Saving Sarah

CHAPTER 1: INCITING WRATHSARAH WANDERED FROM BED TO bed, checking on the few patients at the Hedley Clinic. It was such a welcome contrast from when she’d arrived and established the makeshift hospital off the Rio n***o. The treatment area had overflowed with patients from the first day, all in desperate need of care. Malaria, Yellow Fever, Cholera, Typhoid fever and uncontrolled diabetes had run rampant throughout the area. But thanks to antimalarial drugs, vaccinations, antibiotics and rehydration solutions, the number of patients had dwindled dramatically. Most days brought patients with ear infections, high blood pressure, asthma attacks, and even the occasional prenatal checkup. Still, there was a relatively regular flow of emergency patients suffering injuries from farming accidents and even alligator bites. The enormous black caimans were especially troublesome, particularly during the wet seasons when they ventured into the flooded savannas of the sss basin. Though there was so much more she wished she could do, never a day went by when she didn’t feel she made an important contribution to the surrounding small communities. It was hard work, but it was fulfilling work, and she’d come to view the two nurses and the handful of locals who helped out at the hospital just like family. They really were a family, maybe not by blood, but in every way that counted. They strove together toward common goals, supported one another and were always there to try to help relieve each other’s burdens. They suffered each other’s pain when they encountered tragic loss, and helped to pick one another back up off the ground to keep going. It was home, and she hadn’t once regretted her decision to leave everything she’d known back in Virginia. “Sarah, come quick,” Abby called from the front door of the hospital. Abby was the nurse who had worked alongside her from the beginning. In fact, Abby had been there before the beginning, helping out in the area months before Sarah arrived. And one of the many things she knew about Abby was that the woman seldom panicked. So hearing the shrill tone in her voice meant whatever the emergency was, it was no small matter. She dropped the chart in her hand and dashed down the empty walkway between the beds. And in seconds she knew the source of Abby’s panic. The young boy lay writhing in his mother’s arms as blood dripped in a steady stream from his leg. It was difficult to identify the source of the injury given the smears and drops that covered him from thigh to shin. She reached for the boy without hesitation, taking him to cradle in her own arms and she rushed through the patient area to the lone operating room in a curtained-off area of the small hospital. Laying him out on the rickety wooden table, she went to work and quickly found the source. It was a bite—an alligator bite—on his thigh, in between his knee and hip. And that explained the profuse amount of bleeding. The animal must have nicked the boy’s femoral artery. Fortunately, there wasn’t so much blood that it looked like the gator had bitten clean through. The bone and much of the muscle seemed to still be intact. If she could get to work quickly, there was a very good chance the boy would be OK. “Como te llama?” she asked the boy, garnering his attention. “Todo estara bien,” she told him, reassuring him that everything was going to be all right while Alice—her other nurse—checked the backup generator. Alice had arrived at the hospital just days after Sarah, and since then the three of them had learned to work together like a well-oiled machine, each of them acting as an intricate part of the care they provided their patients. Checking the generator was a necessary step before undergoing any type of major surgery at the jungle hospital. She needed to know that the oxygen machine and suction machine would be up and running in case the boy stopped breathing or aspirated under general anesthesia. Until the arrival of a second generator, much of her work had been done under local anesthetic. She couldn’t rely on a single generator in a life or death situation. With a nod from Alice, Abby administered the ketamine and a wave of relief washed over Sarah, knowing the boy was out of pain for the time being. Now it was up to her to make sure he would be on his way to a full recovery when he woke up. Abby cleaned and sterilized the site, giving her a better view. She located the source of the gator’s bite through the boy’s artery, but it was worse than she’d thought. Though the artery wasn’t fully severed, there were several small gouges where the gator’s teeth had punctured through. Now, instead of having one spot to stitch back together, there were several. There was no way the boy would have survived for long if his mother hadn’t brought him straight there. Just as she inserted a suture in the first of the wounds, a commotion sounded from the door to the hospital. But with the curtain that separated the treatment area from the patients’ beds closed, she couldn’t tell what was going on. Not until a few seconds later when a man came bursting through to the operating room with another man in his arms who was bleeding from several locations. “He needs a doctor, now,” the first man boomed. “I’m sorry. I’ll be there as soon as I can,” she told the man gently. She hated this part. The part where it became blatantly obvious that what the hospital needed so desperately was more doctors. There was nothing she could do. If she left the boy before repairing the damage to his femoral artery, he’d continue to bleed out, likely within a matter of minutes. And really, as horrible as it was, she could tell just by looking at the man lying limply in the other man’s arms, there wasn’t likely much she could do for him. “Abby, go with him. Give him 15 mg morphine and hang an IV. Make him comfortable, Abby. Check his wounds and do what you can,” she instructed. It was all she could do. “Are you a doctor?” the man asked Abby as she started toward them. “No. I’m a nurse. I’m going to try to help.” “I said he needs a doctor, now!” the man hollered even louder. “Get your hands off that boy and get over here now.” She realized then that the man who’d come storming through the curtain wasn’t a local. He wasn’t a poor member of the community whose friend had a nasty run-in with a gator. He was part of a drug cartel. She could tell by the clothes he wore, the arrogance and anger with which he spoke, and the violent look in his eyes. She’d run into the occasional man like him in her time there in the jungle. She’d seen them gator-hunting and doing every other stupid activity that only men whose brains had been altered by overuse of their own product would dare to try. But she