An Open Heart (19 page)

There, in the night, with the sounds of her mother’s snoring and the busy steps of the nurses caring for the other patients, Beatrice pulled her mother’s arm around her like a blanket.
She does care, doesn’t she?

She arranged for the American doctor to see me.

That must mean that she has some powerful friends.

Or is my father secretly watching me?

It was a mental game she’d played, growing up without a father. She imagined that he was someone special. She would look at herself in the small hand mirror her mother had given her one Christmas and try to see her features in the men who visited her mom.

Could it be the man who brought Dr. Rawlings to me? He dressed in a suit and drove a big vehicle for someone important. Did he arrange for my care?

In the early hours of the morning, Beatrice’s nurse stopped by the bed.

“Child, you should sleep.”

Beatrice nodded.

The woman had a kind face, with muddy brown eyes and a Kikuyu name like hers. “Afraid?”

“Yes,” Beatrice whispered.

“Close your eyes. I will pray.”

Beatrice obeyed. And as the woman prayed and stroked her hair, she imagined her mother was the one who was touching her, that her mother was the one who prayed with such vibrancy that Beatrice found herself believing things really could turn out okay.

The next day, work began for the open-heart team at six. The patient was brought down, a central line was placed, an arterial line inserted, sterile fields opened and prepared. IVs were hung, antibiotics dripped, the patient anesthetized, and the skin prepped. By nine, Jace stood at the scrub sink and tried to exorcize his self-doubt. It had been months since his last open-heart case. But what was mere months in time seemed a world away.

As he lathered his hands and arms, instead of a prayer to God, he whispered his sister’s name. “Okay, Janice. Here we go.”

A few minutes later, as he stood with the scalpel poised above his patient’s sternum, Gabby spoke up after clearing her throat. “Dr. Rawlings,” she said, using his formal title since they were in front of staff. “I’d like to begin with a prayer if that’s all right. It’s a historic day for this hospital.” She hesitated. “And for Kenya.”

Jace nodded.
Couldn’t hurt.

Gabby began. “Dear Father, we commit this precious life to You. Watch over her and all the staff. Help us. Guide Dr. Rawlings’s hands. Bring healing. We promise to give You all the glory.”

Jace closed his left hand into a fist during the prayer, hoping to quell a twitch. When Gabby finished praying, he echoed, “Amen.”

He glided the scalpel over the skin, separating the brown skin to reveal a layer of yellow fat beneath. Then he picked up the pencil cautery and applied it to multiple small dermal and subcutaneous bleeders. He then bluntly worked the tip of a scissors beneath the sternum, freeing the soft tissue from the undersurface of the bone. He took a sternal splitter and a mallet and split the sternum. Back in Richmond, he would have done this with a pneumatic saw, but in Kijabe, he did it the old-fashioned way.

In a moment, the lining around the heart was opened and retracted and the patient’s heart was exposed. Across from him, Dave Fitzgerald shook his head. “Man, this is so cool.”

“Nothing like the human heart.” Jace looked at Gabby. “Let’s set up the heart-lung machine.”

As many times as Jace had done this, he was never without amazement at the process. Large bore tubes were sutured into place in the aorta and right atrium, the heart was cooled, and the pump started.

Gabby sat behind her silver cardiac bypass pump, a queen happy in command central. “You know what they say,” she bantered.

Jace knew what was coming. “Okay, Gabby, what do they say?”

Gabby rolled her stool, staring at the machine in front of her. “What is the fastest way to a man’s heart?”

Dave Fitzgerald shrugged. “Through his stomach.”

Gabby laughed. “Between the fourth and fifth ribs.”

Jace smiled behind his mask. He spoke to Gabby, his tone suddenly serious. “Venous line’s to you.”

She understood the notation. She opened the line. “We’re on bypass.”

A heart-stilling medication was infused directly into the heart. This cardioplegia, as it was called, was high in potassium, causing paralysis of the heart muscle cells. The patient was now alive, but without a beating heart. Little blood circulated through the lungs as the heart-lung machine oxygenated the blood as it went through the pump.

Jace went to work, opening the heart, removing the old diseased valve and placing a new one in its place.

While they worked, they fell into routine. Jace discovered that, as on a bicycle, everything came back. He placed sutures with the precision of a watchmaker. Fingers blurred in a flurry of knot tying.

“Gabby,” Jace teased. “I’m sure we can find you a nice Kenyan young man to convince you to stay. I’d bet that one of my Maasai friends would pay twenty or thirty cows for a woman like you.”

Gabby huffed. “Only thirty?”

After forty-five minutes, the heart was closed again, and they began a rewarming process. When the patient’s temperature was within a few degrees of normal, Jace asked for the internal paddles to shock the heart. He looked over the drapes at Evan Martin. “What’s wrong?”

