Authors Note:
The romance and story are fictional. Liz has five diagnosed autoimmune diseases, Raynaud’s, Sjogren’s, Systemic Lupus Erythematosus (SLE), Pulmonary Arterial Hypertension (PAH), and Primary Biliary Cholangitis (PBC). The flashbacks and medical issues all reflect real medical experiences of hers. Please note autoimmune diseases presentations, symptoms, and long-term prognosis vary widely. She was diagnosed with most between 2008-2009. Luckily, medicine, treatments, and long-term prospects are always improving. All names of characters, medical professionals, and locations have been changed and/or are fictional.
Chapter One
January 5
I shifted uncomfortably on the exam table. Without warning, my barking cough came barreling out of my chest again. The deep, wet sound finally stopped, and I struggled to catch my breath for several minutes. Even after I was done coughing, I was still panting.
I’d been sick a lot in the past three years, from strep throat to bronchitis, and had even dislocated my ribs twice due to coughing just last year, but I’d never had a cough like this before. It sounded just like a seal—bark, bark, bark—not at all like my normal cough, which was why I was here instead of in class for my first day of graduate school.
I frowned at the cream-colored wall, struggling and failing to find relief. I didn’t even want to be here, in Atlanta, for graduate school. I’d been accepted into The George Washington University, my dream school, for a Master’s in Economics. It would have given me easy access to an internship at the International Monetary Fund (IMF), my dream job. I’d been lucky to live in Europe for the past several years, but there was so much of the world I wanted to see—no, not just see but explore, understand, and interact with.
The cough ripped through me again, my breath coming out in raspy gasps. This was why I was fucking here. This was why my ex, Alessandro, had cheated on me. I couldn’t stay healthy for two weeks in a row. I couldn’t even start graduate school on the scheduled start date. No—of course I’d be sick. I didn’t want to go to grad school at Georgia State or to live at home, but I needed help. Something was wrong with me. There had to be. No one should be sick this much.
I shifted again against the wall, my breath still heavy, as comfort eluded me. Holding my body upright was a struggle, but if I lay down, I couldn’t breathe. I hadn’t been this exhausted in a long time, if ever.
My ears perked up as the exam room door opened.
“Lucia,” Dr. Steinberg said softly. His gray eyes traveled over me, slowly cataloging everything. He had an analytical brain and had studied medicine at Harvard. He was the smartest and most considerate person I knew. Maybe it was also because he pronounced my name correctly, Lu-chi-ah. I was half-Italian, not Spanish, so most people said it wrong.
I smiled despite it all. I had a deep affection for Dr. Steinberg, who’d seen me off and on since I was fifteen. He’d even had me tested for Sjogren’s last year when I thought I was losing my mind over how dry my mouth was and the fact that my eyes couldn’t open in the morning without eye drops, or that they’d get painful scratches due to dryness. I’d tested positive and had started medicine for it that week. I wished he was my rheumatologist.
Julia, his PA, entered behind him and my shift to acknowledge her started the barking cough again. When I finished, I was more aware of Dr. Steinberg’s concerned gaze and wondered why Julia was in the room too. Normally, I just saw him.
“Is it pneumonia?” I tried to joke. My trip to the chest X-ray had just about killed me. It was just down the elevator and through a hallway maybe three hundred feet long, but I’d had to stop about every ten feet to catch my breath.
Julia and Dr. Steinberg shared a look. “Lucia, it’s not pneumonia,” he said gently. “We need to do a few more tests, but I am going to be admitting you to the hospital. Can I see your ankles?” He stopped to feel them. “Do you have any other symptoms besides the fever, fatigue, and shortness of breath?”
I nodded weakly. “My shoulder is killing me. It feels like someone is stabbing me in the right shoulder blade.” He and Julia shared another look as I started coughing again. Usually, I just got my antibiotics and was sent home, then came back in a few days depending on how sick I was, but I’d never been this tired. “What is it?”
“Well, the reason you are short of breath is you have a large amount of fluid around your heart, and also some in your lungs, which is why you can’t lie down and why your coughing sounds the way it does. It’s probably why your shoulder hurts. Lucia, your heart is stressed. What we don’t know is why. A few things can cause it, but we need to do a few more tests. We need to start the admission process. It’s four now, so you’ll be admitted through the ER.” He paused and added, “Do you want us to call your parents?”
“Yes.” I nodded again, more numbly this time. “What could cause it?” My words weren’t fearful—just confused. My heart? I was twenty-one. Wasn’t that too young for heart problems?
