He saw Hwang standing over the doctor’s body with the bloodied knife in one hand and the still-beating heart in the other. The musky smell of blood and the dankness of the jungle filled his nostrils. A hint of sulfur seemed to burn his nose.
Screams from the man and the howler monkeys resounded in his ears. His eyes frantically searched the restaurant. Why are people looking at me?
Panic assaulted Suk’s brain. He jumped to his feet, tipping over the chair, and ran from the restaurant.
CHAPTER 58
* * *
The Battle
Buck and Katelyn watched the pilot of the corporate jet do a flyby over the small landing strip at the Quetzaltenango airport. Seemingly satisfied, he made the jet fly a wide arc over the mountains and swooped down onto the runway, the engines roaring in reverse thrust to stop.
As a senior partner, Anna’s father had the firm’s jet at his disposal. The firm’s satellite office in Washington, D.C. woke the ambassador to Guatemala in the middle of the night, and the clearance to fly into Guatemala came early that morning.
Katelyn wheeled Buck to the plane as it rolled to a stop. The door lifted open and the stairs swung down. Anna’s father, formally dressed in a navy blue business suit, marched down defiantly. Anna’s mother appeared at the door, clutching a tissue to her nose. Except for the fact that she looked like she had been crying, she could have been Anna’s sister.
Buck put his hand out to the man. “Sir, I’m Buck Hansen. I’m—”
“Take me to our daughter,” he demanded, walking past the wheelchair and ignoring Buck’s hand.
* * *
Anna’s mother had not stopped crying since they got to Anna’s bedside. Anna’s father sat next to the bed holding Anna’s hand. No amount of power or money could ease the pain of seeing their child fighting for her life. The Guatemalan heat had forced him to remove his jacket and loosen his tie, and he sat red-faced, staring at the floor.
Anna looked terrible, and her vital signs reflected the danger she was in. One of an ICU patient’s enemies had come—edema—and it was everywhere. Her face was so engorged—her eyes swollen completely shut. Fluid bubbled out from around her breathing tube. It was a constant struggle to keep her breathing tube free of the fluid leaking from her lungs. If edema caused her brain to swell, she would be dead soon.
Nick wondered if they had missed something. Could a bullet or rib fragment have penetrated the diaphragm and entered the heart or lungs?
He listened again to the different quadrants of her chest while checking the monitors at the head of her bed.
Blood pressure 78/59
Pulse 135
Oxygen Saturation 89 percent
All terrible and it was worse that they were trending downward.
Nick was not an intensivist, someone trained in the care of the very sick in ICU, but he knew she was in trouble. Consulting with Dr. Moore throughout the evening and even with Anna’s father’s own cardiologist, airlifting her out of the Hope Center was out of the question. There was no way she would survive the flight.
The other doctors suggested an IV drip of Levophed, a type of norepinephrine, to keep her pressures up. It was fortunate that Carmen was able to secure some from the local hospital. Anna’s blood pressure leveled off, and her brain and vital organs were getting blood flow. But it was at the expense of blood flow to her arms and legs. Nick recalled more than one patient losing a finger, toe, or worse from the medication. But at this point, it was a necessary risk.
He looked at the Foley bag that collected her urine from a catheter. The urine was dark, and the volume was low; her kidneys were shutting down.
Nick looked at Anna’s father and then at her mother. She must have recognized the signs in Nick’s eyes. She cried sharply, startling her husband.
“Maggie will have the chest x-ray developed shortly. Maybe that will give us some answers,” Nick tried to reassure them.
Anna’s father’s head drooped with a nod, and her mother dabbed Anna’s forehead with a damp cloth.
Nick knew anyone who has cared for a family member or a friend in ICU understands that it becomes a place of anxiety and fear. A place of great loneliness and hopelessness, seeing their loved one strapped to the bed with tubes coming out of every orifice, lying motionless with their chest rising and falling with only the aid of the respirator. There are few other places that produce such a great sense of helplessness—blood pressure and pulse rates rise and fall, one step forward, two backward, and monitors constantly go on and off, reminiscent of the great battle.
