She had manually massaged Lucas’s heart, fruitlessly, until a team of nurses gently took her away. But Dr. Balachandra had done more than just pronounce her baby.
“Yes, I did.” He said matter-of-factly.
“Thank you.”
She finished the sutures and nodded to Dr. Tucker, who began bringing the baby out of anesthesia. They’d already successfully restarted her heart, now it was a matter of giving her some time, then turning off the ventilator, letting the baby breathe on her own and watching her for a couple of days to make sure she didn’t get an infection. While the OR had been adequate to do the surgery, it wasn’t perfect. In the urgency to get it set up, only the critical pieces had been sterilized. Ideally, the whole room was supposed to be prepared to create as clean an environment as possible. Anna reminded herself that she’d assisted surgeons who cut people open in tents with dust blowing around them. Sometimes it was not about doing it perfectly, but about getting it done.
Nico had left at some point, but while the nurses wheeled the breathing baby to the NICU that had been prepared just for her, Anna searched the corridor for him. She found Maria instead.
“He collapsed,” the other woman said without preamble.
Before Anna could even process the words, Maria put a hand on her shoulder. “There are doctors here from the DMAT who are taking care of him.”
“He’s in shock. There’s a wound on his abdomen. It’s probably infected, he—”
Maria was nodding. “They found it, they’re taking care of him. Nothing for us to do.”
Anna bit her lip. This is my fault. He wouldn’t have been out there if it hadn’t been for her. She’d been too self-absorbed to take care of him properly last night. And then instead of getting him medical attention when they’d arrived at the hospital, she had asked him to stay with her, to give her courage to do the surgery. How could she have been so selfish?
“I’m so sorry.”
Maria stared at her. “What for? He cut himself saving Tito from the car.”
Anna wanted to fess up to Maria, explain the whole situation, but somehow felt it wasn’t her place. Nico had come for her; he needed to tell Maria what had happened. “I’d better go check on Emma. Where is Nico?”
“In the ICU.”
Anna didn’t need to hear any more. Dr. Tucker had gone to the NICU with the baby; she’d be fine for a few more minutes. She went straight to the ICU instead. It looked very different from when she’d been here a few days ago. She introduced herself to the physician in charge who was also a captain in the PHS. He was one of the new arrivals.
“Your husband is critical. We gave him a blood transfusion, repaired the laceration and started him on a course of antibiotics, but his pressure is still low.”
“Have you given him vasopressors?”
The man nodded. “We have no idea how far the infection’s spread. We need to give the antibiotics time to work, then see where we stand.”
Anna knew all this already, but somehow she needed to hear it from someone else. She scrubbed her hands, put on a new mask and went to Nico’s room. He was unconscious, a ventilator breathing for him through a tube. His pulse was strong, his EKG showing no arrhythmias. That was a positive sign.
“Nico.” She went to his side and squeezed his hand. Tears fell down her cheeks. “I’m so sorry.” He’d held it together for her. She sat with him until a knock on the door reminded her that she was on the job. Exiting, she came face-to-face with Maria again.
Maria gave her a hug and Anna returned the gesture. The two women sobbed uncontrollably, holding each other up.
“I can’t do this without him.” Was it her or Maria who said the words?
“Dr. Atao?”
She looked up to see one of the nurses standing there. “You need to come with me. Emma has crashed.”
CHAPTER THIRTEEN
“YOU FIRST.” MARIA’S face mirrored the exhaustion Anna felt. She didn’t even know where to begin processing everything that had happened in the past few hours.
“He’s stable but still not out of the woods.” Maria’s voice was weary.
Guilt pierced Anna’s heart. If she hadn’t been so gutted by her own pain, she would’ve treated him correctly last night. They were standing in one of the corridors off the ICU that was blissfully empty. Between patients and the newly arrived medical staff, the entire hospital seemed to be crawling with people. Anna had been on her way to check on Nico when she bumped into Maria. She placed a hand on the wall to steady herself.
