ANNA CHECKED THE clock in the OR. One thousand, nine hundred and seven days and ten hours since she’d felt the tremor that shook her hands now. Kat had been anesthetized. They had a nurse anesthetist and a trauma surgeon who were pulled into the surgery because of who Kat was and the frequent calls from her father, a powerful former senator who had gotten the White House involved.
Her gloved hands twitched as she helped Dr. Balachandra drape Kat and push her legs into position. Kat attached the fetal monitor so they could continue watching the baby’s progress. Since giving Kat a fluid bolus, the fetal heart rate had come up.
Kat’s husband was on his way to the island. How would Anna face Alex if things didn’t go well? After all Kat had done for her, how would she tell him that she couldn’t even save their first baby?
“Dr. Atao?”
She snapped her attention back to Dr. Balachandra. “I’m sorry.”
“I asked whether you were satisfied with the fetal heart rate and ready to begin.”
No I am not. This is a crazy idea, just like me doing Lucas’s surgery was a desperate plan. Kat could die on the table. She could bleed out. We shouldn’t be doing this.
“Let’s do this.” Her voice sounded remarkably calm.
A volunteer who looked like he was about to pass out held up a tablet computer so the OB in Hawaii could watch and direct them. Dr. Balachandra inserted the speculum and began.
“The bleeding is really heavy—I’m having trouble seeing.” Dr. Balachandra couldn’t hide the anxiety in his voice. Her own pulse pounded through her body, the normally cold temperature of the OR unable to stop beads of sweat from prickling her forehead.
The trauma surgeon gave him some suggestions for controlling the bleeding. The beep of the fetal monitor pulled Anna’s attention. The baby’s heart rate was still okay but it had dropped. She checked Kat’s vital signs. “We need to give her some blood—her heart rate is rising and pressure is dropping.”
They only had one unit of blood on hand. Normally for a surgery like this, there would be several, but blood was yet another item that was in short supply on Guam. Yesterday they had done a blood drive in the hospital, but it took time for the Red Cross to test and replenish their inventory.
She didn’t need to tell Dr. Balachandra that he didn’t have much time to stop the bleeding.
“She might have cysts that are causing the bleeding.” The disembodied voice of the OB from Hawaii broke in.
“Okay, I’m in, suctioning now.”
The whole thing lasted twenty-six minutes but it might as well have been twenty-six hours. Once Dr. Balachandra was done, they slowly brought Kat out of anesthesia. She’d been given as light a dose as possible to protect the baby. She was woozy but seemed to be doing well.
“You’re trembling.”
Nico put his arms around Anna as she exited the OR. She let him hold her, her body both cold and hot.
“She’ll be okay. You guys did it.”
Anna had done nothing. “I wish we hadn’t had to do this here.”
“Alex has arranged a medical transport for her. He’ll be here in seven hours.”
Anna hoped they’d done the right thing. After seeing the bleeding, even the mainland OB had his doubts as to whether they’d made the right diagnosis.
“This is just like it was with Lucas. No way off the island.” Anna muttered, her chest burning. “It’ll always be like that—when we need to get off, we can’t. No way out.”
Nico tightened his hold on her. “Anna, I need to tell you something.”
The hesitation in Nico’s voice put her nerves on edge. She pushed away from him so she could look him in the eyes. Now what?
“I lied to you earlier. Kat’s father called the White House and they put pressure on Tom to move Kat up on the priority list for medical transport. We had a helicopter that was leaving in an hour. I made the call not to ask Tom, to avoid bumping someone off the list. So there was a way off the island. I know you don’t believe it because of what happened with Lucas, but there’s always a way. It’s just about making the right choice.”
Anna staggered and hit a wall behind her. She leaned against it for support. Nico reached out for her but she slapped his arms away.
“You had a way to get her off the island?”
“Anna, if we had, the person who would’ve missed his turn was a thirteen-year-old with a bleed in his brain.”