Nick had treated many patients who barely remembered recovering. They often woke up in a room weeks later wondering what had happened to them, not knowing their family had spent sleepless nights and agonizing days at the bedside, watching the moment-to-moment battle unfold.
This was no different.
Nick patted Anna’s arm. Fight, Anna, fight. If only there was more I could do.
Nick smiled at Anna’s mother and walked toward the door.
He was almost through the door when he heard it. He jerked around and saw that Carmen heard it, too. She stood looking at the heart monitor. Anna’s heart rhythm had changed from a constant sinus rhythm to an irregular beat. With all the fluid she was losing into her tissues, her electrolyte balance was tipping.
“Get Maggie,” Nick yelled out the door.
Nick rushed to Anna’s side and looked frantically at Carmen as Anna’s heart flipped into ventricular fibrillation. Her heart quaked in her chest, pumping no blood.
Both Carmen and Nick recognized it immediately. No translation was necessary. Carmen ripped the cardio version paddles from their cradle on the anesthesia machine and thrust them into Nick’s hands. She pulled the blanket off Anna, exposing her bare chest, and then she quickly squirted lube onto the paddles Nick held.
“Everyone, take a step backward and let go of Anna and the bed!” Nick yelled.
Carmen nodded at Nick, but he recognized the sound of a fully charged defibrillator. He pressed the paddles onto Anna’s chest and pushed the buttons.
There was an audible thump as Anna’s body spasmed and jumped from the shock.
“Oh my God!” Maggie screamed as she raced into the room.
Nick and Carmen’s eyes were locked on the monitor, trying to will the erratic line to become a normal heartbeat.
No change.
Nick dropped the paddles on the bed and began chest compressions.
“Tell me when I have done two minutes,” he yelled at Maggie.
Nick saw Anna’s mom fall to her knees.
“Two minutes,” Maggie shouted.
Nick stopped, and they all stared at the monitor.
No change.
He grabbed the paddles as Carmen reset the charge.
“Stand back,” he ordered everyone and pressed the button. Anna’s body flailed and a large plug of mucus rose up in her breathing tube. Carmen suctioned it out and immediately turned back to the monitor.
No change.
Nick restarted chest compressions. “Come on, Anna.”
He was about to tell Carmen to give her a milligram of epinephrine, but she was already drawing up a syringe. “Epinephrine?”
She nodded and injected the medication into the IV.
“Two minutes,” Maggie told him without being asked.
Nick did a few more compressions to make sure the medicine had been circulated. Then he grabbed for the cardio version paddles.
No change. Anna was dying.
Nick placed the paddles on her chest. Everyone stepped back without being told, and he discharged the voltage.
No change.
He continued chest compressions and saw Carmen digging in her medicine drawer, searching for another medication. “Amiodarone?” he asked.
She shook her head. “Lidocaine. Amiodarone…no.” She waved her finger, suggesting they did not have the medication.
Lidocaine would have to do.
They were losin
g the battle.
“Epinephrine?” Nick asked Carmen. She looked down at her watch, quickly calculating the time. She nodded and reached for the syringe.
Nick continued chest compressions, and even though his arms ached, there was no way he was going to give up. His mind scanned through the algorithm for treating v-fib. They were running out of options.
“Two minutes,” Maggie told him, but it was almost irrelevant. At this point, blood flowing to Anna’s brain was running low. As long as the monitor showed any activity, he decided he would continue to shock. He continued compressions for five more cycles.
The lube on the paddles was gone, and he held them out to Carmen to replenish it.
He turned back and placed the electrodes on Anna’s chest and almost pushed the buttons without thinking. He saw Maggie run to the foot of the table. Then he saw a small tuft of hair at Anna’s feet. In the chaos, one of the orphans had wandered in and managed to press her face up against the bottom of Anna’s pale foot.
