MAYA HOPE, a medical thriller - The Dr. Nicklaus Hart series 1

by Timothy Browne, MD

  A gargantuan palm tree had broken Buck’s fall off the mountain and saved his life. It had taken him a minute to remove his mangled prostheses and another to claw his way up the slope on his stumps. Now his stumps brought him barreling toward the Korean terrorist.

  Buck tackled him with full force. He heard Hwang’s spine snap. With the Korean writhing in pain, Buck seized a large rock and smashed it onto the side of Hwang’s head. As it hit its mark, Hwang howled and blood spurted from his ear.

  Buck rolled around and grabbed Nick, pulling his lifeless body to him. He put his mouth over Nick’s, exhaled a large breath, and started CPR.

  Buck took a breath. “Come on, Nick.” He looked up. “Lord, I command life back to his body,” he shouted and continued chest compressions.

  Finally, Nick gasped, coughed, and threw up.

  * * *

  When all they could hear was jungle sounds, Katelyn eased the van back onto the road and backed up slowly in the direction the SUV had gone. She stopped when she came to Buck and Nick lying on the road. She got out of the van with her gun drawn, shouting, “Where is the other vehicle?”

  “Gone,” Buck called back.

  Katelyn saw Hwang lying in the road and bent to feel for a pulse. He was dead.

  Nick watched Buck stand on his stumps.

  “I’d have two shattered tibias, if I still had tibias,” Buck said. “This is about the only time in my life I’m glad I was wearing prosthetics.”

  Nick tried to sit up, still coughing violently.

  “Help me get him into the van,” Buck yelled. “We need to go after the SUV.”

  “I don’t think so,” Maggie said, standing beside the van. “Anna has been hit. She’s bleeding pretty badly. We need to get her to a hospital.”

  CHAPTER 52

  * * *

  In the Balance

  Buck helped Katelyn with the gruesome task of moving the bodies of Miguel and Mr. Kim to the back of the van. They put Nick in the van, and as adrenaline flowed into his cells, he became more and more alert.

  He realized Maggie was tending to Anna, her hands covered in blood.

  “Oh God, oh God, oh God!” Maggie wailed.

  Her wailing in addition to the adrenaline increased his cognizance. He saw Anna sprawled on the van floor with a gunshot to her left upper abdomen. “Oh my God,” he echoed Maggie.

  Nick struggled to take off his shirt and knelt to help. He put pressure over the wound with his shirt.

  Maggie moved to Anna’s head and stroked her forehead. “Anna, are you still with us?”

  Anna eyes fluttered open. “What happened?”

  “Anna, lie still. You’ve been shot. We’re going to get you to the hospital.” Maggie looked frantically at Nick.

  Katelyn started to help Buck into the van, but he brushed her aside and used his strong arms to pull himself into the front passenger seat. He told her to drive. “Afraid I can’t reach the pedals like this,” he said.

  She climbed in behind the wheel.

  “We need to get Anna to care. Urgently.” Nick stated the obvious.

  Katelyn put the vehicle in drive. “And the plan is?”

  Nick looked at Maggie. “We’ve got to get her to a hospital with an OR. A trauma center would be the best.”

  Maggie looked frantic. “The closest trauma center is in Guatemala City, an hour to the airport and then an hour and a half plane ride, if we could get one.”

  “No way,” Nick said, looking at Anna’s pale face. “Give me another option.”

  “What about the hospital in San Benito? We saw it yesterday,” Buck said.

  Nick could tell Maggie was not happy while she considered the suggestion. “It does have a small operating room, but I don’t know if they have a visiting surgical team there or not.”

  “Am I going to be okay?” Anna pleaded.

  “We are not going to let anything happen to you,” Maggie decreed.

  “I’m not sure we have any other option,” Nick said. He looked at the blood soaking his shirt and then at Maggie. “Katelyn, how fast can you get us there?”

  “Everyone hang on, and we’ll see.”

  * * *

  Cho was dead. His corpse slumped against the dashboard. Suk had no idea of Hwang’s fate or the people in the van.

  “Stupid, stupid, idiot,” he shouted at Cho’s dead body.

