An Open Heart

by Harry Kraus

  Jace made a break for the door, but was tackled onto the kitchen floor, slamming his head against a chair as he fell. He felt searing pain and then … nothing.

  In the hospital casualty ward, Dr. Paul Mwaka worked through his own call load. He’d done a spinal tap on a young man with cryptococcal meningitis and HIV, performed a C-section, and was now examining an old man with severe abdominal pain. He didn’t mind the heavy load. Many of his colleagues from medical school had accepted internships at the large government hospital in Nairobi. But even in Kenyatta, their experience wasn’t as hands-on as his was in Kijabe. He knew in Nairobi he would not have been able to first assist on an open-heart case as he had that morning. He still couldn’t believe it. Dr. Rawlings had taught all the way through the case, showing him detailed anatomy and instructing him on technique.

  He looked at the old man’s face as he felt his abdomen and asked him in the Kikuyu language, “Are you having pain here?”

  Paul felt his own heart quicken as he slid his hand over the patient’s upper abdomen. There, feeling as if it was just beneath the skin, something pushed back against his hand. The intern paused. No, something was beating, pulsating. Paul probed gently, outlining a pulsatile mass. He’d not felt anything like it before, but was sure it was a swelling of the aorta known as an aneurysm. If this was responsible for the patient’s pain, it was a clue that the aneurysm was about to rupture or perhaps already beginning to rupture. He may only have a short time before the old man bled out.

  He walked away from the stretcher and talked quietly to the nurse. “Could you start an IV on the patient in bed two?”

  Purity, an experienced nurse, nodded.

  “No,” Dr. Mwaka responded. “Start two IVs. Large gauge, one in each arm. I’m going to call Dr. Rawlings.”

  He picked up the phone, dialed, and let the phone ring ten times.

  After that, he asked the operator to page.

  He walked to the HDU, thinking Dr. Rawlings might be visiting the open-heart patient.

  But Dr. Rawlings wasn’t there.

  He walked back through casualty.

  “Dr. Mwaka,” Purity called, “the old man’s blood pressure is falling. Only eighty systolic.”

  “Okay,” he said. “Don’t try to get it too high. The patient will bleed. I’m going to run up to Dr. Rawlings’s house. Maybe he has his headphones on or something.”

  Paul felt certain the patient was close to death. He needed to find the surgeon stat. He ran up the hill, thankful for a clear night.

  Strange. There are no guards outside his house.

  He knocked, and then banged on the door, calling for the doctor. “Daktari Rawlings!”

  Finally, in frustration, he tried the door. It wasn’t latched; it slid open. He stepped into the kitchen, calling “Daktari!”

  He gasped. On the kitchen floor were two bodies, both male. Both African. And both in a sea of blood. He knelt to take a pulse but pulled away before touching them. Both throats were sliced and their eyes were open, their chests unmoving.

  Paul began to yell for help. He stumbled out of the house and ran down the hill, screaming for the security officer in the little guard station beside the hospital entrance.

  At the guard station, he pointed back up the hill. “Just there,” he gasped. “There’s been a slaughter!”

  43

  Jace opened his eyes. He was in the back of an old car traveling somewhere fast. How long had he been out? The sky was dark, and he’d gone home just before sunset, so it had to have been at least thirty minutes. He studied his surroundings. He was unrestrained, but didn’t move as there was a large African man on the bench seat beside him, carrying an automatic weapon, like something Jace had seen on cop shows in America. The man didn’t seem to know that Jace was awake. He stared out the window at passing trees in a thick forest. Are we on the highway yet? There were two men in the front seat, arguing loudly in Kiswahili, saying something about a payment.

  If Jace was to take advantage of the element of surprise, he’d have to do something quickly before they knew he was conscious. Could he jump from the vehicle? No, they were traveling too fast. He closed his eyes, in case his captors looked at him—then risked a quick glance at the weapon. The man held it loosely, unsuspecting.

