An Open Heart (11 page)

More laughter. “Dr. Rawlings, Minister Okombo is the very man who told me to reduce my fee to five hundred thousand bob.”

Jace hesitated. Was this a bluff? If he caved to such a demand, would more money be exacted in the future?

“Next week, the cost will be 505,” he said. “You may pick up your equipment between nine and four on business days.”

Jace was about to speak, but realized that a click had signaled the end of the call.

Jace looked down at the book on the table in front of him.
I came here to do hearts, not untwist locked colons!

Do I dare ask the hospital to help me get my equipment through customs?

He shook his head to answer his own thought. No, that would certainly end the program before it began.

The phone rang again.

He lifted the receiver. “Dr. Rawlings.”

“Dr. Rawlings, it’s Paul. I have a patient in casualty with free air.”

Again, his gut tightened. Free air was medical lingo for a perforated intestine or stomach. They called the air free because it was not confined to the intestinal tract. It had been years since he’d handled any such problem, and in residency, he always had an attending to hold his hand. Now
he
was the attending, feeling like the captain of a ship without a rudder.

Jace took a deep breath. “I’ll be right there.”

11

Heather lifted the schnauzer onto the table and scratched him behind the ears. “It’s okay, buddy. Dr. Meadows just wants to look at you.”

She’d shown up to walk one of her afternoon regulars, a miniature schnauzer named Skippy, only to find him listless and vomiting. Before walking a pair of Maltese, she had brought Skippy to the vet.

Dr. Steve Meadows frowned. “The blood tests show an elevation of amylase.”

Heather squinted. “And that indicates …”

“Pancreatitis. This breed is prone to it. Maybe little Skippy got into the trash and ate some fatty food of some sort.” He paused, stroking the silver-gray coat of the young animal. “Every time he eats, the pancreas has to work, so we’ll have to force him to fast for a few days. I need to keep him here with an IV.”

“I’ll let his owner know.”

Dr. Meadows smiled. A row of perfect teeth. He brushed his hand against hers as she held onto Skippy’s collar. “How are you doing?” He seemed to hesitate before adding, “I heard your husband left for Africa.”

She nodded. “Who told you?”

“My brother. Ryan is the political one in the family. He’s the governor’s chief of staff.”

She studied his blue eyes. They were soft, caring. She wasn’t sure how much to say. “I’m okay.”

He nodded. “Do you like tea?” He pointed to a shipping box in the corner. “Ever since my brother made friends with the Kenyan leaders, I’m swimming in this stuff.”

He lifted a smaller green box from the larger corrugated one. “Here,” he said. “I’m serious.”

She accepted the gift. “Thanks.”

“Ryan told me about you.”

She felt her face flushing. “What would he know about me?”

The veterinarian shrugged. “Thought your husband was a fool for leaving.”

She thought about telling him that the separation was her idea, but didn’t. Maybe it wasn’t such a bad thing if he thought she’d been abandoned. Instead, she offered a polite smile and stayed quiet, gripping her box of Kenyan tea.

He scribbled something on a clipboard chart as an assistant entered. Heather took a step toward the door.

Dr. Meadows stopped her with a gentle touch of her shoulder. “Take care. You can call me for an update on Skippy tomorrow.”

Inside the operating theater, a fifty-one-year-old Kenyan was being put under anesthesia. Outside, Jace Rawlings stood at the scrub sink and tried to calm his runaway heart. Other than draining the perirectal abscess, this would be his maiden voyage as a surgeon since his accident. To make things worse, his intern had abandoned him to see another patient in casualty.

He scrubbed each finger with a bristle-brush, working up a rich brown iodine-based lather. He held out his left hand and frowned behind his mask. A fine tremor had returned.

He’d called the Fitzgerald house to get some advice from the experienced general surgeon on station, but had talked only to his wife. Dave was in bed, having been up late operating the last three nights. Jace told Ellen not to bother him. He’d call if he needed him.

He felt sweat on his brow in spite of the night’s sixty-degree temperature. Because of the high altitude, Kijabe temperatures plunged when the sun dove below the horizon. He looked through a window in the door separating him from his patient.
What are you doing? You’ve never operated on a patient like this alone. You are a cardiac surgeon. What do you know about this?

He was well trained, he tried to reassure himself. Surgery was surgery. If he could replace a heart valve, he could do this. He backed into the room holding his hands in front of him. Unlike back in Richmond, here he was expected to gown and glove himself, something he did awkwardly, contaminating one gown in the process. When the scrub tech, a young man named David, saw him struggle, he assisted in gloving Jace.

When they had the first pair on, David held up a second pair. “Better double glove, Dr. Rawlings.” He paused. “HIV is everywhere.”

Jace nodded and felt his gut tighten another notch.

A few minutes later, with the abdomen of the sleeping patient prepped and draped, Jace found himself throwing out a silent prayer.
Help!

“Knife.” Jace held out his hand and accepted the scalpel.
I can do this.
He guided the blade across the abdomen starting just under the sternum. A red stripe followed the knife. He touched an electric-pencil cauterizing instrument against the bleeders.

