“CAPTAIN ATAO, YOUR deployment is up in two days.”
Anna had been catching up on her patient charts in the nurses’ station but turned when she heard Dr. Tucker’s voice. She did some quick math and realized Linda was right. How could she have forgotten? She’d been counting down her hours since she got there.
“We’re fully staffed here—I have orders to extend your deployment if you’d like to stay, but I understand if you want to go.”
It had been two days since their trip to the house in Tumon but Anna and Nico hadn’t told anyone besides Maria that they were back together. Nico wanted to tell Nana in his own way once things had calmed on the island, but he’d spoken to Maria right away. She had successfully avoided Anna since the breakfast at Nana’s house despite Anna’s persistence in looking for her.
“I would be willing to stay. I want to oversee Emma coming off the ECMO.” The baby had been doing remarkably well.
Linda nodded and Anna could swear her eyes were teary. “You should be here to hear that baby coo and cry.”
Anna couldn’t wait for the moment when Aurelia got to hold her healthy baby daughter. She wished Kat could’ve seen it too. “When does the congresswoman leave?” she asked Linda.
“Her plane is in two hours. The staff is gathering in the lobby to say goodbye to her.”
Kat had been scheduled to leave days ago, but Luke had to return or face AWOL charges so she was stuck waiting for a seat on an outgoing plane. Commercial airlines still weren’t flying in and out of Guam and only cargo planes with limited passenger space were using the one available runway. Anna would feel much better once Kat was gone. The island’s sole OB, Dr. Li, had quit months ago and while Dr. Balachandra was a good general practitioner, early pregnancy complications were not for the generalists to handle. After everything Kat had done for Guam, her safe return to DC was essential.
Anna followed Linda to the main lobby, where cake and coffee had been laid out. Maria was there and Anna made a beeline for her.
“Before you say it, yes I’ve been avoiding you.”
Anna made a hard stop. She had thought of several ways to apologize and to beg for Maria’s forgiveness, but her mouth was bone-dry and all she could do was open it stupidly.
“I never meant to hurt you,” Anna croaked. How did you tell a woman I’m sorry for taking away the love of her life?
Maria bit her lip and Anna’s heart lurched. “Nico was mine once and I let him go. I’ll be paying for that mistake for the rest of my life. I just hope you won’t throw away your second chance.”
Anna hugged her, and Maria hesitated but then buried her face in Anna’s shoulder. Anna understood Maria’s pain. Giving up Nico had killed her inside. That was a fact she now accepted. That gnawing feeling, like an ulcer had been eating away at her, was gone, replaced by the calm she’d first felt on the island. The feeling of peace.
“I’m sorry to interrupt.”
Anna and Maria turned to find Governor Tom in a suit and tie. It was the first time Anna had seen him dressed so formally. His eyes stayed on Maria, as if he was silently asking her if she was okay. Maria nodded, and only then did he clear his throat. “I’m going to make a little speech, and I’m wondering if you ladies would join me.”
Anna realized that Maria was also looking sharp in a black dress and short maroon jacket. She, on the other hand, was wearing wrinkled scrubs.
Anna shook her head, but Maria grabbed her hand and pulled her along. Nico had appeared and he placed his hand on the small of Anna’s back, a silent reassurance that nothing was amiss.
Tom gave a short speech thanking Kat and all the relief workers, medical personnel and volunteers. He turned to Maria, who thanked everyone for helping open the hospital “by hook and by crook.”
Then she turned to Anna. “And now I need your help making sure that this hospital will continue to stay open and take care of all of you. I’d like to offer Dr. Anna Atao the position of chief medical officer at the new Lucas Memorial Hospital. Please join me in requesting that she accept the position.”
It was a good thing Nico was behind her because Anna felt like she might fall over. She had not been expecting that. He was grinning mischievously. She raised an eyebrow. “How long have you been planning this?”
Maria answered for him. “A few days, and don’t worry, we had the governor call your supervisor at the surgeon general’s office and clear you to stay for two months.”
Nico touched her shoulder. “You can try it, see how it works for you.”
A roar went up from the crowd and someone managed to start a “We want Anna” cheer. Cheeks red, she stood with a frog in her throat, wondering what to say. Did she want that job? She and Nico had studiously avoided talking about their long-term plans. Would he follow her to California? Nana was never going to leave the island, and with her cancer, Anna already knew what Nico needed to do. He wouldn’t abandon his mother.
And then it hit her. This was his way of keeping her here. It was her turn to make a decision. Would she stay or go?
Crash!
Before she could process what had happened, Nico was on top of her, covering her as pieces of concrete rained down on them and water gushed into the foyer.