  Jace lunged for the gun, bringing his fingers over the man’s within the circular guard over the trigger mechanism. The gun’s barrel swung in an arc across the floor away from Jace as it began to fire. The sound was deafening and soon accompanied by the man’s screams as he shot himself in the left foot. Reflexively he dropped the gun. Jace popped open the door on the other side of the man.

  The men in the front seat screamed as the injured captor dove forward in an attempt to grab Jace’s neck. Jace evaded him by sliding off the seat onto the floor. The man toppled into the space of the open doorway. Jace kicked hard and connected with the man’s butt, sending him tumbling onto the pavement. Next, Jace reached forward and grabbed the driver by his hair, snapping his neck backward. The car careened from the road, crashed through a roadside fruit stand, and dropped into a ditch. Jace bounced off the ceiling, then the backseat.

  He took a quick inventory of himself for injuries, then lifted his head and looked around. The two men in the front seat were now half in and half out, sprawled awkwardly through the broken windshield onto the hood.

  Jace’s door had slammed shut and was lodged against a stump. He crawled through the open window and glanced up the street. A woman ran in his direction and would be at the car in a few moments. He squinted toward the forest. Time to get out of here.

  He ran into the trees, pausing to get his breath and listen to the growing crowd only after he was sure he hadn’t been followed.

  He looked at the moon. For now, he was on the run.

  And alone.

  Back in Kijabe, Dave Fitzgerald picked up the phone. “Calm down, Purity. What’s the problem?”

  “A mzee with low blood pressure. I know you are not on call, but we have tried over and over to raise the surgeon on call and have no response.”

  “Dr. Rawlings?”

  “Yes.”

  “He’s probably up in the HDU with his heart patients.”

  “We’ve checked. Meanwhile, I fear for this patient. I cannot find a pressure.”

  Dave sighed. “On my way.”

  In four minutes, he entered casualty. “Where’s Mwaka? The intern needs to be with this patient.”

  “He left to find Dr. Rawlings,” Purity answered. “He thought this was an aneurysm.”

  The surgeon stepped to the bedside. The patient moaned. Dave looked at his eyes. His conjunctiva were pasty pale, a sign of severe anemia. He laid his hand upon the belly and felt the pulsatile bulge above his navel. “Yes, Dr. Mwaka is right.” He looked around. “Call blood bank. Tell them I will need as much blood as they have available.”

  Nearby stood an elderly woman in an orange sweater and a purple headscarf. The patient’s wife. Dave spoke to her, using Purity as a translator. “Your husband’s condition is very critical. He has one slim chance for survival. That chance is surgery.” Deciding that it was better to skip the details of what he needed to do, he said, “The only other option would be to give him pain medication to keep him comfortable, and let nature take its course.”

  “Let him die?”

  Dave nodded.

  The woman shook her head. “Save him. He isn’t ready to die.”

  “We will do all we can. Please pray.”

  Dave called an emergency team, including Evan Martin to do anesthesia.

  “Have you seen Jace?” Dave asked.

  Evan shook his head. “Not since leaving the HDU about an hour ago.”

  Ten minutes later, they were just rolling the patient into theater number one when the medical director walked up, looking pale.

  �
��Hey, Blake, good timing. I could use an assistant. Ruptured aneurysm. Can’t find Jace.”

  “I can’t,” Blake said. “We’ve got a real bad situation here, fellas. I just came from Jace’s house. He’s gone, and two police officers are dead, with their throats slashed.”

  “What?”

  “I came to see if anyone knows where Jace is. He’s disappeared.”

  Dave tied the strings of his mask behind his head. “What’s going on? Where’s Jace?”

  “I don’t know what to think. He’s gone.”

  Evan spoke up. “Someone wants him dead. They’ve taken him. Where are the police?”

  Blake shrugged. “We called them. They are walking up. They don’t have a vehicle.”

  Evan looked back at Dave. “We’ve got to do this operation now if this guy is going to have a chance.”

