Chapter 19: Hearts Can Break

Jacksonville, Florida
December 22, 1995

Jim Ramos, personal paramedic for Matt Tisdale, was buckled into the first-class seat immediately behind his boss/patient as the Boeing 737-300 lifted off from Jacksonville International Airport at 11:30 AM. It was to be a five hour and ten-minute flight, nonstop, to Los Angeles International—pretty much the maximum range of the aircraft. Though the plane was owned and operated by United Airlines, it was not a regularly scheduled passenger flight. It was a charter, arranged for by Matt himself. The tour had finished the last show of this leg the night before in the Jacksonville Coliseum and they were now on Christmas break until January 5^th, when they would start the next leg in New Orleans and then work their way through the south and southwest during the winter months.

National’s plan had been to fly Matt, the band, Greg Gahn, and Jim himself home by commercial air but leave the road crew and all the support personnel in Jacksonville and house them in cheap motels until it was time to head to Louisiana. Matt, upon hearing about it, had declared this plan “fucking bullshit” and tried to get National management to pay for the charter they were now on so everyone could “be home with their fuckin’ families and tappin’ their primary gash”. National refused, so Matt, in a rare display of Christmas spirit (aided by a half a bottle of Jack Daniels and several lines of Bolivian cocaine) decided to pay for the charter himself. Thirteen thousand dollars for each hour of flight time (or fraction thereof) was how much it cost to charter a 737. That was seventy-eight thousand dollars (plus applicable taxes and booking fees) for the flight to LA and then another seventy-eight thousand (plus applicable taxes and booking fees) for the flight back after the break was over. Matt did get National to kick in about twenty-five thousand of that—the amount it would have cost them to house sixty-eight roadies, techies, truck and bus drivers, and other support staff in double occupancy Motel 6 level accommodations for two weeks—but he paid for the rest out of his own pocket. He could have simply paid for everyone to have round-trip commercial tickets to LA and back for much less—around fifty-five grand total—but elected to go charter instead because it was pretty much impossible to get everyone booked on the same flights to and from. He even let Greg Gahn come along for the ride, despite the fact that Gahn was the one who kept passing along National’s denials to him.

Jim, by now a veteran of air travel, planned to sleep the entire way back to LAX. Life as part of a touring rock group was fun, exciting, and everything he had ever dreamed it would be (and quite a bit more), but it was exhausting. The days and nights rolled by in an endless stream of arenas and hotel rooms, charter flights and catered food, booze and groupie sex. Sleep was sometimes left on the back burner, particularly when they had multiple travel days in a row. Jim had fucked some of the most beautiful and uninhibited women imaginable throughout this adventure (though he had not kissed a single one after Matt advised him why he should not), sometimes two at a time, and, on one occasion, three at a time. But the trip was also taking a toll on his body. He hadn’t weighed himself since the trip started—he didn’t want to know the real number—but he was pretty sure he had put on at least ten pounds, maybe more. The lack of exercise combined with the catered food and the booze had stretched his waistline out and added a noticeable spare tire at his midsection. He had to buy a whole new set of jeans and shirts back in Baltimore because his old ones didn’t fit anymore.

I really need to hit the gym over the break, he thought as the plane climbed into the sky and settled on its first leg of the journey. Cut out the booze too. God only knows what this is doing to my blood pressure. That was something else he had not measured during this adventure, again, because he really did not want to see what the number was.

By the time the plane leveled out and started its cruise phase, Jim was asleep and snoring lightly. He did not wake up when the front flight attendant came around asking for drink orders. He did not wake up when the plane hit a particularly nasty pocket of clear air turbulence just north of Mobile, Alabama and several carry-on bags came tumbling out of the overhead compartments. He descended all the way down into REM sleep and likely would have remained there until at least New Mexico or Arizona, had duty not called.

“Jim!” a voice said into his ear. A hand was shaking his shoulder. “Wake up, dude! Matt needs you!”

Sleep fell instantly away from him, jerking him out of dream in which he had been trying to find his way out of a large house because something was after him. He blinked his eyes a few times and stared into the face of Austin Jefferson, the bass player. Austin looked scared. The words he had just said were processed and understood and Jim sat up straight in his seat. “His heart again?” he asked.

“Yeah,” said Matt’s voice from the seat in front of him. “It’s fuckin’ doin’ it again, dude. This shit is getting old.”

