Going into the case, he was nervous that he would break the fragile bone and make matters worse.
Once they got the old man comfortable on the OR table, Nick put a sheet around his chest. Juan Carlos pulled from the opposite direction for counter traction, as Nick manipulated the arm. They pulled and twisted and tugged and pulled—it looked like they were going to pull the man in two—but to no avail. The x-ray images taken with the C-arm showed that only with the most extreme effort would they almost get the shoulder relocated.
In his head, Nick heard his father’s voice: “Almost counts in horseshoes, hand grenades, and skunks.” He hated the saying because it meant he wasn’t trying hard enough.
“Stink,” he said in defeat.
If they pulled any harder they could break ribs or the arm itself. Discouraged, with sweat dripping down his face and back, he told the team they better stop.
Anna stepped up and asked if she could give it a try.
“Seriously?” Nick snapped at her in frustration and was immediately sorry for his insensitivity.
Not letting it phase her, Anna responded gently, “Can I pray for you and this man?”
Nick stared at her, not knowing what to say. Sarcastic words came to mind, but he held his tongue.
She put her hand on Nick’s and said a prayer for Nick and the patient. The Guatemalan team also prayed with her out loud in Spanish.
When they finished, Nick wanted to ask them if they felt better, but he said nothing. Instead, he gently pulled the man’s arm up to remove the sheet out from around him. He heard a pop. Heartbroken, he thought he had broken the shoulder and asked for another x-ray with the C-arm.
There, in perfect position, sat the shoulder in the socket.
What in the world is that about?
He pushed the thoughts from his head. There was no way he was going to be able to reconcile this experience with his medical training.
From under the mango tree, Nick watched a Monarch butterfly flutter and float around the flowers planted in the garden surrounding the bench. It finally settled on the outstretched hand of a small statue of Saint Francis of Assisi.
Nick leaned back and stretched his arms across the top of the bench and wondered if he should head back to the clinic. He was enjoying the momentary solitude.
A wayward ball rolled to Nick’s feet. He kicked it back to the young crowd without leaving the bench.
It was already Friday. He could not believe how fast his first week had gone and that his team had fallen into a pretty good rhythm of clinic one day and surgery the next. But he had a growing sense of uneasiness, with the expanding list of patients that needed surgery.
Nick was still trying to figure out how to get the supplies down for next week. He had talked with his favorite orthopedic implant rep in Memphis who had agreed to put together sets to send him. The problem was, they would practically need a truck to bring down the different instrument sets and boxes of implants, as well as, plates, screws, nails, and other implants to be used to fix bones and replace joints. He would have to prioritize somehow, and that didn’t make him feel any better because there would be people who’d go without.
How do I make that decision?
That thought and the amount of pathology he saw overwhelmed him. Each story from the patients and their families was heartbreaking. Patients with broken arms and legs so easily fixed in the States had received no treatment here, leaving them with devastating deformities and chronic pain. He had already shed more tears here than at any other time of his life, except when he heard the news that John had been killed. He was embarrassed by his tears, but no one seemed to care or even notice. What a different world this was than the hardcore grind of the MED.
The Monarch butterfly flitted from its perch on Saint Francis and landed on Nick’s hand stretched across the top of the bench. It sat on his finger and flapped its wings. Its weight was light like a warm breeze. He admired its beautiful, integral pattern of black and yellow.
“What do you think about this, little guy?”
Anna rounded the corner and interrupted his thoughts. He hoped she hadn’t seen him talking to the butterfly.
“I thought I might find you here. I’m so sorry to bug you, but we have people waiting.” She saw the butterfly. “I see you have a new friend.”
“Cool, huh?” He lifted his finger, and the Monarch drifted away.
“Here,” she said, handing him a glass of iced tea. “You might need this.”
* * *
The exam room fell silent as two of the California students escorted a girl inside. With the young men at her sides, she shuffled into the room. A Maya man and woman followed behind. The man held a cowboy hat to his chest. Nick assumed they were her parents.
Never in his life had Nick seen such a pitiful child. When she entered, it was as if a shadow of gloom filled the room. Nick surveyed the girl and estimated she was around ten years old. She was neatly dressed in a yellow skirt and clean white shirt, but her face was drained of color and life. Nick couldn’t get over her look of sadness, shame, and unfathomable defeat.
But it was not her face that everyone else stared at; it was her bare feet. Nick could tell the child was aware of their stares. He had an instant thought that if he had to take his biggest regrets and deepest, darkest secrets and wear them around his neck, this is how it might feel.
He looked at her feet. Compassion overwhelmed him. The girl’s feet were so badly deformed, they looked as though they had been put on backwards and upside down. In order to walk, she had to walk on the tops of her feet. How painful that must be?
He noticed Anna watching him with her cheeks wet with tears, and he swallowed hard.
The young men helped the girl stand in front of Nick. “Dr. Hart, this is Isabella.”
One of them put Isabella’s hand in Nick’s. Her eyes fixed on the floor.
Nick took her hand. It was limp and lifeless. “Isabella, my name is Dr. Hart. You can call me Nick.”
Anna translated.
“I’m going to put you in a chair, if that’s okay.”
