by Dianne Drake
“But it catches up to you. My mother—the svelte, beautiful actress—has been hating life lately because she’s put on some pounds.”
“If I recall, on the couple times I met her she was very...nice.”
“We all change as we get older. For my mom, it’s her weight. For my dad, it’s his hairline.”
“And for you?”
Frowning, Layla thought for a moment. “I’m here. I think that’s a huge change.”
“But would you be here if there wasn’t something substantial in it for you?”
“Probably not. I do like my material world. Maybe not the way I used to. I mean, I don’t own fifty pairs of shoes now. But a nice warm shower, a comfortable bed without mosquito netting—my needs are much simpler, but they’re still my needs. So, let me ask you what changes you’ve seen in yourself.”
“I think I’m more aware, and tolerant, of people’s needs and differences.”
“You were pretty rigid.”
“It was a brave new world out there for me. I was afraid of getting lost in it. I think it’s easier to be who you really are when you’re where you belong.” He pushed himself off the floor, then headed for the door. But before he even got to the shoe rack, someone outside was yelling. “Bleeding bad. Come help.”
Layla immediately ran to the door and there, in the street, was a panicked woman who was covered in blood. She was explaining something to Arlo. It took her the length of time it took him to put on his sandals, then he ducked back in the hut. “Bad one,” he said. “Grab your bag and follow her. I’ve got to run over to the hospital and get...” he swallowed. “...my amputation kit.”
“What?” Layla sputtered.
“I’m not really sure. But it has something to do with someone caught in a tree, who’s bleeding to death. She—his wife—said his leg won’t come out.”
Layla nodded, her whole body suddenly feeling numb. “Maybe it’s not as bad—” She bit back the rest of her words, grabbed her medical kit and ran outside, only to be passed by Arlo, who was on his way to the hospital. They met up, moments later, down the road. “I’ve never done an amputation,” she said. “If that’s what this is about.”
“Neither have I.” Which meant they were going blind into this. But blind together. While it didn’t improve the situation, it did make him feel much better that Layla would be the one there to help him.
* * *
In the full light of a bright day she could see the drying blood on the woman’s clothing. A lot of it. And ahead, where a crowd was gathering, a man tied into a tree. Bleeding. Tied off so he wouldn’t fall. But in a tree.
“We can’t do anything while he’s up there,” she said to Arlo.
“Unless we can’t get him down with his leg intact.” He pulled away from Layla, then went to talk to the wife, Naiyana, who was already back under the tree, dropped to her knees and crying, as several women were trying to comfort her. She truly wished she understood the language and vowed that for the rest of her time here she’d work hard on learning more of it. Because, if not for Arlo, she was not sure what she’d do.
“He was cutting a branch of a tree. It was hanging too close to their house, obstructing the light, so he went up to cut it down and somehow—and I don’t understand more than the gist of this—it fell back on him, crushing part of his leg, and he can’t get loose of it. A couple of the men went up to see what they could do, and decided he needed medical attention, so they tied him into the tree to make sure he wouldn’t fall out. Naiyana said there’s lots of blood and she thinks he might be dying.”
“Is he conscious?” Layla asked, coming up to the ladder still leaning against the tree, then looking up at her patient—who wasn’t moving.
“I’m not sure. Possibly fading in and out, according to Naiyana. Apparently, he was delirious earlier. Nothing he said was making sense.”
“So...” This wasn’t sounding good. And from the look on Arlo’s face she knew he felt the same way. Which scared her as she thought of him as almost fearless, able to handle any situation, while she was completely helpless trying to climb a tree. Then getting stuck or, worse, falling out of it. He didn’t need two emergencies to deal with, but her hands were shaking. So were her knees. And she was sweating like a genteel lady would never dare to sweat.
“I’ll go up first and get myself on that big limb right above him. If I tie myself on, I can reach down and help you. The amputation, if that’s what it comes to.”
Now her heart was beginning to race, and she feared a panic attack was coming. She was deathly afraid of heights and trees. That one serious fall when she’d been a kid, two surgeries, and three weeks in a hospital and rehab—all that might have been the reason she’d become a doctor. But that wasn’t registering right now. The only thing that was registering was climbing a tree and amputating a leg. “Why can’t you—?”
“Because I need to be able to help lower him down. In this situation my strength is needed more than my medical skill.”
She looked up again, swallowed hard. “I’m not sure I can climb up there, Arlo. You know how I am about—”
“You’ll be safe, I promise,” he said, putting a steadying arm around her shoulder. “No falling out of the tree like you did when you were eight, and no broken leg for you this time.” Pulling her closer, he leaned down and whispered, “I’d never put you in danger, Layla. Never.”
“I know that. But still...” She shook her head. “I’m afraid I won’t be able to...perform, even if I do manage to get up there.” She could almost feel herself falling to the ground. The few seconds of wild fear when her brain wouldn’t function, then hitting hard, and a jolt so paralyzing that she couldn’t breathe. Then the pain. The excruciating pain and the fear that her parents might not care. Even though it had happened when she’d been only a little girl, she felt like that little girl now. Except this time she had Arlo, and she trusted him with everything inside her. “But I’ll try.”