“It” was the supraventricular tachycardia that Matt was plagued with, the reason Jim was employed by him as a personal paramedic. This was not the first time Matt had gone into SVT since Jim had joined him on the tour. He had had a brief episode after the show in Virginia Beach two weeks ago (right after snorting some post-show cocaine) but it had stopped on its own before Jim could even start an IV on him. And then, just the week before, before the show in Charlotte (more than ten hours after Matt’s last line of coke) it happened again. This time Jim was able to start an IV and give him six milligrams of Adenosine, which converted him back to a normal rhythm in about fifteen seconds. Despite Jim’s stern advice to the contrary, Matt had gone on with the show after the conversion, performing the entire set and then snorted coke and bagged himself a two by four afterword.

Jim quickly unbuckled and stood up. In addition to Austin, Greg Gahn, Corban, Steve, Jack Ferguson the security chief, and Diane the cute blonde flight attendant, were all standing around the general area, their faces worried.

Jim stepped forward and looked at his boss/patient. Matt was pale, a little sweaty, his seat reclined slightly, his expression one of resigned fear. A half empty glass of Jack and Coke stood on the tray table before him and the video screen was showing a movie with lots of scantily clad women in it.

“Did it just start?” Jim asked, reaching down and grabbing Matt’s wrist.

“Yeah,” Matt said softly. “About two minutes ago; started out of fuckin’ nowhere. It’s running like a freight train. I can feel it.”

Jim found Matt’s radial pulse with his fingers. He did not need to count it. Matt was right. It was running like a freight train. It was time to earn his money.

“Austin,” he said, “grab my football out of the overhead.”

“Right,” Austin said, reaching up and unlatching the compartment.

“How are you doing otherwise, Matt?” he asked. “Any chest pain?”

“A little tightness,” Matt said. “Not too bad.”

“How’s your breathing?”

“I feel a little winded,” Matt admitted.

“You do seem to be a bit tachypneic,” Jim agreed. “The air pressure at cruise altitude is kind of low. It’s like standing on top of a mountain. That might be what triggered it.”

“I don’t give a fuck what triggered it,” Matt said. “Just fuckin’ fix it.”

“I’ll do my best,” Jim said, taking the football from Austin. He set it down on the floor of the aisle and opened it. He pulled out the LifePak monitor and turned it on. While it went through its self-checks, he opened the pockets and pulled out the cables and a package of electrodes. “All right, Matt,” he said. “You know the drill by now. Get your shirt off.”

Matt pulled off the Gator Bar t-shirt he had picked up in St. Petersburg three nights before, revealing his bare chest and the upper parts of his full sleeve tattoos. Jim quickly applied the sticky electrodes to the front of both shoulders and to both sides of his lower abdomen. He then looked at the monitor screen, which was, by now, showing a display. He did not need to print out a strip to analyze the rhythm (but he did so anyway, for documentation purposes). It was a classic SVT, trucking along at 210 beats per minute.

“Yep,” Jim said. “It’s the SVT all right. Let’s see how the blood pressure is doing.”

He pulled the blood pressure cuff and the stethoscope out of the football and fastened the cuff around Matt’s left upper arm. He put the stethoscope in his ears and the bell to Matt’s inner elbow. He pumped up the cuff to 180 and then slowly released the air, listening for the beat of the artery to return, his eyes watching the needle of the gauge. The beat returned at 106. It disappeared again at 62. Jim nodded happily and let the rest of the air out of the cuff.

“Well?” Matt asked.

“You’re not hypotensive,” he reported. “One-oh-six over sixty-two.”

“You won’t have to light me up then?” Matt asked.

“Not as long as you convert with the Adenosine,” Jim told him. “Let me get an IV started.”

“Do it, dude,” Matt said holding out his arm.

Jim reached back into the football and pulled out a bag of normal saline and a set of IV tubing. He opened the packages and started to assemble them.

“Should I let the captain know we have a medical emergency?” asked Diane, the flight attendant. She looked even more nervous about all this than Matt.

“Naw, baby,” Matt told her. “I’ll be all right in a few minutes, as soon as my man here gives me the shit.”

“The shit?” she asked.

“He should be okay,” Jim told her. “We’ve been through this before.”

“That’s why Jim is here,” said Austin. “He fixes hearts.”

She looked doubtful about this but stayed where she was.

