An Open Heart

by Harry Kraus

  The governor sighed. It had been a long road back. First, he’d had the massive heart attack and emergency surgery, then a postoperative stroke and pneumonia. Only this week had he been able to work a full day without napping. He knew his friend had his best interest at heart.

  “I don’t want the media getting hold of this.” He shook his head and sighed. “I’d always hoped they were wrong about Anita.” He ran his fingers through graying hair. When he looked up, his assistant was standing in the corner, looking out over the grounds of the governor’s mansion. “I messed up, Ryan. I let my political drive take time away from her.”

  “She supported you, Stuart. Don’t be so hard on—”

  He lifted his hand to cut him off. “I should have been there for her. After her miscarriage, things were never quite the same.”

  Ryan poured himself and the governor two fingers of Maker’s Mark Kentucky bourbon. “Do you understand what the report implies?” He lifted a glass to his lips. “Anita was raped. Ketamine is a powerful anesthetic.”

  “So she might have been innocent after all?”

  “Did you trust her?” He tapped the top of the red wax-dipped bottle.

  The governor looked away. “I don’t know.” He paused. “I wanted to believe her. I’d always hoped the media speculation was due to distortion from political enemies.”

  “And so maybe it was. But this ketamine takes her death to a whole new level.”

  “How is that?”

  “If someone gave her ketamine as a date-rape drug, perhaps she was still groggy. Sure, she was hit by a passing motorist, but did the drug affect her ability to get out of the way?”

  “You’re suggesting homicide?”

  Ryan shrugged. “Think about it, Stuart. Who has access to anesthetic drugs?”

  “A heart surgeon.”

  “Who else was with her the night of her death?”

  The governor walked around his desk and poured a second drink. When he spoke again, his voice was etched with anger. “You say you were protecting me by not sharing this with me sooner?”

  Ryan’s voice quivered. “Of course, sir.”

  “Stupid!” he said, spitting bourbon from his lips. “Stupid, stupid, stupid! By sitting on this information, you let Jace Rawlings slip away.”

  “What do you want me to do?”

  “Keep this away from all other eyes. I’m going to talk to the chief of police and the attorney general. I want a DNA match on the semen found in my wife, proof that this was Rawlings.”

  “The man’s made his escape.”

  “Some altruistic mission,” Franks huffed. “He was running away.”

  13

  That afternoon, Jace stood at the bedside of Michael Kagai, the patient with perforated bowel on whom he’d operated the evening before. Jace looked up when he heard his name.

  “Hey, Jace, heard you were busy last night. Welcome to Kijabe.” Dave Fitzgerald smiled.

  Jace nodded. “Thanks.” He handed him a chart. “Would you mind looking over this?” He gestured toward the patient in the bed. “I’m a little new at this general surgery stuff.”

  Jace watched as Dave leafed and hmmed his way through the chart, making short comments to himself. “Free air … perfed bowel … primary anastomosis.” He handed the chart back. “Better check his HIV status and cover him with Cipro. Perforated ileum from typhoid fever is twenty-five times more common in HIV-positive patients than in the regular population.”

  Jace made a note. “Sure.”

  Dave moved closer and spoke to the patient in fluent Kiswahili. The patient responded and wrapped his hands over his chest. Dave then spoke again and the only thing Jace could pick out was “HIV.”

  “Whenever you order an HIV test,” Dave explained, “you need permission. The test comes with counseling.”

  “Why did he do that, wrap his arms around his chest?”

  Dave smiled as he walked away. “I told him you were a famous heart surgeon.”

  “What did he say?”

  Fitzgerald mimicked the patient’s actions. “He’s protecting himself from you.”

  Jace mumbled, “Good idea.” He walked up the hall toward the HDU, where he found his intern fumbling with an ultrasound probe. Paul pushed the machine toward their young heart-failure patient.

  Jace placed the ultrasound probe over Beatrice’s chest to evaluate her heart function. As he did, he taught his intern, Paul, how to interpret the images. “Here is the aortic valve. It’s almost nonfunctional. See the blue and red color here? It shouldn’t show flow both ways across the valve.” Jace pushed a button to freeze the image, then moved the cursor over the wall of the left ventricle, measuring the thickness of the muscle. “See, it’s too thick, hypertrophied as a result of working too hard.”

  “Her oxygen is better than last night,” Paul said. “What do you think about an operation to replace the valve?”

  “She needs it for sure, but I’m not sure we’re ready. I still need my equipment, and that’s only the first step. If I can get my equipment through customs, I’ll need to ask my pump tech and a cardiac anesthesiologist to make an emergency trip. They told me they would if I could get everything ready.” Jace sighed. “It takes a lot of blood to do this sort of thing. I’m not sure the blood bank is up to it.”

  Paul nodded. He smiled and added. “We are a people of faith at this hospital, Dr. Rawlings. I’ve seen God do miracles.”

  Jace stayed quiet. He’d asked God for a miracle only once.

  And God hadn’t come through.

  So Jace hadn’t been on close speaking terms with Him since.

  He studied the chart a minute longer. “Give her an additional dose of Lasix tonight. If she looks better tomorrow, we may consider removing this ventilator.”

