Diagnosis of the Heart – Chapter 1
Priya
The infant was turning blue.
The fluorescent lights cast harsh shadows across the resuscitation bay as Dr. Priya Raman kept her voice steady despite the plummeting oxygen saturation. “Prep for intubation. Get me a 3.0 ETT and Miller zero blade, the smallest tube and instrument for this tiny airway.”
Monitors screamed around her, a cacophony of electronic warnings as the newborn’s condition deteriorated. The baby, barely two hours old, had been fine at delivery, then crashed during routine checks. Now, at 2:17 a.m., Priya stood at the head of the warmer, the fate of this tiny human in her hands.
“Suction ready,” a nurse called as the mechanical whir of the device joined the beeping monitors. “Heart rate dropping to sixty,” another reported, the urgency in her voice matching the plummeting numbers on the screen.
Priya positioned herself, laryngoscope gripped firmly. “Beginning intubation.”
The ED’s fluorescent lights cast harsh shadows as she tilted the infant’s head into position. She’d done this hundreds of times, the weight of the scope familiar in her palm, the delicate anatomy of a newborn’s airway mapped in her mind.
“I’ve got visualization of the cords,” she announced, guiding the blade. “ETT coming in—” she announced, preparing to thread the endotracheal tube into the infant’s delicate airway.
Her right hand trembled.
The movement was subtle, imperceptible to anyone watching, but Priya felt it like an electric shock. She tightened her grip, willing steadiness into her fingers as she advanced the tube toward the tiny vocal cords.
The tremor intensified.
Sweat beaded along her hairline. She couldn’t falter now, not with a life balanced on the edge of her skill. Priya took a steadying breath and pushed forward, but her hand betrayed her again with a visible shake.
“Sats dropping to forty-eight,” someone called.
Maya Velez, the charge nurse, appeared at Priya’s side. Their shoulders brushed, a silent communication developed over years of working together. Without a word, Maya’s hand slid alongside Priya’s on the laryngoscope.
“Let me adjust the light angle,” Maya said, loud enough for everyone to hear. Her eyes met Priya’s for a fraction of a second, concern masked by professional calm.
The handoff was seamless. Maya stabilized the scope while Priya guided the tube with her left hand. No one else in the room noticed the exchange.
“I’m in,” Priya announced thirty seconds later, her voice betraying none of the turmoil raging inside her. “Confirm placement.”
The respiratory therapist attached the ventilator circuit. “Good bilateral breath sounds, meaning the tube was correctly placed in the trachea, not the esophagus.”
“Color improving,” a nurse called.
“Heart rate climbing to ninety… one hundred…”
The room collectively exhaled as pink slowly returned to the infant’s skin. Priya stepped back, sliding her right hand into her scrub pocket where no one could see the persistent trembling.
“Nice save, everyone,” she said, her clinical mask firmly in place. “Let’s get a post-intubation chest X-ray and call for NICU transport.”
The team dispersed to their tasks, crisis averted. Only Maya lingered, her expression carefully neutral as she updated the chart.
“Thanks for the assist,” Priya said quietly.
Maya’s eyes flicked to Priya’s pocket where her hand remained hidden. “That’s the third time this month.”
“It was just awkward positioning.”
“Priya—”
“I’m fine.” The words came automatically, a reflex honed since childhood. “Just tired. Forty-eight hours in three days will do that to anyone.”
Maya opened her mouth to argue, then closed it as the ED doors slid open, bringing in the scent of salt air from the harbor. Another ambulance arrival pulled her attention away. “This conversation isn’t over,” she warned before heading toward the incoming trauma.
Priya used the moment to escape to the doctors’ lounge where she sank onto a worn couch. Only then did she withdraw her hand from her pocket. The tremor had subsided to a faint quiver, but it was undeniably there.
She stared at her fingers, the tools of her trade, her identity. A pediatrician with unsteady hands was useless. Dangerous.
The lounge door opened, and Priya quickly clasped her hands together in her lap.
“Hey,” Dr. Daniel Hooper said, heading for the coffee machine. The overnight emergency physician looked as exhausted as she felt. “Heard you had a rough one with the newborn.”
“We got there,” Priya replied. “NICU’s coming down.”
“Good thing you were on. Not sure I could have managed those tiny cords these days.” He gestured with his coffee mug. “Getting old. Hands aren’t what they used to be.”
The casual comment landed like a blow. Priya was thirty-four, hardly old enough to blame age for what was happening.
“You heading out soon?” Tom asked.
“Just finishing charts.” She forced a smile. “Go save lives, old man.”
After he left, Priya pulled up the electronic medical record and documented the intubation, carefully omitting any mention of the tremor. She typed: Procedure performed without complications.
The lie felt heavy on her fingers, guilt mingling with the fear she refused to acknowledge. Procedure performed without complications. The words mocked her as the tremor in her hand gave them the lie.
