An Open Heart

by Harry Kraus

  The driver heard. “It’s too expensive.”

  Jace sighed. “It’s the closest. Don’t worry about the money.” He looked at Gabby. “Ride up front with him. Evan and I will ride with the patient.”

  They knelt beside the man as the driver sped away, leaving a thick trail of dust and Jace and Evan grabbing for the sides of the pickup.

  Evan shouted, “Just keep his head from rolling around.”

  When the driver slowed behind another truck, Jace addressed the elephant in the room. “So why does a man carrying a gun have my picture in his pocket?”

  His friend kept his hand locked on the side as they swayed and bumped along. “Seems like you were just spared a bit of serious trouble of your own.”

  “The guy was coming over to kill me.”

  Evan squinted into the sun. “Evidently.”

  “So was that whole thing set up? Was our driver in on it?”

  “How else would the guy have known we’d be there?”

  The thought sent a chill down Jace’s back. “Let’s just keep this guy alive so the police can question him.”

  The pickup truck slammed through a series of potholes, then ran off the road onto the shoulder, since it appeared smoother than the road itself. Speeding, passing a matatu, and weaving back into the left lane again, the driver of their pickup kept up a brutal pace, knocking Jace and Evan side to side and prompting Jace to cry out. “Slow down!”

  The driver ignored him. Or didn’t hear.

  By the time they pulled into the hospital parking lot ten minutes later, their patient was gasping, with a thready pulse of 120.

  Jace called to Gabby. “Go ask them for a stretcher. I don’t want to move him twice.”

  She disappeared and came back a minute later with a nurse pushing a stretcher.

  The nurse was a light-skinned Kenyan of about twenty-five. “I am Dr. Rawlings,” Jace said. “This is Dr. Martin. We were traveling from our home in Kijabe when we witnessed this pedestrian accident.”

  She nodded soberly. “You are welcome to help.”

  Wow, Jace thought. That was easy. No complicated application or a critique of my case log. Just a Good Samaritan agreement. Welcome.

  They maneuvered the stretcher against the tailgate and moved the patient. As they were pushing the stretcher toward the casualty entrance, Jace looked over his shoulder to see Gabby laying shillings in the open palm of the driver. She made quick eye contact with Jace. Clearly, it was not her idea, but what could she do?

  The emergency-room facility was better equipped than their department back in Kijabe. Jace asked for IV equipment as another nurse began cutting off the victim’s clothing with a large shears. Evan lowered a cushioned mask over the patient’s nose and mouth and began bag ventilation. “I’ll need a laryngoscope and an endotracheal tube,” he said.

  A nurse responded by wheeling up an emergency cart. She quickly broke a seal and pulled open a drawer. Evan grabbed an Ambu bag and sealed the mask over the patient’s mouth. After another thirty seconds of ventilation, Evan inserted the tube. “I’m in,” he said.

  “Here’s a sixteen-gauge IV,” Jace said, taping down the tubing to the canula just below the patient’s elbow. “Do we have blood available?”

  A young nurse in a white coat scurried toward a desk. “I’ll call the lab to see.”

  Jace connected a bag of saline. “Squeeze this in as fast as it will go.”

  Evan placed a stethoscope on the chest. “The lung sounds are absent on the left,” he said. “And I can feel the crepitance of broken ribs here.”

  “He’s going to need a chest tube.” Jace looked at the nurse. “Do you have a tray or some sort of kit for the placement of chest tubes?”

  An older nurse, a heavy-set woman with white hair, shook her head and looked at the dial on a manual blood-pressure cuff. Her accent was distinctly Kenyan. “Blood pressure is sixty.”

  Jace opened another sixteen-gauge IV needle. “Here,” he said, swiping the skin with an alcohol swab. He shoved the needle into the patient’s right chest. Air and blood sprayed through the needle, relieving the buildup of pressure.

