Kitabı oxu: «Mending The Doctor's Heart»

To all the people who live on remote islands and preserve their natural beauty for us to enjoy.

Acknowledgments

This book and the entire State of the Union series would not happen without my awesome editor, Claire Caldwell.

Most of all, thank you to my readers. Your reviews, emails and letters keep me writing.

Contents

Cover

Back Cover Text

Introduction

Dear Reader

Title Page

About the Author

Dedication

CHAPTER ONE

CHAPTER TWO

CHAPTER THREE

CHAPTER FOUR

CHAPTER FIVE

CHAPTER SIX

CHAPTER SEVEN

CHAPTER EIGHT

CHAPTER NINE

CHAPTER TEN

CHAPTER ELEVEN

CHAPTER TWELVE

CHAPTER THIRTEEN

CHAPTER FOURTEEN

CHAPTER FIFTEEN

CHAPTER SIXTEEN

CHAPTER SEVENTEEN

CHAPTER EIGHTEEN

CHAPTER NINETEEN

CHAPTER TWENTY

CHAPTER TWENTY-ONE

CHAPTER TWENTY-TWO

CHAPTER TWENTY-THREE

CHAPTER TWENTY-FOUR

CHAPTER TWENTY-FIVE

CHAPTER TWENTY-SIX

CHAPTER TWENTY-SEVEN

CHAPTER TWENTY-EIGHT

CHAPTER TWENTY-NINE

CHAPTER THIRTY

CHAPTER THIRTY-ONE

CHAPTER THIRTY-TWO

CHAPTER THIRTY-THREE

EPILOGUE

Extract

Copyright

CHAPTER ONE

FIVE YEARS, TWENTY-SEVEN DAYS and ten hours since she left and swore never to return. Anna watched the swirls of aquamarine, green and royal blue surrounding the little patch of island she once called home. A tiny drop of land in the bucket of the great Pacific Ocean. At ten thousand feet, the view was breathtakingly beautiful, but as the helicopter dropped, the serene vision gave way to the carnage of broken buildings and debris-littered streets. She swallowed hard.

Anna was the only passenger on board, so as soon as they touched down, she unbuckled, grabbed her duffel bag and hopped out. Her boots hit the muddy ground with a squelch. She pulled down the sunglasses parked on top of her head and raised her arm to shield her face from the stinging wind kicked up by the still-revolving helicopter rotors.

This was the golf course where she and Nico were married. It looked far worse on the ground than it did from the air. The pristine green lawn with perfectly planned hills and flower beds was gone. Tree branches were everywhere, strewn about with random garbage. This is the least damaged part of the island? A crushing vise gripped her heart. Is Nico alive? She hadn’t been able to get through to their house on Tumon Bay; the landlines and cell towers were out.

“Captain! You okay?”

Anna turned to see the pilot carrying a box. He tilted his head toward the rest of the cargo, which he had unloaded from the helicopter and set on the ground. How long had she been standing there? She looked toward the medical camp. Tents were set a hundred feet from where she stood, their dull beige forlorn against the calm blue sky.

Anna swung the duffel on her back, looping the handles around her shoulders so she could carry it like a backpack. Her arms protested as she lifted a heavy box. It had been more than a month since her last deployment, and her muscles were a little out of shape.

She carried the box to a waiting staff member, then set down her bag and helped the pilot carry the rest of the supplies from the makeshift helipad. When they were down to the last box, the pilot stepped back into the cockpit, waving to her as he started the rotors.

The helicopter rose and disappeared from view. There was no way off the island now; she was stuck here. Again. The permanent ache in her heart gnawed at her.

Picking up the remaining box, she walked back to the bright-faced staffer. His crisp uniform, regulation lined badges, and chipper hello told her it was his first deployment. She nodded to him and handed over the box.

“Where do I report?”

He pointed her to the medical command tent. She unzipped the outer pocket of her bag to remove her papers. As she entered the tent, her eye caught the big digital clock that hung from a wire. Forty-five hours and twenty-two minutes. That’s how long ago the tsunami had struck. It was also the clock that would determine when she could leave. Around the time it struck 168 hours, the actively wounded would slow to a trickle, mostly limited to those hurt as a result of the rescue efforts. When the red digits ticked to 381 hours, the rescue operation would be over and the focus would turn to recovering bodies. By then, plenty of relief organizations would crowd the small island with their staff outnumbering the injured. She’d be replaced by social workers who would stay here for months dealing with the mental trauma that would haunt people for generations to come.