When she finished, the clock read 2:47 a.m. Her shift ended at six. Three more hours to get through without anyone else noticing what was happening to her.
The ED quieted around four, the fluorescent lights now feeling harsh against Priya’s exhaustion. She slipped away to the staff locker room, desperate for a moment alone without Maya’s worried glances or the constant fear of her hand betraying her again. Just five minutes to regroup, to pretend this wasn’t happening.
The locker room was empty, smelling of coffee and hospital-grade disinfectant. Priya sat on the bench and leaned forward, elbows on knees, finally allowing her composure to crack. Her breathing came in shaky bursts as she stared at her traitorous right hand.
“Stop,” she whispered, anger replacing fear. “I won’t let you do this.”
She tried to tie her shoe, which had come undone during the code, but her fingers fumbled with the lace. Such a simple task, one she’d mastered as a child, now a struggle.
The frustration that welled up was familiar, an echo from her past. Suddenly she was eight years old again, watching her mother drop a glass of water, the shattering sound accompanied by her mother’s soft gasp of pain. “It’s these useless hands,” her mother had whispered, rubbing swollen joints distorted by rheumatoid arthritis. “They just won’t listen anymore.” Young Priya had carefully swept up the glass, making a silent vow as she worked, I’ll never be helpless like that.
She’d spent her childhood being her mother’s hands when they failed, tying shoes, opening jars, cutting food. Later, as her mother’s condition worsened, she became her mother’s legs too, then her nurse, her advocate, her entire support system.
Priya had chosen medicine because of it, to help others, yes, but also to ensure she would always be the caregiver, never the patient.
Now her body was betraying her the same way it had betrayed her mother.
“No,” she said aloud, forcing her fingers to complete the bow on her shoe. “I’m not going there.”
She stood and opened her locker, where a bright yellow flyer was taped to the inside door:
SAVE THE DATE! CASCADE BAY MEDICAL CENTER ANNUAL FUNDRAISING GALA
Help us raise critical funds for our expanding research facilities!
Formal attire. Silent auction. Live music.
Priya grimaced. The gala was a necessary evil, the small coastal hospital was perpetually underfunded, and the new research wing was behind schedule and over budget. As acting head of pediatrics, her attendance was mandatory, though the thought of making small talk with board members while balancing a champagne flute made her stomach clench.
Something slid under the locker room door, a manila envelope landing with a soft thump on the tile floor. Priya frowned and picked it up. No name, no sender information. She tore it open.
Inside was a referral form with a sticky note attached. The handwriting was Maya’s:
He’s only taking two more patients. Don’t make me drag you there myself. M
Priya’s eyes fell to the letterhead: Cascade Bay Neuro-Immunology Research Initiative. Below that, a name: Principal Investigator: Dr. Evan Davis, MD, PhD.
The newly recruited specialist. The reason for the expanding research wing. The doctor whose arrival had been announced in three separate hospital-wide emails, each emphasizing his groundbreaking work in early detection of neurological disorders.
The referral form was already partially completed, her name, medical record number, and symptoms listed in Maya’s neat handwriting: intermittent right-hand tremor, occasional gait instability, reported visual disturbances.
Heat rushed to Priya’s face. Maya had been watching her more closely than she’d realized.
She crumpled the paper in her fist, then thought better of it and carefully flattened it again. If Maya had gone to the trouble of obtaining a referral form, she wouldn’t stop there. Next would come direct confrontation, possibly involving Dr. Wolfe, the Chief of Medicine. Maya’s husband was kind but uncompromising when it came to patient safety, even when the patient was a colleague.
Priya folded the form and slipped it into her pocket, unwilling to examine it further. Acknowledging the symptoms meant admitting something was wrong. Seeing this Dr. Davis meant becoming a patient. Becoming a patient meant risking everything she’d built.
Her pager beeped: NICU transport arrived. Discharge summary needed.
Duty called. She closed her locker and headed for the door, pausing to check her reflection in the small mirror mounted on the wall. The woman who stared back looked composed, professional, exactly as she needed to appear.
“I can handle this,” Priya whispered to herself, squeezing the referral form in her pocket so hard the edges crinkled.
But her hand wouldn’t stop shaking.
You have been reading Diagnosis of the Heart...
The first rule of medicine is *do no harm*. Dr. Priya Raman sleeping with her brilliant, arrogant new neurologist probably counts.
Dr. Evan Davis is everything she shouldn’t want. Her colleague. Her doctor. The one man who holds her future in his capable hands.
He’s also devastatingly attractive, infuriatingly perceptive, and the only person who sees past the confident facade she shows the world.
When a medical crisis forces them into close quarters, professional boundaries become impossible to maintain. Every stolen glance burns. Every accidental touch ignites something they both know they should resist.
He wants to save her. She wants to save her career. Neither of them expected to fall this hard.
The hospital has rules about doctor-patient relationships. But some attractions are too powerful to deny.
