Falling Again in El Salvador

by Julie Danvers

  “Black, with two sugars. There are some things about Cassie Andover that you don’t forget. How she takes her coffee is one of them. Not if you know what’s good for you.”

  “We’ve got a lot of memories, don’t we, Bryce?”

  He returned her smile. “We do. And I’ll even go as far as to say that most of them are good ones.”

  She was silent for a moment, then cocked an eyebrow over her cup of coffee. “Agreed. But I didn’t ask you here this morning to talk over old memories. I want to solve a mystery.”

  He waited, wondering what she was getting at. “As you may remember, I do love a good mystery.”

  She set her cup down. “That’s the thing, Bryce. I do remember that about you. And you remember how I like my coffee. So clearly you are the same Bryce I dated five years ago.”

  “Who else would I be?”

  “That’s the mystery we’re here to solve. The Bryce I remember had to be begged to get on my motorcycle back in New York. He didn’t have one of his own, and if he did, he’d never have driven it the way you drove yours when you picked me up a few weeks ago. The Bryce I knew loved being a surgeon and couldn’t imagine any other career. He didn’t jump out of helicopters or negotiate with gang leaders. And he sure as hell never wrestled any crocodiles in any sort of man versus reptile death match.”

  “Ah, I see you’ve been talking with Manny.” Bryce wondered if Cassie had been seeking out information about him from the boy or perhaps even from some of their other colleagues. Did that mean he’d been on her mind? Just like she’d been on his.

  “Manny’s cute. Don’t change the subject. Who are you and what have you done with the Bryce I used to know?”

  Bryce slowly stirred his coffee, wondering how to answer. Of course, his life had changed since the accident and since giving up his career as a surgeon. But he hadn’t thought that he had changed that much as a person, until now. He supposed Cassie had a point. He had been reluctant to do anything risky back when they’d dated. One of his favorite things about her had been her ability to pull out his adventurous side from wherever it was hidden.

  It had also been one of the reasons he was so devastated when she left.

  As he wasn’t quite sure how to answer her, he stalled for time instead. “It’s been five years, Cass. That’s a pretty big question.”

  “Then start at the beginning. No, actually, start with what I really want to know. How the hell could you afford such a beautiful bike on a Medicine International salary?”

  Typical Cassie. Cutting straight to the heart of things without even realizing it. He’d been enjoying their renewed connection over the past few weeks, but he wasn’t sure he was ready for this conversation. In fact, it might be because of their renewed connection that he didn’t want to simply blurt out the full story of how he’d come by his motorcycle—that he’d bought it by selling the ring he’d meant to propose to her with.

  The trouble was, he’d never been a very good liar. And since their breakup, he’d gotten even worse at it. His hand tremor flared any time he lost control of his emotions. Cassie wouldn’t know to look for it, but if his hands wavered, if she noticed and asked him about it...he had no idea how he’d respond.

  He decided to offer up half the truth.

  “I was dating someone a while back and saved up for an engagement ring. But it didn’t work out. Sold the ring, bought the bike. Not much else to tell.” He shrugged, trying to keep his body posture casual. It was all true. He was simply neglecting to mention that the ring had been meant for Cassie. A small extraneous detail.

  She choked on her coffee. “You almost got engaged? Then you weren’t just dating—it must have been serious.”

  “I thought so, but I guess she didn’t.”

  “What was her name? What was she like?”

  Bryce paused. He hadn’t intended to tell Cassie any outright lies. He’d been hoping he could get away with simply omitting certain truths. He was relieved when she continued, “Actually, scratch that. You don’t have to tell me anything you don’t feel like talking about. Whatever happened, I’m probably the last person you’d want to rehash all of it with. I only invited you to meet here because I wanted the two of us to have a chance to talk about us, about our...” She seemed to be struggling to find the right words.

  “Our friendship?”