“Took you long enough to get here.”

She whirled to come face-to-face with a woman dressed in blue scrubs. Rear Admiral Linda Tucker was Anna’s height, around five foot six, and had red hair streaked in spots to faded copper. Her face sagged with exhaustion but her gray eyes sparked as she surveyed Anna.

The Public Health Service was a uniformed division but worked more like a health care service than a military unit, so Anna didn’t salute and was happy to note that her new supervisor was wearing scrubs. Some PHS field commanders insisted they wear their uniforms, which inevitably made the days uncomfortable. Yet despite this concession, she knew Linda Tucker’s reputation and braced herself.

“I got here as soon as I could,” Anna replied evenly.

“I expected you yesterday.”

Anna had flown from Washington, DC—where she’d been visiting with her sister, Caro—to Japan, where she had to wait for the long-haul military transport helicopter to bring her to Guam. She’d been traveling for twenty-three hours and fifty-three minutes straight.

Shrugging, she settled for a nonchalant. “I was delayed.” What she didn’t say was that she’d come close to being discharged from the PHS for defying orders to board the first transport to Guam. It had taken a call from the surgeon general’s assistant with a plea from the SG himself to get her on board. She was the only PHS officer who spoke Chamorro.

“Well, get changed and meet me back here, we have a lot to do.” Dr. Tucker turned and bent over the newly arrived cardboard boxes, efficiently slicing through the tape. Anna handed her papers to the clerk, a young man with a pockmarked face who looked pained to be there.

Anna scanned the tent while the clerk typed her details into the computer. The tent looked like every other medical command center she’d seen. Every available inch of space was being put to use. Corners were stacked with cardboard supply boxes, the center dominated by U-shaped desks cluttered with laptops and assorted materials. A large fan blew in fresh air from a makeshift window, but the heat was still oppressive. She ran her finger under her collar and twisted her neck, trying to get some air between her sticky skin and the wilted cloth of her once-starched khaki uniform. She scanned the faces in the room but quickly stopped and chided herself. Why would he be here? Nico would be out in the community, helping people defy the odds of survival. If he’s alive. Closing her eyes, Anna took a breath. She’d have to go to the house in Tumon Bay to check on him, find out for sure. From what she’d seen in the air, the roads weren’t passable by car, so she’d have to walk the five miles there. At her typical walking speed, she could do it in an hour and fifteen minutes, but given the condition of the terrain, she figured she’d have to budget at least four hours to get there and back.

“I’ll show you to your tent. That way you can get changed while I process your paperwork,” the clerk said suddenly. Anna turned to see Dr. Tucker motioning to him to hurry things up.

“I need you to get to work.” She bent over the boxes again before Anna could ask when she might be able to go check on Nico.

Anna followed the fast-walking clerk out of the tent and down a narrow pathway. No matter where she went, the sounds of the aftermath of a disaster were always the same. Moans of people in pain, shuffling of fast-paced boots, generators and battery-powered machines rumbling to life, the smell of wet earth and the incessant buzzing of insects.

Nico has to be okay. I’d know if he wasn’t. Wouldn’t I?

The clerk led her to the tiny tent that would be her living quarters. She groaned inwardly at the paper sign in the plastic sleeve on the door-flap indicating she would be sharing the tent with Linda Tucker. So she wasn’t going to get a reprieve on this deployment.

She changed quickly and found Admiral Tucker waiting for her outside the tent. She motioned for Anna to follow. “We don’t have enough wound care supplies or topical and IV antibiotics, so we need to ration them. I understand this isn’t your first deployment?”

“No, ma’am, I’ve been through twenty deployments in five years. My last one was in Brazil for the Zika virus after I returned from Liberia, where I was dealing with the Ebola outbreak.”

The rear admiral’s eyes widened with respect. “Good, then I don’t have to orient you. Feel free to call me Linda.” She continued her brisk pace, weaving through the narrow gaps between tents, dodging pieces of machinery and carts carrying supply boxes from one tent to another.

“The locals are just now mobilizing, so we get about ten new patients an hour. Tent space is at a premium. Anyone who doesn’t need to be monitored gets sent to the high school, mall or the hospital, where they’ve set up shelters.”