Maria leaned against the wall and slid down until she was sitting on the floor. Anna joined her. She didn’t trust her legs to keep her upright.
“You love him, don’t you.” Maria hadn’t asked it as a question, merely stated it as a fact.
Anna sighed. “He has a way of getting under your skin.”
“Don’t I know it. He’s been under mine for twenty-three years.”
“You’ve loved him since high school?”
Maria nodded. Anna could picture it. Once you had a man like Nico, it was hard for anyone else to measure up.
“He’ll be happy with you.” Anna truly meant it.
“I’m not so sure he can ever forget you.”
“He will. You’ve helped him make his dreams come true. That counts for a lot. For Nico, it’s about home—this community is everything to him. It’s what defines him. I never fit in here like you do. Sure, we have history—that’ll never change. But once I leave...” she squeezed Maria’s shoulder “...and I will leave, things will go back to normal for you guys.”
She could hear the relief in Maria’s breath. Now came the hard part. Anna squared her shoulders.
“Listen, Maria, I know you’re already stressed, but I need to tell you—Emma needs an ECMO machine. A heart-lung bypass. Her heart is too weak to heal on its own.”
Maria gasped. “Where am I going to get that kind of equipment? Can she be transported?”
That had been Anna’s first thought, too. Get this poor baby off the island. She had called a pediatric cardiologist on the sat phone to get his opinion. He had confirmed what she knew, that the baby was too unstable to transport. Her only hope of survival was to get an ECMO. And soon.
Anna shook her head. “She’s not stable enough.”
“Where are we going to get an ECMO in the next few hours?”
“Apparently one can be purchased from the Phillipines and be shipped here on helicopter. My colleague in the PHS found a company willing to sell one, but the price is steep. And we have to find a helicopter to bring it over.”
Maria blew out a breath. “We can’t afford it. As it is, I’ve gotten a loan from the bank just to buy the supplies we’ve needed to take care of basic wounds. The relief organizations are still mobilizing and the best places to purchase supplies are Japan and the Philippines because they’re much closer than the US. But those guys want cash upfront.”
“Isn’t there any way to get an advance on the insurance? Something?” An elephant was sitting on Anna’s chest, but she took a deep breath. She couldn’t let Emma die, not after she’d come as far as making it through the surgery. There had to be a way. Finding the machine had been next to impossible, but rather than letting panic seize her, Anna had called everyone she knew until someone gave her a lead.
“I also need to find a dialysis machine, a pharmacy’s worth of medications, and a structural engineer to make sure this building won’t fall on our heads. Everything seems to cost more right now, and everyone on this island seems to be on antiarrhythmic and blood pressure medications that washed down the drain.” Maria blew out a breath. “I need to prioritize. I don’t have cash on hand, and I don’t know whether we will ever get reimbursed for any of this. With Guam Hospital out of commission, we are now the public hospital for this island.�
� She waved her hands around. “What all am I going to get done?”
Anger bubbled through Anna. It was always about resources on the island. Someone got to live at the expense of someone else. The hospital would spend money to fly in a cardiac surgeon who could do surgery on adults but not one who could treat kids. “You want to ration care right now?”
Maria buried her head in her hands. “You think I want to make these kinds of decisions? I have to, or everyone dies. There will be more people who need the dialysis machine. The ECMO is just for Emma.” She looked pleadingly at Anna, big, wet tears in her eyes. “Please try to understand. It’s not how I want to do things, but I can’t save everyone. Besides, helicopters aren’t exactly available—there’s a waiting list of patients who need medical transport out and those copters are all going to Japan. No way one can be spared to go pick up a machine in Manila.”
Anna wanted to argue with her, to be mad and tell her there was always a way, but Maria was right. How many times had she made triage decisions, especially in Liberia? She would spend all of ten seconds evaluating a patient and then decide what color tag to put on them. Red tags for those who could be saved. They would get medical care as soon as possible. Black tags for those who were “expectant,” meaning they’d die and there was no use expending resources on them.