Jim handed the IV bag with the tubing now dangling out of the bottom to Corban. “Here,” he said. “Hold this up.”

“Right,” Corban said.

Jim opened the clamp until the saline started to drip out of the end of the tubing and then closed it again. He then pulled a 10ml saline flush and saline lock out of the football. He screwed the latter onto the former and then flushed the lock of air. He set it down next to him and then pulled out an IV start kit and opened it. Inside was a blue latex tourniquet, a couple of sterile 2x2 pads, two alcohol preps, a sterile transparent dressing, and a small roll of medical tape. He tore three strips of the tape and stuck them to the leg of his pants, right at the thigh. He then took the tourniquet and tied it around Matt’s upper arm, above the elbow. Matt had good veins and he had a variety to choose from. When giving Adenosine, however, the closer the vein was to the heart, the better the medicine worked. It only had a half-life of a few seconds once injected, so the shorter the trip and the faster it was infused, the better. He touched the large antecubital vein right in the crook of Matt’s elbow. It was fat and springy. It was the same place Jim had started the IV last week as well. The fading bruise of that cannulation was still visible.

He opened one of the alcohol preps and swabbed the area vigorously, making the vein stand out even more. He then pulled one of the 18-gauge IV catheters out of the holder and opened the packaging. “Here we go, Matt,” he said. “Big poke. Hold still.”

Matt held still. Jim got an immediate flash of blood in the catheter’s chamber, indicating he was in the vein. He slid the catheter downward, until the hub was flush against the skin, and pulled out the needle, leaving the catheter behind. Needles that safed themselves after use were still a few years in the future, so Jim dropped the sharp on the floor and put his foot over it to keep anyone—particularly himself—from getting accidentally poked with it before it could be secured in the sharps container. God only knew what kind of nasty bloodborne diseases Matt Tisdale might be carrying. He pushed forcefully down on Matt’s vein above the catheter to keep blood from oozing out and then, with the mechanical skill of one who has performed the maneuver hundreds, maybe thousands of times before, he picked up the saline flush and popped the cap off of it with one hand. He then plugged the end into the catheter and released the pressure on the vein. Carefully, he flushed a little bit of saline in, making sure the IV was patent. It was. He then disconnected the syringe part of the flush, leaving the flush tubing and the catheter in place. He dropped the syringe next to the foot covering the exposed needle—it would be placed in the sharps container as well—and then covered the catheter portion with the transparent dressing from the start kit. He then taped everything in place with the tape strips from his leg.

“All right,” he said. “Give me the end of that IV tubing.”

Corban reeled it in and handed it over. Jim removed the cap and screwed it into the hub on the saline lock he had just installed. He then reached over and opened the clamp on the tubing. He looked at the drip chamber and saw the fluid was infusing rapidly. Another confirmation that the IV was correctly placed in a vein. He then looked at Matt’s arm and felt the area just downstream of where the catheter was. There was no swelling or other signs that the IV fluid was extravasating. It was a good line.

“I’m in,” he said. He then looked over at the monitor. Matt was still in SVT at 210.

“Let’s do this thing, dude,” Matt told him. “Give me the shit.”

Jim reached in the football and got the shit. He pulled out a vial of Adenosine and a 10ml syringe. He put a needle on the end of the syringe and then popped the cap on the vial. He drew up two milliliters, which contained six milligrams of the drug. He then recapped the needle, removed it from the syringe, and set it aside in case he needed to use it again. He opened the second alcohol swab from the start kit and used it to sterilize the hub on the IV tubing, the one closest to the end that plugged into the catheter. He then screwed the syringe of Adenosine onto that hub.

“You ready, Matt?” he asked.

“Yeah,” Matt said softly, taking a deep breath. “I really hate this part.”

“Me too,” Jim said. He pinched the IV tubing just above the hub and then rapidly pushed the entire syringe full of Adenosine into the tubing. As soon as it was in, he un-pinched the tubing and glanced at the drip chamber to make sure it was flowing again. It was. He then turned his eyes to the monitor. The Adenosine usually worked in less than ten seconds.

Ten seconds came and went, and nothing happened. The tracing continued to blast along at 210 beats per minute.

“What’s happening?” Matt asked. “I don’t feel that funky shit in my chest like before.”

“It didn’t work,” Jim said.

“What the fuck do you mean, it didn’t work?” Matt barked.

“I mean it didn’t work,” Jim said. “It happens sometimes. Your heart doesn’t want to convert this time.”

