An Open Heart (10 page)

Other than the day of her burial, this was the first time Jace had dared visit his sister’s grave, had dared to confront his painful past.

He didn’t know what to expect. A voice perhaps? Another vision?

Instead, what he experienced was an amplification of the jumbled noise he’d carried around for so many years. Guilt. His parents’ loss. He cupped his hands over his ears and rocked forward, with so many voices echoing within him. His father’s voice.
All things work together for good. His ways are higher than our ways.
Platitudes that spoke to the mind but not the heart. Janice’s scream as she fell.

He shook his head in a vain attempt to silence the memories. “Janice. I’m so sorry, I’m so sorry, I—” his voice cracked— “am sorry.”

A world away in America, he had pushed hard in pursuit of career and professional reputation. As long as he did, his guilt withdrew into the background, a nuisance, nothing more. But all of that changed when he met Anita Franks. Something about her brought Janice to his mind. She was fresh, different from Heather, and apparently open for play. And so, guilt slipped off its background perch and began an assault for recognition.

He wouldn’t have recognized that he’d planned a medical mission to Kenya to soothe his conscience. But it wasn’t always easy for Jace to see the obvious.

The grave marker in front of him was flat, with little to distinguish it from the others. But for Jace, it seemed to loom like the Washington Monument over the Mall.

“Dr. Rawlings.”

Jace recognized the bass voice of John Otieno and looked up.

“I live just over there and saw you. Is everything okay?”

“Sure.” He stood. He wanted away from the big man, but the chaplain stood between Jace and the way back out of the cemetery. He stepped to the side, but John moved to block him. Jace sighed and looked back down at the grave marker.

“I remember Janice,” Otieno said. “I used to chase her out of the hospital after hours. She was always hanging around watching your father.”

“From the time she was in the first grade, she always said she wanted to be a surgeon.”

The chaplain nodded and smiled.

“She wanted to come back here, be a missionary surgeon.”

“And you?”

“My desire to enter medicine came later in life. In college.”

The old chaplain chuckled. “When you were here, all we heard about was Jace and rugby. We thought you’d anchor the first American team in the World Cup.”

Jace smiled and looked at the large Kenyan. A fine spray of wrinkles dignified his face. Whatever wear and tear his skin showed, he’d earned the right to wear it through years of hard work and his share of tears over the troubles of his people.

“This is it, isn’t it, Jace?”

“It?”

“The reason you came back.” He knelt beside the grave. “The answer is right here.”

Jace choked on the apple in his throat and swallowed hard. “Janice asked—” he paused, then rephrased his thought—“would have wanted me to do this.”

10

When Jace finally went to bed, his mind refused to rest. He thought about all he’d seen in the operating rooms, especially how deftly the surgeons had dealt with the intracranial bleeding for the head-injury patient. And that brought back a mental rehearsal of all that led up to his own similar injury not long before.

He’d been on call the night governor Stuart Franks felt sudden chest pain and collapsed at a fundraising dinner for Virginia’s Special Olympics. By the time Jace was called, the governor was clearly in a fight for his life. Jace walked past the bodyguards on his way into an ICU room crowded with two nurses, a respiratory therapist, and two cardiologists.

Dr. Robert Hawthorne looked up. “Hey, Jace, thanks for coming.”

Governor Franks was fifty-five, overweight, and lying in a tangle of monitoring cables and drainage tubes. He was unresponsive except for the rhythmic rise and fall of his chest with the mechanical ventilator. His blood pressure, recorded on the monitor, was seventy systolic.

Cardiologist Hawthorne pointed at a portable echo machine at the bedside. “He’s had a massive MI. I cathed him, was able to open up a 90 percent LAD lesion and a second 80 percenter of the circumflex. Problem is, he’s developed an acute mitral regurgitation. Seems to have ruptured attachments to his mitral valve.”

The second cardiologist, James Green, nodded. “With maximal pressors, we just can’t get his pressure up to snuff. He’s barely staying out of heart failure. As it is, we had to sedate him and put him on the ventilator just so he could be oxygenated.”

Jace studied the monitor screen on the ultrasound machine. Slowly, he replayed the video. “Wow. Look at this,” he said, pointing at the screen. “You can see his mitral valve leaflets just flopping in the breeze, totally uncoordinated.”

“He needs a new valve. Tonight. I’m afraid he won’t last the night if we let this keep on.”

Jace took a deep breath. “Agreed. Has anyone talked to his wife?”

“On and off all evening,” Hawthorne said. “She’s in the waiting room with her husband’s chief of staff, Ryan Meadows. Come with me, I’ll introduce you.”

The cardiologist led Jace down the hall from the ICU to a private seating area that they used for patients’ families. When he pushed open the door, Jace peered in to see a young, fit, bottle-blonde Anita Franks leaning forward and holding hands with Ryan Meadows. Jace’s first thought was that this was the governor’s daughter.

“Mrs. Franks,” Dr. Hawthorne began, “I’d like to introduce you to Dr. Rawlings. He’s a heart surgeon.”

This was the wife, then. She released the hand of the chief of staff to reach out to Jace. “Anita Franks.” Her voice trembled. “A surgeon?”

Jace nodded. “Your husband’s heart attack has damaged his mitral valve, the valve between the main pumping chamber, the left ventricle, and the left atrium, the chamber that receives the blood back from the lungs.” Jace unfolded a laminated card he kept in his coat pocket and pointed. “Here,” he said. “The heart attack has injured the valve so that it is now incompetent. What that means is that blood is allowed to flow in two directions across the valve instead of just one.”