  In the minutes that followed, Jace made a small incision over the patient’s right chest and inserted a clear tube the size of his index finger. Immediately, the tube turned red, colored by a continuous flow of blood from the chest. Jace quickly attached the chest tube to a clear plastic collecting chamber to record the output.

  A nurse returned holding a single unit of blood. “Our surgeons were up late last night operating. This is all we have in the blood bank.”

  Jace looked around. “Anyone here have O negative blood?”

  The chest tube collection system continued to fill. One thousand ccs. And rising.

  Gabby touched the patient’s abdomen. “Look at this. It seems to be expanding.”

  Jace ran his hand over the lower ribs. “Most of his injury seems to be on the right side. His liver is probably lacerated.”

  Evan asked for a flashlight and looked in the patient’s eyes. “His pupils don’t respond.”

  “What’s the pressure?”

  “I can’t measure it.”

  Jace made eye contact with Evan. “Could he be in cardiac tamponade?”

  Evan examined the neck. “Neck veins are flat. That means he needs volume. If his neck veins were up, that would mean tamponade or pneumothorax.”

  Jace looked at the chest-tube container, now containing almost two liters of blood. “We start CPR or we call it.”

  Gabby frowned. “We can’t save him, Jace. Let him go.”

  Jace nodded. “We have no more blood.”

  Evan stepped away from the table. “Time of death, eleven thirty-two.”

  Jace felt like cursing. If they’d had an emergency prehospital system, if they’d had more blood, if they’d had access to equipment in the field … He looked around the room as the nurses began cleaning up. There was no emotion, no tears, just the everyday let’s-get-the-work-done attitude.

  In emergency rooms in Africa, death was a frequent visitor. There wasn’t time to mourn. Only time to prepare for the next victim transferring from life to somewhere beyond.

  Jace needed air and space to think. He sighed deeply, frustrated by his inability to turn the tide against the enemy of death. As he walked toward the entrance, he heard the voice of the nurse. “Who is going to pay his bill?”

  He felt an immediate stab of anger. How could they be thinking of money when a man’s life had just been lost?

  He turned to see the face of the light-skinned nurse holding up a chart. “I’m going to need you to fill out a report.”

  Jace nodded. “Maybe there’s some next of kin. Perhaps he has a family who can help with his bills.”

  “Doubtful,” the white-haired nurse mumbled. She rifled through a discarded pile of bloodstained clothing, lifting a wallet from the man’s pants. “He has an ID,” she said. “His name is Kimathi.”

  Jace froze.

  “Kimathi,” the nurse repeated. “Anthony Kimathi.”

  27

  Jace and Evan split the six-thousand-shilling bill for the supplies they used in their resuscitation attempt of Anthony Kimathi and walked out into the parking lot.

  Gabby followed, rubbing dirt from the front of her dress. “We need to talk to the police, Jace.”

  He shook his head. “I’ve been rethinking this. I think we ought to keep this quiet.”

  “Jace,” Evan said, “that guy, Anthony whoever, clearly had ideas about doing you harm. Don’t you think the police need to hear about that?”

  “That might not be a smart move,” he said. “Think about it. How would that guy have known we would be at that exact spot? Obviously our driver told him where we would be stopped.”

  “Unless they were following us,” Gabby said.

/>   “They were on foot,” Jace answered. “So it all had to be planned. The driver had to know exactly where he would run into the spike strip to flatten a tire.”

  Gabby frowned. “So you assume the police were in on this too?”

  “I think so.”

  “What if our driver just knew where the police were going to be setting up a roadblock?”

  “Unlikely,” Jace said. “You saw that place. It was a crazy place to put a police checkpoint. They were endangering their own lives, setting up just beyond a blind corner.”

  “This is Africa,” Gabby said.

  Jace squinted toward the sun. “Still, I don’t think we can afford to go to the police. They may be in on this.”

  Gabby touched his shoulder. “This is crazy, Jace. Who would want you dead?”

  “I don’t know.”

  “So what’s our next move?” Evan asked. “Should we call our MP friend and give our regrets for lunch?”