  Jace walked back to his little rented house hoping that God would hear Paul’s prayers, but not daring to believe.

  He replayed his conversation with the MP. It would be so much easier if his first case wasn’t such a high-tension production. If he operated and failed and Beatrice died, the minister of health might force the program to shut down, defeating Jace before he could really test the waters. It might be best to drag his heels a bit. The heart program would be safer if Beatrice were to die without an operation than if Jace tried something risky and failed.

  But Jace couldn’t allow himself to travel far down that path. His training, his whole orientation, was to push as hard as he could for as long as he could with whatever means available in order to save a patient’s life.

  And with that approach, sometimes he lost. But when he did, he could still move forward, knowing that he’d given everything he could.

  He sighed. Why did his first case have to be a politician’s daughter? He’d had his fill of cases involving politicians. Invariably, memories of his other recent high-profile case came into focus. Looking back, he wished he’d never performed surgery on Stuart Franks.

  Jace Rawlings stripped off his gown, pulling the disposable covering into a wad inside his sterile gloves, and threw it in the trash. The governor was still on the operating table behind him—critical, but at least alive. Jace thanked his staff and looked at the anesthesiologist. “Thanks, Joe. I’ll see you in the ICU in a few minutes. I need to talk to the family.”

  He found Anita Franks sitting in a private, quiet room along with the governor’s brother Bill and the governor’s chief of staff. “Good news,” he said. “We’re all done.”

  Relief broke across their faces. Hugs were shared. Jace stood back and relished the moment.

  “I had to replace the mitral valve. The operation went fine, but the governor still isn’t out of the woods. Remember, it was an infarction that got him into this condition in the first place. We’ve only just now gotten him stabilized. It is going to be hour by hour for the next few days.”

 
Anita stood. She was taller and slimmer than Heather, Jace thought. And certainly more youthful than the overweight governor. She brushed blonde strands of hair behind an ear pierced with two small gold rings.

  Before he could react, she pulled him into a hug, gushing her thanks. When she pulled away, Jace saw a photographer just outside the privacy area, snapping away. Paparazzi.

  Jace hurried to close the door to the intruding photographer.

  Ryan Meadows shook his hand. “Would you like to talk to the press? We’ve arranged a room on the second floor for media updates.”

  Jace shook his head. “Not yet. Let’s see how the night passes.” He paused. “Just tell them the operation went as planned, but the governor is still considered critical.”

  He walked out, aware that cameras were clicking. His hug with Anita would make the front page of the Richmond Times Dispatch.

  Jace awoke in Kijabe to the squawking of the ibis. He showered and was almost finished dressing when he heard pounding on his front door. He looked out the front door’s inset window. A familiar Toyota Land Cruiser with the emblem of the Ministry of Health sat in the gravel driveway. He opened the door, leaving the metal bars in place, and found himself across the bars from two uniformed officers.

  The first held up a badge. “Kenya Police. We’ve been instructed to bring you in for questioning.”

  Jace unlocked the bars. “On what charge?”

  “Extortion of a government official. Bribery.”

  Jace sighed. He knew arguing with the officers would get him nowhere. They were pawns of someone in the government intent on making his life miserable. “Come in,” Jace said. “I’m almost ready. Would you like some chai?”

  The officers smiled. “Asante.” Thank you.

  Jace fixed the sweet milky tea and set three steaming mugs on the table.

  “An American knows how to make Kenyan chai?” The taller of the two officers took a sip.

  Jace nodded. “Kenya was my first home.” He paused and shook his head. “But it seems Kenya doesn’t love me anymore.”

  They sipped their tea and talked of an upcoming rugby World Cup match.

  In fifteen minutes, Jace followed them to the vehicle. “This belongs to John Okombo. Did he send you to get me?”

  “Our department is suffering. We have limited vehicles. Minister Okombo was kind enough to lend us his.” The officer’s large smile of perfect white teeth gave Jace the impression that he’d been handed the standard bull. Of course Okombo sent you. He wants to show me how powerful he is.

  Jace stayed quiet during the trip, enduring yet another version of African NASCAR. They took him all the way back into Nairobi to a police station off Ngong road.

  As they entered the two-room facility, Jace paused to let his eyes adjust. Either the electricity was off or they hadn’t paid the light bill. The room was dark, dusty, and contained only a desk and two wooden chairs. A uniformed man with black hair and a well-trimmed moustache sat behind the desk. The men who had accompanied Jace greeted him with a nod. “Captain.”

  “So this is the American heart surgeon.”

  Jace squinted.

  “Why is it that you insist on cluttering up my day, Dr. Rawlings? Certainly we have better things to do than to sort out your problems.”

  “I’m not sure what you’re talking about.”

  “You are accused of bribing a government official.”

  “Ridiculous.” Jace studied the men and pondered his next step. Ask for an attorney? He needed more information. He’d heard from his father that as long as you let the official feel like the big man, and didn’t try to argue, business would go smoothly. He decided to try. “With all due respect, Captain, I would like to know the exact nature of your concerns. Perhaps I can clarify the issue for you.”

  He raised his voice. “Bring the recording.”

