An Open Heart

by Harry Kraus

  After the counseling session, the nurse drew Naomi’s blood. Then she waited, watching the little indicator in the circle on the test strip. If it showed a blue plus sign, it would mean Naomi was HIV positive.

  She felt a little silly, really. But Beatrice had latched onto the idea with such vigor that Naomi had finally relented. “Okay,” she said, “since there is a voluntary testing center in this hospital, I’ll go. Besides, you need to get your rest.”

  A twinge of anxiety tightened her gut. What if Beatrice is right? Images from her past moved through her consciousness. Countless encounters for a few shillings. Men as desperate for her as she was for the drugs she would buy with their money.

  She watched, her gaze fixated on the test strip.

  A bright blue plus sign appeared and darkened.

  HIV positive.

  For the rest of the day, Jace was haunted by Beatrice’s words, but discounted them as the product of some sort of paranoid reaction after cardiopulmonary bypass. Weird neurologic sequelae had been reported after cardiac bypass. This must have been just another unreported side effect. Maybe one small area of her brain wasn’t perfused well during the bypass portion of the operation.

  Nonetheless, Jace checked on Michael Kagai not once, not twice, but three times during the day. Each time, the man was jovial. He’d accepted, even anticipated his HIV-positive status. Jace had referred him to the medicine team that planned to start him on antiretroviral medications. He was eating and walking well enough for discharge. Jace promised Michael that he’d let him go in the morning. Unlike in America, where Jace constantly had insurance reviewers breathing down his neck and demanding patient discharges, in Africa, he often had to make sure his post-op patients were well enough to walk five or ten kilometers to get to their homes in the bush. And that meant extra days of recovery in the hospital—but at less than ten dollars per day for in-hospital room and board, no one was complaining.

  Nairobi’s top newspaper, The Standard, ran a story about Kijabe’s heart program along with a picture of Jace at the bedside of Beatrice Wanjiku. The article was favorable, done in response to a press release by the hospital administration. Jace stood at the newspaper stand outside the front entrance of the hospital, thumbing through the article and smiling. For good or ill, the word was out: Kijabe Hospital was doing heart surgery.

  Jace was just turning toward the driveway in front of the hospital and looking up at the many weaver birds’ nests in the tree when his pager sounded. He returned to the guard station to answer. He punched in the number. Wairegi men’s ward. “Dr. Rawlings. I was paged.”

  “Dr. Rawlings,” the nurse gasped. “Please come back to Wairegi. Your patient is not breathing.”

  “Not breathing? Who?”

  The nurse must have covered the phone with her hand. In a muffled tone, he heard her ask who was coding. He heard the answer. “Mr. Michael Kagai.”

  “I’ll be right there.”

  He ran back up the sidewalk and into the building, rushing up the long graded hallway to the second floor. At the top of the ramp, he turned left onto the men’s ward.

  A full code was in progress. His patient had been intubated by the intern and a nurse was doing CPR.

  “What happened?” Jace questioned.

  “He walked up to the nurses’ station. Then he collapsed when he turned to go back to his bed. He grabbed his chest and fell to the floor.”

  “How long have you been at this?”

  The intern checked his watch. “Ten minutes.”

  “What does the monitor say?”

  “Asystole.”

  They continued giving two rounds of drugs.

  No response.

  How could this have happened? He looked fine an hour ago!

  Jace immediately thought back to Beatrice’s comments, now a prophecy fulfilled. He sighed and pulled out a pocket penlight. He shone it into the eyes of his patient. “It’s no use. His pupils are already fixed and dilated. We’ve lost him.”

  “Must have had a pulmonary embolus.”

  “Or an acute MI.”

  Jace shook his head. “It was his time.”

  Wow. I’m thinking like a Kenyan.

  He looked at his watch. “Let’s call it. Time of death, seven ten.”

  He stayed a few minutes and filled out a death certificate. As he walked down the hallway a few minutes later, he paused. I’ve got to talk to Beatrice. How did she know?

