An Open Heart

by Harry Kraus

  “But I need you here. At least for another case or two.”

  “If we even get to keep doing this. I heard about how mad Fitzgerald was after that kid died of a ruptured spleen.” He sighed heavily. “We’re taxing an already overloaded system, Jace. I think it’s better all around if I go home where I know what to expect.”

  “Evan,” Jace said, trying to keep his voice from showing the urgency he felt. “What if someone really is trying to get a message to me?”

  Evan raised his eyebrows. “This from my friend the scientist?”

  Jace sighed. “Maybe I’m changing.”

  “If someone is trying to send you a message, you don’t exactly need me for that.”

  “You’re wrong. I need you. I need you to do exactly what you did in the first two cases.”

  “And what—you’re going to hope your patient contacts the great beyond and gives you whatever message you came here for?”

  Jace sat back. “It sounds stupid to have you put it that way, but yes.” His eyes bored into his friend’s. “I don’t get what’s happening either, but …” He stopped talking while a Kenyan mother carrying a baby passed their table. “But something is clearly going on here. Someone—” he paused— “or some thing—has a message for me.”

  “Maybe I have a message for you,” Evan said. “You need to stop chasing weird messages and go home to your wife.”

  Jace shook his head. “I just need you to reproduce everything you did in the first two cases.”

  “Better find your case soon,” Evan said. “Because I’m going home.”

  “Scared?”

  Jace expected defensiveness. Instead, he got honesty. “Yeah, Jace, I’m scared.” Evan paused and leaned toward his friend, his eyes glistening and his voice etched with tension. “Scared for you.”

  33

  On his next call night, Jace started at the sound of his pager and groaned. Two thirty. This had better be good.

  He picked up the phone and dialed the number.

  “Casualty.”

  “This is Dr. Rawlings. I was paged.”

  “Dr. Rawlings, my name is Charity. I’m the medical intern on call.”

  “What is it?”

  “I am seeing a twenty-two-year-old Somali man. He has been having fevers for a week. He was injured three weeks ago in fighting in Mogadishu.”

  “What kind of injury?”

  “He was shot in the left groin. He says there was a lot of bleeding and that a doctor there sewed him up.” She paused. “Now he has a fever and an elevated white blood cell count to nineteen thousand. I’m wondering if the wound might be infected.”

  “Are there signs of infection?”

  “Tenderness.”

  Jace yawned. “When was the injury?”

  “Three weeks ago.”

  And why am I getting up in the middle of the night to see him? Jace hid his sarcasm. “I’ll be right there.”

  He dressed, splashed water on his face, threw on a white lab coat, and plodded down the path to the hospital. A few moments later, Dr. Charity N’ganga introduced him to his patient.

  “This is Mohamed Omar Abdullahi,” she said, pulling back a curtain to reveal the young man. “He speaks good English.”

  Jace studied him for a moment. “Al-shabaab?”

  “No, sir. I went to school in Minnesota and returned to Mogadishu to work with the World Food Bank.” He shrugged. “I was in the wrong place at the wrong time.”

  Jace lifted the blanket. “May I see the wound?”

  He nodded.

  Jace put on an exam glove and carefully palpated the length of a four-inch surgical scar. “How old is your wound?”

  “Three weeks tomorrow.”

  “And how long have you been having fever?”

  “Ten days.”

  “Any abdominal pain? Painful urination? Cough? Pain over an IV site? Skin rash?”

  To each question the patient answered no.

  Jace looked at the intern. “This wound doesn’t look infected to me. You have to look elsewhere for a source of infection.” He asked the patient, “Are you taking any drugs?”

  “No.”

  Jace explained. “You must always consider drug fever.”

  The surgeon gently squeezed the patient’s calf on the side of his injury. “No signs of deep venous thrombosis.”

  Jace lifted his stethoscope and laid the bell on the man’s chest. After listening a few seconds, he asked, “Have you ever been told that you have a heart murmur?”