“What the fuck do we do now?” Matt demanded.

“I’ll give you another dose,” Jim said. “Twelve milligrams this time.”

“Jesus fucking Christ,” Matt said, shaking his head. “You’re not earning your fuckin’ Christmas bonus here, dude!”

Jim screwed the needle back on the syringe and opened another vial of Adenosine. This time he drew up four milliliters of the drug. He swabbed the hub with the alcohol prep again and fastened the syringe.

“All right,” Jim said. “Let’s hope it works this time.” He pinched the tubing, injected the medication, and then un-pinched. A quick glance at the drip chamber and then his eyes went back to the monitor screen.

This time, something happened. Matt’s heartbeat stopped completely for the better part of five seconds. Jim glanced over at him and saw he was even more pale.

“Ohhhh, fuck, I hate this shit,” Matt groaned.

Jim understood. It undoubtedly felt terrible when your heart was no longer beating. But at least the medicine had worked this time. As long as Matt’s heart started back up, everything should be good.

Two wide-complex beats fired off on the monitor screen. There was another long pause and then two more fired. A shorter pause and then three narrow, inverted beats fired in rapid succession. After that, normal complexes began to fire at a reasonably regular rate of ninety-two per minute. Jim breathed a sigh of relief.

Matt’s sigh of relief was even bigger. “Fuck me,” he said. “My chest feels normal again and I can breathe. Did it work?”

“It seems like it did,” Jim said. “You’re back in a normal sinus rhythm.”

Matt nodded. “My man,” he said. “That’s why I keep you around.”

“He’s better now?” Diane, the flight attendant, asked carefully.

“It seems like it,” Jim said. “Let me just check his blood pressure again.”

Jim put the stethoscope back in his ears and pumped up the cuff once again. This time, Matt’s reading was 162/90, which Jim suspected was his normal pressure that he walked around with day in and day out.

“How are you feeling, Matt?” Jim asked him.

“Better,” Matt said. “Much better. Go ahead and get all this shit off of me now.”

“No way, Jose,” Jim said. “I’m keeping this monitor on you and that IV in your arm and this football open until we’re on the ground. And when we get there, I want you to go to the hospital immediately.”

“Fuck that shit,” Matt said. “I just want to finish my drink and then catch a little sleep.”

“I’m going to have to insist this time, Matt,” Jim said. “You’re having these episodes way too often now and they’re getting harder to break. You need a cardiology workup.”

“You don’t get to insist anything, dude,” Matt told him. “You’re here to do what you just did, and I thank you for it.”

“Listen, Matt,” Jim said. “This is some serious shit you’ve got going on here. Do you want to die? Because this might very well kill you one of these times.”

“We all gotta go sometime,” Matt said.

No one had noticed that Diane had disappeared. At least no one noticed until she came back with a middle-aged balding man in a white uniform in tow.

“Hello,” the man said, his voice stern and unamused. “I’m Michael Bordon, the captain of this aircraft.”

“Shouldn’t you be flying the fuckin’ plane then?” Matt asked plainly.

“My copilot has got it under control at the moment,” Bordon said stiffly. “Right now, I’m a little more concerned that one of my passengers is having a medical emergency involving his heart.”

“It’s cool, dude,” Matt assured him. “It’s happened to me before. My man Jim here fixed me up. Everything’s back to normal now.”

Bordon looked at the monitor beeping away, the IV bag that Corban was still holding aloft going into Matt’s arm, the opened packages and debris lying on the floor of the aisle. “It doesn’t look like everything is cool to me,” he said. “It looks like a serious medical issue is occurring on my aircraft and that makes me responsible. I think it would be in everyone’s best interest if I were to make an emergency landing as soon as possible and have an ambulance waiting for you on the ground.”

“How fast could you make that happen?” asked Austin.

“Austin!” Matt barked. “What the fuck, dude?”

“I think the man’s right, boss,” Austin told him. “We’re way up in the fuckin’ sky here. And Jim’s the shit, I’ll be the first to agree, but this is your heart, man!”

“We’re flying over southeastern Texas right now,” Bordon said. “I can have us on the ground at Houston Intercontinental in twenty-five minutes.”

“Texas!” Matt nearly screamed. “No fuckin’ way! Bad shit always happens to me in Texas!”

“I’m sorry,” Bordon said. “I’m afraid I don’t have a choice here.”

