Of Flesh and Blood (37 page)

“That’s the problem. I can’t predict. They can happen anywhere, anytime. Last week I had one as I was starting a transplant. I was lucky I didn’t wind up killing my patient.”

He laid a hand on her shoulder. “How long has this been going on?”

“Two months or so.”

“Never before?”

Erin shook her head.

“Why now, Erin? What’s changed?”

“Africa.”

Tyler didn’t look surprised. “What happened to you over there?”

“It wasn’t so much what happened to me . . .”

“Come on, Erin. Tell me.”

“The hospitals in Nakuru don’t have heart-lung machines, but there’s no shortage of people who need coronary bypasses. I went there to perform off-the-pump bypasses.”

Tyler nodded. A year before, she had walked him through the tricky procedure of operating on a still-beating heart.

“The off-the-pump surgery is a real technical challenge,” Erin went on. “I’m always refining my technique. This was an opportunity for me, too. But my timing really sucked. I showed up days after the contested general election. All hell was breaking loose in the Rift Valley. Political and tribal unrest, that kind of thing. Especially between the two main tribes, the Kikuyus and the Kalenjins.”

“I thought you didn’t get caught up in any of that.”

Erin looked down and spoke to the dusty trail. “I had only been there two days. People warned me not to go to the hospital that afternoon. They said it wasn’t safe.” She swallowed. “But some patients had been waiting a year for me to come operate on them. I couldn’t just abandon them.”

“Erin,” Tyler said. “What happened?”

“I was supposed to do a bypass on a sixty-five-year-old man with bad coronary disease. Turns out he was one of the elders of the Kalenjins. But all I knew when they wheeled him into the operating room was that, with his plugged arteries, his heart was a time bomb. The hospital had no central air-conditioning. It was so damn hot in the OR that afternoon.” As she spoke the scene drifted through her head as though she were watching it on a reel of film.

There were six of them in the operating room, including the patient. The anesthesiologist, Jomo Karanja, was handsome and fairer-skinned than the others. Roughly the same age as Erin, he lived and worked in Nairobi but had come to the Rift Valley as part of Erin’s surgical outreach team. Even though they had only known each other for three days, with Jomo’s congenial attitude and easy laugh, Erin found him impossible not to like.

Erin had met the three nurses in the OR only a few minutes earlier, but she quickly recognized them as capable scrub nurses. In their mid-twenties, Ayanna and Ita were both petite, by Kenyan standards, and had matching large almond eyes. More solidly built and at least twenty years older, Sesi was clearly in charge. Aside from her Kenyan accent, she could have passed for a head nurse in any American hospital with her no-nonsense attitude and seamless efficiency. Erin soon fell into a comfortable collegial rapport with the entire staff.

Even Kipruto Mugenya, the patient lying on the operating table, couldn’t stop flashing his golden-toothed grin, despite being moments away from open-heart surgery. Tall and skinny to the point of skeletal, Mugenya had coal-black skin that contrasted with his whitish hair. His gratitude seemed to be bottomless, as he kept interrupting Erin to thank her while she tried to walk him through the steps of his impending surgery.

Ita had scrounged a second electrical fan to supplement the minimal cooling from the first one. Erin was concerned that the steady stream of sweat dripping into her eyes might hamper her surgical technique. But Ayanna always seemed to be nearby at the perfect moment with a sponge to dab her brow.

Sitting at the head of the OR table, Jomo reached forward with the flat of his hand and patted the patient on his chest. “Well, my friend.” The anesthesiologist laughed. “Are you ready to have your heart fixed, good as new?”

“Yes. Yes,” Mugenya answered eagerly.

“Good.” Jomo reached for a syringe. He laughed again as he squeezed out an air bubble in the tip. “You’re lucky, Kipruto. You are the only one who gets to sleep through this heat.”

Mugenya chuckled. “I hope I am the only one.”

Erin laughed, too. She barely even noticed the steady shuffling sound coming from outside the door of the OR, until she saw Ita and Ayanna exchange wary glances. Even Sesi put down the surgical tray she was holding to stop and listen with obvious concern.

Erin eyed Jomo with a wordless question. He grimaced and shrugged back, looking as bewildered as she felt.

