An Open Heart (24 page)

Jace found his patient, Joseph Ole Kosoi, awake and with a familiar face of terror.

Jace winced.

Just like Beatrice.

He told himself it was just the patient’s unfamiliarity with his high-tech surroundings. If you were used to sleeping in a mud hut, the environment of the high dependency unit at Kijabe Hospital would certainly be a scary place. With the lights, monitors, electronic alarms, and physical restraints, who wouldn’t wake up afraid?

Jace studied the numbers. Blood pressure, check. Ins and outs, check. Central venous pressure, check. Ventilatory mechanics, check. It was time to remove Joseph’s endotracheal tube and let him fly on his own.

He looked at the monitor. “He’s a bit tachycardic,” Jace said, referring to his fast heart rate. “When is the last time he had pain medicine?”

The nurse, a young Kikuyu woman named Dorcas, responded. “He has not received pain medication.”

He frowned. “Nothing?”

The nurse checked his bedside chart. “He is Maasai.”

“Maasai have pain.”

“But they never want pain medication.”

“That’s crazy. Maasai have pain like everyone else.”

“This young man was circumcised without anesthesia and would not dare to whimper or show pain.”

“Look at his heart rate. I think he is having pain.”

“Look at his face. I do not think it is pain driving up his heart rate.”

Jace inhaled. In spite of all Joseph had been through, including a Betadine chest scrub in preparation for surgery, the distinct scent of charcoal lingered.

After the nurse prepared an oxygen mask, Jace told Joseph, “I’m going to take this tube out of your throat.” He removed the tape holding the tube in place. He pulled the air out of the balloon with a syringe. “Now cough!”

Joseph obeyed and Jace pulled out the tube.

“Rest, Joseph,” he said as he pulled an oxygen facemask over his nose.

His patient struggled to talk, his eyes locked onto Jace’s.

Jace sighed and leaned in close to his patient. “Okay, what is it?”

“Your patient, Anthony Kimathi.”

He thought through his patient list. He didn’t know anyone named Kimathi. “What about him?”

“He’s going to die.”

“Rest, Joseph,” Jace said as the heart-rate alarm sounded. One hundred twenty. “Relax. I’ll look into it.” He put his hand on the young man’s shoulder. He’d get the details when Joseph was stronger. “We’ll talk more later.”

Jace took a step away from the bedside and pulled a white index card from his pocket. On it he’d written the names of all the patients he’d seen. Not one Anthony and no Kimathis.

He took a deep breath and blew it out slowly, unsure how to react. He hadn’t come to Kenya to deal with weird messages from the next life. He was a scientist. Heart surgery was supposed to be predictable. Cardiac output was based on stroke volume and heart rate. But the comforting sameness of physiology hadn’t given him a framework for understanding spiritual problems. This experience called him to look back to his Christian roots, the God of his sister, and pushed him toward painful territory.

He checked his watch and looked over at Dorcas. “Do you know Anthony Kimathi?”

“No.”

He looked at Joseph. “Do you know him?”

The patient shook his head.

Dorcas seemed to be taking it all in stride.

“Doesn’t this strike you as unusual?”

Dorcas wrinkled her nose.

Evidently not.

Jace frowned. “My first two open-heart patients survive to give me spooky messages. Why am I the only one to think this is weird?”

Dorcas lifted her stethoscope from around her neck, preparing to examine the patient. She paused, looking at Jace. “The world you see is not the only reality, Dr. Rawlings. Does this collide with your culture?” She waited for an answer, but when he stayed quiet, she added. “This does not surprise me. What surprises me is that we don’t hear about it more.”

He walked away thinking that he had traveled across an ocean expecting to arrive in Kenya, and had landed instead on a different planet. Here, young men lived in mud huts and were initiated into manhood by circumcision without anesthesia. Here, witch doctors spoke to the dead, herbs made bruises disappear, and the unseen and seen blurred together in daily life, all accepted as a part of normality. He muttered something about the Twilight Zone and thought ahead to his lunch meeting with the minister of health.

