by Dianne Drake
“Yeah, yeah. I know. You couldn’t tell me.”
“But since I haven’t, I guess it doesn’t matter, does it?”
He glanced over at the ranch. Just a quick glance at pretty much nothing now. They were long past the headquarters building and the bunkhouses where those who didn’t make it home every night slept. Right now the only scenery was wide open prairie. “I’m assuming you know how it is between my father and me? Not many secrets.”
“I’ve heard some things.”
“I’ll just bet you have.” He laughed bitterly. “A mass murderer would be more welcome here than I am.” He glanced over at the ranch again. “So is this what you really want, Joanna?”
“What I really want is all this with a nice, new, modern medical clinic to go along with it.”
“And you’re the crusader who’s going to build it?”
“Is that cynicism I’m hearing in your voice?” she asked. “The doctor from Chicago doesn’t think I can do it?” Of course he didn’t. It was silly to waste good breath even mentioning it. Living the hard life, fighting the hard battles wasn’t part of the medical repertoire any more. At least in Chay’s medical circles. Thank God she never crossed over into his medical circles.
“Yes. I’ve seen it happen too many times. A do-gooder comes in, raises the hopes of the people with empty and probably well-meant promises, then leaves once he, or she, realizes just how empty those promises were. And I don’t doubt that you mean it when you say you want to set up a nice new, modern clinic out here. I’m sure you do. But so did the doctor before you, and the doctor before that. So, yes, that’s cynicism you’re hearing because I’m a cynic. I was born and raised here, and if there’s one thing I’ve never done it’s delude myself. Dreams don’t happen out here. So I admire your ambitions and wish you well with them, but don’t count me among the optimists, because I’m not.”
“And this is where you expect me to get offended and huffy and defensive, and tell you how wrong you are, that I can do anything I set my mind to?” Truth was, she wasn’t offended. Chay was right on most counts, except one. Dreams could happen anywhere. She believed it, had always believed it, and in the dark hours, when she was too exhausted to crawl up her stairs to bed, and curling up on the floor at the bottom of them was good enough, she still had that dream.
“Can you?”
“What?”
“Do anything you set your mind to?”
“I suppose if you stay here long enough, you’ll be able to see for yourself.”
There was a small crowd gathered outside Betty Red Elk’s house. Mostly women, a few children. They were unusually quiet. Not a good sign, she thought. These people were outgoing, gregarious, and even before she stopped her Jeep she could see worried expressions all around. “I think it’s bad,” she said, grabbing her medical bag.
“What kind of doctor are you, Joanna?”
“Now you ask?”
“Just wanted to know what I was getting myself into. I mean, I’ve assumed you’re a medical doctor, but for all I know you could be a proctologist, which won’t do this poor kid any good at all unless it turns out to be a hemorrhoid instead of a broken leg.”
“Internal medicine. Which means I can hold my own with a hemorrhoid. But I’ve had training in trauma, so I’m not too bad with a broken leg either.”
The crowd parted as Joanna and Chay made their way up to the front door, and the first thing she noticed as she pulled the screen door back was that it was too quiet inside the house. Michael should have been sobbing, maybe screaming, but there was nothing. Not a peep. Not from Michael, not from his mother.
Joanna knew the way to the bedroom occupied by all four of the Red Elk sons and hurried along the darkened hallway to the tiny eight-by-ten room where she saw Michael lying on the bottom bunk of the two bunk beds lining the walls. Fred and Betty Red Elk were huddling near the closet door opposite the beds while Leonard Ducheneaux was standing over the boy, saying words that Joanna didn’t understand but knew to be a prayer of some sort. Michael needed more than prayers. But when it came to her healing versus Leonard Ducheneaux’s, she was standing on the far side of a very thin line. One that she wasn’t necessarily allowed to cross over, and when she was, the gesture was more often than not conditional.
“What’s he doing?” she whispered to Chay.
“Not enough,” he whispered, backing out of the room.