  “No.”

  He nodded at the young Kikuyu intern. “Charity, listen here. Sounds like tricuspid regurgitation.”

  “What are you suggesting?”

  “He needs to be treated for endocarditis.”

  “A heart-valve infection.”

  “Exactly. Something seeded his blood, perhaps the bullet fragment, and the bacteria have decided to rest on a heart valve. I’ll do an ultrasound tomorrow to look for vegetations. I’d like you to get two sets of blood cultures and a chest X-ray tonight. Start him on broad-spectrum antibiotics.”

  The intern took rapid notes.

  Jace headed for the door, but stopped and turned around when he’d gone only a few steps. “Get the first dose of antibiotics on board stat. If he has clumps of bacteria on the valve, they could embolize and give him a pulmonary abscess.”

  The patient’s eyes widened.

  Jace nodded. “Unlikely, but possible.” He turned to the patient. “We are going to do everything we can for you.”

  And now, I need some sleep.

  The following morning Jace threw Mohamed Omar’s chest X-ray on the view box and smiled. He’d just found his third open-heart case.

  “Hey, Paul,” he called to his intern standing a few feet away at the theater desk. “Look at this.”

  Paul squinted toward the film.

  “Presented last night. Twenty-two-year-old Somali male with a three-week-old shrapnel injury to the left groin, fever, and a new tricuspid murmur.”

  “What is that?” Paul pointed to a bright white irregular object overlying the heart shadow.

  “Yes, what is that?” Jace stood back.

  “It’s a trick,” Paul said. “It’s on his skin, right?”

  “Nope.” Jace threw up the lateral chest film. “Here it is again,” he said, pointing.

  “He was shot in the chest?”

  “No. His injury is in his thigh near the inguinal crease.”

  “It looks like a bullet.”

  “Exactly. But how did it get there?”

  Paul scratched his head.

  “It’s called a bullet embolis. The bullet entered his femoral vein through an open wound, then escaped up the vein and traveled to the heart where it appears to have lodged in his right ventricle.” He paused. “He seems to have endocarditis, so the bullet must have carried bacteria to the heart valve, causing an infection.”

  “What do we do?”

  “Treat his endocarditis with antibiotics, then operate to remove the fragment when the infection clears.”

  “Will the bullet move out into the lung?”

  “Not likely. It’s stayed put for three weeks. It must be stuck.”

  Paul’s eyes brightened. “Cool.”

  “For us,” Jace said. “Try being the patient. Now,” he said, “let’s go get the ultrasound and confirm my suspicions.”

  Twenty minutes later, he did just that. Scanning over the precordium, Jace demonstrated the bullet lodged next to the valve. “It appears to be entangled in the tendinous insertion of the valve leaflets. The murmur could be coming from dysfunction of the valve, but also because the bullet could have carried bacteria and infected the valve.” He paused. “The good news is that I don’t see any significant bacterial vegetations
on the valve leaflets.”

  Paul pointed at the screen, an area of apparent turbulent flow. “What’s that?”

  Jace moved the scanner. “Looks like a small atrial septal defect. Probably something he was born with.”

  Jace turned to Mohamed. “You’ve got a bullet fragment that traveled from the vein in your leg and has become trapped in your heart. If we do nothing, it could cause continued infections of the valve, or even infect the lining around the heart. There is a small chance the bullet fragment could travel out into the lung and cause death to a portion of lung or an abscess.” He paused. “Or it could cross the small hole between your heart’s upper chambers and cause a stroke.”

  “Meaning?”

  Jace shrugged soberly. “Paralysis. Maybe death.”

  “So what are you recommending?”

  “An operation to remove the bullet, repair the valve, and repair the hole in the heart.”

  A look of fear spread over the patient’s face. “Here?”

  Jace nodded. “We have a program to do this right here. I have brought the necessary people over from the United States to do the surgery.”

  “Or I could go back to the US. I live in Minnesota. I could go to the Mayo Clinic.”