  “I’m sure he has already heard,” Jace said. “The driver would have phoned him.” He looked at Evan and Gabby, making eye contact with them both. “Besides, I’m a little concerned that he may have been in on all of this. He insisted we come on a certain day. He arranges for his driver to pick us up. We just happen to flatten a tire on a police spike strip …”

  “Does seem like a lot of coincidences.”

  Gabby scratched another blob of dried mud from her dress. “Okay, if the MP set this up, why?”

  “Who would benefit from you being gone?” Evan asked.

  “Someone afraid I might take their business?”

  “And the minister of health would be in on it?”

  “If someone paid him enough.” Jace paused, rubbing his bloodstained shoe against the curb. “I’m just guessing. I really have no idea.”

  Evan looked over his shoulder at the Karen Hospital looming over them. “If there were surgeons behind such an attack, I’d suspect they’d be at a place like this, somewhere you could attract private patients and charge them Western prices.”

  “It really makes no sense. I’m only taking care of the poor patients these doctors wouldn’t want anyway.”

  “Then who wants you dead?” Gabby asked.

  “I have no idea. Really. No idea.”

  “Here comes a matatu,” Evan said. “Let’s catch a ride back toward Kijabe.”

  One day, a month before Jace’s graduation from Rift Valley Academy, he had walked into the kitchen and startled his father and sister, who spilled a glass of tea onto the table.

  As she scrambled to clean up the spill, Jace studied them for a moment. “What’s up? You guys look like you were solving the world’s problems.”

  He watched as Janice and his father exchanged looks.

  His father took a deep breath. “We should tell him.”

  Jace squinted at them, feeling a knot tighten in his throat. “What?”

  His father gestured toward a chair. “Sit down, Jace.”

  He obeyed.

  “This may be nothing, Jace.”

  Jace stared at them. Janice had her hand over her mouth.

  “But it may be a legitimate warning.”

  “A warning?” he asked.

  Janice spoke. “I’ve had two very vivid dreams, Jace.” She halted a moment. “About you. It’s one of those weird dreams where you wake up and you’ve been crying.”

  He wasn’t sure what to say. “Okay.”

  “Both times, I was talking to Pastor Wally.”

  RVA’s minister for the student body.

  “Both times it seemed so real.”

  “What did he say? Something about me?” Jace shifted in his seat, wondering just what sin he’d committed that was about to be publicly discussed.

  “Yes, something about you,” she said. “He told me to invite you to follow Christ. He told me I wouldn’t have many more chances.”

  “What?” he said. “What are you saying? I’m going to die or something?”

  “I—I don’t know. I just know it seemed so real. I had the distinct feeling that I wouldn’t have many opportunities to talk with you again.”

  Jace stood, squeaking the feet of his chair across the floor. “That’s crazy.”

  His father nodded. “Sounds crazy, doesn’t it?” He stood to face his son. “But what if Janice has been warned for a reason?”

  “It was a dream, Dad. Nothing else. Janice has dreams like this because this is what she thinks about during the day. We just had spiritual-emphasis week. We’ve been talking about this stuff, so she dreams about it, okay? It’s nothing.”

  Jace went to the refrigerator and poured a glass of mango juice.

  His father spoke again. “Maybe it is nothing, Jace, but there is little of greater importance for you to think about than the eternal destiny of your soul.”

  The phrase ticked him off. “What is that?” he mocked, raising his hands to make air quotes: “‘The eternal destiny of my soul.’” He set down his glass on the counter. “That sounds like flaky stuff to me.”

  “You know what it means, son. You’ve been around this kind of talk all your life.”

  “And all my life I wished we could just talk like normal people.”

  “How can I say it so you will hear what I’m saying?”

  Jace shook his head. “I don’t know.” He turned and faced away. “It’s not that I don’t want to believe,” he said. “But it just seems like a fairy tale.”

  “Too good to be true?”

