Mending the Doctor's Heart

by Sophia Sasson

  And she still did. Somewhere in the past five years, she’d lost track of what she wanted out of life, what the future would hold for her.

  “I still do.”

  “It’s not too late for us,” he said softly. His lips were soft against her ear, his voice pleading. He’d told her that as an only child, he’d always wanted a house full of kids. When they renovated the house in Tumon, they’d converted one big room into two smaller bedrooms. Two girls and two boys. But what would happen if she had another baby with a heart defect, or God forbid the child fell and had a head injury? The mortality rate for children under five years old was high in Guam. Injuries that children on the mainland recovered from couldn’t be treated on the island.

  “I can’t go through what happened with Lucas again. Or with Emma. And look at Kat now. If we were on the mainland, even in the middle of a disaster, a cerclage would be a routine procedure.” She stepped out of his embrace. Nico had a way of making her feel like anything was possible, but she lived in the real world.

  “I know what you’ve been trying to do here, but you can’t possibly get every single specialist you ever need right when you need them.” He looked pained, and she understood. They were back where they’d started. The reason she’d left to begin with.

  “Anna, look around. Five years ago a hospital like this would have been impossible. If people like us, people who can make things happen, leave for the mainland, life will never improve here. Together we can make this community whole.”

  What was she supposed to say to that? That despite working in poorly resourced areas for five years, in extreme situations, she still hadn’t come to the point where she was okay with it? That she was willing to sleep on cots, expose herself to the worst diseases in the world, eat MREs for months on end, but she still couldn’t bring herself to face the notion that someone she loved could die and she wouldn’t be able to save them.

  “I can’t sacrifice any more.”

  “I’m sorry to interrupt.” Both Nico and Anna turned to see Maria standing there. She was wringing her hands, and the stricken look on her face told Anna she was there to give them bad news.

  CHAPTER TWENTY-THREE

  MARIA HELD NICO back as Anna rushed into Kat’s tent.

  Nico closed his eyes. If something happened to Kat, there was no hope for him and Anna. He had to act.

  Maria touched his arm. “Her husband and father have been calling in a number of favors. Tom’s gotten a call directly from the White House. He’s willing to use executive privilege to get Kat on a transport. There’s one on the way back from dropping a patient in Hawaii. She can go out in an hour. Tom wants us to decide what’s best.”

  He squeezed his eyes shut. If only it were so easy to figure out what the right thing was. The words were on his lips to ask Maria to make the call to Tom, but he stopped himself. The triage process was in place to protect people. If he intervened, he was playing God.

  “Why don’t you just ask Anna what she wants to do?” Maria suggested.

  “No!” The last thing he was going to do was burden Anna with this decision. If something happened during transport or whoever was next in line got bumped and died, Anna would never stop blaming herself. But if Kat stayed on Guam and had a bad outcome, Anna would never stay there. She would leave just like she had with Lucas. This was his only chance to show her he could take care of her and their family and the people of the island. He had to. He wasn’t going to abandon them the way his father had.

  “We need to get her off the island.” Anna snapped off her gloves. “We can’t tell on the ultrasound what the exact problem is, but we’re hoping that the cerclage will help. She needs a proper hospital with better diagnostic equipment to figure out what’s going on.”

  “There’s no way to get her off the island,” Nico said simply.

  “I’ve been thinking...” Dr. Balachandra stepped toward them, tapping a finger to his chin. “Dr. Atao, you already have Emma in the hospital. What if we opened a surgical suite and had one of the Stateside OBs talk us through the procedure?”

  Anna shifted on her feet.

  Nico opened his mouth to encourage her, but Dr. Balachandra continued. “I’ve delivered a lot of babies, and I’ve dealt with uterine prolapse—I think I can do this. It’s her best chance, if we put her on a transport, who knows what might happen on the way.”

  “I can get an OR suite sterilized,” Maria chimed in.

  Anna shook her head. “I’m not willing to risk the surgery. We don’t even know if it’s the right procedure!”