  This was something far deeper than the manifestation of post-pump paranoia.

  He walked to the HDU, where he found Beatrice sipping sweet Kenyan chai. He nodded at her soberly. “Hi, Beatrice. Can we talk?”

  She set down a steaming plastic mug. “Sure.”

  “This morning, you warned me about a man named Michael Kagai.”

  “Yes.”

  “Beatrice, he was my patient. He just passed away.”

  “I’m sorry,” she said. “I knew it. I told you. Did you warn him?”

  Jace shook his head slowly. “No. I checked on him three times today. He looked fine. I was planning on sending him home tomorrow.”

  “You should have warned him. He wasn’t a Christian.”

  “Beatrice,” he said, hesitating. “How do you know?”

  “Surely your patients have told you stories.”

  “Stories?”

  She shrugged. “Messages. Warnings.”

  Jace grew frustrated. “No one has ever sent me warnings before. Why do you think my patients would send me messages?”

  “Tell me about my operation. You stopped my heart. I saw it. I was dead and yet I was not dead. I was watching you as you worked on me.”

  Jace shook his head again. “That’s not possible. You weren’t dead. Your heart wasn’t beating, but we had a machine doing the work of your heart while your own heart was still. The machine kept you alive.”

  “Dr. Rawlings, I saw things. Heard things.”

  “What things?”

  “Who was the woman? Gabby, you called her. You joked about finding her a Kenyan husband.”

  Jace drew back, lifting his head with a memory of the conversation. You couldn’t have heard that. You were under anesthesia.

  “I saw people in a new way. Some were filled with light. Some were dark. I saw Mr. Kagai.” She seemed to hesitate. “He was dark.”

  “You saw light?”

  “Inside of people. Christians.”

  Jace touched his hair. This was crazy. She couldn’t know such things. “You predicted he would die.”

  “An angel told me. He said I was to give you the message.”

  “Why me?”

  She shrugged. As nonchalantly as if they were talking about the weather. “Maybe they are sending you a warning.”

  “Warning me? Why?”

  Beatrice bit the inside of her lip and looked away. When she looked back at Jace, she changed the subject. “When can I have this tube taken out?” She gestured toward the tube draining blood from her chest cavity, a mediastinal tube.

  Jace frowned. “You didn’t answer my question.”

  “Maybe you don’t want to know.”

  “Don’t want to know? Of course I want to know.”

  Beatrice eyed a Kenyan nurse who had joined Jace at the bedside. “Because, Dr. Rawlings, I did not see light in you.”

  21

  Jace walked down the sloping hallway from the HDU, wanting only to be alone and get back to his house. He was almost to the door when he heard his name.

  “Dr. Rawlings.”

  He looked around to see Naomi Wanjiku, Beatrice’s mother.

  Naomi ran off a phrase in the Kikuyu language.

  Jace held up his hand and walked a few steps to the door where a hospital guard sat in a chair. “Can you help me understand her?”

 
The guard spoke to the woman. Naomi gesticulated wildly, waving her hands and pointing at Jace and back up to the HDU. Jace understood very little of what she said, except that he recognized his name and Beatrice’s name over and over.

  The guard shook his head and put his hand on Naomi’s shoulder. Finally, she stopped talking. The guard looked at Jace. “She wants to know what you have done to her daughter.”

  Jace began explaining the operation, something he’d done before, though perhaps Naomi hadn’t understood.

  “No, no, not that,” the guard said. “She knows what operation you performed.” He seemed to hesitate, shuffling his feet. “She says that her daughter has powers now.”

  “Powers?”

  “This woman says you have worked magic on her daughter, that you have turned her into a prophetess.”

  Jace squinted. He didn’t like where this was going. “Look, just tell her that I am a scientist. I don’t work magic. I merely performed a heart valve replacement. I’m sure there is some logical explanation for what she is seeing in her daughter.

  “She says her daughter’s face is brighter.”

