An Open Heart (20 page)

Gabby responded, “Charged.”

Jace discharged the paddles. The heart quivered, beat once, twice, and then dropped into a regular rhythm. Clockwork.

“Okay,” Jace said, “let’s dial back the pump.” He paused, studying the heart. “Looks like we need volume. Give me one hundred.”

Gabby responded, “One hundred … in!”

Jace looked over at Evan. “What’s the echo look like?”

Evan studied the ultrasound screen. “Valve looks good.”

“Amazing,” Jace said. “Great job, team.”

Dave Fitzgerald nodded. “You pulled it off, Jace.”

“Dial back the pump another fifty percent. Let’s get out of here.”

19

Jace spent the first eight hours after Beatrice’s surgery doing what surgical interns call “sitting hearts.” From a chair pulled up to the bedside, he watched every beat of the heart on the monitor, noted every cc of urine, calculated every drop of IV fluid, and graphed blood pressure to identify trends.

There at her bedside, Jace could rest, at home in the environment of electronic beeps, the mechanical whine of the ventilator, the smell of antisepsis, and the sight of a spaghetti-tangle of IV tubing and monitoring lines. There, as in the operating room, Jace was focused, happily distracted from assaults on his conscience.

But it was there, after hours of tedious concentration, that his mind began to drift. He remembered waking up in an ICU not so very different from the one he now sat in. But that had been a world away.

That day, he had struggled to open his eyes against lids thick with sleep.
Did someone tape my eyes shut? Where am I?

Another sensation grew, pushing him into consciousness.
Pain!
Throbbing, itching, poking up his scalp with a thousand needles inside his skin.

Something is burrowing its way across my scalp.

Light. Fluorescent tubes behind a lattice covering. Voices. Beeping.

Beeping too fast for my heart.

A female voice. “Dr. Rawlings?”

He strained to lift his hand and saw that it was connected to a clear plastic tube.
I have an IV.

What has happened to me?

My throat is sore.
He explored the dry cave of his mouth with his tongue. He attempted to close his mouth, but found that impossible. Something blocked him.
A tube. Am I intubated?

Someone has to kill the animal inside my head.

A female voice again.
Janice?

Am I dead?

His next thought terrified him.
Was my father right? Am I in hell?

He explored a few inches around his hands. A bed. Another tube. A railing.

“You’re in the hospital.”

A face floated above him.

“Call his wife. I think he’s waking up.”

A touch on Jace’s shoulder brought him back to the present. It was Paul Mwaka, his intern. “Dr. Rawlings, why don’t you go take a break. I’ll oversee Beatrice’s care for the night. I’ll try to wean her from the ventilator.”

Jace rubbed his eyes. “Okay.” He stood and took a step toward the door. “You’ll call me if you have any concerns. Any at all.”

“Of course.”

Jace walked away, his eyes seeing the rocky path in front of him, but his mind still heavy with recollection of his own ICU stay. In the hospital, he’d awakened to a cloudy reality, unsure how he’d gotten there and what events had led him to the point of being in a car with the governor’s wife. And yet, from within the confusion was a new vision for a radical change in his life. From the haze of unclear memories, he’d experienced the real sense that his sister wanted him back in Kenya.

That’s when Jace began a delicate walk, holding the hand of sane reason on one side and the not-so-comfortable hand of mystical experience on the other. That’s all he knew to call it. He wouldn’t have described his calling back to Kenya as spiritual, exactly, but he knew it also wasn’t entirely rational. He’d opened his eyes in the ICU with a vision of his sister leaning over him and imploring him to return.

It wasn’t the kind of thing he could share with the doctors back home. They’d think he was coming unglued.

And Jace wasn’t so sure they were wrong.

That night, in a late celebration of sorts, Gabby Dawson and Dr. Evan Martin joined Jace at his house for supper. Jace had picked up takeout from Mama Chiku’s. That meant hot stew, chapatis, ugali, and the spicy meat-filled dough pockets called samosas.