  “I’m taking the risk, Dr. Atao, all I need you for is to assist and monitor the baby, but this is not on you.”

  Anna flashed her eyes at Dr. Balachandra. “It’s not about blame, it’s about doing what’s best for the patient and making sure we don’t let our personal desire for heroics affect our decision-making.”

  Nico stepped back. Did she think that’s what he was doing? Or what she’d done when she operated on Lucas?

  “These are unusual circumstances, and it requires creative thinking,” Maria said carefully.

  Anna didn’t have to say it out loud for Nico to know what she was thinking. It was the way things always seemed to work on Guam. And she wasn’t wrong. There was greater acceptance here for the fact that not everything could be fixed. But as a woman of modern medicine, Anna would never acknowledge that.

  “I’ll go start setting up.” Maria left with Dr. Balachandra in tow.

  “I think this is the wrong thing to do,” Anna said ominously. Nico’s stomach churned. Was he making the right call? If something happened to Kat and Anna found out later that he hadn’t told her about the transport, she’d never trust him again.

  Her eyes were dark, weary from the stress of the last several days. He wanted nothing more than to pull her into his arms and tell her everything would be okay.

  But the sinking feeling in his stomach told him he was going to lose Anna again.

  CHAPTER TWENTY-FOUR

  ANNA CHECKED THE clock in the OR. One thousand, nine hundred and seven days and ten hours since she’d felt the tremor that shook her hands now. Kat had been anesthetized. They had a nurse anesthetist and a trauma surgeon who were pulled into the surgery because of who Kat was and the frequent calls from her father, a powerful former senator who had gotten the White House involved.

  Her gloved hands twitched as she helped Dr. Balachandra drape Kat and push her legs into position. Kat attached the fetal monitor so they could continue watching the baby’s progress. Since giving Kat a fluid bolus, the fetal heart rate had come up.

  Kat’s husband was on his way to the island. How would Anna face Alex if things didn’t go well? After all Kat had done for her, how would she tell him that she couldn’t even save their first baby?

  “Dr. Atao?”

  She snapped her attention back to Dr. Balachandra. “I’m sorry.”

  “I asked whether you were satisfied with the fetal heart rate and ready to begin.”

  No I am not. This is a crazy idea, just like me doing Lucas’s surgery was a desperate plan. Kat could die on the table. She could bleed out. We shouldn’t be doing this.

  “Let’s do this.” Her voice sounded remarkably calm.

  A volunteer who looked like he was about to pass out held up a tablet computer so the OB in Hawaii could watch and direct them. Dr. Balachandra inserted the speculum and began.

  “The bleeding is really heavy—I’m having trouble seeing.” Dr. Balachandra couldn’t hide the anxiety in his voice. Her own pulse pounded through her body, the normally cold temperature of the OR unable to stop beads of sweat from prickling her forehead.

  The trauma surgeon gave him some suggestions for controlling the bleeding. The beep of the fetal monitor pulled Anna’s attention. The baby’s heart rate was still
okay but it had dropped. She checked Kat’s vital signs. “We need to give her some blood—her heart rate is rising and pressure is dropping.”

  They only had one unit of blood on hand. Normally for a surgery like this, there would be several, but blood was yet another item that was in short supply on Guam. Yesterday they had done a blood drive in the hospital, but it took time for the Red Cross to test and replenish their inventory.

  She didn’t need to tell Dr. Balachandra that he didn’t have much time to stop the bleeding.

  “She might have cysts that are causing the bleeding.” The disembodied voice of the OB from Hawaii broke in.

  “Okay, I’m in, suctioning now.”

  The whole thing lasted twenty-six minutes but it might as well have been twenty-six hours. Once Dr. Balachandra was done, they slowly brought Kat out of anesthesia. She’d been given as light a dose as possible to protect the baby. She was woozy but seemed to be doing well.

  “You’re trembling.”

  Nico put his arms around Anna as she exited the OR. She let him hold her, her body both cold and hot.