She glared at him. Kat would never be high on a medical triage list for transport. While her situation was bad, it could be managed. At worst, she could lose her baby, but they could save her life. The kid with the brain bleed would die without neurosurgery. Anna knew he’d made the right decision. That was what disaster triage was all about, making sure those who most needed care got it first. And yet she couldn’t suppress her anger.
“That was a decision you should’ve let me make.”
“I couldn’t.” His eyes pleaded with her. “I didn’t want to put the responsibility on you. I asked Dr. Balachandra to make the call.”
“Don’t you get it, Nico? The responsibility is mine, whether or not I want it.” She sank to the floor and pulled her knees to her chest, burying her head in her arms. The stress of the past few days was catching up with her.
“Hey, it’s okay. You guys saved Kat and her baby. She’ll be fine.” Nico stroked her hair. It felt so good to have Nico share the burden with her. When it was Lucas, Nico had deferred to her medical judgment for all decisions. At the time, she had been driven to save Lucas at any cost.
“You don’t have to take on everything. Kat is our collective responsibility. Not yours alone.”
She lifted her head and rested it against the wall. “I know you can’t leave. You have an obligation to fulfill for your family, and I get that. You need to take care of Nana.”
He hung his head. “It’s not forever, Anna. My obligations, as you call them, won’t last long, especially if Nana isn’t getting treatment. Maria can run this hospital once it’s fully operational. I won’t have to be here physically to help. Can you stay with me for a little while? So we can work this out together?”
Could she?
“Dr. Atao, you need to come right away,” the nurse shouted down the hall. Anna was on her feet in a flash and Nico followed close behind.
She rushed into Kat’s room, where the trauma surgeon and Dr. Balachandra were opening up IV lines.
“She passed out and the fetal heart rate has dropped.”
The portable ultrasound machine had already been set up. Anna did an internal ultrasound. The baby’s heart was beating, but way too slowly. Dr. Balachandra began a pelvic exam. “The sutures are intact, but she’s bleeding.”
Someone left to rouse the Hawaiian OB to see if he had any ideas.
An alarm on the fetal monitor began beeping incessantly. “The heart rate is only fifty…now forty-five…now forty-one…now forty.” Anna closed her eyes. She didn’t need to keep reading to know what was happening. Kat was losing the baby.
Minutes later, there was no heartbeat on the monitor. Anna didn’t try to stop her tears. What was she going to tell Alex when she saw him?
“We have to get her to the OR and do a D and C.”
“I’ll do it,” Anna said wearily.
Both the trauma surgeon and Dr. Balachandra stared at her. “You don’t have to. Unfortunately, I’ve done a lot of these.”
“No, I should be the one,” Anna insisted.
“No!” Nico’s harsh voice cut through the room.
* * *
HE DIDN’T KNOW if it was Anna’s pale face, the haunted look in her eyes, or the boneless way in which her shoulders sagged. But a realization had hit him with more force than the tsunami itself.
Anna needed him to be the strong one. She would keep sacrificing herself until she had nothing left to give. This time he would be the strong one. He would do what needed doing.
He wrapped his arm around her. “Dr. Balachandra, please perform the surgery.” Anna fought against him but he held on to her and firmly guided her to his and Maria’s office. There was a cot there that he’d been using. He set her on it. “I want you to sleep.”
She shook her head. “Nico, are you crazy, this is not the time to sleep! I need to take care of Kat, talk to Alex when he gets here, I need to—”
“I’ve got it, Anna. I will talk to Alex. The other doctors are more than capable of helping Kat. They’ll take care of her, I promise.”
“No, Nico, you don’t understand.” She threw back the blanket he’d covered her with, eyes flashing. “It’s too late. It’s too late for Kat, and it’s too late for us.”
She walked out and he didn’t stop her. There was nothing he could say that would keep Anna on Guam. It was up to him to choose what he wanted more.