ROQUE moved the Doppler ultrasound probe over the man’s distended abdomen. The images were transmitted to the monitor lying between him and Jewel on the woven-vine-covered floor. She couldn’t see them with the screen facing away from her.
“What do you see?” she asked him as soon as he’d concluded his exam of the abdomen and moved on to the pelvis.
“Hmm, just a minute. I’m capturing more images.”
When the minute became five and he still didn’t answer as he clicked away on his laptop, her banked heat rose.
He’d been doing this, ignoring her, since he’d hurled the truth about his parentage at her.
For the hour it had taken to reach the Manis village, she’d shriveled with mortification, trying to imagine how it had been for him, his childhood, his struggles without the support of a family and the difficulties of his mother’s situation—and failing. Could they have had more different formative years?
Then she’d tried to imagine how many hardships he’d had to endure, what level of dedication had seen him rise so far with everything possible against him—and still couldn’t. It was beyond phenomenal.
She’d tried to approach him, convey all that stormed in her heart, but he hadn’t let her. Then they’d reached the village, met the villagers and organized their schedule of exams and educational sessions with the tribal elders, and he’d kept treating her like he did the air around him. It had been then that her mortification had morphed into resentment.
She’d been keeping him at arm’s length out of pure survival. But she hadn’t been ignoring him. Why was he?
Did he regret telling her something so profoundly personal? Did he think she was judging him? Did he think her such a shallow, snobbish, empty shell? Still?
His unapproachable profile made her think of worst-case scenarios, made her wish she hadn’t sent her team off to other cases so she was alone with him. As if he needed her support—in any way!
In another minute she gave up hope that he’d acknowledge or include her, and decided to find answers for herself.
But as he hadn’t even taken the time to make introductions, it was up to her to perform them herself and, using the few indigenous words she knew, she did.
Their patient was Moie and his wife was Tuia. Tuia was as alert as her husband was lethargic, her sun-baked body naked to the waist, like the rest of the tribe, and there was a child no younger than five sleeping on her back. Patting the spot she had vacated beside her husband, she made it look as if she was carrying nothing at all as she jumped to her feet, giving Jewel the optimum place to conduct her exam. Moie squeezed his yellowed black eyes, giving her his consent to examine him.
An overall look, followed by palpating Moie’s abdomen and pelvis and examining his edematous legs, told her a lot. But as he wasn’t up to making the effort, she turned to Tuia and questioned her about his complaints in an elaborate set of pantomimes. The bright woman caught on with amazing accuracy, her answers bolstering Jewel’s suspicions.
But when Jewel tried to ask a more complex question, she found out the limit of non-verbal communication. But even without that answer, she had her diagnosis.
She was delineating treatment in her mind when Roque finally announced his verdict. “Ascites and hepatosplenomegaly.”
Oh, yeah? She could have told him that without all the gadgets. It had taken her a few palpating dips and percussion taps on Moie’s abdomen to detect free fluid floating in his abdominal cavity and the hugely enlarged spleen and liver.
“And your diagnosis?” She raised her eyebrows at him.
He cocked one formidable eyebrow back at her, his eyes devoid of expression for the first time since she’d seen him again. For the first time ever. “Are you testing me now?”
Her heart constricted. Keep it light. She did. “Yep, since you’re on my turf. This case is pure internal medicine.”
“You mean you have a diagnosis?” At her nod, his eyebrows drew together into a forbidding glower. “Don’t you mean a differential diagnosis?”
She shook her head, ignored the itch behind her sternum that his uncharacteristic harshness inflicted. “That’s the problem with you surgeons. You can’t consider coming up with a diagnosis without using all your gadgets on the patient. We internists rely on good old case histories and examination.”
“And that’s why you’re often wrong, as evidenced by the ever-increasing numbers of your chronic patients! And God only knows how many people you actually kill, slowly or quickly, never even realizing it. Then you pat yourselves on the back and go have lunch! Symptoms can overlap from one relatively benign condition to another catastrophic one, and your so-called history taking and exams are never enough to make the distinction. I question your unsubstantiated instincts and self-satisfied diagnostic skills and the way you approach a patient with your human limitations and prejudices. These often blind you to the obvious until it’s too late. ‘Gadgets,’ on the other hand, don’t have opinions or preconceptions—and they certainly don’t have egos!”
