need to understand the stakes. If you miss doses, your AFib will return with a vengeance, your heart rate will skyrocket, and your risk of a thromboembolic stroke climbs exponentially. But if you take too much, or if it accumulates dangerously in your bloodstream, Digoxin toxicity will set in.”
Agatha met his gaze, the old adrenaline junkie in her waking up, not with panic, but with a sudden, sharp clarity. “Define toxicity.”
“Nausea, profound vomiting, visual disturbances—specifically seeing a yellow-green halo around objects, or snowy vision,” Dr Harrison recited grimly. “And worse: severe, fatal arrhythmias. Complete heart block. If your serum potassium drops, the toxicity escalates rapidly. We will be doing routine blood draws to monitor your plasma levels.”
Dr Harrison tore the script off the printer and handed it to her. “Same time every day, Agatha. No doubling up if you miss a dose. No guessing. Treat this pill with absolute respect.”
Agatha took the paper. The white slip felt heavy, a tiny anchor tethering her erratic, wild heart to the rigid demands of survival.
She stood up, untied the paper gown, and began changing back into her sensible wool trousers and silk blouse. As she zipped her boots, she caught her reflection in the small vanity mirror by the sink. Her hair was pulled back in a neat, professional chignon; her expression was calm, composed, entirely suburban.
Nobody looking at her would ever guess the truth. Not the doctors, not her client, not even her children away at boarding school. But beneath her ribs, a fierce little engine was beating out a complex, dangerous rhythm—and Agatha was ready to take the wheel.
After she left, Dr Harrison wrote up his clinical notes and then slipped a piece of paper out from under the keyboard. Earlier in the day, the head of the practice called him in for a meeting. It was about the patient who was listed at 10 am, Agatha Montgomery.
He slid a piece of notepaper torn from a pharmaceutical company’s notepad with a telephone number. “After you have seen her, call this number.”
“Why?”
“That will be between you and the person on the end of the phone.”
“What about doctor-patient confidentiality?”
“Report, as requested, and then we shall speak of it no more.” That was all he said. The meeting was over.
…
© Charles Heath 2026
