“YOU FIRST.” MARIA’S face mirrored the exhaustion Anna felt. She didn’t even know where to begin processing everything that had happened in the past few hours.
“He’s stable but still not out of the woods.” Maria’s voice was weary.
Guilt pierced Anna’s heart. If she hadn’t been so gutted by her own pain, she would’ve treated him correctly last night. They were standing in one of the corridors off the ICU that was blissfully empty. Between patients and the newly arrived medical staff, the entire hospital seemed to be crawling with people. Anna had been on her way to check on Nico when she bumped into Maria. She placed a hand on the wall to steady herself.
Maria leaned against the wall and slid down until she was sitting on the floor. Anna joined her. She didn’t trust her legs to keep her upright.
“You love him, don’t you.” Maria hadn’t asked it as a question, merely stated it as a fact.
Anna sighed. “He has a way of getting under your skin.”
“Don’t I know it. He’s been under mine for twenty-three years.”
“You’ve loved him since high school?”
Maria nodded. Anna could picture it. Once you had a man like Nico, it was hard for anyone else to measure up.
“He’ll be happy with you.” Anna truly meant it.
“I’m not so sure he can ever forget you.”
“He will. You’ve helped him make his dreams come true. That counts for a lot. For Nico, it’s about home—this community is everything to him. It’s what defines him. I never fit in here like you do. Sure, we have history—that’ll never change. But once I leave…” she squeezed Maria’s shoulder “…and I will leave, things will go back to normal for you guys.”
She could hear the relief in Maria’s breath. Now came the hard part. Anna squared her shoulders.
“Listen, Maria, I know you’re already stressed, but I need to tell you—Emma needs an ECMO machine. A heart-lung bypass. Her heart is too weak to heal on its own.”
Maria gasped. “Where am I going to get that kind of equipment? Can she be transported?”
That had been Anna’s first thought, too. Get this poor baby off the island. She had called a pediatric cardiologist on the sat phone to get his opinion. He had confirmed what she knew, that the baby was too unstable to transport. Her only hope of survival was to get an ECMO. And soon.
Anna shook her head. “She’s not stable enough.”
“Where are we going to get an ECMO in the next few hours?”
“Apparently one can be purchased from the Phillipines and be shipped here on helicopter. My colleague in the PHS found a company willing to sell one, but the price is steep. And we have to find a helicopter to bring it over.”
Maria blew out a breath. “We can’t afford it. As it is, I’ve gotten a loan from the bank just to buy the supplies we’ve needed to take care of basic wounds. The relief organizations are still mobilizing and the best places to purchase supplies are Japan and the Philippines because they’re much closer than the US. But those guys want cash upfront.”
“Isn’t there any way to get an advance on the insurance? Something?” An elephant was sitting on Anna’s chest, but she took a deep breath. She couldn’t let Emma die, not after she’d come as far as making it through the surgery. There had to be a way. Finding the machine had been next to impossible, but rather than letting panic seize her, Anna had called everyone she knew until someone gave her a lead.
“I also need to find a dialysis machine, a pharmacy’s worth of medications, and a structural engineer to make sure this building won’t fall on our heads. Everything seems to cost more right now, and everyone on this island seems to be on antiarrhythmic and blood pressure medications that washed down the drain.” Maria blew out a breath. “I need to prioritize. I don’t have cash on hand, and I don’t know whether we will ever get reimbursed for any of this. With Guam Hospital out of commission, we are now the public hospital for this island.” She waved her hands around. “What all am I going to get done?”
Anger bubbled through Anna. It was always about resources on the island. Someone got to live at the expense of someone else. The hospital would spend money to fly in a cardiac surgeon who could do surgery on adults but not one who could treat kids. “You want to ration care right now?”
Maria buried her head in her hands. “You think I want to make these kinds of decisions? I have to, or everyone dies. There will be more people who need the dialysis machine. The ECMO is just for Emma.” She looked pleadingly at Anna, big, wet tears in her eyes. “Please try to understand. It’s not how I want to do things, but I can’t save everyone. Besides, helicopters aren’t exactly available—there’s a waiting list of patients who need medical transport out and those copters are all going to Japan. No way one can be spared to go pick up a machine in Manila.”