An unbearable pressure built behind her eye sockets. Her heart battered her ribs until it shook her whole body, until it felt pulped. So that was how it felt to be really exposed to his wrath. Where did it come from? Was that how he saw her? Or…
Her streaking, stricken thoughts came to a stuttering halt when his eyes squeezed shut. His teeth made a bone-scraping sound as he shredded a string of murderous self-abuse.
She vaguely felt Tuia fidgeting behind her and Moie growing restless. Roque had kept his voice level, his face impassive as he’d delivered his razing summation, but his aggression had been unmistakable and, to her, devastating.
He lowered his head and a bass, shaken groan escaped him. “Jewel—perdoe-me… Deus!” His eyes suddenly rose to hers, black now, shimmering. Their impact punched her breath out. “But how can I ask you to forgive me? That was unforgivable—and nothing to do with you. Believe me, Jewel, forgive me, please…”
His gaze fell again and, moved beyond endurance, she reached out and cupped his cheek. His hand immediately covered hers, his lips turning into her palm in a beseeching kiss that should have burned through it. But it wasn’t that that succeeded in bringing the tears she hadn’t shed in all her ordeals. It was the naked pain in his eyes.
He spoke, his lips still in her palm, his subdued words vibrating in her flesh, booming in her bones. “It was my mother… She was visiting so-called friends, a huge sentimental mistake I tried everything to stop her from making. The town knew what she’d once done for a living and when she fell sick, the doctors assumed fever and consciousness disturbance were an exacerbation of an untreated venereal disease. They started her on antibiotics, antipyretics and sedatives. By the time they suspected their unsubstantiated diagnosis and did an ECG, her myocardial infarction had destroyed most of the cardiac muscle. They called me then. I arrived in time for her last breath.”
Oh, God. Oh, God.
It was all she could do, for their audience’s benefit, to crush back a distressed wail and the urge to envelop him in a frantic hug, to absorb his anguish into herself.
This man she’d married and left, never suspecting how incredible he was, how unique. That he wasn’t ashamed of his mother, that he hadn’t judged or blamed her said volumes. Another man would have writhed for ever in a misogynistic hell, damaged and nurturing endless psychoses. She’d clearly been a good mother to him and he’d as clearly loved her. His unabated anguish at losing her proved just how much he had.
Then an epiphany hit her, hard. Was losing his mother through the prejudice and negligence of other doctors what drove him? Was he saving her in every patient he treated? No wonder he’d come running when he’d suspected she was a prima donna who was only playing doctor, to protect his people from her incompetence. And considering what he’d suffered through most of his life, it was amazing he’d had that much control and grace, dealing with her deliberately ignorant prejudices.
Her hand was still pressed to his cheek. She was enervated by emotion. But she just had to tell him, she had toshow muchshow much…
“I can’t tell you how sorry I am for your loss, Roque,” she choked. “I wish you’d told me before…”
He held her streaming eyes for an endless moment then pressed another kiss into her palm, thankful, apologetic, the fever pitch of emotion leveling. He wiped away her tears, his fingers gentle, cherishing. “Obrigado, Jóia, for making me wish I had.”
With that he turned to Moie and Tuia and made profuse apologies in every indigenous and sign language he knew. Then he turned to her and his smile almost knocked her heart out of her.
“You were going to tell me your diagnosis?” he purred.
She recovered with every iota of control she had and mumbled, “Are you asking for it so you can knock it?”
“I wouldn’t dare.” His eyes sobered and the sincerity in them buffeted her. “I’m truly sorry about that outburst, Jewel. I’d be more than an idiot to belittle your skills. You were right. As a surgeon my clinical powers lie elsewhere. I have differential diagnoses that need more tests to settle on one. But you’ve settled on one. So tell me.”
“It’s—it’ss” Great. Now she was stuttering. Very convincing and authoritative. She tried again, aiming for both qualities, and blurted it out instead. “It’s bilharziasis.”
He stared at her. She felt herself shrinking. “I think…”
After she had muttered the qualification, her prior conviction reasserted itself. The signs and symptoms were too definitive.