She nodded slightly, and Nick lifted her under the arms and set her down on the chair. He sat in his own chair and looked at her. Despite her feet, she was beautiful—perfect, delicate facial features, and thick black hair. But he remained unsettled by her defeated expression and wondered how often she had to endure public humiliation.
“Would you like some water?” he asked.
She shook her head.
“How old are you?”
Isabella did not reply, her eyes locked on the floor.
“Do you go to school?”
Still no reply.
Nick looked at her mother, who came forward to put a hand on Isabella’s shoulder.
“Ella es de doce,” she said looking at Anna to translate.
“She is twelve.”
“Can you tell me about Isabella?” Nick asked the girl’s mother.
Anna translated a sentence at a time as the woman answered.
“Isabella was born very normally. Except that both her feet turned in.” Anna demonstrated with her hands, imitating the mother.
“She is actually a twin, and her sister is without problems. We live far into the jungle and we thought that her feet would straighten themselves, but they kept getting worse and worse. We took her to the local hueseros, and he wrapped her feet and sprinkled medicine over them. The huesero said there was a curse on this child.”
Nick watched Isabella’s face as her mother spoke, blinking back tears.
Nick patted the child’s thigh and looked at Anna. “Sorry, what is the huesero?”
“They call them bonesetters here.”
“You mean an orthopedic surgeon?”
Anna shook her head, “Oh no. More like a witch doctor. It’s something that is usually passed down through the generations. They have sacred objects,” Anna made quotation marks with her fingers, “pieces of bone and stones that they use with chants to break
curses.”
Nick raised eyebrows and turned back to Isabella. “Have you ever been to a real doctor?” he asked without thinking.
Anna looked at Nick without translating. She paused, carefully picking her words. Finally, she said, “Things are different here, Dr. Hart, in lots of ways. It might take them a day or so to walk out of the jungle and then two days on buses to get anywhere with medical care. Not to mention the fact that it might take three or four months of wages to pay for the trip, not counting the cost of medical care.”
Nick was chastened. To cover, he smiled at Isabella’s escorts. “You boys must have had quite an adventure.”
“Yes, sir,” they said proudly.
“This one of your treasures?”
They beamed.
Nick looked at Isabella. “Can I look at your feet?”
She didn’t reply. Nick took that as an affirmative.
He picked up one leg and then the other. Her feet hung from her shinbones like useless appendages. It was disorienting. It was as if her feet really had been put on backwards. For a second, Nick wondered about those curses.
He moved her feet back and forth. Both had five toes and significant callouses on the tops of her feet on which she walked. The tops of her feet were now her soles.
“Unbelievable.”
All of a sudden, it occurred to Nick. “Oh my God. These are untreated clubfeet,” he said inadvertently.
“Really?” Anna joined his enthusiasm, having no idea what he was talking about.
“About one out of a thousand kids are born with this. Way more common than what you would think.”
“Do they all look like this?” Anna asked.
“Oh gosh, no. They are treated as babies, and most the time, you can never tell they had clubfeet.”
One of Isabella’s escorts spoke up. “I had a clubfoot as a baby.” He lifted one of his Nike-covered size-eleven feet.
Everyone looked at his perfect feet, even Isabella who had no idea of what had been said.
The young man didn’t realize the implication until after he had said it and looked down at the ground, “I’m sorry you all. I feel terrible.”
Nick interceded. “Well, you can’t help where you were born. Just be grateful your parents could get you the right care.”
He turned his attention back to Isabella and gently stretched her feet the way they were supposed to go. Her feet went barely a fraction of the way.
“Well, that’s great. Right? If you know what’s wrong, then you can fix it.” Anna looked at Nick waiting for answers. “What can you do to fix her feet?”
Nick was silent for a long time; he moved Isabella’s feet back and forth. His eyes were moist with tears. “I have no idea.”
CHAPTER 21
* * *
God is Good
“Maggie, I can’t do it. I don’t know where to start.” Nick’s anxiety pumped his heart and he wiped sweat from his upper lip.
Maggie rose from the bench to refill Nick’s lemonade glass. A full moon illuminated the Hope Center. It was a relatively warm night. Insects chirped in the trees and the toads croaked in the grass.
Maggie returned to the bench and put her hand on his arm.
Nick was glad to have her close.
They sat in silence for a long time, and an indescribable peace enveloped them.
Maggie felt Nick’s muscles relax as he slumped down on the bench. She continued to let him vent.
“I’m not sure I’ve ever been this…” he searched for the words. “I think I’m in over my head. Besides Isabella, we saw three other kids with clubfeet. During residency, I maybe saw one clubfoot surgery. It’s just not done anymore. Those babies are treated with stretching and casting so fast that not even the pediatric orthopods do the surgery much anymore.”
His pulse pounded and his muscles tightened.
“And that’s on a one or two-year-old, let alone a twelve-year-old. There is no way.” He shook his head. “Even if I knew what I was doing, that surgery is fraught with landmines. My God, you could so easily cut those tiny nerves or blood vessels. Then you would have to cut her foot off.” He made a slashing move against his leg. “I’m sure that would go over good with her parents!”
