MAYA HOPE, a medical thriller - The Dr. Nicklaus Hart series 1

by Timothy Browne, MD

  With all the tables around him filled with sterile instruments and supplies, Nick found a flat surface on the boy’s chest for the pack of sterile gloves. He removed the pair, carefully unfolded the wrapping, and slipped them on.

  He gently lifted the boy’s right leg at the thigh, where a mangled mess of muscle and tissue, connected by frayed tendons, hung from above the knee, or where the knee used to be. He could see the jagged end of the femur stained with grease from the train.

  “Geez,” he said, shaking his head.

  The mess continued down to mid-calf. There lay the dilemma. A perfect ten-year-old foot and lower leg lay at ninety degrees to the leg, hooked on by the grizzly mess. Nick picked up the other leg to see mirrored injuries.

  “What a mess.” Instinctively, he felt for pulses in the feet. He was almost relieved that there were none. He had no idea how to reconstruct all the damage to the tissue and muscle, never mind the huge loss of bone. He hated amputations. They felt like such a defeat.

  Nick’s head spun, and he realized his heart was racing. He leaned against the table to steady himself and wiped sweat from his brow with the back of his wrist.

  “Turn the frickin’ heat down,” he ordered the nurse by the door. “It must be ninety degrees in here.”

  The nurse looked at Nick and shrugged at the anesthesiologist. Dr. Andrews stood up. “I’m sorry for the sauna, Nick, but we have got to keep the little guy’s temp up.”

  Maybe I’m coming down with something, Nick told himself, not wanting to admit his anxiety with the gruesomeness of the situation.

  Two Residents, led by the Senior Trauma Fellow, interrupted Nick’s assessment as they backed through the OR door with their scrubbed hands held up in front of them.

  “Terrible, huh?” Pete, the trauma fellow said, almost reading Nick’s mind. Pete was doing an extra year in trauma training and would join the team as staff in five months. “I thought even about a femoral turn down,” he said, describing a very rare surgery that was mostly used in limb salvage from malignant tumors around the knee. In this surgery, the knee is resected and the lower leg brought up and coupled with the femur, and the foot is intentionally put on backward so the ankle becomes the knee, essentially resulting in an above-the-knee amputation to function as a below-the-knee amputation, speeding up the patient’s recovery.

  Nick stared at the boy’s legs.

  Pete is going to make a great surgeon. He’s a good, critical thinker.

  “That’s good thinking, Pete.” Nick rubbed the end of the bones with his gloved finger. Grease and dirt had been ground into them.

  A nurse slipped Pete’s surgical gown over his arms. Again, as if reading Nick’s mind, he said, “But I’ve made the call to amputate. The wounds are too dirty. Besides, the femoral turn down takes an hour surgery and turns the whole thing into an all-nighter. I’m just not sure the little guy would survive it. Even with the amputations there is no way we will close the wounds today with them being so contaminated. It will probably be at least a week before we can even attempt to close the wounds if he doesn’t pus ‘em out too bad.”

  Nick was aware of the possibility of infection. “That’s the right call,” he sighed. “I’ll go scrub.”

  * * *

  Nick was in no hurry to talk with the boy’s family, but he understood how anxiously they waited an answer. He leaned against his locker as he put on fresh scrubs. No one wants to see their own child’s blood.

  Blood. Maggie’s pastor talked about Christ shedding His blood for all of us. Just not sure I get it.

  It felt like his life was unraveling, and he wanted to run away. Instead, he sat on the bench. He thought about calling his parents, but he didn’t want to worry them. Would they even understand? The Hart family dealt with pain by not talking about it. Pull yourself up by the bootstraps and get on with it. Anxiety was becoming Nick’s constant companion. Even in the OR, typically his place of solace, he found fear and self-doubt creeping in.

  He willed himself up from the bench and his thoughts.

  Hope Maggie is doing okay. I don’t know what I’m going to tell her. I can’t imagine trying to take a week or two off to go to Guatemala.

  Nick went to the waiting area. He realized he didn’t even know the boy’s name. Guilt washed over him.

  Am I getting too calloused by all this?