But Anna wasn’t ready to put a black tag on Emma.
The decision was obviously playing on Maria, as well. She wrung her hands. “Nico would know what to do. He’s good at these things.”
Had Nico known what to do with Lucas? At the time she hadn’t thought so. When Lucas was diagnosed, they were both hopeful. She’d booked a flight to California and contacted every medical school friend she had to find the best pediatric surgeon possible. She hadn’t started to panic until the pilot strike continued and all air travel out of Guam ceased. Then Nico had worked his contacts. He’d called every person he knew to see if someone would be willing to break the strike. It didn’t matter. The airline made a statement with the union. They had taken all planes out of Micronesia. Nico had fought until Lucas worsened, and then he gave up and accepted their son’s fate. That was when Anna’s desperation had kicked in and a rift formed between them that grew and grew until it blew their marriage apart.
“Can your people pay for it?”
Anna had already explored that possibility and come up empty. The DMAT teams could not authorize expensive purchases; only the Office of the Assistant Secretary for Preparedness and Response could do that and they were already running low on their disaster relief funds.
Anna shook her head and stood. She had to go talk to Troy and Aurelia. Prepare them for what was coming. No one had done that when it was Lucas. She had diagnosed him and cared for him. At the time, she was the local pediatrician, the only one on the island. Calling on friends in California, she had sent over Lucas’s ultrasound results and films and they had all confirmed her diagnosis with nothing more useful than “He needs surgery.”
“We will get through this, Anna.” Maria gave her a tight hug, holding on to her, and Anna squeezed her back. Anna didn’t have close friends. She’d moved around so much as a child that her sister became her best friend. The only consistent person she had in her life. Without a doubt, if she’d known Maria when they were younger, they would have been friends. The woman had a goodness inside her that touched Anna’s soul.
“He’s going to make it. I know it in my heart,” Maria whispered.
Anna nodded, not wanting to say what was really in her heart. That Nico was going to die because of her. Just like Lucas had.
Troy and Aurelia stood as soon as Anna walked into the tent. Anyone who didn’t need medical attention had been put in the tents outside. The wind had died down and even the sun was peeking out. Mother Nature was going to give them a break. At least for now.
For the first time, Anna took them in. They were both young, in their midtwenties. Aurelia was a petite girl with dark hair, cream-colored skin and soft brown eyes. Troy was a little taller than her, skinny with a goatee. Anna had already talked to them once, right after the surgery. Now she asked them to walk outside with her. The tent was noisy and distracting with crying babies, children playing games and people catching up with each other, sharing their stories.
Anna explained what was going on with Emma.
“So she’s gonna die.” Troy cut to the chase. Anna was prepared for the question, but none of her stock responses seemed adequate. Troy’s fearful face made the knots in her stomach twist painfully. “I’m going to keep on trying to get that machine. I’ll make some phone calls Stateside and see if there is anyone who can pay for it. If that doesn’t work, I can...”
Aurelia put a hand on her shoulder. Anna forced herself to look into the young woman’s tear-filled eyes. Anna was a doctor; it was her duty to put aside her own pain and console her patients. “Dr. Atao, if it’s Emma’s time, I need to know. I want to say goodbye, I want to hold her, I don’t want her to go alone with all those machines.”
The words hit her like a lightning bolt. Don’t do the surgery, Anna. You want Lucas to die in your arms, comfortably and knowing he’s loved. You don’t want him to die hooked up to machines. This was the first time she’d really thought about what Nico had said. Back then she’d lashed out at him, accused him of giving up when things got really tough, of being willing to sacrifice their son’s life rather than acknowledging that his insistence on staying in Guam was what would kill their baby. The last time she’d held Lucas when he wasn’t cold and stiff was when she’d nursed him before the surgery. All she’d been able to focus on was the steps she needed to go through to conduct the procedure and the long list of what could go wrong.