  “Of course,” Jace said. “She has normal heart function for the first time in a long time. She has more blood flowing to her body. Certainly she will appear more vital.”

  The guard explained in Kikuyu. Naomi interrupted with more emphatic words and hand waving. She motioned for the man to come closer, then whispered something in his ear.

  The guard pulled back, again shaking his head. “She says her daughter awoke from the operation with special knowledge that you had given her.”

  “Tell her the daughter’s mind is confused, a common occurrence after major surgery. I’ve ordered some medications that will help soothe her mind.”

  Jace listened as the guard translated, but after another exchange, the man shook his head. “She says there was no way that her daughter could have predicted her illness, but that her daughter told her about her HIV status.”

  Jace sighed. “Look,” he said in a soft voice. “I’m not sure what you should tell her except to assure her that I am not a magic man. As far as her daughter’s prediction goes, I can assure you that this woman’s occupation puts her at risk for the disease you mentioned. It would not take a scientist to predict the outcome of such a test.”

  Jace turned to go, and left the guard talking rapidly to Naomi. As the door closed behind him, he heard Naomi repeat the English word magic.

  That evening, Jace built a fire in his fireplace to chase away the chill. As had become their usual practice, Evan and Gabby joined him, and the trio sipped Kenyan chai and discussed the future.

  Evan adjusted a small oximeter clip over his index finger. “See,” he said to Gabby. “I’m two points lower at this altitude than back in Richmond.” Then his demeanor shifted and he changed the subject. “I can’t justify staying around if I’m not helping.”

  Jace frowned. “So help out with the general surgery load like I do. You don’t have to do just hearts.”

  “I didn’t come here to do anesthesia for general cases, Jace.”

  “After the newspaper article, I’m sure we’ll get more cases. The word is just getting out.”

  Gabby added granular sugar to her mug. “Maybe you should advertise that we’re giving magical experiences.”

  “Ha, ha,” Jace responded. “Our patient just had some post-pump paranoia, that’s all.”

  Gabby shifted in her seat. “So how do you explain that she predicted her mother’s HIV?”

  “Come on, Gabby. The woman is a prostitute in Kenya. How likely is she to be HIV positive?”

  “Okay, I’ll accept that. But what about her prediction about Michael Kagai?”

  “She must have heard someone mention his name. I could look back, but I think they might have been in the HDU together. The place isn’t exactly huge. It would be easy for one patient to hear what the nurses say about another. Again, he was HIV positive. He wasn’t exactly low risk for dying. She just twisted something she was thinking into a paranoid delusion.”

  “Altogether,” Gabby said, “you’ve got to admit, it seems pretty spooky.”

  “There is a reasonable explanation for all of that stuff.” Jace stood and walked toward the kitchen. He didn’t like Gabby giving credence to Beatrice’s predictions. He was glad that he hadn’t decided to share the description that Beatrice had given about him. The last thing he needed was Christian Gabby talking about the darkness of his soul.

  But discount it as he tried, the description haunted him.

  “Come on, Jace,” Gabby continued. “You of all people should be open to this sort of communication from beyond the grave.”

  Jace stayed quiet, his hand almost involuntarily tracing the scar on his scalp.

  “If you really think your sister sent you a message, why not Beatrice?”

  Jace shook his head, aware of the irony. “I don’t know.” He paced back into the little den where his friends sat. “Okay, let’s play this out. Suppose Beatrice did get a message from another realm. Why would someone ask me to warn someone about death? I’m about the least likely person to be able to help. Why not tell a chaplain?” Jace paused. “So why would someone want me to know this stuff?”

  “Could you have prevented his death?”

  “If I’d been there and witnessed it?” Jace shrugged. “I don’t know.” He sat on the couch and stared at his friends through the steam lifting off the mug in his hands. He didn’t want to admit that Beatrice’s prediction had any merit.

  Because if that was true, he’d have to confront the darkness in his soul.

  The phone rang. Jace was thankful for the diversion. “Yes?”