  Fortunately, staffing the waiting room desk was a volunteer who knew Dr. Hart. He had fixed her broken hip two years earlier.

  “Dr. Hart, Jeremiah’s folks are over there in the corner.” She looked him with tenderness, knowing what he had to do.

  “Thanks, Rose.”

  “Jeremiah,” he said repeating the boy’s name.

  The family stood when they saw the volunteer pointing to them and a surgeon looking their way. The woman held her hand cupped over her mouth, and the man wrapped his arm around her. A teenage boy and older teenage girl stood on either side of them. They were dressed plainly, the bearded man in a plaid shirt and jeans and the woman in a cotton dress and cardigan.

  Nick shook the man’s heavily-calloused, dirt-stained hand, redolent with a mixture of chainsaw oil and sawdust.

  “You are Jeremiah’s parents?”

  The woman nodded.

  “How’s our Jeremiah?” the father asked, still holding Dr. Hart’s hand.

  “The tremendously good news is that it appears that your son is going to survive.”

  Jeremiah’s mother gasped with relief, and his father hugged her with his free arm.

  “Here, please sit down.” Nick gestured to their chairs and pulled another directly in front of them. “I’m sorry that we could not have talked before going into surgery, but your son’s life was in the balance, and we had to proceed quickly to save his life. I’m Nicklaus Hart, and I am his orthopedic surgeon. What have you been told about Jeremiah’s condition?”

  “The police told us that he had been hit by a train. We have been expecting the worst,” the father relayed. “One of the nurses came and sat with us and told us that he was in surgery.”

  “Can we see him?” the mother cried.

  “We will get you back to see him as soon as they have him well-stabilized in the recovery area.”

  “But he’s going to live?” the mother asked.

  “Jeremiah is still very sick from the trauma he has gone through. We have him in a medically-induced coma, and machines are breathing for him so his body can rest, but yes, I expect him to live.”

  Jeremiah’s parents hugged each other again.

  “Thank you, Lord Jesus,” his father proclaimed.

  “Thank you, Father,” his mother said, choking back tears. “Thank you, Dr. Hart, for saving our little boy.” She touched his arm.

  Nick felt guilty. It wasn’t even him they should be thanking. It was the EMTs who provided first care to the boy at the scene and the trauma team in the Emergency Department who really saved his life. He wanted to explain, but they needed to know the bad news. Nausea swept over him.

  “Jeremiah has a long road ahead of him,” Nick began.

  How do I tell his parents that I took off their son’s legs?

  “Did the police or the nurse tell you about the damage the train did to Jeremiah’s legs?”

  The parents stared at him without saying a word, so Nick pressed forward.

  “You see, the train either went right over his legs or his legs somehow got tied up in the wheel mechanism. It was really severe.” Nick flashed back, seeing the mangled legs for the first time. “I want you to know that if there had been absolutely anyway we could have saved his legs, we would have.”

  Nick could see the tears welling in their eyes and feel tears in his own. He could not imagine what it was like to be a parent absorbing this news.

  “I am so sorry, but we had to amputate your son’s legs above the knees.” Nick reached out to both parents and put his hands on their shoulders. “I am so sorry.”

  CHAPTER 9

  * * *

&n
bsp; Human Rights

  Sitting in the grandstand, Pak scanned the sea of soldiers and citizens—63,453 all together—that filled Kim Il-sung Square. Knowing the exact number and the names of each one was the business of his office.

  He winced when a stiff wind blasted his face and the faces of the leaders sitting adjacent to him. There was nothing he could do about the weather, but he was satisfied with the sun warming their backs and the bright light gave them the best view of the crowd.

  He glanced down and to his left and saw his father sitting three chairs from Kim Jong-un. Pak would be glad to see both of them dead. The entire crowd and leadership, including Pak, wore drab green uniforms; only Kim Jong-un wore his trademark black overcoat and leather gloves.

  Between the massive crowd and the grandstand, a military band performed the North Korean national anthem. Kim Jong-un stood, attentive to the massive red and blue flag. The single-starred flag appeared to genuflect in his presence.

