An Open Heart

by Harry Kraus

  Jace smiled. The gadget guy.

  Evan surveyed the mass of people crowding around them, shouting out offers to carry their luggage. “What have you gotten us into?” he said, smiling.

  “Oh, you have no idea,” he said. “No idea.”

  The following week, Jace gathered in the operating room with Gabby and Evan. The occasion: the eve of the maiden-voyage open-heart case at Kijabe Hospital.

  Evan sighed. “It’s going to be awfully crowded in this room.”

  Jace pushed the anesthesia machine back six inches. “This is the biggest room we have.”

  Gabby frowned. “There’s a gap beside this window pane. A fly or mosquito on your sterile field could spell disaster for your patient. The whole operation would be for nothing if she gets a valve infection.”

  Jace took a blue towel and shoved it in the crack. “That should do for now.”

  Evan did a three-sixty while touching each piece of equipment within arm’s reach. The arterial line monitor, his endoscopic echocardiogram, an EKG monitor, and a drawer full of cardiac meds. “Tight, but doable. Remind me to check with pharmacy. We seem to be a bit low on fentanyl.”

  Gabby leaned across her silver pump, the heart-lung machine. Tomorrow, it would whirl, extracting blood from the patient’s right atrium, oxygenating it, and pumping it back through a cannula inserted in the patient’s aortic root. “What’s the blood availability?”

  “Still need two more units. What is your blood type?”

  “No, no,” she said. “I’m already short of breath because of the altitude.”

  “I’m B positive, compatible with the patient,” Jace said. “I gave one unit three days ago. I’ll give another tonight.”

  Evan frowned. “Do you think you should? We need you at one-hundred percent, Jace.”

  “What choice do I have?”

  “You can’t bleed yourself for every case.”

  “This isn’t every case. It’s our first.”

  “Exactly. Look, I’m O negative. I can give,” Evan said.

  Jace nodded. “We’ll both give.” He looked at the clock on the wall. “They’re expecting us in blood bank.”

  Evan shrugged. “You’re asking a lot. First we donate our time, our skills. Now you want me to hemorrhage too.”

  Jace smiled. “We’ve got exactly twelve hours. Let’s get this done.”

  That night, Jace approached the bedside of Beatrice Wanjiku. In a wooden chair next to the bed sat a woman Jace recognized as Beatrice’s mother. Her mascara was streaked, and her sweater was buttoned up to her chin, a concession to seeing her daughter in a church hospital.

  “Dr. Rawlings,” the patient said.

  “Hi, Beatrice.” He took her hand and nodded at her mother. “Nice to see you again.”

  Beatrice forced a smile. “Tell her not to worry. I’m going to be okay.”

  The parent-child relationship in reverse. Beatrice seeking to comfort her mother.

  “We have a good team,” Jace said. “We have every reason to be optimistic.”

  Beatrice looked at her mother and spoke in Kikuyu, their tribal tongue.

  Her mother answered, her questions punctuated with sobs.

  Beatrice looked at Jace. “She says it is not possible to open the heart. She knows the heart is needed to pump my blood.”

  “Tell her that we have a special machine that will take over the function of your heart and lungs during the operation.” He paused. “Will she understand?”

  “I will help her.” Beatrice began a long explanation in Kikuyu, gesturing toward her chest, tracing a path with her fingers up toward her neck and then turning down around her left breast. She closed and opened her fist. The pumping heart.

  Her mother shook her head.

  Beatrice frowned. “She says she will be praying.”

  “That’s good, right? She agrees then?”

  “No. My mother isn’t a religious woman. She says this only to impress you. She wants you to think she is a good woman.”

  “She cares about you.”

  “She is a prostitute. She cares about her next drink.”

  Jace sighed. He knew Beatrice was right, and her insight and lay-it-all-on-the-table approach were both alarming and touching. She’d obviously been forced to grow up fast, and as happens with so many dysfunctional families, the roles of parent and child were reversed and messy. “Many people talk of God when they are facing crisis.” He looked down. “It’s natural, not a bad thing.” Jace felt odd offering an opinion about spirituality. He cleared his throat. “What about you? Do you pray?”