  “She’ll be okay. You guys did it.”

  Anna had done nothing. “I wish we hadn’t had to do this here.”

  “Alex has arranged a medical transport for her. He’ll be here in seven hours.”

  Anna hoped they’d done the right thing. After seeing the bleeding, even the mainland OB had his doubts as to whether they’d made the right diagnosis.

  “This is just like it was with Lucas. No way off the island.” Anna muttered, her chest burning. “It’ll always be like that—when we need to get off, we can’t. No way out.”

  Nico tightened his hold on her. “Anna, I need to tell you something.”

  The hesitation in Nico’s voice put her nerves on edge. She pushed away from him so she could look him in the eyes. Now what?

  “I lied to you earlier. Kat’s father called the White House and they put pressure on Tom to move Kat up on the priority list for medical transport. We had a helicopter that was leaving in an hour. I made the call not to ask Tom, to avoid bumping someone off the list. So there was a way off the island. I know you don’t believe it because of what happened with Lucas, but there’s always a way. It’s just about making the right choice.”

  Anna staggered and hit a wall behind her. She leaned against it for support. Nico reached out for her but she slapped his arms away.

  “You had a way to get her off the island?”

  “Anna, if we had, the person who would’ve missed his turn was a thirteen-year-old with a bleed in his brain.”

  She glared at him. Kat would never be high on a medical triage list for transport. While her situation was bad, it could be managed. At worst, she could lose her baby, but they could save her life. The kid with the brain bleed would die without neurosurgery. Anna knew he’d made the right decision. That was what disaster triage was all about, making sure those who most needed care got it first. And yet she couldn’t suppress her anger.

  “That was a decision you should’ve let me make.”

  “I couldn’t.” His eyes pleaded with her. “I didn’t want to put the responsibility on you. I asked Dr. Balachandra to make the call.”

  “Don’t you get it, Nico? The responsibility is mine, whether or not I want it.” She sank to the floor and pulled her knees to her chest, burying her head in her arms. The stress of the past few days was catching up with her.

  “Hey, it’s okay. You guys saved Kat and her baby. She’ll be fine.” Nico stroked her hair. It felt so good to have Nico share the burden with her. When it was Lucas, Nico had deferred to her medical judgment for all decisions. At the time, she had been driven to save Lucas at any cost.

  “You don’t have to take on everything. Kat is our collective responsibility. Not yours alone.”

  She lifted her head and rested it against the wall. “I know you can’t leave. You have an obligation to fulfill for your family, and I get that. You need to take care of Nana.”

  He hung his head. “It’s not forever, Anna. My obligations, as you call them, won’t last long, especially if Nana isn’t getting treatment. Maria can run this hospital once it’s fully operational. I won’t have to be here physically to help. Can you stay with me for a little while? So we can work this out together?”

  Could she?

  “Dr. Atao, you need to come right away,” the nurse shouted down the hall. Anna was on her feet in a flash and Nico followed close behind.

  She rushed into Kat’s room, where the trauma surgeon and Dr. Balachandra were opening up IV lines.

  “She passed out and the fetal heart rate has dropped.”

  The portable ultrasound machine had already been set up. Anna did an internal ultrasound. The baby’s heart was beating, but way too slowly. Dr. Balachandra began a pelvic exam. “The sutures are intact, but she’s bleeding.”

  Someone left to rouse the Hawaiian OB to see if he had any ideas.

  An alarm on the fetal monitor began beeping incessantly. “The heart rate is only fifty...now forty-five...now forty-one...now forty.” Anna closed her eyes. She didn’t need to keep reading to know what was happening. Kat was losing the baby.

  Minutes later, there was no heartbeat on the monitor. Anna didn’t try to stop her tears. What was she going to tell Alex when she saw him?

  “We have to get her to the OR and do a D and C.”

  “I’ll do it,” Anna said wearily.