  Jace felt the knot in his throat begin to melt. “Kind of, yes.”

  “It’s the gospel, Jace—it is too good to be true,” his father said. “But that doesn’t make it any less true.”

  Jace looked at them. They stared back with pity on their faces. And at that moment, he pulled away. He didn’t want their sympathy. “I’m Esau, don’t you get it?” he shouted. “I hear the stories, but they don’t matter to me. They are just stories.”

  He took a step toward the door, but Janice moved into his path. “You need to hear it again. Maybe you’ll believe.

  He shook his head. “I’ve heard it a thousand times,” he said, pushing past. “Lay off!”

  That evening, Jace sat across the table from Evan, eating stew and chapatis at Mama Chiku’s.

  Jace pulled a generous portion of white ugali through his stew and kept his voice low. “When I went to see Joseph Ole Kosoi this morning, he told me a patient of mine was going to die.”

  Evan huffed, “Again?”

  Jace nodded. “He gave me a name. I blew it off because it wasn’t the name of any patient I recognized.”

  “So, he was wrong. It’s postpump paranoia. Maybe it’s the drugs we’re using here.”

  “No,” Jace said, shaking his head. “The name of the patient was Anthony Kimathi.”

  Evan’s jaw slackened as he stared at Jace. “Good one. You almost had me on that one.”

  Jace leaned forward. “I’m serious, Evan. I didn’t say anything back in Karen because I didn’t want to get Gabby started. You know how she is on all those spooky spiritual things.”

  “Joseph Ole told you that Anthony Kimathi was going to die?”

  Jace nodded. “I need to know what you’re doing. None of my patients back in America experienced this stuff.”

  “I’m doing exactly what I do in America.” His voice trailed off and he shifted in his seat.

  “What?”

  “We’ve been a bit short on the inhalant anesthetics during the first two cases, but I gave Versed hoping to wipe out their memory.”

  Jace sighed. “It didn’t work.”

  Evan folded a chapati into a triangle. “You’ve got to admit, this is pretty spooky. How do you explain Beatrice predicting that Michael Kagai was going to die? Or that her mother had HIV? Or now, this?” He c
leared his throat. “Maybe God is trying to get your attention.”

  Jace shook his head. “What? Are you going to get all spiritual on me too?”

  “I’m just saying it all seems pretty weird.” Evan held up his hands. “Maybe there’s something to this.”

  Jace stayed quiet and looked away.

  “Jace, how long have we known each other?”

  He looked back. “Eight, maybe nine years.”

  “And I’m out here supporting you, right?”

  Jace nodded.

  “I’ve never been one to talk about my faith. But this—this is hard to explain.”

  Jace pushed his plate away.

  “Listen, Jace. Someone apparently wants you dead. And for some reason, you’re getting these weird messages. I’d start paying attention if I were you.”

  “What am I supposed to do?”

  “Things happen for a reason, Jace.”

  “So what am I to make of this, Evan?”

  “Pay attention. Pray.” He shrugged. “If your life is in danger and you’ve got faith issues to work out, I wouldn’t waste a lot of time.”

  Jace stood up and tossed shillings on the table to pay the bill. I’ve heard these warnings before.

  And that didn’t work out so well, did it?

  28

  As Jace walked up the path toward home, he heard his name and looked back to see his intern. “Hey, Paul, what’s up? How are the heart patients?”

  “They are doing fine. But I need help in casualty.”

  “I’m not on call, Paul.”

  “Dr. Fitzgerald is already in surgery with a head-trauma patient.”

  Jace sighed. It wasn’t like he had a wife to go home to. “Okay, what is it?” He reversed direction and started down the path toward the casualty department.

  “Ten-year-old boy fell from a tree. He had rib fractures and a pneumothorax. I put in a chest tube and got out a little blood, but the patient is still hypotensive.”

  Jace quickened his pace. “Which side?”

  “Left.”

  “Left-sided rib fractures are associated with what abdominal injury?”

  “Ruptured spleen.”