Anna’s throat closed. “Is the hospital operational?” she choked out. The last time she’d been at the Guam General Hospital, she’d lost everything she ever loved. She hadn’t used her pediatrics training since then, staying as far away from children as she could.

Linda shook her head. “Not as a medical facility, but the building is still standing so they’re using the space to house people.” Linda slowed and turned to make sure Anna had heard her.

“A local stopped by a few hours ago to say someone’s managed to set up a field hospital in one of the newer buildings. A local physician is helping them, but they have over a hundred people there. If we get through our current patients, I’d like you to go. They can’t get those patients to this side of the island.”

Anna nodded. It would give her a chance to go to Nico’s house, her old house, and make sure he was okay. “Did they tell you where on the island?”

“Talofofo. It’s on the Pacific side, so I’m not sure how well it fared.”

A brick fell through Anna’s stomach. Talofofo. That’s where Nico had bought land. Right after they’d buried Lucas, the piece of herself that would forever be in Guam. Nico had tried to convince her it was the way to heal, a desperate attempt to get her to stay. What happened to his plans? Had they washed away like the rest of their life together?

“Dr. Tucker, I have a request.” Before she could continue, Linda stopped abruptly and Anna almost bumped into her. One of the patients had come out of a tent screaming at her.

“I’m going to die!” A man scarcely over five feet tall stood in front of Linda, his chest puffed out.

“Sir!” Linda’s voice was firm and laced with annoyance. “I’ve told you already—you’re not getting pain medication, so stop the racket.”

Linda turned to her. “He’s yours. Sixty-some-year-old male, leg laceration, five stitches, prior undiagnosed first-degree heart block. He’s been having arrhythmias, which is why he’s still here. Not even close to the worst of the wounded.”

Anna took in the broad, wrinkled forehead, the firm purse of the man’s lips, the gray in his hair and the slight stoop to his back. He was an elder, a man used to getting what he wanted. She stepped up to him and bowed slightly, making her frame smaller so she wouldn’t tower over him, then spoke softly in Chamorro. “We don’t have supplies, the hospital is damaged, we’re saving the pills for people who are badly hurt.”

The patient nodded, thanked her, then went back to the tent.

Linda shook her head. “He speaks English. I heard him talking to the others. These people!”

Anna bristled. “He needed to know that you weren’t making a judgment call in denying him pills. People here understand shortages and rationing...” She muttered under her breath, “They understand it all too well.”

Linda pressed her lips together tightly, and Anna reminded herself that the woman was a superior officer. While Anna wasn’t interested in climbing the career ladder, she had to work and live with Linda for the foreseeable future, and she still had to ask her for a favor.

“He should be grateful we’re here to help him,” Linda said irritably. “But I’m glad you speak Chamorro. Follow me—I think I’ll put you in this tent.”

Anna opened her mouth, then shut it. Linda had already resumed her purposeful walk. Most of the doctors she worked with didn’t appreciate the local cultures. They were adrenaline junkies who went into deployment to feed their hero complexes and left with little understanding of the place. They were dispassionate about the very people they supposedly came to serve. While people like Linda annoyed her, at some level Anna understood the need for emotional distance from the patients they were serving. She had come to Guam and ingrained herself in the community. If she’d treated her time here for what it was, a temporary medical rotation, she never would have married Nico, never would have had Lucas.

Linda went through the open doorway of one of the tents, talking as she went. Anna pushed her attention to Linda. She needed to stop thinking about her past and snap into the present. This could be Liberia, or Sri Lanka, or Thailand. The tents all looked the same, the misery around her was no different. Pretend you’re not in Guam.

“...but I need someone who has a background in pediatrics,” Linda was saying. The sound of crying babies and high-pitched little voices made Anna freeze. Filled wall-to-wall with children of all ages, the tent suddenly spun around her. Older children were sitting on cots, while younger ones played and crawled around on the dirt floor. Mothers held tiny babies and stared at her as she took it all in. She shivered. The flash of a sweet face burned her eyes, and she jolted at the memory of a cold little body in her arms. No. No, no, no, no!

Linda kept talking. “I have my hands full. No one has evaluated these children since they were brought here, and most of the—”

“I...can’t.” Is that my voice? “Listen, I’m not sure what you were told, but I don’t treat children. That’s the only thing I won’t do. You can assign me to the burn unit, send me out into the field to do body recovery... I’m game for anything else, but I don’t treat children.”

