An Open Heart (12 page)

“She’s in heart failure. The damaged valve is worse. She is alive because a machine is forcing oxygen into her lungs.”

“Do everything, Daktari. I’m indebted to you.”

Jace decided to play hardball with the politician. He might never have this kind of leverage again. “I need my equipment.”

“I told customs to release it to you.”

“Yes, for five hundred thousand shillings. I don’t have funds for such a bribe.”

“Bribe? This is an import tax.”

“For a donated, used item? The pump has value only for your people.”

“I’ve already instructed them to give you a fair price. They assured me that they could have asked for much, much more.”

“I spent the night at her bedside adding and adjusting her meds. Beatrice may need surgery soon. If we can’t stabilize her, there will be nothing I can do without my equipment.”

“Surely, to an American heart surgeon, our tax is like buying weekly groceries. I know you would make this amount in one surgery at home.”

Jace frowned. The MP was right. He
could
afford it. It was a matter of principle. But at that moment, Jace wasn’t sure if the MP was bluffing or if, in fact, he was bluffing himself.
Would I really let my patient die if I could save her for five thousand dollars?

He knew the answer. He would move heaven and earth to save this girl if he had to. To lose a patient because of a political battle would be beyond unethical. But he needed the politician to believe that Jace would do just that. After all, tough decisions to limit care were made
every day
in Kenya.

He hesitated. “Beatrice may not last long. I’d hate it if she didn’t make it because of lack of equipment. Should I transfer her to a heart surgeon in Nairobi?” He tapped on the phone. “Or maybe you could arrange an air evacuation to South Africa?”

“You are a more than capable surgeon. Moving her could be risky.”

“My hands are tied.”

“Pay the fee. I’ll see to it that your equipment arrives.”

“Drop the fee, and I’ll do what I can to convince the hospital to take her as our first open-heart case.”

“Don’t play games with my daughter’s life.”

“Exactly,” Jace responded. “Don’t play dangerous games with me. I’ve lost many patients before. But have you lost a daughter?”

The MP huffed.

“Even if I get my equipment, there are still many hurdles.”

“But you will try?”

“If I get my equipment.”

Jace listened as the MP’s voice became muffled. It sounded as if he had covered the phone with his hand while he engaged in a cascade of rhythmic cursing. After only a few seconds, he heard a clicking sound and the dial tone.

His appeal to the MP was over.

In Richmond, governor Stuart Franks sat behind his massive oak desk staring at the medical examiner’s report. He looked up at his chief of staff, Ryan Meadows, and slapped the paper. “Who knows about this?”

“Just the folks down at the medical examiner’s office. They released it to me only because I pressured them. I told them I represented you. Since it’s officially a medical record, it can be accessed only by next of kin.”

“And why has it taken so long for this to come to my attention?”

Ryan walked away. “Look, Stuart, I’ve sat on this for weeks. No one else knew. The police weren’t investigating a homicide.” He sighed. “I didn’t want to tell you until you’d gotten back on your feet yourself.”

The governor sighed. It had been a long road back. First, he’d had the massive heart attack and emergency surgery, then a postoperative stroke and pneumonia. Only this week had he been able to work a full day without napping. He knew his friend had his best interest at heart.

“I don’t want the media getting hold of this.” He shook his head and sighed. “I’d always hoped they were wrong about Anita.” He ran his fingers through graying hair. When he looked up, his assistant was standing in the corner, looking out over the grounds of the governor’s mansion. “I messed up, Ryan. I let my political drive take time away from her.”

“She supported you, Stuart. Don’t be so hard on—”

He lifted his hand to cut him off. “I should have been there for her. After her miscarriage, things were never quite the same.”

Ryan poured himself and the governor two fingers of Maker’s Mark Kentucky bourbon. “Do you understand what the report implies?” He lifted a glass to his lips. “Anita was raped. Ketamine is a powerful anesthetic.”

“So she might have been innocent after all?”

“Did you trust her?” He tapped the top of the red wax-dipped bottle.

The governor looked away. “I don’t know.” He paused. “I wanted to believe her. I’d always hoped the media speculation was due to distortion from political enemies.”

“And so maybe it was. But this ketamine takes her death to a whole new level.”

“How is that?”

“If someone gave her ketamine as a date-rape drug, perhaps she was still groggy. Sure, she was hit by a passing motorist, but did the drug affect her ability to get out of the way?”

“You’re suggesting homicide?”

Ryan shrugged. “Think about it, Stuart. Who has access to anesthetic drugs?”

“A heart surgeon.”

“Who else was with her the night of her death?”

The governor walked around his desk and poured a second drink. When he spoke again, his voice was etched with anger. “You say you were protecting me by not sharing this with me sooner?”

Ryan’s voice quivered. “Of course, sir.”

“Stupid!” he said, spitting bourbon from his lips. “Stupid, stupid, stupid! By sitting on this information, you let Jace Rawlings slip away.”

“What do you want me to do?”

“Keep this away from all other eyes. I’m going to talk to the chief of police and the attorney general. I want a DNA match on the semen found in my wife, proof that this was Rawlings.”

“The man’s made his escape.”

“Some altruistic mission,” Franks huffed. “He was running away.”

