An Open Heart (22 page)

That evening, Jace built a fire in his fireplace to chase away the chill. As had become their usual practice, Evan and Gabby joined him, and the trio sipped Kenyan chai and discussed the future.

Evan adjusted a small oximeter clip over his index finger. “See,” he said to Gabby. “I’m two points lower at this altitude than back in Richmond.” Then his demeanor shifted and he changed the subject. “I can’t justify staying around if I’m not helping.”

Jace frowned. “So help out with the general surgery load like I do. You don’t have to do just hearts.”

“I didn’t come here to do anesthesia for general cases, Jace.”

“After the newspaper article, I’m sure we’ll get more cases. The word is just getting out.”

Gabby added granular sugar to her mug. “Maybe you should advertise that we’re giving magical experiences.”

“Ha, ha,” Jace responded. “Our patient just had some post-pump paranoia, that’s all.”

Gabby shifted in her seat. “So how do you explain that she predicted her mother’s HIV?”

“Come on, Gabby. The woman is a prostitute in Kenya. How likely is she to be HIV positive?”

“Okay, I’ll accept that. But what about her prediction about Michael Kagai?”

“She must have heard someone mention his name. I could look back, but I think they might have been in the HDU together. The place isn’t exactly huge. It would be easy for one patient to hear what the nurses say about another. Again, he was HIV positive. He wasn’t exactly low risk for dying. She just twisted something she was thinking into a paranoid delusion.”

“Altogether,” Gabby said, “you’ve got to admit, it seems pretty spooky.”

“There is a reasonable explanation for all of that stuff.” Jace stood and walked toward the kitchen. He didn’t like Gabby giving credence to Beatrice’s predictions. He was glad that he hadn’t decided to share the description that Beatrice had given about him. The last thing he needed was Christian Gabby talking about the darkness of his soul.

But discount it as he tried, the description haunted him.

“Come on, Jace,” Gabby continued. “You of all people should be open to this sort of communication from beyond the grave.”

Jace stayed quiet, his hand almost involuntarily tracing the scar on his scalp.

“If you really think your sister sent you a message, why not Beatrice?”

Jace shook his head, aware of the irony. “I don’t know.” He paced back into the little den where his friends sat. “Okay, let’s play this out. Suppose Beatrice did get a message from another realm. Why would someone ask
me
to warn someone about death? I’m about the least likely person to be able to help. Why not tell a chaplain?” Jace paused. “So why would someone want me to know this stuff?”

“Could you have prevented his death?”

“If I’d been there and witnessed it?” Jace shrugged. “I don’t know.” He sat on the couch and stared at his friends through the steam lifting off the mug in his hands. He didn’t want to admit that Beatrice’s prediction had any merit.

Because if that was true, he’d have to confront the darkness in his soul.

The phone rang. Jace was thankful for the diversion. “Yes?”

“Dr. Rawlings, we have another young patient with a significant heart murmur.”

Jace recognized his intern’s voice. “What is the situation?”

“Seventeen-year-old male. Very short of breath. Neck veins distended. Looks like heart failure.”

“Use oxygen, give Lasix. I’ll be over soon.”

“We’re in casualty.”

“Okay,” Jace said, hanging up the phone. Then, to Evan he said, “Looks like you might not have to wait so long for our next heart case.”

In the HDU, a young man in a blue business suit identified himself to a nurse as Beatrice’s brother and asked for an update.

A few minutes later, he slipped into the empty corridor to use his cell phone. “Dr. Okayo,” he said quietly, “I’m calling for Minister Okombo. The American doctor’s work is done here.”

The rain started suddenly, prompting Jace to retreat back inside for shelter. Then, with his umbrella low and braced against the wind, he started out again, walking the slick path back down toward the casualty department. He jumped the quickly forming puddles, zigging a diagonal line, imagining himself a checkers piece, conquering his opponent on the way to being crowned.

His little game diverted his attention, and as he arrived at the guard gate, he collided with a young blue-suited man fending off the rain with a newspaper. They glanced off at the shoulders as the man began a reflexive, “Pole, pole sana.” Sorry, so sorry.

Jace caught a glimpse of the man’s face as they passed. Determined look, chin set and clean shaven, and dark eyes that flashed with an instant of recognition. It did not register for a moment, but then Jace remembered.
Samuel, Minister Okombo’s driver.

Jace stepped into a puddle, and muddy water ran into his shoe. He hopped quickly on and raised his umbrella, calling out to the man. “Samuel!”

But the man continued on, rushing away with his newspaper tented over his head. In the downpour, Jace’s words dissolved away and the man was gone.

22

Jace’s night was anything but routine. He started with the admission of a young Maasai man in heart failure, almost certainly another case of valvular destruction after an untreated strep infection. Before he left casualty, two victims of a traffic accident were brought in, one with a jagged and gaping laceration running ear to ear across the top of the head. Jace and his intern, Paul, worked in the theater for an hour just matching up the skin left behind. Then, when he thought he was done for the night, Jace got a call from the student health nurse up at RVA. She was escorting a student down, a senior with right lower-quadrant pain.