“Don’t force yourself,” he whispered. “I don’t want anything happening to you.”
She managed a weak smile. “Neither do I.” Then melted when he bent to kiss her cheek. “I can do this, Arlo. Remember? I am strong!” Brave words she desperately needed to be true, because too many things in life scared her. Being with Arlo, being without him—she couldn’t let the practice of her medicine become one of those fears. “I am strong,” she whispered. Then turned to face Arlo. “I am. I really am.”
“You are,” Arlo agreed, then started up the ladder, leaving her standing underneath her patient, going over the procedure in her mind as her hands began to steady. “Get up there, get myself secured, do my job.” She repeated that out loud several times as she walked round and round the tree, surveying the emergency scene from every angle as Arlo got himself secured. “Just do my job.” And she could, because Arlo believed in her. For the first time she felt that belief. It was palpable. And it braced her for what she had to do.
“Somewhere in medical school I think they forgot to teach us how to do this,” she said as she reached the top of the ladder and slung her leg over the sturdy branch where her patient was dangling, unconscious now, on the far end. “And if I ever open my own medical school...” She began to slide, inch by inch, to the end of the limb.
“Another ambition?” Arlo asked. He was mere feet above her, currently tying himself to the tree trunk.
“Right now, my only ambition is to get this over with and get our patient out of the tree.” She inched a little more, then stopped.
“Tie yourself to the trunk, Layla,” Arlo said.
“If I do, I won’t be able to reach him.” She leaned forward, just enough that her fingers could asses the pulse in his neck. “It’s pretty weak, Arlo. I don’t think we have much time.” She moved forward a little more. “What can you see from up there?”
“His leg is stuck in a fork. It’s swoll
en so badly it won’t come loose without—”
“And my best position to do that from down here?”
“Another few inches forward, Layla. But be careful.”
“Will the branch hold my weight?”
“Virote’s weight—that’s his name—is pretty evenly dispersed between the limbs, so you’ll be good. And since he’s basically just flat on his back and not really hanging, that will simplify things for you.”
“Nothing’s going to simplify things, Arlo. I’m a doctor’s who has never done an amputation, and my first is in a tree.” She looked up at him, managed a weak smile. “Remember when I was talking about creature comforts? Well, this isn’t one of them.”
Layla managed to move herself several more inches and that’s when she was finally able to get a good look at Virote’s leg. The fracture was compound, and bits of bone were shattered and littering his wound. And the bleeding—it was steady. Not profuse but coming hard enough that he would bleed out shortly if they didn’t get it stopped. And the only way to do that—
“He already has a partial amp to the leg,” she said, applying the tourniquet above the wound to stop the bleeding. “And now...” She shook her head and gritted her teeth. This was the moment when everything she’d ever learned as a doctor would be put to the test.
“Is he secured, in case he comes to?” Arlo asked. He was on his belly now, leaning as far down as he could and still be safe.
“I’ve just given him a shot, doubled the medication dose, which is the best I can do.” Yet, she still feared they could all fall out of the tree if Virote woke up and started to fight.
“Take care of yourself, Layla. And if, for any reason, you get dizzy, or anything puts you at risk, get out of there. I know we’ve got to treat our patient, but we’ve also got to keep ourselves from getting hurt. And I don’t want anything happening to you. Do you understand?”
Layla nodded as she opened up the amputation kit while Arlo, above her, prepared ropes to lower Virote to the ground once he was free of the tree. “Same goes for you. Keep safe, Arlo. Oh, and about that tea we were going to have—raincheck?”
* * *
Her first move to help Virote was to pack as much gauze around the wound as she could without compromising her surgical field. And even out on a tree limb, that’s what it was. A surgical field. Then she did a quick assessment of his vital signs. “Blood pressure low,” she said, taking the reading off the wrist monitor she’d managed to get on him. “Pulse weak and too rapid,” she continued. “Also, he’s trying to talk but he’s beginning to perseverate.” Repeat the same words over and over. Likewise, he was beginning to trail off some of his words in guttural animal-type sounds. Sure signs of rapid deterioration.
Arlo shouted something to the people below, and several men turned and ran back to the village. “They’re going to get more rope so we can make a sling to lower him when it’s done, so—it’s time, Layla.”
She swallowed hard against the lump that was forming in her throat. Even though Arlo was close. Still, knowing he was there, looking down at everything she did, made things better. So, first, she took out the scalpel to initiate the procedure, then cleaned the area with alcohol wipes—not that it made much difference considering how dirty the wound was—then proceeded with cutting through skin, muscle and tendons. But halfway through the procedure the scalpel broke, and Arlo gasped from above. The setback lasted only a couple of seconds as she looked through the kit to see what else she could use. Then she saw them. A pair of trauma shears. And they worked beautifully. Got her through this part of the procedure without a hitch.
“OK,” she said to Arlo. “First part’s done. Moving on to the second.”
“You’re doing great,” he said.