Anna wanted to argue with her, to be mad and tell her there was always a way, but Maria was right. How many times had she made triage decisions, especially in Liberia? She would spend all of ten seconds evaluating a patient and then decide what color tag to put on them. Red tags for those who could be saved. They would get medical care as soon as possible. Black tags for those who were “expectant,” meaning they’d die and there was no use expending resources on them.
But Anna wasn’t ready to put a black tag on Emma.
The decision was obviously playing on Maria, as well. She wrung her hands. “Nico would know what to do. He’s good at these things.”
Had Nico known what to do with Lucas? At the time she hadn’t thought so. When Lucas was diagnosed, they were both hopeful. She’d booked a flight to California and contacted every medical school friend she had to find the best pediatric surgeon possible. She hadn’t started to panic until the pilot strike continued and all air travel out of Guam ceased. Then Nico had worked his contacts. He’d called every person he knew to see if someone would be willing to break the strike. It didn’t matter. The airline made a statement with the union. They had taken all planes out of Micronesia. Nico had fought until Lucas worsened, and then he gave up and accepted their son’s fate. That was when Anna’s desperation had kicked in and a rift formed between them that grew and grew until it blew their marriage apart.
“Can your people pay for it?”
Anna had already explored that possibility and come up empty. The DMAT teams could not authorize expensive purchases; only the Office of the Assistant Secretary for Preparedness and Response could do that and they were already running low on their disaster relief funds.
Anna shook her head and stood. She had to go talk to Troy and Aurelia. Prepare them for what was coming. No one had done that when it was Lucas. She had diagnosed him and cared for him. At the time, she was the local pediatrician, the only one on the island. Calling on friends in California, she had sent over Lucas’s ultrasound results and films and they had all confirmed her diagnosis with nothing more useful than “He needs surgery.”
“We will get through this, Anna.” Maria gave her a tight hug, holding on to her, and Anna squeezed her back. Anna didn’t have close friends. She’d moved around so much as a child that her sister became her best friend. The only consistent person she had in her life. Without a doubt, if she’d known Maria when they were younger, they would have been friends. The woman had a goodness inside her that touched Anna’s soul.
“He’s going to make it. I know it in my heart,” Maria whispered.
Anna nodded, not wanting to say what was really in her heart. That Nico was going to die because of her. Just like Lucas had.
Troy and Aurelia stood as soon as Anna walked into the tent. Anyone who didn’t need medical attention had been put in the tents outside. The wind had died down and even the sun was peeking out. Mother Nature was going to give them a break. At least for now.
For the first time, Anna took them in. They were both young, in their midtwenties. Aurelia was a petite girl with dark hair, cream-colored skin and soft brown eyes. Troy was a little taller than her, skinny with a goatee. Anna had already talked to them once, right after the surgery. Now she asked them to walk outside with her. The tent was noisy and distracting with crying babies, children playing games and people catching up with each other, sharing their stories.
Anna explained what was going on with Emma.
“So she’s gonna die.” Troy cut to the chase. Anna was prepared for the question, but none of her stock responses seemed adequate. Troy’s fearful face made the knots in her stomach twist painfully. “I’m going to keep on trying to get that machine. I’ll make some phone calls Stateside and see if there is anyone who can pay for it. If that doesn’t work, I can…”
Aurelia put a hand on her shoulder. Anna forced herself to look into the young woman’s tear-filled eyes. Anna was a doctor; it was her duty to put aside her own pain and console her patients. “Dr. Atao, if it’s Emma’s time, I need to know. I want to say goodbye, I want to hold her, I don’t want her to go alone with all those machines.”
The words hit her like a lightning bolt. Don’t do the surgery, Anna. You want Lucas to die in your arms, comfortably and knowing he’s loved. You don’t want him to die hooked up to machines. This was the first time she’d really thought about what Nico had said. Back then she’d lashed out at him, accused him of giving up when things got really tough, of being willing to sacrifice their son’s life rather than acknowledging that his insistence on staying in Guam was what would kill their baby. The last time she’d held Lucas when he wasn’t cold and stiff was when she’d nursed him before the surgery. All she’d been able to focus on was the steps she needed to go through to conduct the procedure and the long list of what could go wrong.