  A third officer entered the room carrying a small cassette player and set it on the desk in front of Jace. The captain pressed a button and Jace heard his own voice. He recognized his conversation with the minister of health.

  “Drop the fee and I’ll do what I can to convince the hospital to take her as our first open-heart case.”

  “Don’t play games with my daughter’s life.”

  “Exactly,” Jace responded. “Don’t play dangerous games with me. I’ve lost many patients before. But have you lost a daughter?”

  The captain snapped off the tape.

  Jace cringed. They were making him out to be an uncaring jerk. He wanted to scream. That’s not the way I meant it! Instead, he forced himself to remain composed and meet the gaze of the uniformed man.

  “Our beloved minister of health is under the impression that you are trying to escape paying an import tax. It seems you are leveraging the life of a young woman.”

  “Sir, I was only pleading with Minister Okombo to drop the fee so that I can get to work. How can I pay thousands in taxes when the equipment will be used not for financial gain, but to serve the poor of Kenya?”

  “The situation does not sound so simple. Minister Okombo says he sent the girl to you, hoping for help. Instead, all he gets are threats.”

  “I’ve been misunderstood.”

  “Have you? It seems the tape speaks for itself.”

  “I will be glad to operate on the girl if I can get my equipment and the necessary staff to help. I was only hoping a man as powerful as Minister Okombo could use his influence to help me out. I would never put money in front of a patient’s life.”

  “Perhaps you can explain why the tape sounds as if you are doing just that.” He hesitated. “Or do I need to forward this tape to a judge?”

  “Please, sir—surely you understand my desire to keep this out of the courts. That would certainly delay the heart program. I will pay the fee if I have to. I said those things so that Minister Okombo would understand that I am not a pushover. I wanted to make him believe that I believed the stakes were quite high for not getting my equipment through customs. It’s not like it’s the first time I’ve been to Kenya. I grew up here. I know how things work.”

  “Why don’t you explain it to me?”

  Jace hesitated. “Sometimes it is difficult to tell the difference between a legitimate tax and a bribe.”

  “You think our customs official was asking for a bribe?”

  Jace stayed quiet. Yes. Of course it was a bribe.

  “Losing Kenyan lives is a high cost to pay for your games.” He looked at the officers. “Why don’t you take Dr. Rawlings to a holding room until I can contact Minister Okombo? If he is comfortable mediating a solution without the courts, so be it.”

  Jace wanted to argue, but sensed it would only aggravate the men. An officer grabbed Jace by the upper arm and led him out of the room. Outside, he took Jace across the gravel parking lot and shoved him through a high metal gate into a fenced enclosure. The holding room turned out to be a ten-by-ten-foot section of gravel bounded by a ten-foot solid metal fence topped with razor wire.

  Jace sat in the corner and leaned against the fence.

  There he waited for the next three hours, with only a rectangle of sky to occupy his thoughts.

  Jace had had little trouble with the law. His only other point of reference for dealing with public officials had left him suspicious and wounded. His mind slipped back to an afternoon shortly after he’d operated on Virginia’s governor. He’d been in the hospital making his rounds when, as he passed the waiting room, someone called his name. He looked up to see Anita Franks and two men he assumed were security. “Hi, Mrs. Franks. Your husband looks a little better today.”

  “Thanks to you.”

  He studied her a moment. She’d aged in the last two days, but was still very much a woman dressed for the public. “How are you doing with all of this?”

  She took a deep breath. “Got a year?” />
  He forced himself to chuckle. “You do need to leave the hospital occasionally. The team is taking good care of your husband.”

  She nodded. “I do need to get out.” She hesitated. “Would you go with me? I’ll buy you lunch. It would mean so much to be able to thank you.”

  “It’s not necessary, really.”

  “No, but I want to.”

  He checked his watch. “I have to be in my office for clinic in forty-five minutes.”

  “Perfect,” she said.

  In ten minutes, in spite of his misgivings, he sat across from her at a table at a local delicatessen. It took only moments to find himself enraptured by her charm.

  “You’re staring,” she said, returning his gaze.

  “You remind me of someone.”

  “An old girlfriend, perhaps?”

  He shook his head. “Maybe it’s just your hair.” He looked down. “My twin sister had hair just like yours.”

  The sun was past its peak when Jace heard the rumblings of a diesel truck, tires crunching against gravel. A moment later, the gate rattled, so Jace stood and brushed the dirt from his khakis. His throat was dry, and his back ached from leaning against the fence.

  The gate opened, and a guard said, “Come with me.”

  Jace followed the officer to the back of the truck. The man pulled up the sliding door to reveal the crated equipment Jace had brought from Virginia. Alongside his equipment sat a dozen other boxes, each bearing the markings of biotech companies.

  “Minister Okombo wanted me to allow you to inspect your equipment before shipment to Kijabe.”

  “But I thought—”

  The captain’s voice sounded from behind him. “The minister of health wants you to understand a gesture of goodwill.”

  Goodwill? You’ve just kept me locked up for three hours in the sun and you want to talk to me about goodwill? Jace nodded. The big man needed to be in control. “How thoughtful.”