12

The Kijabe Hospital casualty department was a sixty-by-twenty-foot rectangle filled with stretchers separated by old curtains. Jace found Beatrice Wanjiku on a stretcher, sitting bolt upright, sweat beading off her slick dark skin.

It took one look, a ten-second assessment of the ABCs—airway, breathing, circulation—and Jace knew she was in trouble. Life-threatening, in-your-face, I-can’t-get-my-breath trouble. In his time as a cardiothoracic surgeon, Jace had watched plenty of people who looked better than this go south and die in a hurry.

He looked at a nurse. “This patient needs to be intubated now. Do you have a crash cart somewhere?”

“It is just there,” she said, pointing to a wooden cart on wheels in the corner of the room.

He laid his stethoscope against Beatrice’s back and moved it up and down, listening to her shallow and labored breathing. To his intern, he said. “This is classic for wet rales. They go most of the way up her back.” He pointed to the veins in her neck. “Here,” he said, “she has jugular venous distention up to the angles of the jaw. You will not see a better example of heart failure.”

Paul nodded. “I was able to start a small IV in her hand.”

“Give furosemide 80 mg. stat. We need to chip her out.”

Paul’s expression told Jace he didn’t understand.

“Sorry, I’m using slang. We need to cause her to get rid of extra fluid. We say that’s making her dry like a potato chip, so we say chipping her out.”

The nurse frowned.

Jace understood the dilemma. In Kenya, potato chips were called crisps. In Kenya, if you asked for potato chips, you’d get what Americans call fries. “Okay, we’ll call it crisping her out.”

Jace assembled supplies, preparing to slide a breathing tube down into his patient’s trachea. That way, when breathing became too hard for her, the machine could do the work. From the looks of his patient, he didn’t have much time.

Jace looked at the nurse again. “I’ll need some sedative. Do you have Versed and fentanyl?”

“I will bring them.”

Jace stood beside his patient and explained, “You are wearing out, Beatrice. You will die soon if we can’t support your breathing.”

Her eyes widened. “Help me,” she whispered.

“I’m going to give you something to relax you. You won’t remember.”

Jace instructed the intern, gave the IV medication, and placed a mask over the patient’s mouth. He used an inflatable bag known as an Ambu bag to push oxygen into his patient’s lungs. Then, after the patient was no longer fighting, he slid a metal laryngoscope blade into her mouth, pushing the tongue to the side. He stood by his intern at the head of the bed, staring down through the patient’s open mouth toward her feet. “There,” he said, “can you see the vocal cords? Slide the end of the tube through there.”

Paul slid the tube into place and inflated a balloon-cuff to keep air from escaping around the tube. “I’m in.”

“Good job. Let’s get her up to the HDU. Call the medicine doctor. I want all the help we can get to stabilize her.”

 

The next morning, it took two hours of phone calls to finally get the Honorable John Okombo on the phone.

Jace looked at his watch. “Thank you for taking time to speak to me.”

“Dr. Rawlings, my pleasure.”

“Did you know that Beatrice was admitted to Kijabe Hospital last night?”

He heard a faint “Excuse me” and the cessation of background noise. He imagined the MP was stepping away from the ears of others at the mention of his secret daughter. After a moment, Jace heard Minister Okombo’s strong bass voice spoken just above a whisper. “I was unaware. How is she?”

“She’s in heart failure. The damaged valve is worse. She is alive because a machine is forcing oxygen into her lungs.”

“Do everything, Daktari. I’m indebted to you.”

Jace decided to play hardball with the politician. He might never have this kind of leverage again. “I need my equipment.”

“I told customs to release it to you.”

“Yes, for five hundred thousand shillings. I don’t have funds for such a bribe.”

“Bribe? This is an import tax.”

“For a donated, used item? The pump has value only for your people.”

“I’ve already instructed them to give you a fair price. They assured me that they could have asked for much, much more.”

“I spent the night at her bedside adding and adjusting her meds. Beatrice may need surgery soon. If we can’t stabilize her, there will be nothing I can do without my equipment.”

“Surely, to an American heart surgeon, our tax is like buying weekly groceries. I know you would make this amount in one surgery at home.”