  He drove to where the road widened enough to turn around. There was nowhere else to go but back down the mountain. The road ahead dead-ended a kilometer past Cruce Dos Aguadas. Beyond that, the jungle was impenetrable. If he went to the village, the people might see the vehicle with blood splattered on the inside of the windshield and that would invite questions and alarm he preferred to avoid. There was only one way out and that was back from where he’d come.

  He grabbed Cho’s gun from the floor. His hands shook violently. He had no idea what he would find going back down the road—an enraged Hwang standing in the middle of the road over all the dead white bodies waiting for him, or the others with guns blazing to kill him.

  With the pistol in one hand pressed against the steering wheel and the other tightly gripping the wheel, he decided to drive slowly down the road.

  * * *

  Fortunately, it was only fifteen minutes to pavement. Then, it was forty minutes to San Benito at normal speed. Katelyn aimed to shorten that as she floored the gas pedal and blared the horn to move traffic out of her way.

  Nick felt Anna’s thready pulse. She came in and out of consciousness, and he knew she may have lost half her blood volume.

  Maggie kept checking her phone. “I’ve got one bar. Finally.”

  “See if you can get through to the MED,” Nick rattled off the number.

  Maggie punched the numbers and listened.

  For a long moment, there was nothing, then, “It’s ringing!”

  “Tell them I need to speak with Dr. Carson Moore. STAT,” Nick ordered.

  “I have Dr. Hart here, and he needs to speak with Dr. Carson Moore right away.”

  There was a long pause.

  “Then connect me to the OR,” Maggie demanded.

  “Put it on speaker,” Nick suggested.

  “OR. This is Vangie.”

  “Vangie, this is Dr. Hart. Put me through to Moore’s room.”

  “Dr. Hart. Longtime no see. How are you?”

  “Vangie, I’m afraid I don’t have much time. Please put me through,” he shouted into the phone.

  The phone clicked a few times, and when Nick heard Van Halen playing, he knew he was in the right room. He could hear the sounds of the OR in the background.

  “Dr. Hart, I have you on speaker. Dr. Moore is scrubbed in.”

  “Carson, this is Nick Hart.”

  “Nick, my friend. I heard you’d gone native. Where are you? You sound terrible.”

  “Hey, Carson, I hate to interrupt you in surgery.” Nick tried to talk as loud as he could, but his voice was still raspy from nearly getting his windpipe crushed. “Sorry, I have no time to chit-chat. I really need your help.” Alarm was easy to hear in his voice.

  Maggie and Nick heard the OR quiet and the music’s volume decrease.

  “I’m just doing a boring gallbladder. What can I help you with?”

  “I’m in Guatemala. A friend has been shot. Left upper quadrant. Lost tons of blood. We are about twenty minutes away from a hospital.”

  “Crap, Nick, you have gone native.”

  “Carson. Please.”

  “They’re going to need a lap. Left upper quadrant? Abdomen or ribs?”

  “The entry wound is through the last few ribs. Yes, on the left.”

  “You know how a bullet can bounce off the ribs and end up anywhere. You better call ahead to the hospital and tell the surgeon to prepare for emergency lap. They’ve got to open the belly.”

  Nick glanced at Katelyn who read his look, grabbed her phone, and gave it to Maggie to call Shalom Hospital.

  “We’re headed to a little miss
ion hospital,” he said. “I’m not sure they have a surgeon there.”

  “Shoot, Nick, how long has it been since you cracked someone’s abdomen?”

  “Since internship.”

  “Twenty minutes, you’ll be there?”

  “Yeah.”

  “I’m finishing up now. Call me back when you get there. You ready for some real surgery, you dang sawbones?”

  * * *

  Suk crept down the road. There was no sign of the other vehicle. He was getting close to where the encounter happened. He stopped to check the gun. He took the clip out and was shocked to see it empty. He pulled back the chamber—empty.

  Frustrated, he threw the gun at what was left of Cho’s head. The useless weapon clattered on the dash.

  “You idiot,” he yelled and smashed his fist on the steering wheel.

  There was nothing else he could do but move forward.

  I’ll ram them off the road if I see them.