  The anthem rose to a deafening crescendo, and Kim turned and waved to the crowd. As if on command, the crowd erupted in loud applause and praise for their Supreme Leader. The military band followed with a rousing march. Kim clapped his hands to the music’s rhythm, and everyone followed his lead.

  The wind blew the bowl-cut tuft of hair on the leader’s head, and many other leaders reached to secure their own oversized, soviet-style dress uniform headgear. Across the center of the crowd a large banner whipped in the wind, its words dancing like a dervish: “let’s defend with our lives.” Pak secured his own hat and caught a residue of perfume from the latest girl that morning. He could barely suppress a smile of pleasure. Earlier, when he was told he would not accompany Kim to the Sinchon Museum that morning with his father, Pak didn’t protest. He preferred another appointment at the same time at the maternity clinic.

  The rally and the museum visit had been set in motion when a U.S. delegation led the United Nations General Assembly in drafting a resolution to indict Kim on human rights abuses.

  The Sinchon Museum commemorated the alleged mass killing of over 35,000 North Korean civilians by the U.S. military in 1950. It housed rooms full of anti-American propaganda and hatred, including hundreds of paintings depicting U.S. soldiers tearing babies from their mother’s arms, cutting the hearts out of their countrymen, shooting women and children in the back of their heads, and other atrocities.

  Pak knew the museum well, both from the annual visits he had made with his school class and now as the leader of North Korean spy organization. Many of the accusations were unproven, but the museum served its purpose well to feed the masses with hatred of the U.S. pigs.

  He had watched from the clinic the televised and closely orchestrated visit. Kim Jung-un posed in front of a large painting of an American soldier holding a bayonet with a baby speared on the end while the child’s mother clawed at his feet.

  “The massacres committed by the U.S. imperialist aggressors in Sinchon showed that they are cannibals and homicides seeking pleasure in slaughter,” Kim shouted into the microphone of the North Korean Broadcast.

  After the Supreme Leader spoke, a top general was interviewed by the news agency. He stated, “The U.S. imperialists should bear in mind that we have the option to launch a pre-emptive nuclear strike.”

  Pak smiled to himself. The pre-emptive strike was in the works—something that neither the Supreme Leader nor the general knew. He wondered how his team in Guatemala was doing.

  His thoughts were interrupted when Kim Jong-un pumped his fist into the air, and the crowd did likewise followed by a thunderous cheer, “Long live the Kim dynasty.”

  CHAPTER 10

  * * *

  A Welcomed Hero

  The amputation of Jeremiah’s legs catapulted Nick back to the frenzy of the MED, keeping him occupied with more surgeries, procedures, and appointments, busy enough to be distracted from the pain and emotion of the previous week. He did try to call Maggie, but was interrupted by his beeper in mid-dial. He planned to call her back, but hadn’t yet. Maybe it was just as well. He still hadn’t made a decision about going to Guatemala. He hoped time would pass and everyone would forget.

  Nick still wasn’t getting enough sleep. What rest he got was interrupted by dreams, hideous dreams from which he’d wake up, drenching in sweat, narrowly escaping being strangled by a large snake curling itself around his neck. And he was drinking more than usual, including the hard stuff. He knew better; addiction traps of alcohol, drugs and sex run deep for surgeons. But he needed relief from stress.

  Nick was pacing outside the main entrance to the MED, waiting. He glanced at his watch. He was supposed to meet Jeremiah’s family at ten, and it was already quarter past. Jeremiah was recovering nicely, at least physically. They had removed his breathing tube, but it was necessary to take him back to the OR daily to wash his wounds and change the Wound-Vacs. Dirty wounds like Jeremiah’s couldn’t be closed after surgery. They had to be left open to mature and closed only when the infection risk passed. Even with daily anesthesia, it would have been too cruel to pull bandages off the raw flesh. The Wound-Vac was a wonderful addition to a doctor’s toolbox. The Wound-Vac consisted of sponges with a vacuum that sucked fluid and infection from the wound and pulled together the edges of the skin. Jeremiah’s wounds looked so good that Nick hoped to be able close them this afternoon.

  Kids are so resilient.