  Both the trauma surgeon and Dr. Balachandra stared at her. “You don’t have to. Unfortunately, I’ve done a lot of these.”

  “No, I should be the one,” Anna insisted.

  “No!” Nico’s harsh voice cut through the room.

  * * *

  HE DIDN’T KNOW if it was Anna’s pale face, the haunted look in her eyes, or the boneless way in which her shoulders sagged. But a realization had hit him with more force than the tsunami itself.

  Anna needed him to be the strong one. She would keep sacrificing herself until she had nothing left to give. This time he would be the strong one. He would do what needed doing.

  He wrapped his arm around her. “Dr. Balachandra, please perform the surgery.” Anna fought against him but he held on to her and firmly guided her to his and Maria’s office. There was a cot there that he’d been using. He set her on it. “I want you to sleep.”

  She shook her head. “Nico, are you crazy, this is not the time to sleep! I need to take care of Kat, talk to Alex when he gets here, I need to—”

  “I’ve got it, Anna. I will talk to Alex. The other doctors are more than capable of helping Kat. They’ll take care of her, I promise.”

  “No, Nico, you don’t understand.” She threw back the blanket he’d covered her with, eyes flashing. “It’s too late. It’s too late for Kat, and it’s too late for us.”

  She walked out and he didn’t stop her. There was nothing he could say that would keep Anna on Guam. It was up to him to choose what he wanted more.

  CHAPTER TWENTY-FIVE

  “NICO! I’M GLAD you came by. I was going to bring this by the hospital. I made your favorite, alåguan.”

  Nico sighed. He was in need of some comfort food, and the warm, soupy dish of rice and coconut milk would hit the spot. He sat at his mother’s kitchen table, a small Formica contraption that fit only two chairs. They had never needed anything bigger; it had been just the two of them for the longest time. He knew how Anna viewed this house. It was dated, full of things that belonged in the seventies.

  It wasn’t that Guam didn’t have modern comforts. The influx of tourists brought money to the island; there were five-star resorts, fancy malls selling the finest goods, and anything someone needed could be flown or shipped in. Yet most of the indigenous people lived like his mother: in small houses with crumbling roofs and walls. T
he per capita income was half that of the general United States.

  Guam was a strategic outpost for the United States, a “gateway to Asia.” Beyond the military base, there would be no investment in Guam by the federal government. The people needed to improve their own lives. I made a promise to the community that I would be here, be the man my father never was.

  “Look who’s here.”

  Nico turned to see Tito on crutches. “Finally washed up, huh?” Nico teased.

  “Yeah, you were gonna leave me for dead in that field hospital. Lucky for you, I charmed one of the cute nurses and she took good care of me.” He winked at Nico and Nana slapped him on the arm.

  “You sit too. I’ll give you a bowl.”

  Tito grinned and sat in the chair Nana had vacated. “Yeah, my house is, like, gone. The roof is in the neighbors’ yard, my bed is on the road. Dude, my ATV disappeared. I’m okay with the house, but my ATV, that’s rough, man. What’s a tsunami gonna do with an ATV? It ain’t even a water vehicle.”

  Nico grinned. Tito’s silliness was just what he needed right now. Tito slurped some food into his mouth. “Nana...” He kissed his fingers. She smiled and patted him on the head.

  Tito regaled them with stories of the “other” field hospital where he had been transferred when the hurricane came. He had apparently hit on every single available nurse and a few patients, one of whom had turned out to be eighty years old, which Tito didn’t know because he was heavily medicated at the time.

  “I told Tito he could stay in your room until his house is repaired.”

  “It’ll be just like when we were kids.” Tito grinned. When they were younger, Tito’s parents had gone through some hard times and had to go live in a shelter. Tito had come to stay with them and he and Nico had slept in Nico’s double bed together for more than a year while his family got back on their feet. At the time, Nana would not hear of Tito going into foster care or staying at a shelter. They’d been like brothers ever since.

  “Nana, he’s going to break my bed.” Tito was an easy three hundred pounds.