  As he came around the curve, all that was left at the scene was a body lying in the dirt. It was Hwang. Suk stopped and got out of the car.

  Cautiously looking around, he realized that he was alone, surrounded by jungle noises. He walked down the road a hundred yards to a curve and warily peered around. The other vehicle was gone. He looked over the edge at the place where he thought the large Caucasian man had gone over. Twenty feet down the steep slope he saw bright, shiny metal bars, dirty and bent. When he saw a shoe attached to one of the bars, he realized why the man survived the impact. Prosthetic legs.

  The only other thing he saw were tracks in the dirt that looked like the man had crawled back up to the road.

  As he walked back to his SUV, he decided to dump Cho and Hwang off the side of the mountain, and he realized something else. He was free.

  CHAPTER 53

  * * *

  Shalom

  When they pulled up to the front of Shalom Hospital, Nick saw Dr. Becker standing at the door awaiting their arrival. Fortunately, the hospital had answered Maggie’s call; unfortunately, there was no visiting surgical team. Maggie had told Nick that Dr. Becker, a retired anesthesiologist, and his wife, an OR nurse, ran the place. They invited surgical teams down for a week or two at a time to operate and minister to the local people.

  Dr. Becker pushed a gurney up to the van, and his eyes widened at the sight of all the blood.

  “We’re in deep trouble here,” Nick said, looking at Anna who was ashen and unconscious. There was no time for introductions.

  “What’s your plan?”

  “We’re going to have to open her belly. We’ve got to stop the bleeding if at all possible,” Nick said, getting out of the van.

  “My wife is preparing the OR. We’ve got to start some fluids now, or we won’t even make it there.”

  Nick hoped that Dr. Becker, now in his seventies, had seen it all in the forty-plus years that he had administered anesthesiology.

  “With her blood loss, her veins are going to be impossible to find. What about a central line?” Nick suggested.

  “I’ve got a better idea.” Taking large trauma shears, Dr. Becker cut off Anna’s pants. All her clothing would eventually be cut off anyway. He swiped an area below her knee with alcohol and plunged a trocar deep within her proximal tibia; the pain made Anna moan.

  Buck looked at Nick inquisitively.

  “It’s an intraoseous IV,” Nick explained. “Smart. We dump a large volume of fluid into the bone, and it goes right to the vascular system. We’ve got to get her volume up, or her heart will stop with nothing to pump.”

  Nick looked up as Becker plugged in the IV fluid bag, and a steady stream flowed in.

  “That will do for now. I’ll try to slip in a central line when you guys are prepping her for surgery. I’m afraid it’s just me and the Missus here today. You’re going to need some help,” he looked at Maggie, Katelyn, and Buck, who stood a little over four feet tall without his prostheses.

  “Maggie’s going to scrub with me. She used to help John in the OR.”

  The team wheeled Anna to the operating room. Nick handed Katelyn his phone and told her to call Carson Moore. He gave her the number. He heard her talking with Moore, telling him the situation.

  The team lifted Anna onto the OR table. The jolt and the fluids brought her to consciousness. As Becker started a large-bore IV in her arm, Maggie held her and kissed her face. “Lord Jesus, protect this child.”

  Anna looked in Maggie’s eyes. “I’m not afraid,” she whispered.

  “You guys better start rockin’ and rollin’.” Moore’s voice came through the speakerphone. Nick could hear the frustration in his voice and knew he wished he was there.

  “She’s going to sleep now,” Nick told him as Becker injected the anesthetic into the IV.

  “Nick, I’m thinking that the bullet may have hit her spleen if she’s losing that much blood,” Moore said. “At least I’m hoping. If it turned north to her heart, this will be a very short operation,” he said soberly. “So let’s take a tour to her spleen first thing.”

  Nick and Maggie did not bother changing into scrubs and sprayed antiseptic foam on their hands for a prep. Becker slipped in an intratracheal tube and placed Anna on the ventilator, while his wife washed off Anna’s chest and abdomen with betadine.

  Nick and Maggie put on sterile gowns and gloves and hung a large lap drape over Anna.