  But Nick worried about Jeremiah’s mental state because the boy was withdrawing more each day. At Nick’s request, the hospital psychologist visited the boy. The visit occurred on the day Jeremiah looked under the sheets where his legs used to be and was devastated. The psychologist assured him everything would be all right, but Jeremiah only stared out the window saying nothing.

  When that proved fruitless, Nick had another idea, and he was about to put it into action. He glanced at his watch again. Come on.

  He was distracted when a man nearby chuckled, precipitating a coughing spasm. Nick figured the man was one of the many homeless that hung around the MED, and, instinctively, he took a few steps sideways to escape the phlegm from the cough.

  “Your watch broken?” the man said, catching his breath.

  Nick flashed a half smile to appease him.

  The man sat on a bench, bundled in three coats on this warm day; next to him was a bag stuffed with what looked like his worldly belongings.

  “What time is it?” the man croaked.

  “Uh,” Nick glanced at his watch again.

  The man broke into a fit that was more laughter than cough.

  Nick flinched. “It’s quarter past ten. Ten sixteen, to be exact.”

  The man snorted with laughter.

  Nick looked at him and scowled.

  Bug off, old man.

  “You know what time it really is, son?”

  Nick crossed his arms and squared his body. He did not like being ridiculed, especially by this dirty, old bum.

  The man hobbled to his feet. Nick held firm; he could give a sharp right cross if the man came any closer. But just for good measure, he took a step back.

  When he stood upright, the man’s face softened. He smiled and spoke clearly. “Nicklaus, it’s time for a change.”

  Nick was surprised and wary. “Do I know you?”

  “No. No, I suppose you don’t.” He reached for his bag, mumbled something, and nodded at Nick.

  Nick didn’t know what to say or what the man expected. On guard, he watched the man pick up his bag, steady himself for mobility, and walk away. After a few steps, the man turned and winked at Nick. Then he turned away and ambled down the sidewalk.

  That was weird. And how did he know my name?

  Nick pondered this for a moment. Of course. He was wearing his white doctor coat. His name embroidered in blue above the chest pocket. He tried to make sense of the encounter when he was interrupted.

  “Hey, Nick. Sorry I’m late, man.”

  Nick whirled around to face a familiar face in a Service “C” Mari
ne Uniform, looking every part a soldier—leathery face, square jaw, tremendous build.

  “Buck. It’s so good to see you.” Nick stuck out his hand.

  Sergeant Blake “Buck” Hanson pushed his hand away and embraced him. Buck’s big bear hug almost lifted him off the ground. They laughed at Nick’s embarrassment. Nick wasn’t accustomed to this show of affection at work, but Buck was famous for hugs. He was a man who loved life and was not afraid to show it.

  “Who’s your friend?” Buck asked, looking after the old man tottering down the walk.

  “Just one of my many fans, I guess,” Nick shrugged. Who was that man?

  “Well, let’s head ‘em up and move ‘em out,” Buck said in his deep, husky John Wayne voice. He put his arm around Nick’s shoulders and steered him toward the entrance.

  Nick noted Buck’s chest full of ribbons. “Geez, you get some more of those?”

  “Yeah, only two bits apiece at the commissary. Just picked a few more up today,” Buck ribbed back.

  Nick knew Buck had earned each one. The pink scar across his lower jaw was a footnote in his story.

  Nick and Buck made their way to the elevator and walked in. The door was halted by a hand from outside. It belonged to a young woman, accompanied by another. Both wore white scrub uniforms with nametags hanging from lanyards identifying them as student nurses.

  “Sorry,” the first student apologized as they joined the men and turned to face the closing door. They nudged each other. The shorter student blushed and they giggled.

  The blushing student nurse fanned herself with her hand. “Eww, it’s hot in here!” They laughed again.

  Nick noticed the taller student’s white scrub pants revealed bright pink, cheeky panties. She might as well have worn a sign that said, “call me.” He elbowed Buck and tilted his head.

  Buck frowned and raised his fist at Nick.

  Is he going to beat me to a pulp if I don’t stop or is he showing me his wide, gold wedding band?