“And you are so going to owe me a nice dinner in Bangkok before I go home,” she retorted, then lurched backward as Virote began to stir. Quickly she drew up another shot of medication and gave it to him—a much bigger dose than she would have liked, but safety was as important up here as the actual procedure. And, luckily, little by little, Virote settled down again. “And if he needs much more to keep him sedated, I’m afraid you’re going to have to sing him a lullaby because I’ve already given him much more than I’m comfortable with.”
“Can’t sing without my guitar.”
“Then you stay here, while I go back to the hut and find it.” She checked Virote’s eyes and blood pressure. “He’s gone again, so let’s get this over with. When I get done here, he’s going to be all yours to manage because there’s nothing I can do to help get him down from this angle. So, are you ready, because I’m going to do this fast.” As much for her sake as for Virote’s.
“The question is, are you ready?”
“I have to be, don’t I?” Layla grabbed forceps to clamp the skin and other tissue back from the worst part of the wound and also create a tunnel under the bone, which would allow for better access. Then next use the bone saw.
She wiped the sweat from her face before she started that part of the procedure. Normally, one of her surgical attendants did that, but this was surgery at its rawest, something no doctor could ever anticipate doing, and it was all up to her. Suddenly, all the respect she’d felt she’d never had didn’t matter anymore. She had the skill. That’s what counted. “I am strong,” she whispered, then commenced.
* * *
“His vitals are still bad,” Layla said to Arlo. He was driving her SUV while she tended her patient. The procedure had gone as well as could be expected, and with the assistance of several villagers Arlo had been able to give Virote a smooth ride to the ground. But the poor man needed more surgery to repair what she’d cut. And they were on their way to the regional hospital where he would be treated for his shock symptoms and stabilized enough to transport him to a public hospital in Bangkok for the next surgery.
“He’s lucky to be alive,” Arlo said, glancing in the rear-view mirror to see Layla applying another dressing to the still-bleeding wound. “But he’s going to need a lot of volume replacement,” he commented. Blood transfusion.
“And this is just the beginning of it. After his next surgery, and he’s fitted for a prosthesis...”
Arlo interrupted her. “That probably won’t happen for quite a while. If ever.”
“What? Why not?”
“That’s just the way it is. The public hospital will take care of keeping him alive, and even getting him started on some rehab. In other words, living life as an amputee. But for a prosthesis perseverate the waiting lists are long. Where he should be fitted in six to eight weeks, it’ll take twice that long, or more. He’ll have good care in the interim, but nothing about it will be speedy.”
Layla leaned back against the SUV door and shut her eyes. “Seriously?”
“Like I keep telling you, that’s the way it is here, Layla. One of the reasons I stay. Even if I can’t provide them the best medical care, given my limitations, I can do something. If we hadn’t been here to help him today, the villagers would have attempted something that would have killed him. Or he’d have stayed in that tree until he bled to death. When you live in the jungle, things don’t come easy. But there are people like my parents, and me, who do the best we can with what we have. And that’s another thing you should address in your medical school. The differences in medical care around the world.”
“I guess I’ve been too sheltered, because before I came here, I didn’t know... Well, I didn’t know pretty much any of this.”
“Neither did my parents. A lot of their motivation to come here was to get away from the threats Eric’s dad was making. But look at what they did. They became these amazing nomadic doctors who made such a huge difference, which gives me the chance to make a difference as well. They were pioneers in a sense. And it turned into a life they loved with a passion.”
She reached across the back of his seat and brushed his cheek
. “It’s good,” she said. “What you do—all good. I’m glad the people here have you.” And in so many ways she wished she could have him, too. But could she be the partner he needed? Not in the relationship sense so much as the medical? Could she be to Arlo what his mother had been to his father? Life partners with a common goal?
Arlo knew her as the girl who required fifty pairs of shoes to make her happy and, in so many ways, that’s who she had been back when they’d been together and, in a sense, even after she’d come here. Not in the literal sense, of course. But being away from that life made that life she’d lived seem so frivolous. Inconsequential. But could he see past what she’d been, and truly look at what she was becoming? Or was he too stuck in their past to see anything more than what she’d always shown him?
* * *
“Well, it’s not the prettiest view, but it’s the best I could find at a moment’s notice.” Arlo placed two wrapped sandwiches and a bottle of wine on the stone wall surrounding the garden and reflecting pool, then sat down next to her. “Virote just came out of surgery and he’s doing well.”
They hadn’t left the regional hospital yet. Partly because they wanted to see their emergency through to the end and partly because they were both exhausted. Not fit for the long drive back. “It’s been a while since I’ve heard city sounds,” she said, not interested in the food as much as simply sitting here with Arlo, relaxing. “All those horns, and this isn’t even a big city.”
“Just think what it would be like in Bangkok.” He uncorked the wine, which he’d bought at a little market down the street, and poured it into two glasses, not stemware but sturdy hospital glasses.
“I was there for a day before I came out to your hospital. It was...nice. So many things to see and do. But I think I prefer jungle sounds.”
He choked, laughing. “Seriously? You’re turning into Layla of the jungle?”