Anita Franks nodded.

“Instead of allowing blood to flow only into the main pumping chamber, the left ventricle, blood sloshes back and forth across the valve, so that extra blood is pushing back out into the lungs.” Jace paused, searching her face for clues of understanding.

“That’s why he’s having such a hard time breathing?”

“Exactly.” Jace sat across from the duo so that he would be at eye level. “We need to replace the valve with a mechanical one.”

“When?”

“As soon as possible. The heart doctors are doing everything they can, and your husband’s heart is failing. I fear that if we don’t replace the valve soon, we may lose the only window of opportunity we have.” Jace paused again. “Without surgery, he may not survive the night.”

“And with surgery?”

“I won’t sugarcoat it. This is very risky. But I’d give him a fifty-fifty chance with surgery.”

Anita looked at Ryan.

He touched a graying sideburn of his perfect hair. “It’s your choice, Anita.”

She squirmed and tugged at the edge of a too-short skirt. “I have to give him the chance.” She looked at Jace, her eyes pleading. “Do what you have to do to save my husband.”

On Monday, Jace went to the hospital early and found his assigned intern on the Wairegi ward, the men’s ward named after a generous male patient. Dr. Fitzgerald had divided his service, handing Jace a few post-op patients so he could share the load.

Jace looked into the bright face of his intern, Dr. Paul Mwaka. Paul held out his hand. “I hope that you will allow me to assist in heart surgery.”

Jace found himself chuckling. “I only hope we’ll be given the chance.” He paused, looking at a stack of charts. “Can you introduce me to the patients?”

Paul nodded and lifted the top chart. Lean, mostly legs and lungs, he was built like he’d be at home running a marathon.

As they worked through the list, Jace couldn’t help noticing the reversed role. He was the attending surgeon, but the intern was teaching him. Fortunately, Paul was experienced, and Jace deftly stepped around his own lack of knowledge by assuming the role of teacher: He questioned the intern. But instead of testing him, Jace was learning.

The first patient on their rounds had had prostate surgery the day before. Jace felt his gut tighten. He’d had a total of one month’s training in urology years ago during his own internship. “Do you want to stop the bladder irrigation?”

Paul shook his head. “Not yet. We’d better wait until the urine isn’t so red.”

“And what might happen if you stop the irrigation too soon?”

“The catheter may get clogged with a clot, causing the bladder to leak through the suture-closure.”

Jace nodded as if he’d known the answer all along. “Of course.”

The intern handed Jace a chart. Jace reached for it with his left hand, and the chart slipped from his grip and landed on the floor, opening the two-ringed binder and spilling the papers. As Paul hurried to collect the papers, the intern apologized. “Pole sana,” he said softly.
I’m so sorry.
It was Kenyan custom. Apologize even when it’s not your fault.

Jace rubbed his left hand. He’d been through rehabilitation. He’d come a long way, but a slight residual weakness remained in his grip strength. He pushed the next thought from his mind.
I’m ready.
He didn’t want to consider the next accusation that assaulted him.
What if I drop an instrument at a critical moment during surgery?

Almost without thinking, Jace felt and traced the scar on his right scalp buried beneath his hair. When he became conscious that his intern was watching him, he turned away.

Jace’s left hand twitched, but he quickly covered the jerky movement by clasping his hands together. Had the intern noticed? “Shall we see the next patient?”

That evening, Jace picked up the phone in his small flat after the second ring. He’d been waiting for business on this, his first night of general surgery call. The book on his lap was open to a page describing treatment of sigmoid volvulus, a common condition in Africa where the colon twists on itself, causing an emergency obstruction.

“Dr. Rawlings.”

“Ah, Dr. Rawlings, I’m glad to find you at home. I’m calling from the customs office at Jomo Kenyatta International Airport. I believe we have some of your equipment.”

Jace sighed. “Yes.”

The voice on the other end spoke with a Kenyan accent. Although firm, he spoke very softly, another Kenyan distinction. “We have made an assessment of value on the equipment. We are authorized to release it to you after payment of an import tax.”

“How much?”

“Five hundred thousand shillings.”

Jace shook his head.
That’s over five thousand dollars!
“Look,” he said. “I’ve talked to the minister of health. He told me he would help me get my equipment through customs. The equipment was donated at no cost to me. It has no value except to the needy patients of Kenya.” Jace sighed. “Do you have the letter from Compassion Industries? They donated the equipment and arranged to have it air-freighted to arrive with me.”

The man laughed. “Of course I have the letter.”

“It explains that the equipment is used and is of no retail value.”

“I understand how the system works, Dr. Rawlings. Your hospital devalues used equipment over a few years so that they will not be taxed. But this does not mean that the items have no value in Kenya, correct? Also you will earn a great deal as a result of using the equipment. I know this equipment is for heart surgery.”

“Yes. Heart surgery on those who cannot afford to pay me for the service.”

The man on the other end of the phone scoffed. “We cannot keep such items in our warehouse forever. The storage fee is five thousand shillings a week.”

“Please,” Jace found himself begging. “I cannot pay such a fee. Talk to the Honorable John Okombo. He will vouch for me.” He winced at his own words. Truthfully, he
could
pay the fee. He had the money. But it was the principle of the matter. His father had passed that Rawlings stubbornness on to Jace:
If you pay the bribe, it will only make it worse for the next doctor trying to help.