Suddenly, Mugenya sat bolt upright, accidentally yanking out the intravenous line that ran into his elbow. Fresh blood oozed down his forearm,
but he didn’t even notice. His pupils seemed to fill his entire eye sockets. “The Kikuyu,” he whispered.

“Who?” Erin asked, as the pounding footsteps grew louder.

“Mr. Mugenya is a Kalenjin,” Sesi hurried to explain in a low voice. She pointed to the other nurses. “We all are. But Mr. Mugenya is an elder, a leader, in our community. Since the election, Kikuyu militia have been on the rampage in Nakuru. They want—”

The door to the OR burst open, cutting off Sesi’s explanation. Eight or nine men stormed inside. Ranging in age from their late teens to their mid-twenties, they wore an array of outfits from old jeans and T-shirts to what appeared to be tattered soccer uniforms. Two of them had on mismatched combat fatigues. The only unifying features were the red berets they wore, and the weapons they all brandished. Each of them carried either a club or a long machete.

One of the men in fatigues, who looked to be the oldest, marched the group toward the table. Before they reached the patient, Mugenya jumped to his feet. He leaned back against the operating table and pointed a shaky finger at the leader. “You have no right—”

With his weapon-free hand, the leader silenced Mugenya with a quick slap to his face and a punch to his gut.

As Mugenya doubled over, Sesi rushed toward the aggressor. “What is the meaning of this?” she demanded.

The man spat something in what sounded like Swahili and shoved her roughly away.

Erin stepped closer to them. “What the hell are you doing here?”

The leader turned to her, eyes ablaze. “Shut up!” he snapped in clear English. “This is none of your business. This is about our home, not yours.”

The leader’s head whipped back to Mugenya. He berated the old man in a stream of rapid Swahili accompanied by a steady spray of spit. In spite of the fierce tirade, the fear seemed to seep from Mugenya’s eyes. He stood up straighter and folded his arms across his chest. A look of intense pride crossed his face. He even flashed the leader a golden smile. “I do not accept any of what you say,” he said in English. “I have done nothing but serve my people well.”

The militia leader shook his head slowly, as though terribly disappointed.

Jomo leapt off his chair and hurried over to Mugenya’s side. “This is a hospital! A place of healing. Not a place to settle tribal disputes.”

The leader glanced at Jomo and laughed. Then, without warning, he suddenly swung his machete like an ax at Mugenya. It whizzed through the air and buried itself into the old man’s chest with a horrific whoosh. The older man cried out as he crumpled back against the table.

Shrieks of terror and hoots of encouragement erupted simultaneously and filled the room.

The leader jerked the blade free and swung again, slashing deep into Mugenya’s neck. A fountain of blood burst from the slashed carotid, splattering Erin’s gown.

“You can’t,” Erin screamed, instinctively lurching toward her patient.

A pair of strong hands wrapped around her upper arms and yanked her away from the fallen man. Then the same hands tightened around her neck. The smell of stale sweat and rum filled her nose as the young man began to choke her. Her eyes darted around the room, desperately seeking help. She saw Jomo struggling against two men. He managed to pin one of the men against the wall, but with his back turned to the other he didn’t notice the bat cocked over his head, ready to swing.

Erin tried to call out to Jomo, but only a weak croak emerged past the choking grip. She watched in horror as the bat came down full force on the top of his scalp. He dropped to the ground. The two youths jumped on him and swung wildly at his unconscious body as though trying to crack a stubborn piñata.

Suffocating from the grip, Erin thrashed wildly against her captor but she could not free herself. She heard another bloodcurdling shriek. It was Sesi. Out of the corner of her eye, Erin saw the blur of the blade as it dug into the nurse’s abdomen and drove the woman backward.

“
No!
” Erin gasped.

Erin scanned the carnage around her. Sesi lay dead on the floor. They were still beating Jomo’s lifeless body with clubs. And two other youths were dragging Ayanna and Ita by their hair toward a man in the corner of the room who waited with a bloody machete.

Suddenly, Erin’s view was obscured by a tall man in military fatigues. His broad face hovered over her. His eyes were filled with bloodlust and his
thick lips curved in a malicious grin. He cocked the machete. Just as the blade rose over his head, another hand wrapped around his wrist and yanked it back roughly.