Linda put her hands on her hips. “Dr. Atao, you’re a pediatrician! Need I remind you that we’re in the middle of a disaster here? You don’t get to pick where you work, and we have a tent full of children who need attending to.”

Anna’s chest tightened, but she forced herself to meet Linda’s eyes. “I have an understanding with the PHS that I don’t treat children anymore. I—”

“Are you refusing an order?”

A child’s wail pierced through her. Her muscles tightened. Technically her understanding with the PHS was just that, an unwritten agreement. Her boss knew what had happened with Lucas, and her orders usually had a note attached about not assigning her young children to work with. It had never been an issue, not once in all her deployments. And perhaps in another place she could have handled it... But not here on Guam.

She shook her head. “I’m really sorry, I’ll do anything else. I just can’t...”

Linda wasn’t listening. One of the staff in the tent had handed her a writhing infant. “The paramedics are a little concerned about this baby. You’re the only one who has any pediatrics training.”

Linda extended her arms, ready to transfer the little body into Anna’s.

Anna stepped back. There was definitely something wrong with the infant; she looked a little blue around the lips. A cold hand squeezed her heart and her brain shut down. All she could see was a still little body, his skin cold as ice.

“Give her oxygen now, check blood gases and listen to her heart for murmurs,” she choked out.

She couldn’t breathe. Her lungs were squeezed shut, no air would go in or come out. She turned and ran outside, desperate for oxygen. As soon as she’d cleared the tent, she put her head between her knees trying to calm down enough to get air into her lungs.

“No. No. No. No. No!” She barely realized she was chanting the words.

Her chest burned as she gasped for air. Everything spun around her. Her knees buckled and she fell, scraping her hands. She sat on the muddy ground and closed her eyes, picturing herself in the depths of the ocean, imagining the schools of fish going about their business, corals moving with the currents. One of her PHS colleagues had suggested taking up scuba diving. The hobby had given her the muscle memory she needed to control her breathing and the ability to close her senses and focus on a visual. A way to cope. To be a functional human being again.

Three hundred and thirty-six hours, and then she could leave.

She opened her eyes. Linda was standing with one hand on her hip, the other holding out a little cup of water.

Anna drank even though she wasn’t thirsty. She knew the act of swallowing would force her diaphragm to relax and slow her breathing.

“Are you dismissing me?” Anna wheezed out.

“I should. But besides you, I’m the only doctor here. The local nurses and paramedics have barely enough training to help. I haven’t slept in over a day.” She blew out a breath. “I have to deal with you until reinforcements arrive. But this will be noted in your record.”

Anna didn’t care about a reprimand in her file. “I’m a competent doctor. I can deal with just about anything other than children. It’s personal.”

Linda sighed, clearly frustrated but resigned. She gave a dismissive shake of her head. “Guess I need to go treat those kids.” She pointed to an area where people were erecting more tents. So far the camp had about twenty, but just in the time Anna had been walking around, a new one had been put up.

“I’ve already checked on everyone to this point.” Linda gestured to the tents at the periphery. “I need you to start with those who arrived in the last two hours. They’ve been put in tent twenty-four. The paramedics who’ve been helping triage have been instructed to start putting people in tents as they’re built.”

Linda turned to walk away.

“Dr. Tucker, I have one more request.”

Linda turned, her brows furrowed with impatience.

“I have some family here in Guam, and I don’t know whether they’re okay. Can I go check on them?” Anna hadn’t meant to sound desperate, but Linda’s frown softened.

“Start by checking the roster to see if they’re here.” She glanced at her watch. “Can you go in after seeing the backlogged patients? I need a few hours of sleep.” Her tone was almost pleading.

Anna nodded. She’d been waiting for almost two days. A few more hours wouldn’t make a difference. Not to Nico.

She parted ways with Linda and went to the medical command to ask the clerk for the roster of patients.

“I’m still transferring the paper logs to the computer. Check in later.”

“Can you see if there was anyone by the last name Atao?” she said softly. The clerk looked up, eyeing the nameplate on her right breast pocket. He nodded, then tapped on the keyboard and shook his head.

“No one so far. I’ll come find you if I see that name appear in the paper logs or the new arrivals.”

Anna thanked him.

“We’re not the only medical camp around the island. I’ll ask the others when I make my status calls.”