  “I pray every day that God will help me escape my life in Kibera. Escape my life with a woman who embarrasses me.”

  Jace looked at Beatrice’s mother. “She is concerned. That ought to mean something.”

  Beatrice shook her head. “She came to take me home. She says we cannot afford an operation.”

  “Don’t worry about the money. Someone has offered to pay your bill.”

  Beatrice spoke again to her mother, gesturing again, opening her hands in front of her. The two talked for a few minutes with Beatrice’s mother becoming more and more animated.

  Jace watched, unsure how to proceed. “If you leave, you will die.”

  “My mother wants me to see a doctor in Kibera.”

  Jace pulled down on Beatrice’s gown, moving the neckline lower to expose a series of burn scars on her upper chest. “The doctor who gave you these?”

  “Yes.” Beatrice sniffed and her eyes were glistening.

  Jace studied her. She appeared to be trying not to cry. “The traditional healers have nothing to offer you.”

  Beatrice shrugged. “You won’t convince her. She feels it is impossible to open the heart without causing death.”

  Jace sat on the edge of the bed and faced his patient’s mother, studying eyes that glistened with tears. “I will make your daughter well again.”

  Slowly, over the next twenty minutes, with Beatrice interpreting, Jace explained all he could to help the mother understand.

  Finally, she agreed. Jace stood again.

  Beatrice caught his hand as he turned to leave. “Dr. Rawlings,” she said, her voice thickening, “I’m so afraid.”

  “I will be with you the whole time,” he said. “I won’t let you down.”

  He wished he could say more. He wished he were like his father, who always had an encouraging Bible verse to share. But he was empty. So he squeezed her hand and walked away, out into the main hall where he saw the chaplain standing with the other members of his team. “Dr. Rawlings,” he said, “we are gathering in the chapel to pray on this eve of such a momentous day for Kijabe hospital.”

  Jace nodded, making eye contact with Gabby. She would be all over this. She wasn’t noisy about her faith but wasn’t exactly quiet, either. She constantly told Jace about the answers to her prayers.

  He followed the chaplain into the small chapel and stood in a circle with the staff members who had gathered there. He recognized a few of the theater nurses and two hospital administrators, along with the medical director, Blake, and Dave Fitzgerald.

  Jace nodded at Dave without speaking. Who twisted your arm to be here?

  Jace would have been more comfortable without fanfare, without ceremony, but this was the Kijabe way. Significant events did not pass without acknowledgment, often a formal meeting, a speaker perhaps, but at least a formal prayer.

  Blake led the little circle. “We have come a long way in a short time. From the time Dr. Rawlings contacted us, equipment was donated, the Ministry of Health approved our request, and these gracious members have donated their time. So we mark this day with a prayer of thanks and a plea for God’s healing, guidance, and mercy.” He looked over at Jace. “Comments, Dr. Rawlings?”

  He cleared his throat.
“I’d like to thank each one of you for your support. We’ve got an early day tomorrow. Let’s get some rest.” His eyes met Blake’s. “After the prayer, of course.”

  The nurses and Chaplain Otieno chuckled. “Of course,” Otieno said. “I will lead in prayer.”

  He began softly, pleading for God to continue his blessings on the ministry of Kijabe Hospital. When he got around to praying for Jace, he placed his hands upon Jace’s shoulders and moved so close that Jace could feel his breath blowing across his forehead. “Take this man. Use his mind and his hands for your glory,” he asked.

  The chaplain’s hands were heavy. Jace could not imagine a man with hands so hot and so heavy. Just as Jace’s knees began to buckle, the pressure lifted.

  Had he imagined it?

  He reached up and touched his shoulder, where only moments before the chaplain’s meaty hand had rested. It‘s hot.

  Jace shook his head. Just my imagination.