Jace suspected appendicitis. Unfortunately, it took the better part of the next hour to successfully contact the student’s father by phone. The parents, missionaries in the bush near Dire Dawa, Ethiopia, gave consent. The mother would try to come down the next day.

By three, Jace plodded home, tired but strangely invigorated. Rather than being put off by his general surgery call duties, he found he enjoyed dealing with fixable problems. While not life-and-death like most of his heart patients, the general surgery problems were nonetheless serious, and tended to improve rapidly after an operation. There was something comforting to Jace about having done a neat operation on a kid who would get better and go back to school in a day or two.
Yes,
he thought,
I can still do general surgery.
He smiled and imagined himself like the first cardiac surgeons. He’d read stories of Michael DeBakey, the infamous heart surgeon from Texas. His operative schedule might include an open-heart case, a bowel case, and a hemorrhoid all in one day.

By three fifteen, Jace had stripped off his clothes, including the sock still damp from his encounter with the puddle, and collapsed into bed. He knew nothing after that until his alarm sounded at seven.

He met Evan Martin for rounds the next morning. Together, they used the ultrasound machine to look at the heart of young Joseph Ole Kosoi.
Ole
means “son of” in the Kimaasai language. Joseph had returned home from boarding school saying he had been unable to keep up with the other boys in rugby practice. Whereas in prior seasons he’d always been able to outperform his peers, now he became winded with a slow jog across the field. Jace traced the problems back to an episode of flu-like symptoms two months before. Now, the patient was exhibiting classic signs of heart failure: distended neck veins, shortness of breath, and difficulty breathing while lying flat on his back. Whenever he tried, he felt like he was drowning.

Which he was, his lungs filling with the fluid his heart was too weak to pump away. The patient coughed and spat the wet foam into a plastic cup.

Jace placed his stethoscope against Joseph’s back and explained what he heard to his intern. “This is what rales sound like,” he said. “The classic description is the crackling sound of hair being rolled between the fingers in front of the ear. The further up on the back you hear the rales, the worse the failure.”

The intern listened, stepping the diaphragm of his stethoscope up the patient’s back. His eyes widened as he reached the apex. “Here,” he said.

Jace nodded soberly. No wonder the patient couldn’t breathe.

Joseph wore a red-patterned shuka. Jace suspected that Joseph wore Western dress at his boarding school, but quickly reverted to traditional dress at home. He smelled of smoke, cow leather, and sweat. Jace had been in the small mud-and-manure dwellings of the Maasai tribe, so he understood. Inside, the huts were dark and permeated with the heavy odor of the open fires used for cooking. On either side of the cooking area were beds, leather stretched tight across a natural stick frame.

Evan repositioned the patient and scanned across the chest with the ultrasound. “Just what you thought. The aortic valve is destroyed.”

Jace nodded. “Our next case.”

Paul frowned. “The blood bank is exhausted. They warned me no more hearts until they can find donors.”

Jace raised his index finger. “I’ve been thinking about that.” He held out his hand to his anesthesiologist friend. “Let me see your wallet.”

Evan handed it over. Naive.

Jace lifted a small handful of bills. “This ought to do.”

Evan protested. “What are you doing?”

“Hey, you’re the one who said you were leaving if you couldn’t do hearts. Call this a loan. You want to do hearts, you may just have to pay.”

Jace walked away, deaf to his friend’s protests.

Fifteen minutes later, Jace made a deal with a local shopkeeper, the owner of the Supa-Duka, the colorful local general store. Jace paid the shopkeeper twenty thousand shillings to purchase forty five-hundred-shilling vouchers. His plan was to hand out vouchers to anyone willing to donate a unit of blood. In an economy where the hourly wage was closer to fifty shillings an hour, a five-hundred-shilling voucher would tempt anyone. To sweeten the deal, he paid for thirty lunches at Mama Chiku’s so that the first thirty donors could eat stew and chapatis.

Jace went home to print vouchers, then paid a schoolboy fifty shillings to distribute them throughout Kijabe town.

By four o’clock, they had forty fresh units of blood in the blood bank. Ten units were compatible with Joseph Ole Kosoi’s blood type.

By six, Jace was planning his next open-heart case. He looked at Paul. “We continue to diurese him for the next thirty-six hours. If we can stabilize him, I think we can operate.”

The intern nodded. “I will be monitoring the urine output and his vital signs.” He paused and touched a small bandage at his elbow crease.

Jace pointed at the bandage. “Are you okay?”

“Just donated a unit of blood for a worthy cause.”

Jace smiled. “For a free meal.”

Now the intern smiled back. “Sawa sawa,” he said. The phrase was Kiswahili and meant, “Okay, okay.”

That night, the phone woke Jace. He shook his head and mumbled, “I’m not on call,” before forcing himself from the comfort of his chair in front of the warm fireplace. He winced as his bare feet touched the cool linoleum. Picking up the phone, he growled, “Hello.”