“You don’t understand, dude!” Matt told him. “Texas is a fucked-up place! I had a bunch of good old boys kick the shit out of me at a truck stop in Texas and then me and Jake Kingsley got sent to jail for it. And, once in that jail, a couple of cops beat my head in with a telephone book just because I asked one of them if his daughter took it up the ass!”

“That’s all very unfortunate,” Bordon said, “and perhaps even understandable if you indeed asked the man that, but the fact of the matter is...”

“That ain’t all though!” Matt interrupted. “My bud Darren—God rest his soul and may Kingsley rot in hell—fuckin’ blew himself up on stage in Texas! And he fucked up the end of our show there too! And, as if that shit ain’t enough, the first time my heart ever did this SVT shit and some medic had to light me up like fuckin’ Hiroshima 1945, was in Texas! In Houston, Texas as a matter of fact! You can’t take me down there!”

“Those are all incidents that sound regrettable and traumatic,” Bordon allowed, “but nevertheless, I don’t really have a choice. When I am told that one of my passengers has a heart condition and it was required in-flight that he receive intravenous cardiac medications because of a life-threatening arrythmia, my hands are kind of tied. We’ll be landing in Houston in about twenty-five minutes. An ambulance will be there waiting for you at the terminal. It is your choice whether or not to get in that ambulance, but you will not be going any further on this aircraft than that.”

With that, Bordon turned around and walked back to the cockpit. He closed the door behind him.

“Man, what a rip,” Matt said, shaking his head.

“I think it’s for the best, Matt,” Jim told him. “Truth be told, I wasn’t that thrilled about finishing out the flight after what just happened.”

“I would’ve been fine,” Matt grumbled. “I always have been before, right?”

The captain used the overhead intercom to announce that the plane was making an emergency landing at Houston Intercontinental due to a medical emergency aboard, that descent would start immediately, and ordered everyone to buckle back into their respective seats. Diane, the flight attendant, tried to get Jim to stow the monitor back in the overhead compartment but he refused.

“No way,” he told her. “I’ll string it back here and buckle it into the seat next to me, but it’s going to stay attached to Matt so I can monitor him.”

She agreed to this plan as long as she got to inspect how it was buckled and the rest of the football was closed up and stowed back in the overhead. They had hardly even begun this task when the sound of the engines decreased and the nose of the aircraft dipped downward, reducing everyone’s weight by an eighth of a G or so.

Matt’s heart rhythm continued to bound along at a rate that, while not quite sedate, was at least not dangerous. Matt himself continued to insist that he felt fine and that all of this shit was unnecessary.

“But you’ll go to the hospital, right?” Jim asked him several times.

“Yeah,” Matt grumbled. “I’ll fuckin’ go, if only to get you to stop nagging me about it like a bitch.”

“Deal,” Jim agreed.

The plane landed normally and taxied to one of the gates in Terminal C. As promised, there was an airport fire crew and an ambulance crew from the City of Houston Fire Department waiting for them. The EMS crew and two of the firefighters boarded the plane and, at Diane’s direction, stopped at Matt’s seat. Jim, by now, had unbuckled and was standing up, the LifePak back on the floor. The paramedic—a young male in his late-twenties with short, neatly cropped hair—looked first at the monitor and the IV bag (raising his eyebrows a bit at the sight of them) and then took a good look at his patient. It was plain to see that he recognized him.

“Matt Tisdale?” he asked, surprised. “No way!”

“Way,” Jim told him. “We were on our way back to LA from Jacksonville and had to make an emergency landing here. I’m Jim Ramos, Matt’s tour paramedic.”

“Tour paramedic for Matt Tisdale?” the Houston medic asked. “That’s tight! How’d you get a job like that?”

“I just kind of stumbled into it, really,” Jim told him. “Anyway, Matt is a thirty-six-year-old male with a history of PSVT episodes, sometimes requiring cardioversion, sometimes treatable with Adenosine. He is also a habitual cocaine user, heavy marijuana smoker, heavy cigarette smoker, and a card-carrying alcoholic.”

“Damn, dude,” Matt said. “That’s harsh. Ain’t you got anything nice to say about me?”

“I’m giving report to the medic who is going to be taking care of you,” Jim told him. “I have to give him your history.”

“I’m down with that,” Matt said, “but can’t you throw in some of my good attributes as well?”