“Everybody out!” he shouted, though no one needed encouragement. People were rushing for the exits, and Nico pushed Anna in that direction, but she resisted.
“No, we have to get the patients from the top floors. We can’t leave them behind.” A piece of the exterior wall had caved in. Who knew what else was coming down?
“I’ll go get them,” Nico said.
Anna was on his heels. She wouldn’t leave without her patients; she had to make sure Emma was okay.
Maria ran to the announcement system, which they had just gotten up and running this morning, to encourage anyone who could walk without assistance to get outdoors. The fire alarm was unfortunately not fully functional.
It was a maddening process, but all the medical personnel understood it. Those who could walk got out first. That would clear the hallways for them to carry out those who couldn’t. No matter how many times Anna had been through situations like this, she could never look the bedridden patients in the eyes. Thailand had been the worst. They’d had to leave some patients behind when the building collapsed too fast to get them out.
But that wasn’t going to happen today because every able-bodied man and woman in the community had come running back into the hospital to help carry stretchers, wheelchairs and patients attached to machines. They were willing to risk their own lives for others.
Once everyone was out and there was no more falling debris, Nico and Maria walked back into the building to survey the damage. Anna joined them and squared her shoulders when Nico gave her an exasperated look and pointed to the door.
“If you want me to be the CMO of this crumbling heap, I’m going to be here, for better or worse.”
Maria failed to suppress her smile. Even under the circumstances, Nico’s glare was priceless.
He eyed the source of the wall cave-in. “I’m no engineer, but my guess is that crack in the foundation we’ve been worried about stressed a load-bearing wall. The water was from a pipe burst.” Nico’s voice was weary, and Anna knew he was blaming himself.
Maria swore under her breath. “That’s where the water must have come from during the hurricane. I haven’t been able to get a structural engineer in to check it out.”
“The more immediate problem is what we do with the patients,” Anna chimed in. “The battery backups on the machines won’t last long, especially the ECMO. Emma and the burn patients need to be in a sterile environment.”
The DMAT and PHS teams were already erecting tents a safe distance away from the hospital. Nico rubbed his neck. Anna touched his arm, but it was Maria who had a solution in mind.
“Here’s what we do—see if the congresswoman can lean on the base commander to send the army corps of engineers to do an assessment. Bruno said his friend at the base told him they’re there doing repairs.”
Nico snapped his fingers. “Good. Maria, while we see if the Army can spare someone, you check if the governor knows anyone at the fire department—they’re responsible for condemning buildings, so they have to know someone who can do assessments.”
“I’ll go talk to Kat,” Anna volunteered, trying to shake the sinking feeling that there was another disaster in store for them.
* * *
ANNA DIDN’T LIKE Kat’s face when she finally found her in one of the tents. She was whiter than the bedsheet she was lying on. Vickie was beside her, holding her hand.
“What’s wrong?”
Dr. Balachandra was tending to her. “She started cramping. I did a pelvic exam—she’s bleeding.”
A cold dread spread through Anna’s veins. “Do we have a portable ultrasound?”
Dr. Balachandra nodded. “One of the volunteers is getting it for me. We left it in the hospital.”
“Kat, how’re you feeling?”
To her credit, Kat cracked a small smile. “Great timing to have a complication, huh? Alex is going to kill me.”
Anna grabbed her hand. “We’re going to take care of you.” She was not going to let anything happen to Kat. Not after everything the woman had done for them. The volunteer rolled in the ultrasound machine and they lifted Kat’s shirt to apply the conduction gel. Anna let out a breath when they saw the fetal heartbeat. She wasn’t a trained ob-gyn and her ultrasound skills were basic. She needed a specialist. Dr. Balachandra peered at the screen with her.
“We don’t see anything wrong with the baby.”
Kat breathed a sigh of relief but Anna exchanged a glance with Dr. Balachandra. Bleeding and cramping together was a bad sign, but they didn’t have the expertise to make a diagnosis.
“Was Kat able to call the base?” Maria breezed in and stopped short when she saw what was going on. She slapped a hand to her mouth.
“What’s happened? What do you need me to do?” Trust Kat to worry about everybody else.
“You take care of yourself right now, Kat,” Anna said firmly, but of course the congresswoman was already sitting up, gazing expectantly at Maria who shot Anna an apologetic look.
“Sorry, Tom said the guy from the fire department who did assessments died in the tsunami, so we have no other choice.”
Maria explained the situation to Kat, who promptly pulled out her phone to call the garrison commander in charge of base logistics.