Protecting the child from electrocution from the shock, Nick pulled the paddles off Anna, and Maggie swept the child into her arms. “Oh, mija, you should not be in here.”
Nick replaced the paddles and was about to yell clear.
That is when he heard it. They all heard it. The beautiful, rhythmic beating of Anna’s heart. Carmen squeezed Nick’s hand, and they all turned to the monitor.
Normal sinus rhythm.
CHAPTER 59
* * *
Miracle
Nick sat on the floor, exhausted, and Maggie held the orphan, now asleep. It was clear—the child had ushered in the presence of God and a miracle.
“Miracles are funny things,” Maggie whispered. “There’s no way to wrap your head around them or explain them. They just are. It’s like catching a glimpse of something, only to have it disappear when you try to look for it.”
Nick’s medically trained mind wasn’t so sure, but the evidence was staring him in the face. The urine collection bag hanging from the side of Anna’s bed was quickly filling. Her kidneys were working. He heard her regular heartbeat bleeping from the monitor. He looked again and saw that her blood pressure was solid at 124/68 and her pulse was steady at 85.
Could it have been the mucus plug that was dislodged during resuscitation? The medication? Something else?
Anna’s mother hugged everyone she could get hold of. Anna’s father pressed his face against Anna’s and kissed her forehead over and over. Tears streamed down his corporate face.
Why am I having such a hard time understanding this?
Nick’s mind swirled. He looked at the clock on the wall. Thirty minutes ago, he was doing chest compressions. His analytical mind ran through the what ifs and wondered what landmines lay ahead. His tired body was bound to the floor, but his buoyant heart leapt with joy.
* * *
The morning wore on in a blur of exhaustion and relief. Everyone was too tired to leave the room, but it was clear Anna’s life was spared. As her narcotics wore off, she opened her eyes, shifted her body, and tried to speak around her breathing tube. Relieved as they were, it was terrible to stand at her bedside to watch. Her lungs were not quite ready to work on their own; in the haze of narcotics and trauma, her face filled with anxiety, and she pleaded with her eyes to understand what was happening.
Carmen humanely titrated her narcotics, adjusting them so Anna could sleep and allow her body to rest.
By afternoon, Maggie took charge. She ordered everyone out of the room to eat and rest. But Carmen and Anna’s mother refused, and Maggie was smart enough not to push.
CHAPTER 60
* * *
Recovery
The following morning before breakfast, Maggie rose to bless their meal. The team and Anna’s parents were still unbalanced from exhaustion. Their giddiness was fueled by Anna’s continued improvement and lots of coffee.
All the orphans and the team gathered in the cafeteria, except for Carmen who was starting to wean Anna off the narcotics.
“We have so much to be grateful for this morning,” Maggie said. Her voice cracking with tears. “Anna is getting better,” she told the children. “God is so good.” Maggie put her hand on her heart.
The children erupted with cheer and shouts of praise to God.
Not realizing how famished they were, everyone dove into the meal, including Nick, even though his throat was still sore when he swallowed.
When everyone was chewing in silent content, Katelyn spoke. “I hate to break this joy, but I need to tell you that I am headed back to Tikal today. I have been communicating with the authorities and the local police about the men in the FOCO SUV. The police found two of them dead on the road to the village. The third is missing. The police searched the house they were apparently renting and found very little information. There is much we don’t yet understand.”
She took a sip of water. “The Beckers were kind enough to make arrangements with the funeral home in San Benito, but I…” she lowered her voice so the children could not hear. “But I need to make arrangements for Mr. Kim to get home.”
As joyful and hungry as Nick was, the reminder of what they had left behind hit him hard, and he lost his appetite. The thought of Miguel’s mother, who was fighting end-stage cancer and had now lost her son, was unbearable. He had been so focused on Anna that he had pushed everything else from his mind.
Katelyn was right. There was still so much to do.
“I am so sorry about Mr. Kim,” Nick told Katelyn.
