And then it hit her. This was his way of keeping her here. It was her turn to make a decision. Would she stay or go?
Crash!
Before she could process what had happened, Nico was on top of her, covering her as pieces of concrete rained down on them and water gushed into the foyer.
“Everybody out!” he shouted, though no one needed encouragement. People were rushing for the exits, and Nico pushed Anna in that direction, but she resisted.
“No, we have to get the patients from the top floors. We can’t leave them behind.” A piece of the exterior wall had caved in. Who knew what else was coming down?
“I’ll go get them,” Nico said.
Anna was on his heels. She wouldn’t leave without her patients; she had to make sure Emma was okay.
Maria ran to the announcement system, which they had just gotten up and running this morning, to encourage anyone who could walk without assistance to get outdoors. The fire alarm was unfortunately not fully functional.
It was a maddening process, but all the medical personnel understood it. Those who could walk got out first. That would clear the hallways for them to carry out those who couldn’t. No matter how many times Anna had been through situations like this, she could never look the bedridden patients in the eyes. Thailand had been the worst. They’d had to leave some patients behind when the building collapsed too fast to get them out.
But that wasn’t going to happen today because every able-bodied man and woman in the community had come running back into the hospital to help carry stretchers, wheelchairs and patients attached to machines. They were willing to risk their own lives for others.
Once everyone was out and there was no more falling debris, Nico and Maria walked back into the building to survey the damage. Anna joined them and squared her shoulders when Nico gave her an exasperated look and pointed to the door.
“If you want me to be the CMO of this crumbling heap, I’m going to be here, for better or worse.”
Maria failed to suppress her smile. Even under the circumstances, Nico’s glare was priceless.
He eyed the source of the wall cave-in. “I’m no engineer, but my guess is that crack in the foundation we’ve been worried about stressed a load-bearing wall. The water was from a pipe burst.” Nico’s voice was weary, and Anna knew he was blaming himself.
Maria swore under her breath. “That’s where the water must have come from during the hurricane. I haven’t been able to get a structural engineer in to check it out.”
“The more immediate problem is what we do with the patients,” Anna chimed in. “The battery backups on the machines won’t last long, especially the ECMO. Emma and the burn patients need to be in a sterile environment.”
The DMAT and PHS teams were already erecting tents a safe distance away from the hospital. Nico rubbed his neck. Anna touched his arm, but it was Maria who had a solution in mind.
“Here’s what we do—see if the congresswoman can lean on the base commander to send the army corps of engineers to do an assessment. Bruno said his friend at the base told him they’re there doing repairs.”
Nico snapped his fingers. “Good. Maria, while we see if the Army can spare someone, you check if the governor knows anyone at the fire department—they’re responsible for condemning buildings, so they have to know someone who can do assessments.”
“I’ll go talk to Kat,” Anna volunteered, trying to shake the sinking feeling that there was another disaster in store for them.
* * *
ANNA DIDN’T LIKE Kat’s face when she finally found her in one of the tents. She was whiter than the bedsheet she was lying on. Vickie was beside her, holding her hand.
“What’s wrong?”
Dr. Balachandra was tending to her. “She started cramping. I did a pelvic exam—she’s bleeding.”
A cold dread spread through Anna’s veins. “Do we have a portable ultrasound?”
Dr. Balachandra nodded. “One of the volunteers is getting it for me. We left it in the hospital.”
“Kat, how’re you feeling?”
To her credit, Kat cracked a small smile. “Great timing to have a complication, huh? Alex is going to kill me.”
Anna grabbed her hand. “We’re going to take care of you.” She was not going to let anything happen to Kat. Not after everything the woman had done for them. The volunteer rolled in the ultrasound machine and they lifted Kat’s shirt to apply the conduction gel. Anna let out a breath when they saw the fetal heartbeat. She wasn’t a trained ob-gyn and her ultrasound skills were basic. She needed a specialist. Dr. Balachandra peered at the screen with her.
“We don’t see anything wrong with the baby.”
Kat breathed a sigh of relief but Anna exchanged a glance with Dr. Balachandra. Bleeding and cramping together was a bad sign, but they didn’t have the expertise to make a diagnosis.
“Was Kat able to call the base?” Maria breezed in and stopped short when she saw what was going on. She slapped a hand to her mouth.
“What’s happened? What do you need me to do?” Trust Kat to worry about everybody else.
“You take care of yourself right now, Kat,” Anna said firmly, but of course the congresswoman was already sitting up, gazing expectantly at Maria who shot Anna an apologetic look.
“Sorry, Tom said the guy from the fire department who did assessments died in the tsunami, so we have no other choice.”
Maria explained the situation to Kat, who promptly pulled out her phone to call the garrison commander in charge of base logistics.
Anna stepped aside to work her own contacts to find an OB who could help them over Skype. She finally got hold of one who told her they’d need to do more tests. Anna returned to the tent to find Kat was still on the phone with the base.