  Dave nodded. “Get me some help, Blake. I can’t do this alone.”

  Gabby sat alone in her Kijabe duplex wishing she could will the clock forward and leave for the airport now. She opened her laptop and connected to the Internet to get her email. There was a note from Heather, frustrated at Jace’s poor communication. She’d done a little digging. She knew something about Anita’s sexual partner. Could Gabby ask Jace about his blood type to see if he’s a match?

  Gabby scrolled down to see an attachment, the data on the semen analysis on Anita’s attacker.

  As she read, her throat went dry. Oh, Jace!

  She needed to talk to him.

  She picked up the phone and dialed. He didn’t answer.

  Oh well, he probably crashed after his big day in the OR. I suppose this can wait another day. It’s not like he’s going anywhere tonight.

  Jace pushed on into the forest, pausing occasionally to look at the stars. He thought he must be on the west side of the highway that led north out of Nairobi toward Nakuru. He’d hiked these woods a hundred times growing up. He knew the waterfalls and the caves like his own backyard. If he continued, he should hit the railroad, the infamous line that had stalled at Tsavo during its construction because of the man-eating lions.

  He limped on, stepping carefully, looking for a trail. So far, all he’d found were the crisscrossing paths of the ruthless men who illegally cut timber for the charcoal industry. That’s all I need, he thought. A run-in with the charcoal burners.

  He listened to the sounds of the night. Everything was alive. As he moved forward, branches overhead swayed from scampering colobus monkeys. After thirty minutes, he stopped, leaning against a tree. The sounds of the highway had vanished; only nature spoke to him now.

  He closed his eyes, trying to rid his memory of the gruesome images of his guards killed without mercy. As a surgeon, he was accustomed to blood, but not the uncontrolled release he’d witnessed. He took a deep breath. This is all my fault. It began on a fateful night in Richmond when I walked away from Heather.

  He lifted his face toward the night sky. Are You punishing me because of Janice? I thought coming here would make up for my sin.

  Jace ran his hand over his right hip where a deep pain seemed to originate. He hadn’t done a proper inventory since crawling from the car. How long ago was that? Are they after me still?

  The bone seemed intact, but there was sharp pain every time he pressed against the ligaments of his right hip. A strain. I deserved worse.

  A twig snapped nearby. Something moved in the distance, something heavy. A baboon? A man?

  A volley of automatic-weapon fire cut through the night. Jace pressed his body against the tree and held his breath.

  They were looking, trying to scare him into running.

  He heard voices. Shouting. Kikuyu, he thought.

  I must get to the railroad. Or to a stream. I can follow it west toward the escarpment over the Rift Valley. Then I’ll know where I am.

  The voices passed to his left by fifty meters. They don’t know where I am.

  He waited a few moments, then doubled back, limping away from the voices. Tree to tree. Stay in the shadows. He winced when his weight broke a stick. The voices halted. Another burst of gunfire. This time, with bullets spraying the tree above his head. Monkeys squealed and fell silent.

  He smelled charcoal. Or was it from the gunfire?

  Why does someone want me dead?

  Jace crawled away, beneath banana leaves, his clothes now damp with sweat and moisture from the forest floor. He stood again, leaning low, and stumbled onto a path. After a few steps, he came to a mound of fresh dirt. Smoke seeped from several small openings.

  A charcoal burning spot.

  A rough voice greeted him. “Habari.”

  He looked up to see a boy holding up a machete. His teeth were yellow, visibly stained even in the moonlight.

  The boy pressed the tip of the machete to Jace’s throat.

  Jace lifted his hands in surrender. “Don’t hurt me,” he whispered. “I have money.”

  44

  Dave Fitzgerald worked quickly to get the abdomen open, relieved to see that the aortic rupture had been confined to a small area next to the aorta known as the retroperitoneum. If there had been a free rupture, he was sure he’d have been doing an autopsy rather than an attempt at saving the patient’s life.