Anna stepped aside to work her own contacts to find an OB who could help them over Skype. She finally got hold of one who told her they’d need to do more tests. Anna returned to the tent to find Kat was still on the phone with the base.
“I understand, Commander, but I must say that when I return to DC, I’m going to talk with the armed services committee chairman, who is a friend of my father’s. I’ll have to convey your utter lack of compassion in a time of crisis.” Maria and Dr. Balachandra were staring at her in awe, and despite the acid churning in her stomach, Anna had to take a second to admire Kat.
“Well, I’m glad you can spare someone, after all. We’ll expect him within the hour.”
“Okay, everyone out.” Anna was firm. “Dr. Balachandra and I need to take care of Kat.”
Vickie stood to leave but Anna waved her down. Kat would need her sister in case they had bad news.
“What’s going on?” Vickie’s voice was laced with worry. “I thought the baby was fine.”
“The baby is fine, but we need to do an internal ultrasound to see why you’re bleeding. I have an OB from Hawaii on the line.”
Anna reactivated the connection with the OB and turned her phone so Kat could see him. He directed Anna as she did an internal ultrasound, instructing her on how to take measurements using the machine.
“Unfortunately, the portable ultrasound does not have the sensitivity I’d need for a full diagnosis,” he said when the test was complete. “If she were Stateside, I’d send her to Maternal-Fetal Medicine to get her cervical length properly measured, but I think she is likely experiencing cervical incompetence. I recommend you do a cerclage.” The OB’s crackly voice cut through the room.
Anna’s heart dropped to the soles of her feet. They weren’t equipped to perform this surgery on a pregnant woman. At least when they operated on Emma they had a proper facility. In addition to not having properly trained staff, they didn‘t have a sterile OR. This was not something she had ever done or been trained to do and judging by the panic in Dr. Balachandra’s eyes, he hadn’t, either.
“Can we transport her?”
The OB considered this. “If that’s the only option, keep her on bed rest and see if you can get a medical transport right away.”
Anna motioned to Vickie, who was already on her phone. They had missed their scheduled flight waiting to make sure everyone made it out of the hospital. Kat had refused to ask someone to drive them to the airport in the middle of the evacuation.
As they exited the tent, Vickie turned to Anna, her voice filled with fear. “There are no flights out for two days. They’re saying it’s only supply planes that can’t carry people.”
Heart thumping, Anna forced herself to take some deep breaths. “Let’s go talk to Maria about medical helicopters.”
They found Maria, who started to apologize for her earlier blunder. Anna explained the situation.
“CNMI was badly hit too, so between all the relief organizations, we only have two medical helicopters.” The Commonwealth of the Northern Marianas was a group of neighboring islands that were also a US Territory and the only major land mass near Guam. Maria wrung her hands. “They’re running twenty-four hours, but they have a priority list of patients. I will ask because Kat is a congresswoman but…” She looked from Vickie to Anna.
Anna didn’t wait for her to continue. “I know. The critical patients go out first. Kat’s condition is urgent, but the heart patients, stroke victims and people with head injuries take priority.”
Vickie put a palm to her forehead. “And knowing Kat, she wouldn’t want to cut in line.”
Nico joined them and Anna brought him up to speed. “Then we do the surgery here,” he said.
“Nico!” Anna stared at him, flabbergasted.
“Look, I’m no doctor and I know you’ll say we don’t have the resources, but that’s the whole point of this hospital. When people can’t get off the island, we have to find a way to get them the care they need. That’s why I built the surgical suite with telemedicine capabilities so you can get a specialist to talk you through things.”
“Nico, it doesn’t work that way. I’ve never done a cerclage and neither has Dr. Balachandra. We can’t take such risks with Kat’s life—or her baby’s. We nick something the wrong way, and she could bleed out.”
But he wasn’t listening. She recognized the stubborn jut of his chin, the pressed lips and concentrated frown. It was the way he’d looked when they found out they couldn’t get Lucas off the island.
She grabbed his arm. “Nico, this is not the time to prove a point. Kat has done a lot for us—we can’t play with her family.”
He shook off her arm. “This is not about making a point. Kat’s life is no more important than any other person’s. Just like we did everything we could to save Emma, we will do what’s necessary to save Kat.”
Then he strode away and all Anna was left with was the red-hot anger that rose in her belly. Nico was wrong; he was trying to prove something to her, and his stubbornness would get Kat killed.
She turned to Maria. “Make the call, see if you can get Kat on a list or get a new helicopter for her.” She asked Vickie to call the base and anyone she could think of in Washington, DC. Maybe Luke could commandeer another helicopter.
Anna was going to get Kat off this island if it was the last thing she did.