He worked on, opening, identifying a hole in the ileum, tying, resecting, irrigating, sewing, and closing. At every step, when he hesitated, the scrub tech quietly helped by handing him the instrument or suture he needed. Jace was humbled. Rescued.

Later that night, Jace sank into the only soft chair in his small living room, fighting emotion that he thought he’d conquered in training. Self-doubt had set up camp on his doorstep since his accident, and he wondered where the confident Jace had gone.
Instead of just putting his bowel back together, should I have brought out the proximal end as a stoma? Will the anastomosis hold together? I should have called for the surgeon’s advice. Pride!

Who am I fooling?
he thought as he gripped his trembling left hand.
Did I come here because I feared I’d fail in Virginia with everyone watching?

Jace fell into a fitful sleep at midnight, only to be called at three a.m. by his intern again. “Dr. Rawlings, I am admitting a girl who is in florid heart failure.”

“Sounds like a medical problem,” Jace responded, rubbing sleep from his eyes. “Why are you calling me?”

“She is very weak. She can barely talk. Her pressure is low.”

Jace sighed. “How’s her oxygen saturation?”

“I’m not sure our monitor is picking up properly. It reads seventy.”

“She needs to be intubated, put on the ventilator.”

“I’m not sure she will survive the night. She is very afraid.”

“She’ll need a pressor drip. Does the hospital have dopamine?”

“Yes.”

“I still don’t understand. Why aren’t you calling the medicine doctor? I’m a surgeon.”

“I know, sir. But she came in asking for you. She said that she’s your patient.”

“My patient? There must be some mistake.”

“It’s no mistake, sir. She is from Kibera. A girl named Beatrice.”

12

The Kijabe Hospital casualty department was a sixty-by-twenty-foot rectangle filled with stretchers separated by old curtains. Jace found Beatrice Wanjiku on a stretcher, sitting bolt upright, sweat beading off her slick dark skin.

It took one look, a ten-second assessment of the ABCs—airway, breathing, circulation—and Jace knew she was in trouble. Life-threatening, in-your-face, I-can’t-get-my-breath trouble. In his time as a cardiothoracic surgeon, Jace had watched plenty of people who looked better than this go south and die in a hurry.

He looked at a nurse. “This patient needs to be intubated now. Do you have a crash cart somewhere?”

“It is just there,” she said, pointing to a wooden cart on wheels in the corner of the room.

He laid his stethoscope against Beatrice’s back and moved it up and down, listening to her shallow and labored breathing. To his intern, he said. “This is classic for wet rales. They go most of the way up her back.” He pointed to the veins in her neck. “Here,” he said, “she has jugular venous distention up to the angles of the jaw. You will not see a better example of heart failure.”

Paul nodded. “I was able to start a small IV in her hand.”

“Give furosemide 80 mg. stat. We need to chip her out.”

Paul’s expression told Jace he didn’t understand.

“Sorry, I’m using slang. We need to cause her to get rid of extra fluid. We say that’s making her dry like a potato chip, so we say
chipping her out
.”

The nurse frowned.

Jace understood the dilemma. In Kenya, potato chips were called crisps. In Kenya, if you asked for potato chips, you’d get what Americans call fries. “Okay, we’ll call it
crisping her out
.”

Jace assembled supplies, preparing to slide a breathing tube down into his patient’s trachea. That way, when breathing became too hard for her, the machine could do the work. From the looks of his patient, he didn’t have much time.

Jace looked at the nurse again. “I’ll need some sedative. Do you have Versed and fentanyl?”

“I will bring them.”

Jace stood beside his patient and explained, “You are wearing out, Beatrice. You will die soon if we can’t support your breathing.”

Her eyes widened. “Help me,” she whispered.

“I’m going to give you something to relax you. You won’t remember.”

Jace instructed the intern, gave the IV medication, and placed a mask over the patient’s mouth. He used an inflatable bag known as an Ambu bag to push oxygen into his patient’s lungs. Then, after the patient was no longer fighting, he slid a metal laryngoscope blade into her mouth, pushing the tongue to the side. He stood by his intern at the head of the bed, staring down through the patient’s open mouth toward her feet. “There,” he said, “can you see the vocal cords? Slide the end of the tube through there.”

Paul slid the tube into place and inflated a balloon-cuff to keep air from escaping around the tube. “I’m in.”

“Good job. Let’s get her up to the HDU. Call the medicine doctor. I want all the help we can get to stabilize her.”

The next morning, it took two hours of phone calls to finally get the Honorable John Okombo on the phone.

Jace looked at his watch. “Thank you for taking time to speak to me.”

“Dr. Rawlings, my pleasure.”

“Did you know that Beatrice was admitted to Kijabe Hospital last night?”

He heard a faint “Excuse me” and the cessation of background noise. He imagined the MP was stepping away from the ears of others at the mention of his secret daughter. After a moment, Jace heard Minister Okombo’s strong bass voice spoken just above a whisper. “I was unaware. How is she?”