She hadn’t taken a moment to enjoy the last moments of Lucas’s life when she could just be his mother.
“Dr. Atao?”
She snapped her attention back to Aurelia. “Come with me. I won’t take her off the ventilator and IV drips just yet, but I can let you hold her.”
Back in the NICU where Emma was the only patient, Anna made Aurelia and Troy scrub their hands and arms, gown up and put masks on like they would if they were going into surgery, then led them to the incubator where Emma was fighting for her life. How could Anna have forgotten this? It was well-known that infants responded to touch and to being held. The kangaroo hold, named for the animal who carried her children in her belly pocket, was commonly used by pediatricians to help underdeveloped infants. Parents were encouraged to cradle them skin to skin.
Anna handed Emma to Aurelia and encouraged her to touch her cheek to the baby, to hold and talk to her the way she normally did. As she turned to leave, Troy grabbed her hand.
“Thank you, Doctor.” The words were said with such sincerity that Anna couldn’t hide her own tears. She didn’t deserve their appreciation.
Unsure of what to do, she went to the ICU, passing through hallways crowded with people. Some sat on the floor, others stood waiting. Now that a number of other medical personnel had arrived, Anna’s orders were less clear. She hadn’t seen Linda Tucker since the surgery. All medical staff were wearing scrubs and name tags to indicate who they were, but Anna wasn’t even sure who was in charge of medical command. It wasn’t unusual in disasters. Normally she thrived in the chaos, letting it sweep her up in the moment so she didn’t have to be alone with her thoughts for very long. But today she wanted quiet. She needed to think.
Nico was still on a ventilator, and a nurse that Anna didn’t recognize was noting his vital signs from the monitor.
“He’s stable,” the nurse whispered before leaving. Perhaps because of who Nico was, or Maria’s influence, they hadn’t doubled him up. All the other rooms held two or three beds. Anna squeezed his hand, sitting on the edge of the bed. Why had she come here? She had nothing left to say to Nico. All the words in her heart, the hateful ones, the ones of love—she’d said them all. Yet something niggled at her. His chest rose and fell as the ventilator pushed air into his lungs. Her vibrant, full-of-life Nico with the strength of several horses was lying still.
“I need you to live, Nico.” Perhaps she had come to feel his warm body, to know that he was still with her.
Then she realized what she hadn’t yet said to him. With a stone weighing her heart to the floor, she leaned over and kissed his forehead. “I want you to know that I forgive you for what happened with Lucas. You were right. I should’ve accepted his fate and enjoyed the last few minutes of his life. I don’t want to make the same mistake with you. Please don’t leave me.”
His hand twitched and she looked up, tears streaming down her face, but he remained motionless. It was just a muscle contraction. Patting his hand, she stood to leave. Despite the extra help they now had, there was still a shortage of doctors and she had a job to do.
Someone entered the room.
“Nana.”
Nico’s mother had aged since yesterday. Her gray hair was loose around her shoulders. Anna had only seen it like that when she stepped out of the shower. The woman always got herself put together every morning, hair, lipstick and immaculate clothes. She was not the type to be found lounging in pajamas past nine in the morning.
Sitting on Nico’s bed, she placed her hand on top of her son’s chest, then bent her head and began sobbing. Anna put an arm around her and squeezed her shoulders. The only other time Nana had cried was at Lucas’s funeral. Even then, Anna got the feeling she was crying for Nico’s pain, not necessarily for the loss of her grandson.
“Nico is all I have, all I’ve ever had. What will I do without him?” Her broken voice twisted Anna’s stomach.
“He’s going to make it through, I know it. Nico is a strong man.” Her words were as much a prayer as reassurance. She held Nana until her sobs subsided.
“He went to California to get you back.”
Anna knew this already. She had been in Liberia and not within phone or internet range, but her mother had sent a letter after the fact to let her know that Nico wanted her back, that he had come and begged for her. He’d even called the PHS to find out where she was, but of course they weren’t going to reveal her exact location or allow him to visit.