“Yes, he was a very honorable man, a good man. He has left a wife and a young daughter behind.”
The table went quiet as they contemplated this.
“I am so sorry,” Maggie said and put her arm around Katelyn’s waist.
“Is your Agency sending help? You can’t go alone,” Nick insisted.
“They are. They will be here in a few days. But I’m afraid our investigation can’t wait.”
“One of those…” Nick was going to swear, but saw the children looking at him. “One of those bad guys is still out there. I am not going to let you go by yourself.”
“I can take care of myself.”
“Yes, I know that. But if we can get Anna’s breathing tube out this morning, I’m going with you,” he said firmly.
“I should be going with you also,” Buck said. He put down his fork. “But a lot of help I am.” He turned his wheelchair away from the table and headed for the door.
Nick got up from the table. “I’m going after him.” Before he left, he pointed his finger at Katelyn, “But you’re not going anywhere alone.”
* * *
Nick caught up to Buck in their room. He put his hand on the big man’s shoulder. Buck’s shoulders quaked, and his chest heaved. “We should have never allowed her to go,” he cried through his tears. “I promised to protect her.”
Nick let him grieve. He grabbed a chair and sat down next to his friend.
“I tell you, I read the cries of David in the Psalms when things were not going well, and he’s like, where are you God?” Buck said between sobs. “Then I hit a point like this, and I find myself asking the same thing. It’s so easy to question God. Maybe that’s why people are so fast to blame Him.”
Buck wiped his tears with his hands. “This life is no cakewalk. I’m glad I have my faith and the promise of heaven. How do you get through this life otherwise?”
Buck’s sobs subsided.
Nick put his hand on Buck’s immense forearm. “Buck…I uh…I pray that I can become half the man you are—your faith, how much your wife and family mean to you, how you treat other people, your integrity and courage. Maybe, I never told you this back when I was caring for you, but being around you…I guess it makes me want to be a better person. Everyone talked about you at the hospital, how you treated the nurses and the rest of the staff, even when you were in all that pain. You are truly one of the most Christ-like people I know.” Nick paused. “Buck, I consider you one of my best fr
iends, and now I owe you my life. You knocked that monster off of me. I know I was down for the count. I don’t even remember what happened next. I only remember coming to in the van.”
Buck looked Nick in the eyes and smiled. “Well, nothing that a little mouth-to-mouth and a few chest compressions couldn’t solve.”
Nick opened his eyes wide, realizing what Buck had done for him, and then he cracked up. “I’ve been wondering why my sternum is so sore. And why I’ve had this overwhelming urge to brush my teeth over and over.”
They both chuckled.
Nick stretched his arm and hugged Buck’s neck. “Thank you, you big lug. Thank you for saving my life.”
Buck pulled away slightly so he could look Nick in the eyes. “You understand, don’t you, that Jesus was the one who really paid the price for your life?”
Nick saw Buck’s sincerity. “Yes. Yes, I really do,” he declared. “After Anna’s surgery…” Nick struggled finding the words. “I am not sure how to describe this…but I feel like God touched me. I’m not sure what this means, but I gave my life to Him.”
Buck’s eyes widened. “Then the pain I’m going through is worth it,” he acknowledged. “I have a great sense, my friend, that your life is about to change in really big ways.”
CHAPTER 61
* * *
Rest in Peace
Nick called Maggie from San Benito and was reassured with the news. “Thank God.” He turned to Katelyn, “Anna’s awake and talking,” and back to Maggie, “Call me if you see any problems. Otherwise, I’ll call in an hour or so. Yeah, love you too. We will. I promise.”
“Maggie tells us to be careful,” he told Katelyn who was driving the rental car to the funeral home. They had waited until Anna’s breathing tube was removed and she was stable before they took the plane back to Tikal. Nick preferred the fancy helicopter, but Maggie advised against becoming too friendly with the cartel.
MAYA HOPE, a medical thriller - The Dr. Nicklaus Hart series 1 Page 30