Jace wasn’t looking forward to it. In spite of the honor, walking the tightropes of political correctness and cultural appropriateness deflated any air of joy in the experience for him.

When he gathered with Gabby and Evan to wait for John Okombo’s driver, Jace warned, “I haven’t figured Minister Okombo out. During my first meeting, he drops our governor’s name, calling him Stuart as if they are the best of friends. He has me brought to Nairobi to see him as if he is sizing me up, wondering whether I can be trusted. Then, he tells me that Beatrice is his daughter and he wants me to operate—and then orchestrates the hang-up of my equipment in customs, demanding a large tax. Finally, he accuses me of playing games, leveraging his daughter’s health to get my equipment through, but then drops the tax altogether and even donates more equipment for us to use in our program.”

Evan adjusted his tie, looking unhappy about straying from his normal wardrobe of scrubs. “Sounds like the politician wants to secure your loyalties.”

Gabby asked, “How does he know our governor?”

“It seems he was somehow in the middle of a trade deal with the Franks administration: Kenyan tea and coffee for Virginia tobacco.”

Evan nodded. “I read about that. The deal is worth millions.”

Jace frowned. “Sounds like Virginia gets the sweet part of that deal. We get coffee; the Africans get cancer.”

Evan continued fumbling with his tie. “Tobacco growers predict they have another twenty years to flood the African continent with cigarettes before the legal system clamps down with restrictions on advertising and lawsuits over health issues.”

Gabby made a final adjustment of Evan’s tie and patted his chest. “It’s fine.”

He frowned. “It’s too long.”

“Button your coat,” Jace said. “No one will notice.”

The sound of gravel crunching in the driveway signaled the arrival of their driver.

Jace looked out a window to see a well-dressed Samuel exiting the Land Cruiser. “Let’s roll.”

In Richmond, Detective Steve Brady circled the back parking lot of the medical examiner’s office to see if the service entrance was crowded with funeral-home vehicles. If his morning report predicted correctly, the ME would have plenty of business—there were two fresh homicides, victims of drug-related gang violence.

He parked and walked into the front office. A middle-aged woman sat at a desk behind a counter, looking up as the door opened. “Morning, Steve. Haven’t seen you since you left Homicide. How’s your new bride?”

He smiled. “Great. Carol’s working for Heatwole and Granstead.” He lifted a travel mug of coffee in a pretend toast. “Maybe I should retire.”

“Fat chance of that,” she said, laughing. “You’re a crime junkie.”

“Always looking for my next fix.”

“So what can I do for you?” she said, standing and doing a pirouette. “I know you didn’t come by to congratulate me on my new figure.”

“Wow,” he said. “What did you do?”

She smiled. “Weight Watchers.”

“You look great.”

“I’ve lost thirty-eight pounds.” She smoothed her skirt and sat back behind the desk. “So what’s up?”

“I need to know about an ME report on the governor’s wife. Can you check your records to see who might have accessed her autopsy report?”

She shrugged. “Sure.” She tapped on a computer keyboard while he waited. “Here it is,” she said. “It’s confidential information, so our list is pretty short. We released it to the governor’s office for his eyes only. Other than that, the report only goes out to her physicians.”

“I need a list.”

“Well, it looks like only one.”

Steve picked up his pen. “And who is that?”

“Dr. Jace Rawlings.”

25

At Dagoretti corner, John Okombo’s driver exited the highway.

Jace looked out at the crowded shantytown and motioned for Evan to lock his door. “Samuel, why are we going this way?”

“We need to avoid Uhuru Highway because of protests today. I’m taking you in the back way.”

The Land Cruiser slowly parted a sea of street children and men pushing carts laden with vegetables. The crowd separated, but quickly pressed in around them with children holding out their hands to the white faces on the other side of the glass windows.

Jace shifted in his seat and looked into the eyes of several teen boys standing next to a burning trash barrel.

