Dr Velascos' Unexpected Baby

by Dianne Drake

  “Yes, but usually it’s not so bad as it is today.”

  Untreated asthma scared Bella because it could be a killer in the way it methodically shut down the air passages. In Ricardo’s case, he was in the throes of a severe broncho-spasm, where his air passages were opening up to let the oxygen in then shutting off once it was, literally trapping it there so it couldn’t be replenished with fresh oxygen. The sheer effort of forcing that air back out exhausted the body because it was starving for more oxygen, and the more it needed and didn’t get, the more fatigued the body became. Without the means to diagnose Ricardo, Bella still guessed there was a marked increase in swelling in his air passages, trapping that air inside his lungs more and more each passing second.

  The boy was wheezing hard, his respirations much too short and fast. He was also growing agitated because his brain demanded oxygen it wasn’t getting in sufficient supply. At this stage, the brain started shutting down.

  Laying her fingers to Ricardo’s small wrist, Bella counted a pulse of one hundred and thirty, which was well beyond normal. That, coupled with the way he was fighting so hard to breathe that he was using accessory muscles in his neck and shoulders, was a dire sign. “Ricardo,” she said, readjusting her position so she could help him sit up. Lying down during an attack only made it worse. “I’m a doctor, and I’m here to help you.” Not that there was much she could do without asthma drugs. “What I want you to do is sit up and don’t lie back down. I’ll help you. Do you understand?”

  Ricardo’s mother translated the instructions for him. Unfortunately, Ricardo was very sluggish to respond even to her voice, which meant his lack of oxygen was probably causing him some confusion now. “Listen to me, Ricardo. You have to sit up.”

  Ricardo did roll his eyes up at her, but rather than waiting for him to signal that he understood what he needed to do, Bella pulled him to a sitting position, held him in place, then propped a pillow behind his back. “Más almohados, por favor.” More pillows please. Immediately six more were tossed at her.

  Within seconds Bella had Ricardo sitting up, nearly straight, against a wall of pillows. “Now, I want you to relax, and calm down.” Good, encouraging words that sounded so calm when Cielo translated them, and sometimes staying calm was all it took to control an asthma attack. But not this time she feared after another minute without response from Ricardo. Not for a child who was scared to death the way Ricardo was.

  “¿Es médico usted?” Are you a doctor? He choked out the weak words between breaths. Eyes shut, head slumped to the side, arms so weak that when she lifted one up then pulled her own hand away, it dropped like a rag doll’s, Bella recognized that his stage of fatigue was advanced. Ricardo was fighting, but there was only so much fight in such a small body, and this was fast turning into a battle he wasn’t winning.

  Pulse one-forty and thready now. Lips turning blue. The rattling from Ricardo’s lungs was so loud it could be heard on the other side of the room. In the best-case scenario he would have been hospitalized already, with the medicines he needed flowing into his veins and fresh oxygen from a mask going into his lungs. “How long do these attacks normally last before he gets over them?” she called to his mother.

  “Sometimes they go away quickly. Sometimes they last a while. Maybe half an hour. Then he starts feeling better.”

  “¿Ricardo, todavía me puede oír usted?” Can you still hear me? Much to her relief, he tried to respond, turning his head slightly to face her. But the struggle for him to suck in a breath made even the simplest effort so difficult that he simply gave up trying and let his head sink back, limp, against the pillows. His eyes did flutter open briefly, though. And she understood the look she saw in them…fear. Pure fear. “Defiendase,” she whispered to him. “Fight back. I know it’s not easy right now, but fight back, Ricardo. Think about every breath you take. Think about taking it in, think about letting it back out.” Was he hearing her voice now? Was he hearing his mother’s voice translate the words? With the way his eyes fluttered shut again, Bella doubted it.

  “Your medical kit.” Teresa squeezed into the tiny room and crawled her way across all the beds with it. “And Father Carlos has gone to find Juan Gabriel.”

