One Sunday afternoon, my mother-in-law called my husband. "I hate to bother you," she said, "but could you drive me to the emergency room? I think this flu I've got may be turning into pneumonia. My chest hurts when I breathe."

A few hours later, my husband called from Concord Hospital. It wasn't pneumonia after all. The doctor thought my mother-in-law might have a touch of pleurisy, nothing to worry about. He was sending her home with a prescription for painkillers and antibiotics.

An hour passed and the phone rang again. "We're back at the hospital," my husband explained. "Halfway home, Mom said she had to go back, that something was really wrong. She was so worried about ruining our Sunday -she wanted me to drop her off. She said she'd wait for an ambulance to come and get her."

He chuckled, but I could hear the tension in his voice. Then suddenly he said, "I have to go," and hung up.

An hour and a half later, my brother-in-law called me. "Mom passed away," he said. "She had a heart attack."

My mother-in-law died 11 years ago. But the recent death of John Arsenault brought it back to me again. The hospital staff sent Arsenault by cab from the emergency room to a local homeless shelter. Six hours later, the shelter staff, concerned by his inability to sit or stand, called an ambulance to take him back to the hospital, where he died.

I can imagine the shock and anger of his family on learning of his death. I still remember the look on my husband's face when at last he arrived home from the hospital that long ago Sunday. He was pale with grief and misery. But beneath his sadness lay a quiet fury aimed at the emergency room doctor.

He explained that as he was talking to me on the telephone, his mother, who had been sitting on a gurney, clutched her chest, cried out and fell back.

She was dead. He knew she was dead. Still, her body was rushed off into another room, where the same doctor who had diagnosed pleurisy tried to revive her. There was the thumping sound of the defibrillator and then nothing.

"Do it again!" my husband heard the nurse yell at the doctor. "She told me she's taking piano lessons. You have to try again."Again a thump. Again nothing.

The doctor burst into the waiting area. "You need to make a decision," he said to my husband. "I can try massaging her heart. But I need to do it right away. What do you want me to do?"

This won't look good

My husband's mother was 82. She still taught high school part-time. She played games with her grandchildren, changed their diapers, wiped their noses. She had recently moved back in with her ex-husband, to care for him as he wasted away from Parkinson's disease. She weeded the garden with gusto, walked two miles every day, ate a vegetarian diet.

She was indeed taking piano lessons, dropping into our living room most afternoons to plunk away at Mozart and Bach on the piano her own father had ordered from Sears Roebuck in 1913.

But for all that, my husband knew his mother wouldn't want to spend the rest of her days bedridden and ill.

"Let her go," he told the doctor.

My husband said the doctor was shaken by the death, afraid of how it reflected on his skill. "Do you know what he actually said to me? 'This isn't going to look good.' My mother's dead, and all he has to say is, 'This isn't going to look good.'"

For a few days, the family considered a malpractice suit. But in spite of the doctor's misdiagnosis, in spite of his self-absorption after my mother-in-law's death, we decided against it.

The more we thought about what had happened, the more responsible we felt. In hindsight, it was clear: My mother-in-law had had heart disease for a long time, and we, her family, hadn't realized it.

Taking responsibility

Cardiovascular disease is the leading cause of death in women in the United States - about 500,000 women succumb to it every year. (next page »)