  “Wow,” Dr. Mwaka gasped. “It’s huge.”

  The surgeon felt the area above the aneurysm. “We are fortunate. I think it starts below the takeoff of the renal arteries. Here,” he instructed, “give me counter traction on the duodenum. I need to dissect it away so we can get this baby clamped.”

  The duo worked on. “This is a big day for you, huh?”

  The intern nodded. “An open-heart case and an aneurysm in one day. Unbelievable.”

  “Believe it,” Dave said. “This is Kijabe.”

  Evan’s voice was etched with concern. “The pressure is sagging again. Have you clamped the aorta?”

  “Working on it.”

  Evan stood up and squeezed a bag of blood. “Work faster.”

  Gabby was undressing when a knock interrupted her preparations for bed.

  “Just a minute,” she called.

  From outside the door, she heard the Australian accent. “It’s just me, Gabby, Blake Anderson.”

  She pulled a robe around her and unlocked the door, and pulled it open to stare at the medical director through the second barred door. “What’s up?”

  “Have you seen Jace?”

  She shook her head. “No. I mean not since shortly after our case.”

  “He’s missing, Gabby. The guards at his house were killed. He’s nowhere to be found.”

  Gabby swallowed hard. No! “I was afraid of this.”

  “Why?”

  She squinted at him. “Hasn’t he kept you in the loop about his misery?”

  “I guess not.”

  “Hang on,” she said, unlocking the bars. “Let me dress. We have some catching up to do.”

  “The gunfire,” the boy chuckled. “I thought they were coming after me.” He smiled with a row of uneven teeth. “But they are after you.”

  Jace nodded. “Yes. Please keep your voice down.”

  It was too late. He heard voices and movement crashing through the trees.

  “Lie down,” the boy said. “I’ll cover you with sticks.”

  Jace obeyed. He had little choice. The boy pulled branches across Jace and sat down, machete in hand.

  Jace looked out from beneath the pile of cut branches, the discard that was too small to make good charcoal. His young partner was tapping the machete against a worn pair of Bata Bullets, the Kenyan version of cheap Converse court shoes.

  Two more men appeared, one carrying an AK-47. They spoke to the boy in rapid Kikuyu.

  Their voices rose. Arguing. The boy gestured with his knife, shaking his head.

  The man shoved the
boy to the ground. More arguing.

  Finally, a deal. The man pulled out a stack of bills and peeled off three.

  The boy pointed at the sticks.

  Jace had been sold out for three thousand shillings.

  Back in Kijabe, the night turned to morning, and word of Jace’s disappearance traveled fast. Gabby paced her small apartment and prayed, while wondering, What do I really know about this man?

  She pulled an old RVA yearbook from a shelf and turned to the index. After a few minutes, she found what she’d been looking for. There, on page 72, were the senior pictures of the Rawlings twins, Jace first, sporting a serious pose, and then Janice, smiling as if she were a sunbeam ready to light the world.

  The thing that struck Gabby was the girl’s eyes. And the more she stared, the more she saw another face. Anita Franks.

  Wow, Gabby thought. Subtract a few years and Anita was Janice.

  The phone rang. It was Chaplain Otieno.

  “Hello, John.”

  “Sorry for the early hour,” he said, skipping the routine greetings. “I wanted you to know that a group is gathering for prayer. We need to lift up Jace. We will be at station hall in one hour.”

  “I’ll be there.”

  She looked at her suitcases. All that remained was to put in her toothbrush. Oh, God, she prayed silently, I so want to be on that plane.

  Dave tied the last suture knot to close the skin. His patient was alive. “Stay with him in HDU and monitor his urine output every hour. If he falls below fifty ccs per hour, let me know. Give him morphine liberally. Cover him with Kefzol. And don’t even think about extubating him until morning.”

  Paul smiled in spite of his fatigue. He couldn’t wait to call his mother. He was sure his village would all know of his exploits by lunch.