“I understand, Commander, but I must say that when I return to DC, I’m going to talk with the armed services committee chairman, who is a friend of my father’s. I’ll have to convey your utter lack of compassion in a time of crisis.” Maria and Dr. Balachandra were staring at her in awe, and despite the acid churning in her stomach, Anna had to take a second to admire Kat.
“Well, I’m glad you can spare someone, after all. We’ll expect him within the hour.”
“Okay, everyone out.” Anna was firm. “Dr. Balachandra and I need to take care of Kat.”
Vickie stood to leave but Anna waved her down. Kat would need her sister in case they had bad news.
“What’s going on?” Vickie’s voice was laced with worry. “I thought the baby was fine.”
“The baby is fine, but we need to do an internal ultrasound to see why you’re bleeding. I have an OB from Hawaii on the line.”
Anna reactivated the connection with the OB and turned her phone so Kat could see him. He directed Anna as she did an internal ultrasound, instructing her on how to take measurements using the machine.
“Unfortunately, the portable ultrasound does not have the sensitivity I’d need for a full diagnosis,” he said when the test was complete. “If she were Stateside, I’d send her to Maternal-Fetal Medicine to get her cervical length properly measured, but I think she is likely experiencing cervical incompetence. I recommend you do a cerclage.” The OB’s crackly voice cut through the room.
Anna’s heart dropped to the soles of her feet. They weren’t equipped to perform this surgery on a pregnant woman. At least when they operated on Emma they had a proper facility. In addition to not having properly trained staff, they didn‘t have a sterile OR. This was not something she had ever done or been trained to do and judging by the panic in Dr. Balachandra’s eyes, he hadn’t, either.
“Can we transport her?”
The OB considered this. “If that’s the only option, keep her on bed rest and see if you can get a medical transport right away.”
Anna motioned to Vickie, who was already on her phone. They had missed their scheduled flight waiting to make sure everyone made it out of the hospital. Kat had refused to ask someone to drive them to the airport in the middle of the evacuation.
As they exited the tent, Vickie turned to Anna, her voice filled with fear. “There are no flights out for two days. They’re saying it’s only supply planes that can’t carry people.”
Heart thumping, Anna forced herself to take some deep breaths. “Let’s go talk to Maria about medical helicopters.”
They found Maria, who started to apologize for her earlier blunder. Anna explained the situation.
“CNMI was badly hit too, so between all the relief organizations, we only have two medical helicopters.” The Commonwealth of the Northern Marianas was a group of neighboring islands that were also a US Territory and the only major land mass near Guam. Maria wrung her hands. “They’re running twenty-four hours, but they have a priority list of patients. I will ask because Kat is a congresswoman but...” She looked from Vickie to Anna.
Anna didn’t wait for her to continue. “I know. The critical patients go out first. Kat’s condition is urgent, but the heart patients, stroke victims and people with head injuries take priority.”
Vickie put a palm to her forehead. “And knowing Kat, she wouldn’t want to cut in line.”
Nico joined them and Anna brought him up to speed. “Then we do the surgery here,” he said.
“Nico!” Anna stared at him, flabbergasted.
“Look, I’m no doctor and I know you’ll say we don’t have the resources, but that’s the whole point of this hospital. When people can’t get off the island, we have to find a way to get them the care they need. That’s why I built the surgical suite with telemedicine capabilities so you can get a specialist to talk you through things.”
“Nico, it doesn’t work that way. I’ve never done a cerclage and neither has Dr. Balachandra. We can’t take such risks with Kat’s life—or her baby’s. We nick something the wrong way, and she could bleed out.”
But he wasn’t listening. She recognized the stubborn jut of his chin, the pressed lips and concentrated frown. It was the way he’d looked when they found out they couldn’t get Lucas off the island.
She grabbed his arm. “Nico, this is not the time to prove a point. Kat has done a lot for us—we can’t play with her family.”
He shook off her arm. “This is not about making a point. Kat’s life is no more important than any other person’s. Just like we did everything we could to save Emma, we will do what’s necessary to save Kat.”
Then he strode away and all Anna was left with was the red-hot anger that rose in her belly. Nico was wrong; he was trying to prove something to her, and his stubbornness would get Kat killed.
She turned to Maria. “Make the call, see if you can get Kat on a list or get a new helicopter for her.” She asked Vickie to call the base and anyone she could think of in Washington, DC. Maybe Luke could commandeer another helicopter.
Anna was going to get Kat off this island if it was the last thing she did.
CHAPTER TWENTY-TWO
NICO DIDN’T KNOW whether to consider it good news or bad news. The army engineer was a stand-up guy who not only brought equipment to survey the damage but also a small crew that could work to repair it. The bad news was that there was a crack in the foundation, probably caused by the tsunami and exacerbated by the hurricane. The good news was that the crew could seal it, shore up the wall that had fallen, and the rest of the building was stable. They recommended fixing the foundation and letting it dry before bringing anyone into the building. So the hospital would be out of commission for at least two days.
While the men went to work, Nico checked in with Maria. There was rain in the forecast, but no storms. The DMAT and PHS teams had plenty of tents to house the current patients, especially if they could use the lawn space closer to the building.