The driver picked his way among the frequent potholes, following a colorful matatu covered with paintings of young African men heavy with bling and ghetto attitudes.

Samuel lurched forward, cutting left around a bright orange duka painted with the slogans of a cell-phone company. The Land Cruiser sped down the rutted dirt road, a thick forest on the left and a jumble of tin-roofed shacks on the right.

As they approached a blind corner, Samuel eased the accelerator, but not enough. The Land Cruiser splashed through a puddle, spraying the windows with black water, and careened past a speeding matatu. He rounded the corner, which was crowded by a grove of eucalyptus trees on one side and a billboard for Kenya Airways on the other. Perhaps predictably, right beyond the blind corner, the police had set up a roadblock. Extending well into both lanes from opposite sides of the road were two spiked metal strips that forced the traffic to slow down and detour through a narrow opening after being inspected by the police.

Samuel slammed the brakes, skidding to a stop, but not before the right front tire rocked over the spike strip. The tire exploded and Samuel cursed. A moment later, he was out of the vehicle, gesturing wildly and yelling at the police, pointing to the writing on the side of the government vehicle.

The police made a show of loud speech, but then dragged the metal strips from the road, loaded them in the back of a blue truck, and retreated.

While Samuel changed the flattened tire, Jace and his friends walked across the street to stand beneath the grove of eucalyptus trees. A minute later, a speeding matatu suddenly appeared, rounded the corner, and fishtailed, splashing water in their direction. Jace felt his breath catch. “That was too close,” he said, taking Gabby’s hand and backing away from the street.

“Ugh,” she moaned, “my dress.”

A few minutes later, a trio of young men appeared from the other side of the Land Cruiser. The tallest wore a long coat, an odd sight on the warm day. He yelled something at Samuel and placed the heel of a black boot against his back as Samuel knelt to remove the lug nuts from the wheel.

Samuel shook his head and pointed across the road toward the forest. The trio was obviously upset about something and yelled at Samuel again. The tallest stuck his hand inside his coat and began to walk across the street, his eyes now fixed on Jace.

There was something about the young man’s expression that tightened Jace’s gut. He looked around for a rock or stick. Just as he leaned over to close his hand around an apple-sized rock, a second matatu roared around the blind corner, dust cloud trailing. The eyes of the man in the road were still fixed upon Jace. At the last moment, he turned toward the matatu.

The matatu swerved. The man jumped for the side of the road.

Too late. The van struck him head-on in a sickening crunch of bone meets metal, skin meets windshield.

The man cartwheeled off the edge of the road, his arms rag-doll limp and his raincoat flapping. Some sort of automatic weapon flew out of his coat, skidding to a halt across the road. After a moment’s shock, Jace sprang to action, running to the victim.

Airway.
Fortunately, the man was already on his back. Jace put his fingers behind the angle of his jaw and thrust his mandible forward. The man gasped.

Breathing.
The man took a second breath, and then fell into a pattern of rapid, shallow gasps.

Circulation.
Jace pinched just over the radial artery at the wrist. Nothing. When he laid his fingers at the side of the trachea, he could feel a weak pulse.

He looked over at Evan. “His pressure is low, probably sixty-range. We need to get this guy to a hospital to have a chance.”

Jace looked around. A crowd had started to gather.

That made Jace worry. Crowds in Kenya have a reputation for turning violent, seeking someone to blame for whatever it was that started the gathering.

“We need to find a way to move him,” Evan said.

Jace kept one hand on the man’s forehead to keep his neck from moving, and one on his jaw to keep it thrust forward, keeping his airway open. “Look at this,” Jace said. “His neck veins are up.”

Evan looked worried. “I need a stethoscope. He either has cardiac tamponade or a pneumothorax.”

Jace looked up to see Gabby flagging down a passing pickup truck.

An angry man straddled the victim, looking down at Jace. He pointed at the Land Cruiser. “Is that your vehicle?”