The Broken Pump

The human heart is just a pump.

In medical school, they teach you the physics of it. It is a muscle about the size of your fist. It beats about 100,000 times a day, pushing blood through miles of tubes. If the pump is healthy, it works without you ever thinking about it. But if the muscle is weak, and if you put too much stress on it, the pump begins to fail.

Scarlet had a weak pump. She had been taking digitalis—a medicine that helps the heart beat stronger—since we were children. But this week, she had thrown her medicine against the wall. She had replaced her pills with fear, guilt, and sleepless nights.

It is Friday night. The grand ballroom of the Ford Luxury Hotel in Makati is blindingly bright.

The room is full of crystal chandeliers, white silk curtains, and the sound of hundreds of wealthy people talking at the same time. Men in black suits and women in diamonds are drinking expensive champagne. At the front of the room, a massive digital screen shows the company’s logo: Ford International.

My father, Damien, stands on the main stage. He looks powerful. His voice is deep and steady as he speaks into the microphone, telling the investors how much money the family empire is going to make this year.

Next to the stage, my mother, Calista, stands with a straight back. She smiles at every photographer. Her berry-colored lipstick shines under the spotlights. Everything looks perfect. The family lie is working.

I am sitting at the VIP table near the back. I wear a heavy purple dress that feels too tight around my ribs. Under my eyes, the heavy makeup feels like dry mud.

Then I see Scarlet walk off the stage.

She is wearing a beautiful gold dress that catches the light, but she is walking slowly. Very slowly. Her hand is gripping the edge of the tables as she passes them. Her head is tilted down.

I stand up. My doctor's brain takes over. I do not see my sister as the Vice President anymore. I see a patient in danger.

I follow her out of the ballroom, through the heavy double doors, and into the quiet, air-conditioned hallway. Scarlet turns into the ladies' lounge. The room is empty, decorated with large mirrors and pink roses.

When I walk in, Scarlet is leaning over the marble sink.

The gold dress is open a little at the neck. Her skin is not pale—it is grey. A strange, blue-grey color that means there is not enough oxygen in her blood. Her chest is moving up and down like a piston, but she is not getting any air. She is gasping, making a small, wet whistling sound in her throat.

"Scarlet," I say, stepping closer.

She turns her head to look at me. Her eyes are wide and completely bloodshot. She tries to speak, but only a dry sob comes out.

"I... I can't," she whispers. She clutches her chest with both hands, tearing at the gold fabric of her dress. "Snow. My chest. It’s too heavy."

"Sit down," I order her. I grab her waist and help her slide down onto the clean floor. I lean her back against the wall. 

Her skin is freezing cold, but she is sweating through her makeup. Thick, heavy drops of sweat are rolling down her forehead. I press two fingers against her wrist to check her pulse.

Her heartbeat is scary. It is way too fast to count. It is messy and wild. Her weak heart is losing its rhythm. It is spinning completely out of control. 

"The girl," Scarlet gasps. She looks at the empty corner of the bathroom, her vision blurring. "Snow... she’s standing there. In the water. She’s holding the bumper."

"Scarlet, stop it. There is no one there," I say, my voice shaking now. I loosen the tight collar of her dress. "You are having a panic attack. You need to slow your breathing."

"No," she cries. A wet, rattling sound comes from deep inside her lungs. "It’s not an attack. My heart... it feels like it’s exploding. I can't breathe, Snow. The water is coming up."

I understand what is happening now. It is acute heart failure.

Because she missed her medicine, and because the anxiety has been squeezing her blood vessels for a week, her weak heart cannot keep up. The blood is backing up. Instead of moving through her body, the fluid is filling her lungs. She is drowning from the inside, right here on the bathroom floor.

"I'm calling an ambulance," I say, reaching for my phone.

"No!" Scarlet reaches out and grabs my wrist with surprising strength. Her fingers are turning blue at the tips. "No police. Dad... the launch..."

"To hell with the launch!" I scream. My tears finally mess up my makeup. "Your heart is failing, Scarlet!"

Suddenly, her hand goes weak and lets go. 

Her eyes roll back into her head. Her body goes completely stiff for one second, and then she falls forward onto my lap. 

"Scarlet!" I shake her shoulders.

She does not answer. She is not breathing.

I quickly press my fingers against her neck to feel for a heartbeat. Nothing. It is completely quiet and still. Her heart has stopped beating. 

The room goes completely quiet. The distant sound of the applause from the ballroom drifts under the door, a faint, mocking rumble. My father is still giving his speech. My mother is still smiling for the cameras. And on the bathroom floor, my twin sister is dying.

The clinical frame inside my head snaps back into place. I cannot be her sister right now. I have to be the trauma doctor.

I lay her body flat on the hard floor. I get on my knees next to her. I put my hands in the middle of her chest, lock my arms straight, and start pushing down. 

One. Two. Three. Four.

I press hard, using the weight of my whole body. The bones of her chest creak under my palms. I am manually squeezing her heart, forcing the blood to go to her brain so she doesn't die right here.

Ten. Eleven. Twelve.

"Come on, Scarlet," I cry. My tears fall right onto her grey face. "Breathe. You do not get to die yet. You do not get to run away from what you did." 

I lean down, pinch her nose, and blow two quick breaths into her mouth. Her chest rises, then falls with a hollow sigh.

I go back to the compressions.

One. Two. Three.

My arms are burning. My purple dress is ripping. The expensive roses in the vase above us smell sweet and heavy, mixing with the nasty taste of fear in my mouth. 

The door of the lounge swings open.

My mother, steps inside, holding a glass of champagne. Her smile vanishes instantly when she looks at the floor. The glass drops from her hand, shattering on the tiles, spilling gold liquid everywhere.

"Oh my God! Scarlet!" my mother screams, her hand covering her mouth. "Snow, what did you do to her?"

"Call the hotel medic!" I shout without stopping my rhythm. My hands are still pumping, regular and hard. Push. Release. Push. Release. "She is in cardiac arrest, Ma! Tell them to bring the defibrillator! The machine to shock her heart! Move!"

Mom does not move. She freezes, her eyes darting from Scarlet’s blue lips to the door, terrified that an investor might walk in and see the mess.

"Ma, look at her!" I scream loudly, breaking the quiet.  "She is dying! Call the team right now!"

Finally, my mother turns and runs out into the hallway, her fancy shoes click loudly on the floor as she runs. 

I am alone again with the ghost of my sister. I keep pressing down on her chest, counting the numbers in my head. The golden dress is ruined. The makeup is gone. The wealth of the Ford family cannot buy another heartbeat.

Twenty-eight. Twenty-nine. Thirty.

I lean down and breathe into her again.

Underneath her grey skin, she looks exactly like me. We have the same nose and the same lips. If her heart does not start beating again, I am staring right at my own future—a cold, empty body buried under a family name that was never actually clean.