  After the chaplain’s prayer, amens were shared around the circle. Each member gave Jace a vigorous handshake, an affirmation of their support.

  Even Dave seemed to have been won over. “I’ll be there at six sharp.”

  Jace thanked everyone again, and the group broke up, each one exiting the chapel into the cool night. He said good night to Gabby and Evan and strode off to his little home, knowing that sleep would be difficult.

  That night, Beatrice’s mother refused to leave, sitting on Beatrice’s small hospital bed in the women’s ward, amid all the other patients. For Beatrice, sleep was difficult enough, as it was hard for her to breathe while lying flat on the bed. That had something to do with her heart failing, Dr. Rawlings had explained.

  Sometime after midnight, her mother curled against Beatrice, stealing her warmth and further disrupting her sleep with her snores. Her mother told her she wouldn’t leave her on the night before her big day, but she knew her mother had no other place to go. If she did not sleep with Beatrice, she would find a patch of ground beneath a tree outside—or worse, find the company of a stranger.

  Beatrice didn’t want that. Besides, it comforted her, having her mother there. At least she could tell herself she had a mother who cared.

  There, in the night, with the sounds of her mother’s snoring and the busy steps of the nurses caring for the other patients, Beatrice pulled her mother’s arm around her like a blanket. She does care, doesn’t she?

  She arranged for the American doctor to see me.

  That must mean that she has some powerful friends.

  Or is my father secretly watching me?

  It was a mental game she’d played, growing up without a father. She imagined that he was someone special. She would look at herself in the small hand mirror her mother had given her one Christmas and try to see her features in the men who visited her mom.

  Could it be the man who brought Dr. Rawlings to me? He dressed in a suit and drove a big vehicle for someone important. Did he arrange for my care?

  In the early hours of the morning, Beatrice’s nurse stopped by the bed.

  “Child, you should sleep.”

  Beatrice nodded.

  The woman had a kind face, with muddy brown eyes and a Kikuyu name like hers. “Afraid?”

  “Yes,” Beatrice whispered.

  “Close your eyes. I will pray.”

  Beatrice obeyed. And as the woman prayed and stroked her hair, she imagined her mother was the one who was touching her, that her mother was the one who prayed with such vibrancy that Beatrice found herself believing things really could turn out okay.

  The next day, work began for the open-heart team at six. The patient was brought down, a central line was placed, an arterial line inserted, sterile fields opened and prepared. IVs were hung, antibiotics dripped, the patient anesthetized, and the skin prepped. By nine, Jace stood at the scrub sink and tried to exorcize his self-doubt. It had been months since his last open-heart case. But what was mere months in time seemed a world away.

  As he lathered his hands and arms, instead of a prayer to God, he whispered his sister’s name. “Okay, Janice. Here we go.”

  A few minutes later, as he stood with the scalpel poised above his patient’s sternum, Gabby spoke up after clearing her throat. “Dr. Rawlings,” she said, using his formal title since they were in front of staff. “I’d like to begin with a prayer if that’s all right. It’s a historic day for this hospital.” She hesitated. “And for Kenya.”

  Jace nodded. Couldn’t hurt.

  Gabby began. “Dear Father, we commit this precious life to You. Watch over her and all the staff. Help us. Guide Dr. Rawlings’s hands. Bring healing. We promise to give You all the glory.”

  Jace closed his left hand into a fist during the prayer, hoping to quell a twitch. When Gabby finished praying, he echoed, “Amen.”

  He glided the scalpel over the skin, separating the brown skin to reveal a layer of yellow fat beneath. Then he picked up the pencil cautery and applied it to multiple small dermal and subcutaneous bleeders. He then bluntly worked the tip of a scissors beneath the sternum, freeing the soft tissue from the undersurface of the bone. He took a sternal splitter and a mallet and split the sternum. Back in Richmond, he would have done this with a pneumatic saw, but in Kijabe, he did it the old-fashioned way.

  In a moment, the lining around the heart was opened and retracted and the patient’s heart was exposed. Across from him, Dave Fitzgerald shook his head. “Man, this is so cool.”