  “You guys there yet?” Moore yelled through the phone. “Your friend’s not going to be very happy with the incision, but, Nick, just do a full-length laparotomy incision from her chest to her pubis. You’re going to have to see everything.”

  Maggie handed Nick the scalpel. He took a deep breath. “Jesus, help us.”

  The scalpel plunged through Anna’s delicate skin, exposing the thin, fat layer, and took the incision right down to the abdominal musculature. “I’m down to fascia,” he called into the phone.

  “Okay, Nick. Split through the linea alba, the fascia that runs up and down from the sternum to the pubis. Curve around the navel.”

  Nick followed the instructions, being careful to not go too deep and enter the bowel.

  “You should see the greater omentum, the fat layer covering the bowels.”

  “Oh my God!” Maggie cried out.

  “And?” he yelled.

  “There’s a ton of blood in here!” Nick cried, terrified.

  “It’s okay. Keep going.”

  “Her pressure is really dropping, guys,” Becker hollered.

  “Nick, reach up in the left upper quadrant right under the diaphragm. I want you to sweep your hand up and out. You should feel a softball-size organ as you go. Pull this right out into the wound. That’s the spleen. Remember, its blood supply is a pedicle of vessels that feed into it. If the spleen is bleeding, pinch off those vessels. If not…I’m afraid…”

  Nick reached up under the diaphragm—blood soaking through his gown sleeve—the pressure causing blood to splash onto the floor.

  “Oh my God. Oh Jesus,” Maggie cried in prayer.

  Sweat poured from Nick’s forehead.

  “What do you see?” Moore shouted through the phone. “Nick?”

  It seemed an eternity until Nick withdrew his hand, holding an angry-looking organ, blood pouring from part of it. Quickly, he pinched off the vessels running to it. The bleeding stopped immediately.

  The room erupted with a cheer.

  “Thank God,” Moore said.

  “I hate to rain on your parade, guys, but her blood pressure is eighty over nothing, and we need to hope that’s the end of the bleeding or else we’re going to lose her,” Becker broke the joy. “Suck up as much of her blood as you can, and we’ll give it back to her.”

  Nick looked up and realized the Beckers had wisely hooked a blood saver unit to the suction, and they could filter and return Anna’s own blood to her.

  Moore instructed Nick on how to clamp the vessels and tie them off with suture. Then Nick took Mayo scissors and cut the organ free.
Fortunately, it was an organ she could live without. Maggie held out a surgical pan, and he dropped it in.

  “Done,” Nick pronounced.

  “Okay, good deal, my friend. Well done,” Moore said. “We may turn you into a real surgeon yet. Let’s run the bowel now and look at the other organs to see if a fragment could have hit anything else.”

  Moore walked him through each quadrant and system. Besides sucking out large clots around the abdomen, Nick and Maggie could find no other damage.

  “Carson, I don’t see any other damage.”

  “Okay. That’s awesome. Let’s get her closed up and off that table.”

  Nick looked up at Becker. “Well?”

  He shook his head. “I don’t know. Her pressure is pretty low. She’s hanging on by a thread.”

  Dr. Hart, the surgeon, had been running on high-octane adrenaline. Suddenly it occurred to Nick that it was his dear friend Anna whose life hung in the balance; it was Anna who had barely survived the surgery. It was personal, and he had no idea if her brain suffered damage from anoxia, or if their hasty surgery would cause her to die a horrible death from a raging abdominal infection. Worst of all, it was his fault for letting her come with them. With his head spinning, Dr. Hart ripped off his mask, and Nick puked into the garbage can behind him.

  CHAPTER 54

  * * *

  Blood of Life

  “I hate seeing what I did to her,” Nick said, looking at Anna’s toned abdomen with an angry scar running its full length. After they had closed the large abdominal incision with surgical staples, Maggie cleaned the blood from Anna’s body.

  “She’s alive,” Maggie said.

  “I’m trying to keep her pressure up as well as I can, but I’m afraid she’s pumping more saline than blood cells,” Becker added. “I will keep her in an induced coma for now. It will be easier on her heart. I’m sorry we don’t have a respirator. I can support her breathing on the anesthesia machine for now, but we need to get her to a place that does.”