She patted his arm and smiled at him.
“Maggie, say something. Help me out here.”
Nick was at a loss. It was as if dark clouds smothered his soul and filled his brain with self-doubt and incompetence, echoes of messages he told himself growing up.
How would Maggie see me if I told her I am too afraid to do it?
He steeled himself against her stare. “What are you thinking?” he ventured.
“I’m just sitting here praying for you, Nick.”
“Geez and that’s another thing. This whole God thing. I don’t get it.” He stopped before he said something that would hurt her feelings.
Again, there was silence.
Maggie cleared her throat. “You know I believe in you.”
“Yeah, but clubfeet?” He covered his face with his hands.
“Nick, I believe in you,” she began again, “and I trust you to make the right decision.”
He grabbed for a solution. “How about sending these kids to the States? I’m sure we could find someone who would be brave enough to tackle this.”
Maggie sipped her lemonade. “Well, I wish it were that simple. We have been successful in sending exactly one person to the States for care and that was seven years ago. It was a young man with the worst scoliosis that John had ever seen. It was going to kill this kid. His heart and lungs were being compressed. A friend of John’s is a spine surgeon in Texas, and he helped arrange it all. John went to assist and did the initial approach through the chest and abdomen. They opened him up from his throat to his pubis.”
She stood for effect, drawing the incision line down her front.
“John had to move everything out of the way—heart, lungs, intestines—everything. John swore he had never sweated so much in his life. They had to go to every level of the spine and cut all the ligaments. Even then, they had to remove some ribs to release the deformity. After a week in ICU on a respirator, they took him back to surgery and opened his back all the way from the base of his skull to his sacrum and put in screws and rods to stretch his spine.” She illustrated, turning her back, stretching one hand to the base of her skull and the other to her lower back.
“John said he had never seen anything like it in his life. But that young man survived all that and walked away six inches taller, his dignity restored.”
“Wow.”
“Yeah, right?” she sat back down.
“Can’t we do something like that?” Nick asked.
“At the end of it all, the bill was close to a million dollars. It was so remarkable that the hospital and surgeons wrote the bill off.”
“Try to get that done these days,” Nick said.
“Exactly. Hospitals don’t have that kind of expendable money anymore. Even the Shriners are having a hard time taking care of the kids in the States.”
Nick stood. He needed to move. “So what happens to Isabella?”
“Well, we tell them that there is nothing we can do for her except to pray, and we send them home.”
“You’re kidding me. I feel like I’m in an impossible situation.”
Maggie smiled and searched his eyes. “Nick, honestly, sometimes when we get to the end of the rope, when nothing seems possible, that’s when we find God. I’ve seen Him do the impossible. That’s the God we serve. If there is anything I learned growing up on the Rez and living here, it’s that.”
“What kind of God would let a child be born like this and not give her a way out?” His voice was angrier than he’d intended.
“Oh, my dear Nick. This sort of thing does not come from God. God doesn’t give what he doesn’t have. The God we serve is a loving, kind God. Our heavenly Father is a good daddy.”
“How do you explain something like this then?” Still
frustrated, he returned to the bench.
“Nick, it is terribly difficult to understand how an all-seeing, all-knowing, all-powerful God could let this happen. I know you are going to hate this answer, but sometimes you have to embrace the mystery of it all. I do know this—there is a battle that rages between good and evil. Look what happened to John.” She stopped and began to cry.
Nick’s head swirled, not knowing what to say or do.
Then she pierced his eyes with a gaze that was kind and full of such conviction that moved his heart and soul.
“Maggie, I am so sorry.” He wiped a tear from her cheek, and quickly lowered his hand, reluctant in the intimacy.
But Maggie took his hand and held it against her cheek. Then she kissed his palm and said, “You’re a good friend, Nicklaus.”
Suddenly, their moment was shattered by shouts and screams outside the compound—the sounds of an angry mob, yelling men and women, and a woman screaming for her life.
Maggie squeezed Nick’s leg and bounded from the bench. “Oh my God, what is happening?” They took off running, Maggie three steps ahead of Nick. The gate was swung open and they were confronted by a howling, frantic mob. The guard was nowhere in sight.
The ruckus had awakened the entire campus, and some of the California men, shirtless and in sleeping shorts, had raced to the fracas.
Car lights shed some light on more than thirty people huddled in a circle, shouting. Nick couldn’t understand what they said, but he knew they were angry.
As danger bells rang loudly in his head, everything inside of him told him to slow down. He watched Maggie dive into the melee, and he couldn’t let her go alone.
Despite her tiny frame, Maggie was a scrapper. She pushed through the crowd into the center. Nick followed. He heard Maggie screech at the top of her lungs: “Joseph, no! Stop! Joseph! For God sake, Joseph, remember who you are.”
Nick caught up to her to see Joseph, the Hope Center’s guard, looming over a crouching, screaming woman, holding his gun above his head and aiming its butt at his victim’s head.
Maggie blasted past him and threw herself over the woman, raising an arm with fingers splayed and pleading, “No, Joseph, no.”
MAYA HOPE, a medical thriller - The Dr. Nicklaus Hart series 1 Page 14