Tears stung her eyes at the pity in his voice. She stood straight, thanked him, then turned. Despite her best efforts, she hadn’t been able to sleep on the plane. Couldn’t stop herself from imagining all the scenarios she would face on Guam. Still, she was alert and eager to get to work.

The tents were filled to capacity. A standard issue tent could comfortably take twenty patients, but there were easily more than forty per tent. Each person shared his or her narrow cot with one or two others, taking as little space as they could so there was room for everyone. Anna introduced herself to the local paramedic, Jared, who was assigned to watch over the tent, and got right to work. Most people had broken bones and wounds of various sorts, which the paramedic had bandaged. A dialysis patient was worried about how he would manage. Anna figured the patient could comfortably make it another day or two before he would get toxic; hopefully resources would arrive by then. The first days after a disaster were always the hardest.

The young paramedic with curly black hair and dark eyes followed her from patient to patient, chatting away.

“My cousins are helping get the airport fixed,” Jared told her. “There’s so much junk on the runway, Lando—that’s my uncle—had to go get a garbage truck to haul it all out.”

Anna knew that one of the reasons so few resources had made it to the island was that helicopters were very inefficient. They could only carry so much weight to conserve fuel for the long journey back to Japan or the Philippines. The neighboring Marshall Islands and the Commonwealth of the Northern Marianas Islands—CNMI—had also been badly damaged in the tsunami.

“What about the military base?” Anna inquired as she drained the infected wound of an older woman.

“They were also damaged. They’re repairing the base and sent an engineer to direct the efforts to fix up the airport, but there aren’t a lot of people on base.”

Anna nodded. Five years ago she had pleaded with the garrison officer on the air force base and each of the two navy bases, but they hadn’t been able to help her. They’d been stretched thin with troop surges in Iraq and Afghanistan and there were no helicopters to transport Lucas off the island, no cardiac surgeons at the military hospital to perform the operation that could have saved his life.

“Have there been a lot of casualties?” Anna asked out of earshot of the patients as they went to get more supplies.

Jared shrugged. “It’s hard to say right now. We had a brief warning from Hawaii saying they detected an earthquake off their coast, so we told everyone to take shelter inland, but not everyone made it. We’re seeing a lot of rescuer injuries.”

Her stomach roiled. Knowing Nico, he’d be out there putting himself at risk.

Once she was done gathering supplies, she moved on to the next tent, scanning every face for the one she knew so well. Yet another paramedic assisted her as she checked each patient in the overflowing tent. The hours sped by as more tents were put up, additional workers arrived and patients who’d been waiting in a triage area outdoors were moved to shelter.

Anna was surprised to see it was already dark when she came out of the last tent. People were still coming in, but she’d visited every patient at least once and discharged several after bandaging their wounds. She rolled her shoulders, trying to ease out the tension. She’d been on the island for five hours and forty minutes. She wondered whether she should try to find Linda or just inform the medical command clerk that she was heading to Tumon Bay to check on Nico. He’s probably okay. Still, she couldn’t shake the uneasy feeling in her stomach.

A shout grabbed her attention. “We have incoming, they need a doctor. Now!”

Anna ran to the triage area, where a group of new arrivals were gathered. A man yelled, “Ayuda, ayuda.”

Anna stepped up and placed a hand on the man’s shoulders. “I will help you. Tell me what’s wrong,” she said in Chamorro.

The man blinked rapidly. “A car fell on this man.” He pointed across the field. Anna turned and asked the clerk to go find Linda and anyone else who was available. The damage from the tsunami was astounding; she’d seen a boat perched on top of a tree. In such cases, secondary accidents after the disaster injured more people than the event itself. She followed the shouting man away from the camp. They got to the main road, which was blocked by a big tree. On the other side of the trunk was a farm tractor with a wagon attached.

“Anna?”

She turned toward the familiar voice, momentarily blinded by the lights of the tractor. Is that really her? She shielded her eyes from the glare. Her chest squeezed painfully.

“Nana?” she said. Nana was what Nico called his mother. What Anna had once called the small woman standing before her. Nana stepped forward, blocking the light from the tractor. She looked exactly as she had five years ago, her curly gray hair pinned in a bun, standing tall in her five-foot frame.

“Anna!” She closed the distance between them, then reached out and clasped Anna’s hands, her eyes wild. “Please, you must help Nico.”