She hadn’t taken a moment to enjoy the last moments of Lucas’s life when she could just be his mother.
“Dr. Atao?”
She snapped her attention back to Aurelia. “Come with me. I won’t take her off the ventilator and IV drips just yet, but I can let you hold her.”
Back in the NICU where Emma was the only patient, Anna made Aurelia and Troy scrub their hands and arms, gown up and put masks on like they would if they were going into surgery, then led them to the incubator where Emma was fighting for her life. How could Anna have forgotten this? It was well-known that infants responded to touch and to being held. The kangaroo hold, named for the animal who carried her children in her belly pocket, was commonly used by pediatricians to help underdeveloped infants. Parents were encouraged to cradle them skin to skin.
Anna handed Emma to Aurelia and encouraged her to touch her cheek to the baby, to hold and talk to her the way she normally did. As she turned to leave, Troy grabbed her hand.
“Thank you, Doctor.” The words were said with such sincerity that Anna couldn’t hide her own tears. She didn’t deserve their appreciation.
Unsure of what to do, she went to the ICU, passing through hallways crowded with people. Some sat on the floor, others stood waiting. Now that a number of other medical personnel had arrived, Anna’s orders were less clear. She hadn’t seen Linda Tucker since the surgery. All medical staff were wearing scrubs and name tags to indicate who they were, but Anna wasn’t even sure who was in charge of medical command. It wasn’t unusual in disasters. Normally she thrived in the chaos, letting it sweep her up in the moment so she didn’t have to be alone with her thoughts for very long. But today she wanted quiet. She needed to think.
Nico was still on a ventilator, and a nurse that Anna didn’t recognize was noting his vital signs from the monitor.
“He’s stable,” the nurse whispered before leaving. Perhaps because of who Nico was, or Maria’s influence, they hadn’t doubled him up. All the other rooms held two or three beds. Anna squeezed his hand, sitting on the edge of the bed. Why had she come here? She had nothing left to say to Nico. All the words in her heart, the hateful ones, the ones of love—she’d said them
all. Yet something niggled at her. His chest rose and fell as the ventilator pushed air into his lungs. Her vibrant, full-of-life Nico with the strength of several horses was lying still.
“I need you to live, Nico.” Perhaps she had come to feel his warm body, to know that he was still with her.
Then she realized what she hadn’t yet said to him. With a stone weighing her heart to the floor, she leaned over and kissed his forehead. “I want you to know that I forgive you for what happened with Lucas. You were right. I should’ve accepted his fate and enjoyed the last few minutes of his life. I don’t want to make the same mistake with you. Please don’t leave me.”
His hand twitched and she looked up, tears streaming down her face, but he remained motionless. It was just a muscle contraction. Patting his hand, she stood to leave. Despite the extra help they now had, there was still a shortage of doctors and she had a job to do.
Someone entered the room.
“Nana.”
Nico’s mother had aged since yesterday. Her gray hair was loose around her shoulders. Anna had only seen it like that when she stepped out of the shower. The woman always got herself put together every morning, hair, lipstick and immaculate clothes. She was not the type to be found lounging in pajamas past nine in the morning.
Sitting on Nico’s bed, she placed her hand on top of her son’s chest, then bent her head and began sobbing. Anna put an arm around her and squeezed her shoulders. The only other time Nana had cried was at Lucas’s funeral. Even then, Anna got the feeling she was crying for Nico’s pain, not necessarily for the loss of her grandson.
“Nico is all I have, all I’ve ever had. What will I do without him?” Her broken voice twisted Anna’s stomach.
“He’s going to make it through, I know it. Nico is a strong man.” Her words were as much a prayer as reassurance. She held Nana until her sobs subsided.
“He went to California to get you back.”
Anna knew this already. She had been in Liberia and not within phone or internet range, but her mother had sent a letter after the fact to let her know that Nico wanted her back, that he had come and begged for her. He’d even called the PHS to find out where she was, but of course they weren’t going to reveal her exact location or allow him to visit.
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