13

That afternoon, Jace stood at the bedside of Michael Kagai, the patient with perforated bowel on whom he’d operated the evening before. Jace looked up when he heard his name.

“Hey, Jace, heard you were busy last night. Welcome to Kijabe.” Dave Fitzgerald smiled.

Jace nodded. “Thanks.” He handed him a chart. “Would you mind looking over this?” He gestured toward the patient in the bed. “I’m a little new at this general surgery stuff.”

Jace watched as Dave leafed and
hmmed
his way through the chart, making short comments to himself. “Free air … perfed bowel … primary anastomosis.” He handed the chart back. “Better check his HIV status and cover him with Cipro. Perforated ileum from typhoid fever is twenty-five times more common in HIV-positive patients than in the regular population.”

Jace made a note. “Sure.”

Dave moved closer and spoke to the patient in fluent Kiswahili. The patient responded and wrapped his hands over his chest. Dave then spoke again and the only thing Jace could pick out was “HIV.”

“Whenever you order an HIV test,” Dave explained, “you need permission. The test comes with counseling.”

“Why did he do that, wrap his arms around his chest?”

Dave smiled as he walked away. “I told him you were a famous heart surgeon.”

“What did he say?”

Fitzgerald mimicked the patient’s actions. “He’s protecting himself from you.”

Jace mumbled, “Good idea.” He walked up the hall toward the HDU, where he found his intern fumbling with an ultrasound probe. Paul pushed the machine toward their young heart-failure patient.

Jace placed the ultrasound probe over Beatrice’s chest to evaluate her heart function. As he did, he taught his intern, Paul, how to interpret the images. “Here is the aortic valve. It’s almost nonfunctional. See the blue and red color here? It shouldn’t show flow both ways across the valve.” Jace pushed a button to freeze the image, then moved the cursor over the wall of the left ventricle, measuring the thickness of the muscle. “See, it’s too thick, hypertrophied as a result of working too hard.”

“Her oxygen is better than last night,” Paul said. “What do you think about an operation to replace the valve?”

“She needs it for sure, but I’m not sure we’re ready. I still need my equipment, and that’s only the first step. If I can get my equipment through customs, I’ll need to ask my pump tech and a cardiac anesthesiologist to make an emergency trip. They told me they would if I could get everything ready.” Jace sighed. “It takes a lot of blood to do this sort of thing. I’m not sure the blood bank is up to it.”

Paul nodded. He smiled and added. “We are a people of faith at this hospital, Dr. Rawlings. I’ve seen God do miracles.”

Jace stayed quiet. He’d asked God for a miracle only once.

And God hadn’t come through.

So Jace hadn’t been on close speaking terms with Him since.

He studied the chart a minute longer. “Give her an additional dose of Lasix tonight. If she looks better tomorrow, we may consider removing this ventilator.”

Jace walked back to his little rented house hoping that God would hear Paul’s prayers, but not daring to believe.

He replayed his conversation with the MP. It would be so much easier if his first case wasn’t such a high-tension production. If he operated and failed and Beatrice died, the minister of health might force the program to shut down, defeating Jace before he could really test the waters. It might be best to drag his heels a bit. The heart program would be safer if Beatrice were to die without an operation than if Jace tried something risky and failed.

But Jace couldn’t allow himself to travel far down that path. His training, his whole orientation, was to push as hard as he could for as long as he could with whatever means available in order to save a patient’s life.

And with that approach, sometimes he lost. But when he did, he could still move forward, knowing that he’d given everything he could.

He sighed.
Why did his first case have to be a politician’s daughter?
He’d had his fill of cases involving politicians. Invariably, memories of his other recent high-profile case came into focus. Looking back, he wished he’d never performed surgery on Stuart Franks.

Jace Rawlings stripped off his gown, pulling the disposable covering into a wad inside his sterile gloves, and threw it in the trash. The governor was still on the operating table behind him—critical, but at least alive. Jace thanked his staff and looked at the anesthesiologist. “Thanks, Joe. I’ll see you in the ICU in a few minutes. I need to talk to the family.”

He found Anita Franks sitting in a private, quiet room along with the governor’s brother Bill and the governor’s chief of staff. “Good news,” he said. “We’re all done.”

Relief broke across their faces. Hugs were shared. Jace stood back and relished the moment.

“I had to replace the mitral valve. The operation went fine, but the governor still isn’t out of the woods. Remember, it was an infarction that got him into this condition in the first place. We’ve only just now gotten him stabilized. It is going to be hour by hour for the next few days.”

Anita stood. She was taller and slimmer than Heather, Jace thought. And certainly more youthful than the overweight governor. She brushed blonde strands of hair behind an ear pierced with two small gold rings.

Before he could react, she pulled him into a hug, gushing her thanks. When she pulled away, Jace saw a photographer just outside the privacy area, snapping away.
Paparazzi.

Jace hurried to close the door to the intruding photographer.

Ryan Meadows shook his hand. “Would you like to talk to the press? We’ve arranged a room on the second floor for media updates.”

Jace shook his head. “Not yet. Let’s see how the night passes.” He paused. “Just tell them the operation went as planned, but the governor is still considered critical.”

He walked out, aware that cameras were clicking. His hug with Anita would make the front page of the
Richmond Times Dispatch.