This wasn’t the way he’d wanted it to be. Their first meeting in all these years shouldn’t have been as healer to healer, one vying against the other for the treatment of a little boy. But that’s what it had come down to. His father was going through the ritual of extraction—removing bad energy, replacing it with healing energy—but Chay needed to tend the boy’s fracture, stabilizing his vital signs and finding a way to get him the hell out of there to a hospital. Time was precious here, but as he watched his father take the bad energy and neutralize it in a bowl of water, he knew there was no consideration of time in Leonard’s practices. It was all about preparing the body spiritually to accept healing energy and not about treating the injury.
“Does this happen a lot?” he snapped at Joanna, who had stepped out of the cramped bedroom.
“Not a lot, but I run into it every now and then. They trust your father, and as often as not they call him before they call me.”
“The kid could lose his leg.”
“So what do you want me to do, Chay? Physically drag your father out of there? Because, apart from that, he’s not going anywhere until he’s finished.”
Chay swiped angrily at his hair. “What kind of transport can we get to the nearest hospital in Billings? A helicopter?”
Joanna shook her head. “An ambulance maybe. Fastest way is to put Michael in his dad’s truck and take him there straight away.”
“Won’t work. I don’t want him on the road that long. Too bumpy. He’s already shocky, and heaven knows what else is going on with him since I can’t get close enough to take a look.” He could hear his father chanting to the sun to come down and take the boy’s pain into the water. Morphine would have been better.
“We only get a helicopter if it’s life and death, since these people don’t have insurance to pay for it.”
“How about life and limb? Because that kid could lose his leg if it’s what I think it is.” Possibly a compartmental fracture, meaning the swelling was shutting off the circulation. Very bad, possibly even fatal in extreme cases.
“Unless you’ve got a credit card that hasn’t blown over its limit, it’s not going to happen. My superiors won’t approve it.”
“Yeah, well, watch me. Where the hell’s the phone?”
“Do you know how much it’s going to cost you?”
“Do you know what it’s like to be eight and get your leg chopped off?” He paused, took a deep breath. “Go get Michael’s vitals. The extraction’s almost over. By now my father is filling the void where the bad energy was with a new healing energy, and he won’t quit, or even be distracted, until that’s done, so you won’t be intruding.”
“You know the ceremony?”
Hell, yes, he knew the ceremony. He’d gone through it with his father dozens of times. It was the only proper thing to do as the next shaman in the family lineage, to learn early the ways of his forefathers. In his case, that had happened when he’d been sixteen. “What’s the matter? You don’t recognize an honest-to-goodness shaman when you see one?” he muttered. “Look, I’ll be back in a minute.”
He found the phone on the kitchen wall, made a couple of calls, and offered up his credit-card number. As he was reciting the expiration date to the woman who was taking the information, the chopper had already been dispatched and was en route. “Wonder what my father would say about the healing energy in plastic?” he muttered, tucking the card back into his wallet.
Heading back to the hall, Chayton saw his father coming toward him. And Macawi was right. He looked old, tired. Too thin. All these years, and Cha
yton suddenly found himself with nothing to say. Which, as it turned out, didn’t matter since his father didn’t speak to him, didn’t even glance his way, not for a fraction of a second, as he passed by. It was as it had been for a long time. To Leonard Ducheneaux, Chayton Ducheneaux did not exist.
Joanna saw the brief exchange. Lack of exchange was more like it. For a second she also thought she saw a flash of anguish cross Chay’s face. So he’s not so cold-hearted after all, she thought. It had to hurt him, even though he put up a good front. She remembered all the hurt from her own father. Two years when he’d preferred the bottle over her. Two years when she’d been turned away every time she’d tried approaching him. Yes, it hurt, and it was a pain she’d never get over because her father had died still turned away from her.
“Vitals normal,” she said. “On the high side, but not bad. “Breathing is fine, too.”
Chay brushed by her to Michael’s bedside, and bent down to look at the leg. “How’re you doing, Michael?” he asked, running his fingers lightly over the injury.
“I didn’t mean to do it,” he said. “But I thought it would be OK just for a couple of minutes.”
“Football?” Joanna asked.