  “Yeah,” she said. “Our friendship. It’s such a small camp, and we see each other every day. And aside from the initial shock of seeing you on my first day, now that I’ve had some time to adjust... I really like it here. The only thing that could possibly make life better would be if the two of us could be friends. But in order to do that, we’d have to get to know each other again, don’t you think?”

  She was right. They’d both changed. He probably was a bit more reckless than he used to be, especially as he didn’t have to obsess over protecting his hands anymore. And he’d always thought of her as bold, adventurous. But now he’d learned that those qualities didn’t come naturally for her. She’d had to work to find them. He wondered if she’d been able to keep in touch with her adventurous side over the years since they’d been apart.

  She was right. They needed a chance to get to know each other.

  “You’re not the only one with questions, you know,” he said.

  “I’ll answer yours if you answer mine.”

  “Okay. I’ll go first. What’s the best ob-gyn in New York City doing in El Salvador?”

  Her burst of laughter surprised him. “Did I say something funny?”

  Her eyes sparkled. “I think I laughed because your question answered itself. My job in New York is what drove me straight here. And I don’t know that I was the best ob-gyn.”

  “Come on, don’t be modest. My friend Marcus’s wife said she couldn’t even get an appointment with you. The scuttlebutt is that you have to know someone who knows someone if you want to get an appointment with Cassie Andover.”

  She rolled her eyes. “Ugh, that’s exactly why I came here. I never meant for it to be that way.”

  “But there has to be some truth to it, otherwise you wouldn’t have earned that reputation.”

  “Maybe. But honestly, sometimes I think my entire reputation is a fluke. I was just in the right place at a significant time in someone’s life.”

  “How so?”

  “A few years ago, there was a car crash off the interstate. One of the survivors was a pregnant mother who started going into premature labor. She also happened to be a very famous singer. I delivered the baby, word got around and suddenly I was working more and delivering some very wealthy babies into the world. Which meant dealing with some of the most demanding parents I’ve ever met. And the more money they have, the more demands they have. They treated me and my nursing staff like servants.”

  “Sounds like you needed a change.”

  “Exactly. And so—” she spread her arms out to indicate the mess hall and the rest of the medical camp “—here we are.”

  Suddenly, her eyes flickered in recognition. “Did you say Marcus’s wife wanted to get in to see me? Marcus, from the old hospital? God, I haven’t seen Marcus since—” her face broke into a grin “—since the last day of his surgical rotation, when you dared him to drink from that phlebotomy sample cup.”

  “I did not dare him... I kindly offered him fifty dollars to drink whatever I might have happened to put in the cup.”

  “Which happened to be a pale yellow liquid.”

  “As I recall, you were the one who walked away with the fifty dollars.”

  Cassie scoffed. “It was obviously apple juice.”

  “But you had no way of being sure.”

  She smirked at him. “I trusted you. For the most part. I’m surprised Marcus didn’t. He could have made a quick fifty bucks.”

  “The face he made when he saw you drinking what he t
hought was a urine sample was pretty priceless. Well worth fifty dollars.”

  “Poor Marcus. We were pretty relentless with the pranks.”

  “We all were,” he said. “Marcus got back at me by putting surgical lube on my stethoscope ear tips. That was just delightful to put into my ears, let me tell you. And I remember a time when it wasn’t safe to fall asleep in the staff room because you’d wake up finding that someone had put a plaster cast on one of your arms or legs.”

  They’d had a lot of fun, roping one another into hijinks back when they’d worked together. Bryce had always felt passionate about medicine, but it was also something he’d approached very seriously. Cassie had added something to his passion. She’d made working at the hospital fun.

  “I miss things being so easygoing,” she said. “Brooklyn General’s a lot more uptight than our old hospital. There’s no tolerance for pranks. With our clientele, all of the focus is on meeting their demands. No one has the time or energy to let loose.”

  “So you haven’t pulled any death-defying stunts lately? I thought for sure I’d hear about you delivering a baby while white-water rafting by now.”