  “Dr. Rawlings, we have another young patient with a significant heart murmur.”

  Jace recognized his intern’s voice. “What is the situation?”

  “Seventeen-year-old male. Very short of breath. Neck veins distended. Looks like heart failure.”

  “Use oxygen, give Lasix. I’ll be over soon.”

  “We’re in casualty.”

  “Okay,” Jace said, hanging up the phone. Then, to Evan he said, “Looks like you might not have to wait so long for our next heart case.”

  In the HDU, a young man in a blue business suit identified himself to a nurse as Beatrice’s brother and asked for an update.

  A few minutes later, he slipped into the empty corridor to use his cell phone. “Dr. Okayo,” he said quietly, “I’m calling for Minister Okombo. The American doctor’s work is done here.”

  The rain started suddenly, prompting Jace to retreat back inside for shelter. Then, with his umbrella low and braced against the wind, he started out again, walking the slick path back down toward the casualty department. He jumped the quickly forming puddles, zigging a diagonal line, imagining himself a checkers piece, conquering his opponent on the way to being crowned.

  His little game diverted his attention, and as he arrived at the guard gate, he collided with a young blue-suited man fending off the rain with a newspaper. They glanced off at the shoulders as the man began a reflexive, “Pole, pole sana.” Sorry, so sorry.

  Jace caught a glimpse of the man’s face as they passed. Determined look, chin set and clean shaven, and dark eyes that flashed with an instant of recognition. It did not register for a moment, but then Jace remembered. Samuel, Minister Okombo’s driver.

  Jace stepped into a puddle, and muddy water ran into his shoe. He hopped quickly on and raised his umbrella, calling out to the man. “Samuel!”

  But the man continued on, rushing away with his newspaper tented over his head. In the downpour, Jace’s words dissolved away and the man was gone.

  22

  Jace’s night was anything but routine. He started with the admission of a young Maasai man in heart failure, almost certainly another case of valvular destruction afte
r an untreated strep infection. Before he left casualty, two victims of a traffic accident were brought in, one with a jagged and gaping laceration running ear to ear across the top of the head. Jace and his intern, Paul, worked in the theater for an hour just matching up the skin left behind. Then, when he thought he was done for the night, Jace got a call from the student health nurse up at RVA. She was escorting a student down, a senior with right lower-quadrant pain.

  Jace suspected appendicitis. Unfortunately, it took the better part of the next hour to successfully contact the student’s father by phone. The parents, missionaries in the bush near Dire Dawa, Ethiopia, gave consent. The mother would try to come down the next day.

  By three, Jace plodded home, tired but strangely invigorated. Rather than being put off by his general surgery call duties, he found he enjoyed dealing with fixable problems. While not life-and-death like most of his heart patients, the general surgery problems were nonetheless serious, and tended to improve rapidly after an operation. There was something comforting to Jace about having done a neat operation on a kid who would get better and go back to school in a day or two. Yes, he thought, I can still do general surgery. He smiled and imagined himself like the first cardiac surgeons. He’d read stories of Michael DeBakey, the infamous heart surgeon from Texas. His operative schedule might include an open-heart case, a bowel case, and a hemorrhoid all in one day.

  By three fifteen, Jace had stripped off his clothes, including the sock still damp from his encounter with the puddle, and collapsed into bed. He knew nothing after that until his alarm sounded at seven.

  He met Evan Martin for rounds the next morning. Together, they used the ultrasound machine to look at the heart of young Joseph Ole Kosoi. Ole means “son of” in the Kimaasai language. Joseph had returned home from boarding school saying he had been unable to keep up with the other boys in rugby practice. Whereas in prior seasons he’d always been able to outperform his peers, now he became winded with a slow jog across the field. Jace traced the problems back to an episode of flu-like symptoms two months before. Now, the patient was exhibiting classic signs of heart failure: distended neck veins, shortness of breath, and difficulty breathing while lying flat on his back. Whenever he tried, he felt like he was drowning.