The main problem was preparing the surgical facility for Kat and finding a generator for the ECMO machine, ventilators and other medical equipment that were about to run out of batteries. The generator the DMAT team had brought was low on gas and there were no propane tanks left on the island.
“We have to bring the patients in.” Nico told Maria. “The engineers said the building is still solid, and we can put them on the west side, away from the damaged section.” There were solar panels on the roof that had been repaired, so the hospital itself had electricity.
“Nico, the man said it’s not safe to have people inside while they’re repairing the foundation in case something goes wrong.”
“We don’t have a choice. We can keep them outside as long as possible, but Kat needs surgery. She’s not getting off the island.”
Maria chewed on her lower lip. “Tom says if we say the word, he’ll override the priority list for the medical transports.”
“What should we do?” He’d always valued Maria’s judgment and he knew his judgment was colored by Anna.
“Mrs. LaCosta had a stroke and she needs out. She’s next on the list. You remember Ryan Louis? That kid who scored the touchdown in the last game against CNMI? He needs neurosurgery.” She was conflicted, and so was he.
“It’s not the right thing to do, Maria. We can’t play with people’s lives like that.”
She sighed wearily. “I know. But if something happens to Kat, Anna will never forgive you.”
He didn’t need to be reminded of that fact. While they had reconciled, he and Anna hadn’t talked about her moving back to the island. They needed some breathing room before making that decision. It had been Maria’s idea to offer her the CMO position, but he’d had the same thought days ago when they’d first discussed it. He’d gone to Tom to ask him to call the mainland to see if they would consider extending her deployment.
But he’d watched Anna’s face when Maria made the announcement. Nico hadn’t wanted to do it publicly, but Maria had insisted that Anna would hear the encouragement of the crowd and get swept away. Instead she’d looked panicked. Like the reality of her decision to be with Nico was crashing down on her.
“We have to show Anna that she’s wrong.”
Nico spent the next hours talking to every doctor who had arrived on island and each relief organization that had the capacity to bring people in. Nobody was an ob-gyn and everyone agreed that while losing the baby would be a horrible outcome for Kat, there were more urgent situations on the island. Some people who had suffered semiserious injuries days ago were now in critical condition due to the ongoing shortages of drugs and medical supplies. The Red Cross had set up a field hospital on the other side of the island and medical command was sympathetic with Nico but couldn’t offer any more support. They had even fewer doctors, nurses, supplies and surgical facilities than he did. They were using a tent for their surgical suite with bare-bones equipment.
But he had to find a way to save Kat’s baby. His marriage depended on it.
* * *
IT WAS PAST midnight when Anna finally saw Nico again. She was with Baby Emma, who was breathing on her own after being weaned off the ECMO. Emma, Troy and Aurelia were the only ones with Anna in the eerily quiet NICU.
“How is she?” he asked.
Anna sighed. “We won’t be able to tell for a few more days. She’s come off the machine well, she’s breathing on her own and her heart is pumping. Now we just have to see if it can stand the workload, and make sure she doesn’t get an infection.” That was one of the big reasons they’d brought Emma inside, despite the ongoing repair work.
“Can I hold her?”
Anna smiled at Aurelia. She wanted the other woman to be able to hold her baby without Emma being attached to machines. She held up her finger, then worked inside the incubator to cap off her IV line. Emma would continue needing intravenous medications, so they c
ouldn’t take the line out, but Anna could disconnect her temporarily. Checking to make sure Emma was oxygenating well, she also disconnected the tube in the baby’s nose.
Picking up the little baby, Anna felt her wiggle and move in her arms. It had been well over five years since she’d held a baby like this. Anna was having trouble counting the exact number of days. The little movements of Emma’s body should have seized her with panic, but all she felt was happiness. Emma gurgled, her little arms and legs working furiously, like she was excited to be awake and off the machines. She was alive and wanted people to know it. Nico was beside her, ready to take the baby from her if she wanted. His eyes plainly said what was in her heart. She had paid the penance for Lucas’s death.
Handing the baby to Aurelia, Anna watched the young woman kiss her daughter, letting the tears flow down her cheeks. Emma reached up to touch her mother’s face with her chubby hands, and Aurelia kissed them.
“Thank you.” Troy said the simple words with such deep emotion that Anna’s tears flowed with his.
Emma’s wails had them all laughing. “I think after days of IV nutrition, she’s ready for her mommy.” Anna smiled at Aurelia and touched Nico’s arm so they could leave and let the parents enjoy their baby.
On the way out, she instructed the nurse to put Emma back in the incubator after a few minutes. She wasn’t totally out of the woods yet.
“You did it,” Nico whispered and pulled her into his arms. Resting her head against his chest, she felt the beat of his heart. She needed him to hold her, to not have to deal with the flood of emotions on her own.
“Holding Emma like that...” Her voice cracked.
Nico stroked her hair, “I know you’ve always wanted a big family.”
Mending the Doctor's Heart Page 16