  “Only if it becomes the next celebrity birthing craze. Which wouldn’t entirely surprise me. In fact, keep that thought to yourself—don’t give my patients any ideas.”

  “That bad, huh?”

  She shook her head. “I was working so much that I could barely tell my days apart anymore. I wanted something that would let me slow down and get in touch with what really mattered. Whatever that might be.”

  Now it was his turn to raise an eyebrow. “Only you would come to a country with twenty active volcanoes to slow down.”

  “Hey, that’s not fair! I’ve actually become fairly responsible over the years.”

  He snorted. “I’ll believe that when I see it.”

  “But you’ve changed, too. Tell me about this new Bryce who jumps out of helicopters.”

  “It doesn’t happen that often. Maybe four times over the past year.”

  “Even once a year is just very...different from the Bryce I used to know. But it’s not just the idea of you jumping into danger that surprises me. You changed specialties. Why on earth would you do that? That’s huge, that’s not something one does on a whim. Especially as you were such a talented surgeon.”

  He cringed inwardly. There they were, the words he dreaded most: you were talented. The words he’d come to El Salvador to avoid ever hearing again.

  He reminded himself that Cassie didn’t know about the accident. She couldn’t know how much of the past was a sore spot for him.

  For a moment, he thought about coming out with the whole story. The crash, the tremor it had left in his hands and how he didn’t have to worry about preventing injuries anymore because protecting his hands didn’t matter as much as it used to. But something stopped him. Cassie had clearly heard some stories about some of the more dangerous things he’d done since coming to El Salvador. There was a familiar light in her eyes, an eagerness he remembered from the old days. He’d seen a flicker of it when he’d picked her up and insisted she get on his bike.

  He couldn’t quite bring himself to tell her that he hadn’t turned into some sort of adventurous medical version of Indiana Jones. He didn’t take on the camp’s more dangerous duties because he craved excitement. He did it because it simply didn’t matter if he got injured anymore. He wasn’t brave; he just didn’t care if he got hurt.

  But even though years had passed, even though the way she felt about him shouldn’t matter anymore...for some reason, he didn’t want her to stop looking at him the way she was right now. As though he were someone who was fearless.

  He told himself he was being ridiculous. The way Cassie looked at him shouldn’t matter. It hadn’t mattered for years, and he’d gotten along just fine without giving a moment’s notice to what she might think of him. So there was no reason for him to hesitate in giving her the truth now.

  He opened his mouth, about to explain, when the doors of the mess hall burst open and Anna, the midwife, rushed in. “We’ve got a complicated delivery in tent three,” she said. Bryce noticed she was somewhat breathless. She must have run across the camp. “We need you both right now.”

  As Bryce and Cassie rushed to their feet, he realized that the moment to explain the changes in his life over the past few years was gone. But that was all right, he told himself. He’d simply explain things later. If the subject happened to come up.

  * * *

  They dashed across the camp to the birthing tent, Cassie and Anna struggling to keep up with Bryce’s long strides.

  As they entered the birthing tent, Cassie recognized the patient. Elena Hernandez lived in a village nearby. Cassie knew Elena had had several miscarriages and desperately wanted a child. She also knew that the baby was far too early, as Elena was only a little more than halfway through her third trimester.

  “What’s the situation?” said Bryce.

  “She’s fully dilated,” said Anna. “But she’s labored for three hours with no progress. At first I thought maybe the baby’s shoulder was stuck, but it’s been so long that there might be something else going on that we can’t see.”

  Cassie was still getting used to the challenge of working without a fetal heart monitor. But as she gently ran her hands over Elena’s abdomen, she had a feeling that she didn’t need modern medical equipment to guess at one piece of this puzzle.

  “We might be looking at twins,” she said. Elena’s build was slight, and Cassie surmised that malnourishment combined with premature labor was likely to make it look from the outside as though she carried one baby rather than two. She hoped there were no more than two.