He didn’t answer, but she could tell from the guilt crossing his face it had been football. Amazing, she thought, his lack of pain. Poor kid should have been in agony.
“It’s definitely compartmental,” Chay said, confirming his worst fears after he’d had a look. “I’m getting a tight feel to the muscle compartment. And Michael’s sensation seems decreased overall.”
Joanna sucked in her breath and held it. She’d never seen a compartmental fracture, but she certainly knew the consequences. Chay was right about this. Without speedy help Michael could—and probably would—lose his leg.
“How long ago did this happen?” he asked.
“This morning, early,” Betty Red Elk responded. “Maybe six hours ago. We put his leg on some pillows, wrapped a bandage on it to keep the swelling down. Then we called…um…Leonard, and DocJo, of course.”
“Damn. Almost too many hours. Look, I’ve called for a helicopter because Michael needs to go to the hospital. Mr Red Elk, would you wait outside to watch for them? And, Mrs Red Elk, since Michael’s going to need surgery this time, maybe you should go pack a few things for him.”
Both obliged quickly. “What’s up?” Joanna asked.
Chay pulled her to the opposite side of the room from Michael. “Six hours is still in safe territory if the swelling isn’t too severe, but the limb has to stay flat and free of anything binding.”
“Oh, God,” she moaned. “They had his leg…” She looked over at Michael.
“I need to do a fasciotomy to relieve the pressure before we can send him. Anything else is going to be risky, and that’s the only way I can guarantee to save his leg.” A fasciotomy was the removal of the fascia, thin connective tissue covering, or separating, the muscles and internal organs of the body. It was a simple procedure, but not one done in the field too often. Certainly, in her trauma experience Joanna had never done one. But she understood the need. Michael’s hours were ticking away. His leg had already been elevated, which was the second worst thing that could have happened. The leg needed to stay level with the heart so it wouldn’t strain so much to pump blood to it. And the worst thing had been wrapping it, keeping the swelling compressed. That put more pressure on the blood vessels and nerves. Combined, those two scenarios were serious, and poor Michael had been subjected to both. But an emergency fasciotomy here?
“You think he really needs it right now?” she sputtered.
“He’s your patient, Joanna, so it’s your call. It could go either way. I might be wrong and he’ll be fine until he can get to the hospital and have surgery. Or I might be right and he’s on the verge of permanent and irreversible damage. But I’m only the hands here. You’re his real doctor.”
She looked over at Michael, who was drifting off to sleep. “Why’s he doing that? Sleeping, staying calm, not acting like he’s in pain,” she asked. “Did your dad do something? Give him something? Maybe some peyote? I’ve heard they, the healers, use peyote.” A hallucinogenic made from the Peyote cactus.
Chay chuckled. “He gave him some peace of mind maybe, but no drugs. Peyote is what my father uses to stay in touch with the spirits, but he wouldn’t give it to someone else.”
“So that extraction thing he did might be working?” Certainly, she didn’t rule out the possibility. Having lived on the Hawk Reservation for six months now, she’d seen many medical situations that hadn’t come with logical explanations. If Leonard’s extraction ritual had given Michael the psychological or emotional boost to get through this, she’d thank Leonard next time she bumped into him.
“Maybe, maybe not. If he’s a believer, then I suppose it worked.”
No way to tell if Chay was a believer. He was definitely an evader, but beyond that she didn’t know. “What’s the helicopter’s ETA?”
“Thirty minutes, then we’re looking at another ten in preparation to transport, thirty back and at a minimum another thirty on top of that to get him prepped and into surgery.”
The time factor was certainly going against them at this point. “Are you a good doctor, Chay?” she asked. “Your grandmother says you are, but she’s your grandmother. I need to hear it from you. Are you good?” He seemed like he was, and she wanted to believe that. But she didn’t know. And the bottom line here was that she was risking Michael’s leg to someone about whom she had questions.
He nodded, but said nothing.