Jace frowned. The MP was right. He could afford it. It was a matter of principle. But at that moment, Jace wasn’t sure if the MP was bluffing or if, in fact, he was bluffing himself. Would I really let my patient die if I could save her for five thousand dollars?

He knew the answer. He would move heaven and earth to save this girl if he had to. To lose a patient because of a political battle would be beyond unethical. But he needed the politician to believe that Jace would do just that. After all, tough decisions to limit care were made every day in Kenya.

He hesitated. “Beatrice may not last long. I’d hate it if she didn’t make it because of lack of equipment. Should I transfer her to a heart surgeon in Nairobi?” He tapped on the phone. “Or maybe you could arrange an air evacuation to South Africa?”

“You are a more than capable surgeon. Moving her could be risky.”

“My hands are tied.”

“Pay the fee. I’ll see to it that your equipment arrives.”

“Drop the fee, and I’ll do what I can to convince the hospital to take her as our first open-heart case.”

“Don’t play games with my daughter’s life.”

“Exactly,” Jace responded. “Don’t play dangerous games with me. I’ve lost many patients before. But have you lost a daughter?”

The MP huffed.

“Even if I get my equipment, there are still many hurdles.”

“But you will try?”

“If I get my equipment.”

Jace listened as the MP’s voice became muffled. It sounded as if he had covered the phone with his hand while he engaged in a cascade of rhythmic cursing. After only a few seconds, he heard a clicking sound and the dial tone.

His appeal to the MP was over.

 

In Richmond, governor Stuart Franks sat behind his massive oak desk staring at the medical examiner’s report. He looked up at his chief of staff, Ryan Meadows, and slapped the paper. “Who knows about this?”

“Just the folks down at the medical examiner’s office. They released it to me only because I pressured them. I told them I represented you. Since it’s officially a medical record, it can be accessed only by next of kin.”

“And why has it taken so long for this to come to my attention?”

Ryan walked away. “Look, Stuart, I’ve sat on this for weeks. No one else knew. The police weren’t investigating a homicide.” He sighed. “I didn’t want to tell you until you’d gotten back on your feet yourself.”

The governor sighed. It had been a long road back. First, he’d had the massive heart attack and emergency surgery, then a postoperative stroke and pneumonia. Only this week had he been able to work a full day without napping. He knew his friend had his best interest at heart.

“I don’t want the media getting hold of this.” He shook his head and sighed. “I’d always hoped they were wrong about Anita.” He ran his fingers through graying hair. When he looked up, his assistant was standing in the corner, looking out over the grounds of the governor’s mansion. “I messed up, Ryan. I let my political drive take time away from her.”

“She supported you, Stuart. Don’t be so hard on—”

He lifted his hand to cut him off. “I should have been there for her. After her miscarriage, things were never quite the same.”

Ryan poured himself and the governor two fingers of Maker’s Mark Kentucky bourbon. “Do you understand what the report implies?” He lifted a glass to his lips. “Anita was raped. Ketamine is a powerful anesthetic.”

“So she might have been innocent after all?”

“Did you trust her?” He tapped the top of the red wax-dipped bottle.

The governor looked away. “I don’t know.” He paused. “I wanted to believe her. I’d always hoped the media speculation was due to distortion from political enemies.”

“And so maybe it was. But this ketamine takes her death to a whole new level.”

“How is that?”

“If someone gave her ketamine as a date-rape drug, perhaps she was still groggy. Sure, she was hit by a passing motorist, but did the drug affect her ability to get out of the way?”

“You’re suggesting homicide?”

Ryan shrugged. “Think about it, Stuart. Who has access to anesthetic drugs?”

“A heart surgeon.”

“Who else was with her the night of her death?”

The governor walked around his desk and poured a second drink. When he spoke again, his voice was etched with anger. “You say you were protecting me by not sharing this with me sooner?”

Ryan’s voice quivered. “Of course, sir.”

“Stupid!” he said, spitting bourbon from his lips. “Stupid, stupid, stupid! By sitting on this information, you let Jace Rawlings slip away.”

“What do you want me to do?”

“Keep this away from all other eyes. I’m going to talk to the chief of police and the attorney general. I want a DNA match on the semen found in my wife, proof that this was Rawlings.”

“The man’s made his escape.”

“Some altruistic mission,” Franks huffed. “He was running away.”