  A medical kit that would do no earthly good because she needed drugs to end Ricardo’s crisis, and she didn’t travel with drugs of any kind any more. Most doctors didn’t these days—it put them at too high a risk of being robbed. And the restrictions of air travel pretty well prohibited traveling with them if you did still carry anything with you. Bella doubted it would be any different with Gabriel, although she was glad he was on his way.

  “Ricardo will be OK in a little while, won’t he?” Cielo asked from the doorway. There was no confidence in her voice, however. Only fear.

  “This is a severe attack. I don’t know if it’s worse than others he’s had in the past, but he’s having a pretty rough time of it right now.” While Bella didn’t need a better listen to his chest to know exactly what was going on inside, she positioned her stethoscope and listened to the wheezing anyway. It was bilateral, spread out over both his lungs, and the amount of air passing in and out now was so little she actually started going through a mental check list of how to proceed with cardio-pulmonary resuscitation should that become necessary. But to what end? That’s what was scaring her, as she could perform all the essential lifesaving steps necessary, yet she had nothing to give him medical support to come after it. No oxygen, no medicine or IV fluids, no way to continuously measure his oxygen levels. Not even a good way to get him to the hospital because, as weak as he was now, Ricardo didn’t stand a very good chance of surviving the long, bumpy trip off the mountain—not by truck or car, anyway.

  “Arabella!” Gabriel called from the hallway, his footsteps pounding hard on the wooden floor as he ran to the bedroom. Father Carlos, who was a good foot shorter than Gabriel with half the stride, followed on Gabriel’s heels, scrambling to keep up.

  “Do you have any kind of a bronchodilator? Albuterol, or even a corticosteroid?” she called.

  “No. Unfortunately, I don’t have anything.” Bending down, Gabriel began his crawl across the beds, tossing his medical bag in front of him. He stopped next to Bella, took one look at Ricardo, who was slumped so limply into the pillows now it was anybody’s guess if he was still conscious. The expression on Gabriel’s face as he instinctively took Ricardo’s pulse told her he knew exactly how critical this situation was. And neither of them had what they needed to take care of it. Simple things. All they needed were simple things, and that’s what was so frustrating. So little could have done so much for a dying little boy.

  “He really will get better,” Cielo called from her station by the door. “He always does, after he rests for a little while. He just needs his sleep now.” The words of a mother whose hope was fading. “Sleep will make him better.”

  In a mother’s estimation sleep might have been the cure, but in a doctor’s view sleep wasn’t Ricardo’s friend now. “Is there any way to get him to a medical facility?” Bella asked Gabriel. “Helicopter?”

  Gabriel shook his head. “Not easily. We can’t get a helicopter in here, not anywhere close. No place to land. And you’ve traveled the road in…the only road in on this side of the mountain…so you know how bad that is. The one on the other side is better, easier to travel, but much longer, and either way it would take forever to get an ambulance here, if we could even get someone to send one, which I doubt anyone would. But maybe I could have an ambulance from the hospital in Iquitos meet us halfway.”

  “How long would that take?”

  “At a moderate pace, maybe an hour and a half, if we’re lucky.”

  “And at the pace we’d have to drive…” Much longer. Too long. Gabriel didn’t have to answer her because the expression in his face told her everything she needed to know. In Ricardo’s present condition he wouldn’t survive the trip, no matter how short it was.

  Meaning they were running out of opt
ions.

  On a discouraging sigh, Gabriel wrapped a blood-pressure cuff around Ricardo’s arm and took a reading. Then he listened to his chest. But rather than calling out results Bella already knew were bad, he simply shook his head.

  “Have them meet us,” she told him. “Find out how far they’ll come and tell them we’ll meet them there.” It was a risk, but there wasn’t another choice. The boy needed what they didn’t have.

  “I’ll take care of that!” Father Carlos called. Outside the door, where he’d been standing, the crowd had grown to twenty people, all of them huddled together, none of them making a sound.

  “Now, Gabriel, here’s what I need you to do. I’m going to try something called progressive relaxation technique…”

  “Hypnosis?” He leveled a clearly puzzled stare on her, one that didn’t doubt or decry her idea but one that was more surprised than anything else.