Drawing in a deep breath, Joanna shut her eyes. Something deep inside was compelling her to trust him. Normally she wasn’t like that. She wanted to see the proof—the outcome of other such surgeries, the credentials, the notes of his follow-ups. But he’d said he was good and for the first time in her practical, conservative life, something far beyond her normal logic was telling her to believe that he was good, and that he would save Michael’s leg.
“So let’s do it. I’ve got some minor surgical supplies in my bag, enough for a fasciotomy anyway. Plus Xylocaine if you want to give him a local anesthetic, morphine if you want something stronger. You tell me what to do.”
“I’ll prep him while you go explain it to his parents. OK?”
Joanna scurried down the hall to find Betty Red Elk, who was sitting in an old recliner. Clutching a backpack full of Michael’s clothing and wringing it between her fingers, she was pale, shaking, on the verge of tears. Looking plaintively through the window at her husband standing out in the front yard waiting for the helicopter, then at Joanna, she asked, “Is he going to die, DocJo? Is my Michael going to die? I heard what you were talking about in there, about operating on him right here before you take him to Billings, and that sounds very serious.”
Joanna bent down to her and took her hands. They were cold. But they would be. She was suffering the pain only a mother could feel when her child was so ill. “Dr Ducheneaux will take care of him.”
“Ducheneaux?”
“Yes. He’s Leonard’s son, Chayton.”
“I went to school with Chayton. I was a couple of years ahead of him so we were never friends, but I remember how he was different from the others around here. A lot like Michael is, always doing what he’s not supposed to do even though he knows better.”
A knot was forming in Joanna’s gut. Would Betty have the sentiment of so many others, that Chay was no longer one of them, that he was to be shunned? The sentiment his own father held? If that turned out to be the case, and if Betty, or her husband, refused the emergency procedure because it was being done by Chay, Michael stood to lose his leg. Chay believed that to be the outcome. Because he did, so did she. “He’s a very good doctor, Betty. A respected orthopedic surgeon in Chicago. Michael needs this surgery right now to save his leg and Chay has done it dozens of times. And I’m not qualified to do it, not the way Chay is.” She sounded confident to her own ears, and she surely hop
ed that was coming across to Betty Red Elk, because if it wasn’t…well, she didn’t want to think about that. Michael was going to recover, and she was going to entrust that to Chay.
“When Leonard came to do the extraction, he said he was preparing Michael for the one who came after. I thought that meant you, DocJo, but it was Chayton, wasn’t it?” She paused for a moment, looking to the hallway leading to Michael’s room, even though Michael wasn’t visible to her. “So, yes, I trust him to look after my boy the right way, whatever that is.”
Relieved, Joanna took a couple of minutes to explain the procedure to the Red Elks, had them sign a consent form, then rushed back to the bedroom, where Michael was already prepped, and Chay was waiting at the side of the bed. She glanced at Michael, who was sound asleep. There was no fear on his face. No pain either. Nothing but the quiet look of a little boy who’d merely drifted off to dream little-boy dreams.
“So let’s do it,” Chay said. “I’ll make the cut, you be the anesthesiologist, although I doubt he’ll be waking up. If he does, I think two and a half of morphine will do him.”
The procedure was quick. A swift, vertical incision over the swollen area of Michael’s leg, a cut through the fatty tissue, none of it necrotic yet, Joanna noted as she looked over Chay’s shoulder. That was good. The area wasn’t yet dying for lack of blood flow.
Once he was through the fatty tissue, Chay excised a small piece of the fascia, then he swabbed the area with sterile gauze, bandaged it, and the procedure was over. Minimal bleeding, all things considered. And from the looks of it, minimal effort for Chay. He was so confident, Joanna thought. Certainly, with her experience in trauma she could have done this. But not the way he’d done it, not with such skill and precision. “Thank you,” she said, pulling off her surgical gloves. “That was amazing.”
Chay snapped off his own gloves and tossed them into the trash can. “What’s amazing is that Betty Red Elk would even let me touch her son after my father was here.” He took Joanna’s stethoscope and placed it in his ears, then listened to Michael’s chest. “Good heartbeat. Will you grab his BP?”