“Uh ... sure,” Jim said. He turned back to the Houston medic. “He’s also a badass guitar player, a great singer, a boss who pays me quite well for the job I do, and he scores more and better pussy than a firefighter like yourself could probably even imagine.”

“That’s saying a lot,” the medic said respectfully.

“Isn’t it?” Jim asked. “Anyway, this is what happened today:” And, with that, he explained about Matt’s latest episode of SVT and what he, Jim had done about it.

“You have Adenosine, huh?” the Houston medic asked. “That’s cool shit. We’ve been trying to get the EMS authority to give us that for years.”

Jim did not mention that the legality of him carrying and using the Adenosine was questionable at best. “Yeah, the doc who oversees me is onboard with all the latest. Anyway, the captain insisted that we land here and get Matt to the hospital. Matt is reluctant, but he agreed to go.”

“Sounds good,” the medic said. He then went over the entire story with Matt one more time, just to make sure they were all on the same page. While he assessed the guitarist, his partner and the fire crew took a set of vital signs on Matt and then replaced Jim’s Lifepak with one of their own. Jim handed the medic several printouts he had recorded when Matt had been in the SVT.

“Do you want us to stay with you, Matt?” asked Austin as the medic got ready to walk Matt off the aircraft.

“Fuck no,” Matt said. “You all just stay on the plane and get home to those you want to rail. I’ll be all right. I’ll let them do their thing at the hospital and then I’ll be on another plane later tonight.”

“I’ll stay with you, Matt,” said Greg Gahn. “It’s my job as...”

“No fuckin’ way!” Matt said. “The last thing in the world I want to deal with now is a hypocrite Mormon tour manager. You stay on the plane with everyone else.”

“But who is going to arrange for hotel rooms and travel for you?” Greg asked.

“I can do that shit myself,” Matt said.

“But...”

“Don’t worry, Greg,” Jim said. “I’m going to stay with Matt through this.”

Greg looked at him. “You are?”

“I am,” Jim said. “It’s my job.”

“You don’t have to stay with me, dude,” Matt told Jim, though he seemed rather touched that the paramedic had made the offer.

“I know I don’t,” Jim said, “but I’m going to. It’s what you pay me for, right?”

Matt smiled. “Right,” he said.

The ambulance took him to Houston Methodist Hospital, the same facility he had been taken to after his first bout of SVT during the Next Phase tour. The trip took a little over thirty minutes. Jim rode in the back, in the airway seat behind the driver’s compartment, but offered no contributions to the care being given by the Houston Fire medic. It would have been uncouth. Instead, they talked mostly about their jobs, the Houston medic giving Jim a rundown on how their department and the Houston EMS system worked and Jim giving the Houston medic a rundown on how it worked in his little corner of southern California. He then told a few anecdotes of his travels with Matt Tisdale. The Houston medic was much more interested in these tales—in which he was told why you should never kiss a groupie and what exactly a two by four or a three by six entailed.

As fate would have it, the same doctor who had treated him before—Dr. Goldstein—was on duty in the emergency room when they wheeled Matt in.

“Hey, doc,” Matt greeted him. “Bet you never thought you’d see me again, huh?”

“As a matter of fact, Mr. Tisdale,” Goldstein said, “I’m amazed it took so long.”

They went through a standard cardiac workup. An EKG was done. Matt’s complete blood count, electrolytes, and a dozen other labs were checked. They checked his urine for infection and drugs of abuse. His labs came back remarkably similar to the last time he had been there. Red blood cells, white blood cells, and electrolytes were all normal. His hepatic enzymes were elevated to a level that indicated Matt’s liver was not particularly happy with him. His drugs of abuse screen came back positive for marijuana and cocaine. His cardiac enzymes were just a point below what would be considered positive for heart damage. His chest x-ray, however, revealed something quite significant.

“You have cardiomegaly,” Goldstein told him.

“What the fuck’s that?” Matt asked.

“It means your heart is enlarged,” the doctor clarified. “It is quite apparent on the chest x-ray.”

“What’s wrong with having a big heart?” asked Matt. “The more the better, right?”

“Wrong,” Goldstein told him. “A big heart is a less efficient heart. It doesn’t pump blood as well as a normal heart. The condition, if allowed to continue, will eventually lead to heart failure and more than triples your risk of sudden cardiac death; particularly when you add in your correctable risk factors.”