  “It can work, particularly in asthmatics whose attacks aren’t triggered by allergies. Ricardo’s are triggered by exercise, which is in our favor. So I need you to speak for me since I don’t speak the language well enough. Much of the success will be Ricardo understanding what you’re saying and connecting to your voice.”

  “Me? I’ve never done anything like this. I cut them open to save their lives, but I don’t talk them through it in the way you want me to.”

  “I’ll get you through it, Gabriel. You trust me, Ricardo trusts you.”

  He nodded, reaching across and giving her hand a squeeze. “I’m impressed. You have hidden abilities I didn’t expect.”

  “You know what they say about desperate times calling for desperate measures.” She was glad to have Gabriel there with her, not only to assist her medically but to give her confidence. She’d never done this before. Practiced it, yes, but had never applied it in a medical situation or crisis. There was medical research to support it, though. Research indicating a good outcome. And all she wanted was that good outcome for Ricardo, no matter how she went about getting it. But reading the research and applying it were two different things, and she was nervous because there really was nothing else to do, now. Quite plainly, it was this, or the boy would die.

  “Well, I’d put my desperate times in your hands any day. In fact, I already have, with Ana Maria. And I would again.”

  “It’s a controversial technique, and I wasn’t allowed to use it in our clinic because it’s not recognized as traditional medicine.”

  “Every little advance in medicine starts out as something that’s not traditional. People resist it until it’s proven valuable then suddenly it’s traditional. If you think it’s worth a try, I’m with you.” Their eyes met briefly, then Gabriel gave her a confident nod. “And I trust you, Arabella, maybe even more than you trust yourself.”

  That meant everything to her. More than she’d expected it to. “Thank you,” she whispered.

  He smiled before he turned his full attention to the boy. “Can you hear me, Ricardo?” he said in words the boy could understand. “Dr. Bella did an amazing job helping my baby get better, and she’s going to do the same thing for you now, too. But you’ve got to trust that this will make you better. Can you do that for me? “

  His baby. He’d called Ana Maria his baby, but his voice had been stiff. Bella could hear it and for a moment she wondered if Gabriel and Ana Maria were bonding yet, or if he was still so detached from her, doing the right things for his little girl from an emotional distance. “Are you ready?”

  “Ready.”

  He looked concerned, as he should have. But he didn’t protest, didn’t question her as she gave him instructions, told him exactly what to say, and when. “Good. Now, keep your voice low, quiet, and talk slowly. The way I’m doing now.” She drew in a deep breath. This might be their only chance.

  Gabriel nodded again, then began. “Ricardo, I know this is very difficult for you, but you need to concentrate only on one breath. Listen only to my voice, and take one breath. Take it in, take it in, take…it…in…Good. Now, let it out. Let…it…out. Good job. Now, let’s do that again.” He glanced over at Arabella, who smiled.

  For the next few minutes Gabriel focused solely on coaching Ricardo through every one of his breaths, and while the boy struggled desperately with them, Bella did notice that after a little while he was actually fighting to match his breaths to Gabriel’s calculated cadence. And Gabriel was concentrating so hard on this he’d shut out everything around him. What an amazing man, she thought as he continued to talk Ricardo through this breathing, breath by breath.

  “Pulse one-thirty.” Bella matched the tone of her voice to the dulcet tone of Gabriel’s. To be honest, she was fairly hypnotized by it herself. Maybe even a little seduced. A voice for the bedroom, and silk sheets and candlelight. Which she didn’t do, she had to remind herself. She had to shake her head to physically shake off the feeling coming over her.

  “Ricardo,” Gabriel continued, “keep your eyes closed, and begin to feel yourself relaxing. Relax, and breathe. Relax…and breathe. Relax…breathe. That’s all you have to do.”

  “Pulse one-twenty,” Bella whispered. “Blood pressure holding stable.” She leaned over and whispered further instructions in his ear so not to break Ricardo’s concentration, which seemed very good. All in all, she was encouraged by what she was seeing.