“He told me he would leave Guam. If that’s what it took to get you back, he would leave here forever.”
What? Not once in their entire courtship or marriage had that notion been on the table. Nico had made it very clear that Guam was his home. Even after she threatened to go to California, he had never once considered leaving.
“His father, he didn’t just betray us.” The words were spoken so softly, Anna wasn’t sure whether they’d been spoken at all. From the day she was introduced to Nico, she’d heard the story of how Nana had fallen in love with a marine who left her pregnant, then took up with another woman Stateside. Anna knew Nico felt responsible for his mother, who had sacrificed a lot to raise him.
“Nico’s father left because he stole money from half the island. He convinced everyone to invest in this community center. It was supposed to have private tutors for children so they could be more competitive for colleges on the mainland, job training programs, computer classes, a place for kids to play after school so they wouldn’t get into trouble. That’s what attracted me to him, his spirit, how much he wanted to do something for the community. We all put our savings into it. They all trusted him because he was my husband.”
Goose bumps prickled Anna’s skin. She had never heard this part of the story. Not from Nico, and not from the community.
“One day I wake up and there’s a note on the bed stand that he’s been deployed. I didn’t think much of it—we all know soldiers get sent away. After months went by and I didn’t hear from him, I started to get worried. So I called his commanding officer. The man tells me he didn’t even know Michael was married. By now I am seven months pregnant with Nico and people are starting to ask about their money. The land Michael said he had bought for the community center was being sold to a developer to build a resort. No one knew what was going on…”
The pain in Nana’s voice was so raw, it was as if she were describing events that happened four months ago, not four decades in the past. “There was no money in our bank account. I had to get myself a job cleaning one of the government buildings. My fourth cousin gave me the job out of pity so I could buy food. Then I get the divorce papers. I call his CO again and he tells me Michael has taken up with another woman and his tour of duty is up with the military so there’s nothing he can do.”
Nana fell silent and Anna let the quiet linger in the room.
“I didn’t have money to hire a lawyer. Bruno’s friend tried to fight for the money Michael took from all of us, but it was long gone. No trace of it. He was unemployed and the court in Texas where he went wouldn’t ask him to pay child support. I was fighting the case from here, now with a baby in my arms and no way to even pay for long-distance calls.”
Anna rubbed her back. The woman was sobbing, reliving the worst pain of her life.
“The community helped me out. They took care of me, bought me food so my baby could eat, knitted me clothes for Nico. And when I was well, the women watched him so I could go to work and take care of us. No one asked for their money back. No one filed a court case against me. No one said a word. They lost everything, their savings, their hopes and dreams, and they said nothing.”
Anna swallowed against the lump in her throat. So that was why Nico wouldn’t leave the island. He was paying everyone back for what his father had done.
“The only time in his entire life that Nico has said he would leave was after you went.”
Anna closed her eyes.
“I don’t know what it’s like to lose a child. I thank the Lord every day that he gave me Nico. It’s the only reason I’ve found peace in my heart for Michael. I understand why you wanted to leave, and I don’t blame you.”
Opening her eyes, she found Nana patting her hand. “When Nico married, you became my child too, and my heart still weeps for the pain you hold inside you.”
Anna couldn’t hold it back any longer. Tears flooded her face and Nana pulled her close and held her, stroking her head the way a mother would when consoling a small child.
It was as if a dam had broken inside her. Her own mother had been too focused on her various husbands to pay much attention to Anna when she was growing up. As the older sibling, she’d been responsible for making sure she and her younger sister, Caroline, made it home from school. There were always take-out meals in the refrigerator. Husband number two had been a decent man who at least tried to make them dinner. He hadn’t lasted very long. Both Anna and Caro had gone to college as far away from home as possible. As children they’d been moved from one place to another with every husband upgrade. They never belonged anywhere; home was whatever apartment or house they happened to live in. Even their furniture was often rented. All of Anna’s belongings could fit in a suitcase.
The community in Guam, the island itself, had filled a hole in her heart. But it had also ripped it to shreds.
“I won’t take Nico away from here. I promise you that.” And she meant it.