  Jace nodded. “You could. It is possible that with the proper equipment, the bullet could be retrieved with a catheter threaded up from a vein in your leg, but that is not something we can do here.”

  “What would you do?” The patient looked at the Kenyan intern.

  “Delaying to travel to America could be risky.” Paul put his hand on the man’s shoulder. “Dr. Rawlings is one of the best. He operated on the governor of Virginia.”

  “I can’t lie. There are possible complications,” Jace said.

  “I will stay here. I will be okay. Insha’Allah.” It was the mantra of Islam: If Allah wills.

  Jace understood.

  He looked up to see one of the hospital security guards lingering on the other side of the patient’s bed. Jace made eye contact.

  The security guard, a man not much older than twenty, nodded seriously. “Dr. Rawlings, the Kenyan police visited us this morning. They are insisting we escort you when you are on hospital grounds.”

  “Escort me?”

  “Yes, sir. They seem to think you are in danger.”

  Just then, Dave Fitzgerald walked up. “What’s going on, Rawlings? There’s a huge crowd of unhappy people at the gate. The police have set up a perimeter and are insisting that we revise our visiting policy: no one but family members, and they want everyone to produce a doctor’s note to confirm that they are needed inside.”

  “I don’t know,” Jace said. “I didn’t know anything about this.”

  “Well, I need you to go out there and straighten things out.”

  Jace hesitated.

  “Now!” Fitzgerald said.

  On Sunday morning, Heather planned a late arrival and early departure from church. She loved hearing Pastor Ken exposit the Scripture but disliked the judgmental looks of the church members.

  I’m reading too much into their expressions, she told herself. Maybe it’s pity or concern and not criticism for separating from Jace.

  Jace. He was the congregation’s favorite son. Famous surgeon. Missionary family. Rich enough to help the budget stay in the black.

  Sunday mornings with Jace were always a zoo of old women fawning over him, thanking him for operating on this relative or that. One woman had even pulled aside a pearl necklace, pointed to the scar starting on her upper chest and disappearing into her cleavage, and gushed, “He saved my life.”

  Sometimes, Heather wondered just who was being worshipped, Jace or Jesus. She’d brought it up only once, and Jace’s reaction was a flippant, “You’re crazy!”

  But since she’d dared to return after a month’s hiatus, the attention was gone, replaced by silent nods and expressions that threw scalpels of judgment—or an avoidance of eye contact altogether.

  So she opted to slip into the last row after the first hymn at six minutes past the hour. Sadly, the service was that predictable. She wondered how they would handle it if God showed up and requested a change in the program. Not allowed. You are scheduled for 11:20 to 11:40.

  It didn’t seem to matter that the media had painted her husband as the unfaithful one. Heather felt just as guilty when she walked in alone under the stares of Richmond’s upper crust.

  She moved toward the center of the pew, an antique wooden structure with red upholstery, and sat. A second hymn. Announcements. Offertory. Dismiss the children. Responsive reading. Morning scripture reading. A sermon by Pastor Ken. Closing hymn.

  Time to escape.

  When everyone stood to sing, Heather slipped quietly out the back. She made it as far as the parking lot before she heard her name. “Heather.”

  She turned to see Lisa Sprague, the feature writer for the Richmond Times Dispatch. “Hi, Lisa.”

  Lisa looked around. They were alone. “Can we talk?”

  Heather studied her expression. “Something wrong?”

  “Maybe.” Lisa wore a dark skirt, a designer blouse, and a bit more jewelry than Heather’s taste would allow, but her makeup was perfect. And unnecessary, given Lisa’s youth and the blonde hair that fell in ringlets to her shoulders. She probably looked just like that when she woke up.

  “I talked to Steve Brady,” she said. “He’s a friend.” She paused. “We share stories. Sometimes, when he doesn’t have the time or authority to look into something, he throws me a bone.”

  “He told you about Jace?”