Erin saw that it was the militia leader who had intervened to stop her execution. “No!” he snapped. “Leave the American.”

Fuming, William McGrath sat in his chair with the newspaper spread open on his desk and the phone to his ear. It took every iota of restraint not to explode into the receiver as he listened to the high-pitched self-important voice of the reporter who had written the article about his son.

Because of the Alfredson’s size, scope, and international standing, including the celebrity and VIP status of some patients, the administration building’s entire sixth floor was dedicated to the communications and media relations department. The staff numbered more than twenty. They were supposed to screen media inquiries and intercept them before they reached William’s line.
How did this parasite, of all people, slip through?

William knew the reporter, Denny Rymer, only by reputation. Rymer was the self-appointed watchdog of the region’s professional community. Physicians were his favorite prey. He hounded them with the zeal of the McCarthy-era Communist witch-hunts. Rymer had a knack for digging up sympathetic “victims” (often children or the disabled) who had suffered from questionable medical care. Sometimes he uncovered acts of true negligence or incompetence, but more often Rymer torpedoed the reputation of physicians who were guiltless. Once Rymer got his teeth into a story, he rarely let go, often drawing out his inquisition for days or weeks across the front pages of the paper.

“Do you agree that Dr. McGrath—the
other
Dr. McGrath—performed a potentially lethal procedure without getting fully informed consent from the family?” Rymer demanded in his self-righteous nasal tone.

William took a slow breath while he mentally vetted his reply. “That is an issue of patient-doctor confidentiality on which I simply cannot comment,” he said, unconcerned by how trite the answer sounded.

“Hmmm,” Rymer grunted. “Perhaps if we weren’t discussing your son . . .”

William’s grip tightened on the receiver until his fingers ached. “My response would be the same.”

“I wonder,” Rymer grunted again. “The parents swear that your son did not fully explain the risks—”

“No procedure occurs at the Alfredson without a signed consent. We ensure everyone adheres to that policy.”

“Yes, but according to Mr. and Mrs. Stafford, your son deliberately misrepresented the risks of the procedure in order to get them to sign the consent.”

William’s face burned. “Mr. Rymer, you sound more like some kind of personal injury attorney than an impartial reporter.”

“I don’t have much choice, do I?” Rymer said petulantly. “Your son has refused to talk to me, so I cannot present his side of the story. That’s why I was hoping you
might
be a little more forthcoming.”

“It would be highly irresponsible for a physician to comment publicly on medical care provided to a patient,” William said pointedly. “Since the Stafford family has stated their intent to file suit,
no one
—including the family—should be discussing this case.”

“Now who sounds like a lawyer?”

“If you have no further questions—”

“Listen, Dr. McGrath.” Rymer’s tone suddenly softened to the point of sounding sympathetic. “I realize we’re talking about your son, and that can’t be easy. But try to see this from the Staffords’ point of view for just a moment. They’ve lost their only son to a treatment they agreed to without being fully aware of its risks. The guilt is killing them.”

“It must be extremely difficult for the family. And I am sorry for their loss.” Despite his strong bias, he believed Tyler was at least partly in the wrong for his approach to the consent. However, he knew better than to share that with anyone, especially a reporter who made a career out of disgracing physicians.

“So you agree that Dr.
Tyler
McGrath bears some responsibility for the outcome?” Rymer demanded.

The resurging anger swept away William’s empathy. “You’re putting words in my mouth, Mr. Rymer. I did not even remotely suggest that.”

“You can’t, can you? Not with your son facing a lawsuit.”

“Mr. Rymer, do you have any idea how many malpractice suits are launched every single day in this country?”

“I don’t see what that—”

“Thousands. The vast majority are dropped, dismissed, or proven frivolous. Very, very few of them reach the newspaper. I do not understand why you are choosing to pursue this case. This is not a newsworthy story.”

“A child died, Dr. McGrath.”

“And there is no sadder loss,” William said. “However, that does not mean anyone is responsible for what happened.”

“His parents think otherwise.” With a slight snicker, Rymer added, “And you
clearly
know how strong the urge is for a parent to protect his son.”

“Mr. Rymer, I think it would be best if you directed future questions directly to our media relations department.”