Evan shook his head. “This girl is so sensitive. I’ve had her on next to no anesthesia.”

“I’m operating on her heart and she’s not under anesthesia?”

“Chemically paralyzed, that’s about it.”

“Just give her something to keep her from remembering. Here she is being suspended between life and death. It could be pretty freaky for her.”

Awareness.

Darkened passages, a sudden bright light, like looking into the sun, but different. She had no need to shield her eyes.

Did she have eyes?

Weightless, floating, hearing, seeing, feeling, but not embodied. Away from the light, she tried to focus.
That’s me down there. That’s my heart.

I’m dead.

My doctor doesn’t know. He doesn’t seem concerned. He jokes with the woman about getting a husband.

Beatrice looked on with a strange sort of detachment.
My heart. My chest pried open by steel jaws. But I feel no pain.

So I must be dead.

Can I travel? Move?

Thought seemed to move her around the room. She reached out to touch a pole laden with IVs, but her hand passed
through
it. She tried again. Same result. She touched the surface of a monitor, then pushed her hand
into
it.

Inventory time.

Is this heaven? Hell?

In between?

Alive?

Dead?

Up.

A thought took her through the ceiling, passing through wiring, rafters and roof. Warmth of the sun.

Down.

Instantly, a descent back through the building and into a damp world of worms and dirt, darkness and cool.

Cold, but temperature did not affect her. She had no desire to warm herself.

Up!

Inside again. She looked at the monitor. No activity. She’d grown accustomed to the sound of her own heart while in the HDU. She’d awoken several times in fear, only to comfort herself with the rhythmic blips of her own heart.
Alive!
She’d imagined herself in a little car, riding along the green road of the monitor’s glowing line. She would bump, jump, and skip from hump to hump, using the small swellings to vault her over the jagged pointy cliffs, land, and jump again.

But not now; the monitor was dark except for a silent horizontal line running from left to right. The squiggles of life, the treacherous road of bumps, hills, and cliffs were flattened in the crush of death.

Right.

Through the walls to hover in a small waiting room above her mother slouched in a plastic chair.

An empty woman without hope, crying a prayer into her hands. “She is all I have.”

She looked closer, seeing not just her mother, but
inside.
A battle. An invader. Not spiritual, but a violence nonetheless. And no one else in the room seemed to notice. Swirling, gnawing, the color of deep red, not blood, but something foreign, circling, attacking, enveloping.

Weakening.

The AIDS virus.

Beatrice just knew. Her mother’s cough, the continuous fight with diarrhea, the glistening of her forehead with fever. It was the African prostitute’s destiny, a lifetime virus left in deposit for ten minutes of flesh pressed against flesh. It was a payment for pleasure, with pain the currency.

Beatrice knelt in front of her, taking her head in her hands, first letting them pass through, and then concentrating on resting on the surface.

Her mother jerked upright, staring wildly at the other people in the little room.

She studied the people in the room.
I can see through them.
Some were glowing white, some dull. She looked at a man with a glowing white heart. In his hand, a leather-bound book seemed to captivate him.
A Christian?

Her mother seemed to push into Beatrice’s touch.
She can feel me.

She willed her mother to relax.
I’m here.

“Beatrice,”
a male voice echoed.
From inside me?

She looked to see a body wrapped in a glow, light streaks that bent, swirled, and
moved
, hovering just above the skin. If it could be called skin at all.

To say handsome would have been a vast understatement. He was the most beautiful creature she’d ever seen. Tall. Muscled. Light shooting from his fingertips, trailing like a flare as he gestured her closer.

But then she saw his eyes. Dark, ominous, and small, windows into blackness.

She drew back. Away!

She moved into the operating theater again, not wanting to go with the creature.

But he followed, up, down, mirroring her movements.

She looked at the monitor. Silent.

She watched as Dr. Rawlings placed what appeared to be two spoons on the heart.
My heart.

“I have a message for you to give to Dr. Rawlings.”

He doesn’t have a mouth, but he communicates his thoughts with me
. She wanted to get away.

Dr. Rawlings spoke calmly. “Charge to fifteen.” For a moment, she stared at her surgeon.
Is his heart white?
Beatrice wanted to see.

The woman behind the silver machine, adjusting a dial on the machine’s face, had light streaming from her chest. She twisted the knob before speaking.
“Charged.”

Crisis.

The surgeon depressed a button on the handle of the spoon.

The monitor blipped once, twice, then the glowing green road of hills, bumps, and cliffs began to tent up the once-flattened line.

Beatrice dropped.

Darkness.

Jace positioned the spoon-like paddles directly on the heart muscle. “Charge to fifteen.”

The point of crisis. The critical point to move from the still heart to restoration of heart function.