  Gabriel smiled his understanding, then continued. “Very good, Ricardo. You’re doing a good job. Now, think about your right arm. That’s all I want you to think about. Your right arm. Relax your right arm, let it grow more and more comfortable. Let your muscles become loose and limp and even more relaxed until your arm feels so light it could almost float.” Gabriel repeated that several times, then moved on to various other body parts…Ricardo’s left arm, his legs, his neck, his shoulders, then finally his lungs. And amazingly, with each instruction, the vital signs Bella whispered back to him got better and better.

  They were winning the battle for Ricardo. She felt certain of that as she listened to the boy’s chest. His breathing was evening out, the flow of air smoother now, while the wheezes that had been so loud just minutes before were diminishing to where they’d become only audible through her stethoscope. After about twenty minutes of Gabriel’s relaxation technique, she whispered more instructions to him, sighing in relief. It was over. Finally.

  “Ricardo, listen to me. I’m going to count to five,” Gabriel said, “and when you hear that number, your eyes will open and you’ll feel relaxed and refreshed.” He repeated his instruction then counted slowly to five, his voice a little less soothing and a little more awake and normal with each passing second. When he reached the magic number, Gabriel drew in a deep breath, braced himself, then said, “Eyes open, Ricardo! You’re awake now, feeling better, breathing better.”

  Miraculously, the boy opened his eyes, and what Bella saw there wasn’t the same fear she’d seen earlier. He was still frightened, of course, but not on the same profound level. What she saw in the boy’s eyes was…trust. And the silent acknowledgment that all was well. As a doctor she felt gratified. But as a person she felt…connected.

  “We did it!” Gabriel said, sounding totally amazed, looking totally stunned.

  Without thinking, she threw her arms around his neck and hugged him. Naturally, when she realized what she was doing, and enjoying more than she had a right to, she tried pushing herself away, only to find that Gabriel was holding on to her.

  “We’re a hell of a team, Arabella Burke,” he whispered in her ear.

  She responded with goose bumps stampeding up and down her arms. Had he noticed the way she reacted to him? Dear God, she hoped not. She also hoped he hadn’t noted the way she’d simply melted into his embrace when it had become obvious that it had turned into his embrace.

  They were simply two people celebrating a happy moment. That’s all it was, she told herself when they finally did break away from each other. But the goose bumps still running riot all over her said something altogether different.
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  The ride to meet the ambulance that would take Ricardo on to the hospital was a long, nerve-wracking one, taking half again as much time as it normally should have, with Gabriel driving painfully slowly to avoid the bumps and holes in the road. Cielo sat in the front seat with him, alternately praying, assuring her son that everything would be fine and thanking Bella and Gabriel for their help, while Bella stayed in the back seat with Ricardo, keeping a close watch on him. He was awake now, his breathing steady, but he was still a little weak. Nothing serious, though.

  Fernando Alcantara, Cielo’s husband, who followed along in the family truck, met up with them at the rendezvous point just as the medics anchored an IV in Ricardo’s arm and strapped an oxygen mask to his face. It was more for the sake of precaution than anything else because Ricardo was already protesting the treatment. To be honest, he really didn’t need to be hospitalized in his present condition but Bella wanted him checked in a regular medical setting, with some blood work and pulmonary function tests performed. More than that, she wanted the doctor there to give him an inhaler to be used when he felt an attack coming on. It was a short-term solution to a long-term problem, because she had no idea what the Alcantara family would do when that inhaler needed a refill. She was sure the public hospital would provide it at a cost they could afford, or even give it to them free, but what about the long trip to go for it?

  That was the big question that couldn’t be answered. In practical terms, the prognosis for that happening wasn’t so bright when the trip to get it was nearly impossible for the Alcantaras, as well as for so many of the others in the mountain regions. It was a problem that worried her because there was no easy solution. It had worried Rosie, too, and Bella was beginning to understand why.