She tried again, with more confidence this time. “He has symptoms of both types of the flatworm infestation. Urinary-tract symptoms are painful urination with bleeding at the end. Gastrointestinal symptoms are diarrhea, dysentery, also liver involvement, evidenced by vomiting blood, ascites, lower limb edema and enlarged liver and spleen.”
Roque’s smile broke out slowly and a full orchestra swelled in her ears. “Who needs gadgets when I have you?”
This man was out to kill her today!
“It fits his condition perfectly. But…” He rubbed his jaw. “The open waters of the Amazon are not known for harboring the parasite’s snail host. So where could he have gotten infected?”
“I tried to ask Tuia if there’s a body of water where only he went, but that was where sign language failed.”
“It has to be a side-stream or a stagnant—Wait!” His hand gripped hers. “I noticed plots of land hacked out of the jungle and planted with maize. Those were flooded, perfect for the snail to live in. And only the men farm it there.”
“So all the other men who also farm are probably infected.”
He nodded. “But none as advanced as Moie here. That was an incredible piece of diagnosis, bela.”
His praise left her shaking with the effort to suppress the urge to throw herself into his arms. “Wait until we make sure before you start praising my acumen, Roque.”
“We’ll run tests but I can’t think of another diagnosis now. You cracked this one open with a touch, amor.”
Amor. He’d been saying that constantly, in mockery, in seduction. Now it felt as if he meant it. Could it be…?
“But we have a dilemma.” He seemed oblivious to her state. Or she was a better actress than she’d thought. “Bilharziasis is one thing—probably the first of many—that I didn’t come prepared for. I don’t expect you have any Biltricide in your pharmacy?”
Biltricide, the drug of choice, which had a 100 percent cure rate with a single oral dose, was stocked in their pharmacy, thanks to Inácio. She told him.
“Maravilhoso. I’ll have to let Inácio humiliate me in another chess game in reward for his foresight. But while the drug will cure Moie’s worm load, we must now treat his complications. So, amor, while I run tests, you tell the others to get the drug from the riverboat and educate the tribe in eradicating the snail host and preventing re-infection.”
She nodded, performed her chore then hurried back to find Roque explaining it all to Moie and Tuia. She didn’t understand most of what he said, but she could tell from a few words here and there, from his expression and tone and their reactions, that in extreme care and compassion he made them understand that, though some irreversible damage had occurred, if Moie followed their instructions and didn’t get re-infected, he’d improve until he could lead an almost normal life.
Then he rose and gently escorted Tuia and her still soundly asleep child out. He came back as she settled on Moie’s other side, his eyes settling on her. “So—what’s your treatment plan, Jóia?”
She cleared her emotion-clogged throat. She could tell he wasn’t testing her, just reveling in this incredible alliance as much as she was.
“Diuretics for his ascites, then a TIPS procedure.” This came out too breathless. “Thank God you’re here to do it.” And this came out too fervent.
“No other reasons to thank God I’m here?”
She tried not to give him too complete a victory, gave him a dismaying, “None.” It came out too swooning.
In answer, he gave her an inscrutable look.
With a booming heart, she administered pre-procedure medications, asked, “Conscious sedation or general anesthesia?”
“You can handle general?” There was no surprise in his voice, just—wonder? She nodded, fluttering. “Let’s go for concious. Better for his general condition.”
Then he started the procedure and it felt so right to be assisting him, as if she’d trained all those years to that end. Was that somehow true?
The minutes passed as he performed the complicated sequence. Then he finally murmured, “Done.”
And in under an hour for a procedure notorious for lasting three.
He withdrew his catheter and she jumped with a dressing to the puncture site. They continued their fluent interaction, finishing off the post-procedure care.
With Moie sleeping peacefully, she took off her surgical garb, struggled up on numb legs to rush out to Tuia with the good news. And Roque’s arms caught her.
Only anticipation held her up as he captured her head in both hands. He groaned her name, moved feverish fingers and eyes over her eyelids and lips, and her knees melted.
He ravaged her senses just being near him. Then he took her lips. With the voracity of a predator unleashed on a prey that had been long kept an inch out of reach. With the cherishing of a man fearing for his only sustenance in life.
When her whimpering became incessant, he severed the deep kiss on a frustrated snarl, kept mashing their lips together as he rasped, “Senhora Da Costa, we must do this together often. Very, very often.”