  “Let’s cross that bridge when we come to it,” said Bryce. “For now, we need to prepare for a cesarean section. We should move her to the operating tent.”

  In addition to working without a fetal heart monitor, there were other adjustments Cassie was making as she learned to adapt to the equipment at the medical camp. About half of the hospital beds in use had been made without wheels. In every hospital Cassie had ever worked at, she’d typically transferred patients by wheelchair or by rolling a gurney down a hall—but wheelchairs and beds with wheels were luxuries she no longer had easy access to. Transferring Elena to the operating tent’s table would require some ingenuity.

  Cassie watched as Bryce and Anna began unfolding a large swath of canvas. Bryce handed one end to her. She stared at it, confused.

  “We’re going to make a makeshift stretcher to slide her onto for transport,” he explained.

  Oh. Of course. Without wheels on the hospital bed or a gurney to transport Mrs. Hernandez, they’d have to be creative. Sheepishly, she grabbed one end of the canvas.

  She and Bryce held the canvas taut from end to end while Anna eased Mrs. Hernandez onto it. They transported the canvas to the OR tent with small hurried steps and placed Mrs. Hernandez onto the operating table.

  As they got Elena on the table, Cassie saw something that made her stomach drop. In the few minutes it had taken to transfer their patient to the operating tent, the situation had changed dramatically. Elena’s abdomen had contorted into an hourglass shape, indicating that something was obstructing the birth canal. Elena was at risk of immediate uterine rupture, and possibly death, if they didn’t act fast.

  “Anesthetize the patient as best you can,” Cassie said to the operating room nurse. “We need to start immediately. What equipment do we have available for neonatal resuscitation?”

  “Just our breath and thumbs,” said Bryce.

  “Great,” said Cassie through gritted teeth. It was life or death. If the baby was born in distress, there would be no equipment to assist—she’d have to perform neonatal CPR. If it came to that. She decided she wouldn’t let it come to that.

  Bryce began to make the incision for the cesarean. But i
nexplicably, almost as soon as he had begun, he stopped.

  “What is it?” she said. “Bryce, we have to act now. There’s not a moment to spare.”

  He handed the scalpel to her. “You do it.”

  “But you’ve already started.”

  “Doesn’t matter. This is a complicated procedure. You should be the one to do it. You’re the best ob-gyn in Brooklyn.”

  She took the scalpel, unwilling to quibble further while the seconds ticked away. She tried to control her intense irritation. Bryce had already started the operation. There was absolutely no reason for him to hand the scalpel over to her. What did it matter whether she or Bryce did the surgery? They were both competent doctors, and Elena and her baby needed help quickly. As she concentrated on the procedure, the thought flashed through her mind that Bryce seemed to have been nervous to start the C-section. But surely that couldn’t be true. She’d seen Bryce deliver a few babies over the past few days, and he’d been more than competent. He was a skilled obstetrician. True, she hadn’t seen him do any C-sections, but if anything, an obstetrician with Bryce’s background as a surgeon should feel even more confident during C-sections.

  But there was no time to figure out what on earth he was thinking now. Cassie carefully completed the incision. Like so many of her patients here who suffered from malnutrition, there was no fat tissue to put aside, only a thin layer of skin to protect the uterus. She made another careful incision, knowing that she had to get the baby out quickly. A clearer view showed her what had been obstructing labor: the baby’s head was just a little too big. It was also a bit too far down the birth canal for her to cup and deliver.

  Bryce immediately saw the problem and came to assist. With a few skilled maneuvers, Cassie was able to reach the baby’s feet and deliver it bottom-first. A wave of relief washed over her as she heard the tiny cry of a newborn girl fill the room.

  The others in the tent cheered as she handed the baby to one of the midwives for cleaning. She had stepped away from Elena and was letting her breath out in relief when Bryce nodded toward their patient. “Don’t relax too much,” he said. “You were right the first time. She had company in there.”