“I wish I had a few cold Tuskers to share,” Jace said. “I’d like for you to be able to sample Kenyan beer, but Kijabe is pretty much a teetotaler kind of town.”

Evan sat at the table laden with local food. “Against the law?” He looked at his watch. Not waiting for Jace’s reply, he added, “Did you know we’re nearly a mile and a half over sea level here? I’ll bet all our patients are a few points down on their oxygen saturation.”

“Reports from the gadget guy,” Gabby said before asking Jace again, “So drinking is against the law?”

“Not a written one exactly. More of an expected way for the missionary community to behave.”

Gabby chuckled. “So when did our Dr. Rawlings decide to start painting inside the lines?”

Jace sighed. “Recently,” he said, pausing uncomfortably. He wasn’t good at offering prayers, but felt something was needed. He looked at Gabby. “Would you say grace?”

She nodded and bowed her head. “Dear Father, thanks for this food we are about to eat. And thanks especially for watching over Beatrice and our team. I pray Your continued guidance for Jace and for Your hand of healing to rest upon our patient. In Jesus’ name, amen.”

They filled their plates. The trio fell silent as they sampled the local fare. Soon, approving grunts and “umms” followed.

Jace dragged his ugali through the stew, the customary way to eat the thick white starch. “So you think that’s what got me here?”

Gabby looked confused.

“God’s guidance,” Jace suggested. “You asked God to continue to guide me. I guess that means you think I’m following His lead.”

She sighed. From satisfaction or anxiety, Jace wasn’t sure. “I hope you are, Jace. Something big has obviously happened to you. If anyone was ever on the professional track to stardom back home, it was you.” She gestured around the little room and its sparse furnishings. “Now look at you. You live here, of all places, and are giving your services away.”

Evan leaned forward. “I think traveling all the way over here to help you entitles us to the inside story. There are all sorts of rumors back in Richmond about why you left. Some say you’re running. Others talk of a Damascus-road experience.”

Jace frowned. “Damascus?”

The anesthesiologist nodded. “The Christian-hater Saul turned into Paul the apostle on the road to Damascus where he saw a bright light and heard a call from Christ.” He gestured, palms up. “
Damascus-road
refers to a turnaround of similar proportion.”

“I’m not sure my experience was so spiritual.”

“So what?” Evan asked, helping himself to another hot samosa. “If it isn’t spiritual, are you running from something?”

Jace hesitated.

Evan probed again. “Did you cheat on your wife?”

“That’s not your business.”

“I think the fact that I came all the way over here to make sure you find the success you desire makes it my business. I need to know who I’m working for here. Why are we doing this? To appease your conscience?”

“I love my wife.”

Evan stared down his longtime friend. “So you weren’t having an affair with the governor’s wife?”

Jace set down his fork and gripped his left hand to cover up a tremor. He shook his head. “I really don’t know.”

“Don’t tell me,” Evan replied with sarcasm, “Heather didn’t buy it.”

Gabby interrupted. “Of course she didn’t buy it. You lost your memory. How convenient.”

“It’s the truth.”

“Tell me what you remember, Jace,” Gabby said softly.

He took a deep breath. “Anita Franks was an intriguing woman.”

“Stop it, Jace,” Evan interrupted. “She was gorgeous. Everyone could see that.”

“Okay, she was gorgeous. And interested in me. We shared a meal or two, mostly just professional stuff, me filling her in on her husband’s progress. But ….” He paused. “I got the feeling that she was unhappy in her marriage. She talked about the governor. He was never home, didn’t treat her like he used to, that kind of thing.”

Jace’s friends sat and met his gaze, saying nothing.

“We never did anything.”

“Jace,” Evan said, “you were seen with her exiting a downtown hotel.”

“That was the night of the accident.” Jace moved his hand across his scalp, tracing a long scar. “I don’t remember.”

“Did you want to have an affair?” Gabby asked.