  “A few things. Can we talk?”

  “I’m not really interested in splashing our story in the papers.”

  “But you are interested in what happened to Jace.”

  “Yes.”

  “Then we should talk.” She smiled. “Let’s do lunch. I have connections. I can help you learn the truth.”

  Heather smiled back. “The truth.” She gestured toward her car. “For that, I’ll drive.”

  34

  Heather and Lisa sat in a booth at Applebee’s. Lisa looked at Heather’s bacon cheeseburger and shook her head.

  Heather understood the unspoken question. “I walk a lot.”

  Lisa pushed her chicken Caesar salad around the bowl and leaned forward. “How are you doing? You and Jace seemed so—” she hesitated while she searched for the right word—“comfortable with each other back when I did the story on his career.”

  Heather nodded. “That pretty much sums it up. But this whole Anita Franks thing and his accident seem to have shaken everything up.”

  “What happened? I would have thought you guys had the faith foundation to weather just about anything.”

  “I thought so too. But after his accident, Jace didn’t seem sure about anything.” She took a bite of her sandwich. “Especially his faith.”

  “What gives? I thought his faith was important to him.”

  “Me, too. I tried to talk to him about it, but he just kept pulling away. It was as if his accident brought back something horrible from his past. He just kept talking about his need to go back to Africa.” Heather hesitated. “He was very close to his twin sister, but she died in an accident shortly before they graduated from high school. He never talked to me about it, but I know Jace was there when his sister died, and he felt responsible because he couldn’t help her. I think it’s why he became a doctor.”

  “Guilt?”

  Heather nodded again. “A powerful motivator.”

  Lisa leaned forward. “In spite of knowing the gospel, many Christians struggle with guilt.”

  Heather stared out the front window at the busy street. “It’s weird. Jace and I were both from missionary families, so I always assumed that Jace was a true believer. He was always quiet about his faith. He went with me to
church, but he never talked about it. Then, after his accident, he started talking about needing to go back to Africa, and I thought it was just a crazy idea, but then he up and resigned his practice and expected me to jump on board.”

  “But you didn’t see it his way?”

  “He said he thought his sister would have wanted him to come. He claims he saw a vision of her on the night of his accident. He said he saw her face, asking him to ‘come back to me.’” Heather shrugged. “He couldn’t articulate it, but I think he felt so guilty about having an affair that he ran off to Africa for penance.”

  “So you believe the rumors?”

  “I’m not sure what to believe.” Heather sipped her tea and told Lisa the whole story, beginning with Jace’s accident and including the findings of Anita Franks’s autopsy.

  “Steve Brady mentioned that.” She paused. “So Jace doesn’t remember anything?”

  “Jace and I were out to see a movie that night. I know we didn’t get out until at least 10:45. But that doesn’t jive with what the manager of the Jefferson Hotel told Ryan Meadows. Ryan reports that the manager took notes to document the evening after the accident, in case the police questioned him. He claims that he escorted Jace to Mrs. Franks’s suite shortly after ten.”

  Lisa raised her overly plucked eyebrows and wrote something on a notepad. “What is Jace’s blood type?”

  Heather shook her head. “Not a clue. Why?”

  “I’ve learned a little bit following the crime beat in this town. If the autopsy had a semen sample, it could be easier to rule Jace in or at least out by analyzing it. You see, eighty percent of males are secretors. That means they secrete their blood-type antigens in their body fluids, including semen. If the semen sample has blood antigens that don’t match Jace, it could get him off the hook.”

  “But if they match Jace …”

  “Well, it doesn’t prove it’s him. But a DNA study would be conclusive.”

  “I asked Gabby Dawson, his pump tech, to bring me some of Jace’s blood.”

  “It wouldn’t even take blood. It could be a cigarette butt or a glass that he used, anything with DNA.”

  Heather sighed. “I’m not sure she’ll do it. She’s very loyal to Jace and doubts he is guilty of adultery.”