  “Nothing like the human heart.” Jace looked at Gabby. “Let’s set up the heart-lung machine.”

  As many times as Jace had done this, he was never without amazement at the process. Large bore tubes were sutured into place in the aorta and right atrium, the heart was cooled, and the pump started.

  Gabby sat behind her silver cardiac bypass pump, a queen happy in command central. “You know what they say,” she bantered.

  Jace knew what was coming. “Okay, Gabby, what do they say?”

  Gabby rolled her stool, staring at the machine in front of her. “What is the fastest way to a man’s heart?”

  Dave Fitzgerald shrugged. “Through his stomach.”

  Gabby laughed. “Between the fourth and fifth ribs.”

  Jace smiled behind his mask. He spoke to Gabby, his tone suddenly serious. “Venous line’s to you.”

  She understood the notation. She opened the line. “We’re on bypass.”

  A heart-stilling medication was infused directly into the heart. This cardioplegia, as it was called, was high in potassium, causing paralysis of the heart muscle cells. The patient was now alive, but without a beating heart. Little blood circulated through the lungs as the heart-lung machine oxygenated the blood as it went through the pump.

  Jace went to work, opening the heart, removing the old diseased valve and placing a new one in its place.

  While they worked, they fell into routine. Jace discovered that, as on a bicycle, everything came back. He placed sutures with the precision of a watchmaker. Fingers blurred in a flurry of knot tying.

  “Gabby,” Jace teased. “I’m sure we can find you a nice Kenyan young man to convince you to stay. I’d bet that one of my Maasai friends would pay twenty or thirty cows for a woman like you.”

  Gabby huffed. “Only thirty?”

  After forty-five minutes, the heart was closed again, and they began a rewarming process. When the patient’s temperature was within a few degrees of normal, Jace asked for the internal paddles to shock the heart. He looked over the drapes at Evan Martin. “What’s wrong?”

  Evan shook his head. “This girl is so sensitive. I’ve had her on next to no anesthesia.”

  “I’m operating on her heart and she’s not under anesthesia?”

  “Chemically paralyzed, that’s about it.”

  “Just give her something to keep her from remembering. Here s
he is being suspended between life and death. It could be pretty freaky for her.”

  Awareness.

  Darkened passages, a sudden bright light, like looking into the sun, but different. She had no need to shield her eyes.

  Did she have eyes?

  Weightless, floating, hearing, seeing, feeling, but not embodied. Away from the light, she tried to focus. That’s me down there. That’s my heart.

  I’m dead.

  My doctor doesn’t know. He doesn’t seem concerned. He jokes with the woman about getting a husband.

  Beatrice looked on with a strange sort of detachment. My heart. My chest pried open by steel jaws. But I feel no pain.

  So I must be dead.

  Can I travel? Move?

  Thought seemed to move her around the room. She reached out to touch a pole laden with IVs, but her hand passed through it. She tried again. Same result. She touched the surface of a monitor, then pushed her hand into it.

  Inventory time.

  Is this heaven? Hell?

  In between?

  Alive?

  Dead?

  Up.

  A thought took her through the ceiling, passing through wiring, rafters and roof. Warmth of the sun.

  Down.

  Instantly, a descent back through the building and into a damp world of worms and dirt, darkness and cool.

  Cold, but temperature did not affect her. She had no desire to warm herself.

  Up!

  Inside again. She looked at the monitor. No activity. She’d grown accustomed to the sound of her own heart while in the HDU. She’d awoken several times in fear, only to comfort herself with the rhythmic blips of her own heart. Alive! She’d imagined herself in a little car, riding along the green road of the monitor’s glowing line. She would bump, jump, and skip from hump to hump, using the small swellings to vault her over the jagged pointy cliffs, land, and jump again.

  But not now; the monitor was dark except for a silent horizontal line running from left to right. The squiggles of life, the treacherous road of bumps, hills, and cliffs were flattened in the crush of death.