“Look, what I wanted isn’t relevant. You saw Anita Franks. What testosterone-bearing male wouldn’t want her, at least at some level? The proper question is, am I capable of giving in to desire like that? Could I really throw away what I had with Heather for lust?”

“You’re worried that you did?”

Jace answered slowly. “I’ve entertained my share of worry.” He paused. “I thought about Anita. Heather and I fought about her all the time. I didn’t sleep with her. At least not until …” He halted. “I don’t know what I did during that last visit before she died.”

Gabby pushed back from the table. “There’s something else you should know, Jace. Anita Franks had an autopsy by the medical examiner. There was evidence of recent sexual intercourse just prior to death.”

Jace felt sick.

“There’s more. Her serum tested positive for ketamine.”

“Ketamine? Why ketamine?”

Evan coughed. “I use it all the time in the OR. But recreational use?”

Gabby shook her head. “Not recreational exactly. Ketamine is used for date rape.”

“Date rape?” Jace stood up and began to pace. “You don’t think that I …”

Evan Martin tapped the tabletop. “Don’t jump to conclusions, Jace. I think the presence of ketamine actually helps you.”

“And how is that?”

“You say you think Anita Franks was interested in you? Interested in an affair?”

Jace shrugged. “She was pretty friendly. Always hugging.”

“So if you were reading the cues correctly, you wouldn’t have needed ketamine to—” He hesitated, clearing his throat. “Well, to have an affair.”

Gabby shook her head. “The problem with the ketamine is that you had access to the drug through your work.” She added stew to her empty plate. “You could choose to give a DNA sample. They could compare it to the semen sample found in Anita Franks. That could exonerate you.”

Jace stopped pacing in front of his little sink. He looked out the window to the night beyond. “Or prove to everyone, even me, that Jace Rawlings isn’t the altruistic surgeon that he wants everyone to believe, that Jace Rawlings is nothing more than a manipulative cheat, running from scandal.”

20

The next morning, Jace headed to the HDU before sunup. When he approached Beatrice’s bed, she made immediate eye contact, locking on Jace with an intensity unusual in the Kenyan culture.

Her wrists were tied with padded restraints, an effort to keep her from pulling out her endotracheal tube, the tube placed through her mouth that delivered oxygen straight into her trachea.

Jace went over her clipboard data, noting vital signs, ins and outs and oxygen saturation. Other than a tachycardia, which seemed to have developed since he arrived, her night had been perfect. When he looked up, she glared at him, her eyes unflinching and her brow beaded with sweat.

“Everything looks good, Beatrice,” he said, taking her hand in his below her wrist restraint. Instead of a gentle squeeze, she returned a vice-grip on his fingers. He pulled away, shaking his hand. “Wow. Okay. Good grip,” he said.

He studied her ventilator settings. Everything seemed to indicate that she was ready to breathe on her own.

He looked at her nurse. “Could you set up an oxygen facemask? I want to pull this tube.”

While the nurse prepared, Jace asked Beatrice to lift her head from the pillow. One last test to see if she was strong enough to stay off the ventilator.

Beatrice lifted her head, still not averting her gaze.

Jace worked to free the tape holding in the tube from the patient’s cheeks and generous lips. He used a syringe to pull the air out of the tube’s balloon-cuff. “Cough,” he said. As she did, he slipped the tube out of her mouth.

“Dr. Raw-Raw-Rawlings,” she gasped.

“Don’t try to talk now, Beatrice. Save your energy.” He fixed her facemask in place, pulling a stretchy band around the top of her head.

He watched her a few moments while he freed her from the restraints. “That should be more comfortable.”

When he turned to leave, she gripped the tail of his white coat.

He turned. Her face was etched with fear. “Beatrice, what’s wrong? Are you in pain?”

She shook her head. “I have a message for you.”

“A message?” He slipped his hand in hers again. “From whom?”

“Go see Michael Kagai.”

Jace recognized the name of his bowel-perforation patient. “I don’t understand. How do you know Michael?”