wasn’t going to let that man scare her into letting this boy die. “I can’t. I know he’s your friend, but look at him,” she eyed him intentionally, trying to convey that his friend was dying without heaping that burden upon the injured man. It was unfortunate, but the puddle of blood on the floor beneath him, his shallow breath and his pale color said it all. Maybe back in the US there would have been some hope for him with blood transfusions and the latest in modern technology. But there in the jungle, all she had were some basic surgical supplies. “This boy needs my help. You know that. Now let my nurse give your friend a morphine injection. Please, it will take away his pain.” The man hesitated, possibly thinking through the unfortunate logic in what she was saying, but he didn’t hesitate for long. Balancing the man in one arm, he reached behind him and pulled a gun from the back waist of his pants. “I said—now!” and he pointed the weapon directly at her. No! No, she wouldn’t do it. God, she wished she could, but she couldn’t. She wasn’t ready to die, but it wasn’t right. She couldn’t willingly walk away from the little boy in front of her. How could she ever look into his mother’s eyes? How could she ever face any of the people she’d come to care for so much when she would let one of them die to save her own hide? She couldn’t. “No,” she whispered, and with the decision made, she turned her attention back to the boy, working furiously, hoping she’d be able to stitch him up enough before the man pulled the trigger. If she was going to die there, it had to be for something. Her death had to mean something. It had to be in exchange for the little boy’s life. She worked as fast as her fingers could move, waiting with baited breath to hear it, the bang a split second before his bullet lodged itself into her body. “Boludo concha!” he cursed at her. “You’ll regret this,” he hissed in English before turning and storming out with his near-lifeless load. With the curtain open, she watched as he laid the man down on a nearby bed, and he stood back as Abby moved in to give the injured man the injection of morphine. Weakly, the man opened his eyes and he spoke to the other man, but what was said in the exchange, she couldn’t make out. For now, she had a reprieve, at least a few moments before the man would be back. Because if she had to guess, she’d estimate the wounded man had no more than five minutes left. She hated that she’d seen so much death she could guesstimate a person’s end so well, but she had to use those minutes wisely. It was all she could do. So she turned her attention back to the young boy, racing through one puncture wound after another, stitching him up as quickly as she could. And once she was confident his femoral artery was intact, she focused her attention outward, suturing the layers of the wide lacerations on his thigh. Mentally she kept track of the passing of time, forcing her fingers to move faster, racing to beat the man’s clock. And she did it. With the last suture she let out the breath she hadn’t realized she’d been holding. It was done; the boy would have the chance to recover. But before she could check the boy’s vitals, another commotion sounded in the patient area. She whipped her head around in time to see the man’s violent outburst, punching walls, turning over empty cots and kicking everything out of his path as he stormed to the outer door. “This is not over. You will pay for this,” he seethed back at her, and then he was gone, his footsteps sounding in the gravel and dirt outside. An engine roared to life and then grew quieter as he sped away. She was relieved he was gone, but she had a sinking feeling he wasn’t gone for good. Even without his words, the violence that had raged in his eyes spoke volumes. But maybe he was just angry, and what had really enraged him was knowing there was nothing anyone could have done to save his friend. Perhaps he knew that whatever foolish endeavor the two of them had ventured into was ultimately what had resulted in the needless death. It sickened and angered her, too, that they would throw away life so easily, when others clung onto it with everything they had, even when they knew it was a futile fight. Still, a man had died in her hospital. As much as she hated what he’d been, everyone was entitled to the respect of a decent burial. Everyone. “Abby, can you keep an eye on the boy. When he’s awake, you can bring his mother in to see him.” “Will do. Are you all right, Sarah?” “Yes, I’m fine. I’m just going to take care of this.” She motioned to the bloodied man laying dead on a cot. “Alice, can you help me?” The two women picked up the man, taking care not to injure his shell any further. It wasn’t that she felt a dead body was particularly sacred, but it always reminded her that no matter what life path one chose, every person comes to the same place in the end. It was sobering, and it was that notion which she treated with respect. Outside, they rounded the building with their heavy load to the place she’d bordered off as a cemetery for the patients she’d lost. She kept them close; a constant reminder of her failures. It wasn’t to punish herself, but to motivate her to do better, to work harder, to remember that her every action had consequences. It kept her as sharp as she could be. Once there, Alice helped her lower the man to the ground. “Thank you. I’ll take it from here,” she told her nurse, and Alice nodded before turning back toward the hospital. This part belonged to her and no one else. It gave her a chance to think, sometimes to remember the person, at others, to remember what had gone wrong or what could have gone better. And this time, to pay her respects to the man she couldn’t save. She crossed the plot of land to the shovel she kept hidden in a patch of bushes nearby, and she got to work, digging down deep. It was arduous work and her muscles would be sore by the time she was done but it was worth it. Minutes passed, and then a full hour. She was concerned about the boy inside the hospital, but she knew Abby or Alice would come get her right away if there was any sign of trouble. Finally, an hour and a half after she’d begun, she was done. She pulled the man to the grave as gently as she could, committing his face to memory before she rolled him the final few inches and into the grave. In her movement, she could see the injuries that had lead him to where he was now. The little boy had been lucky enough to escape a gator’s attack, but this man wasn’t so fortunate. Multiple lacerations cut across his thighs and others dug in deep into his abdomen. Her first judgment had been right; there was no way he would have survived even if she and all her staff had devoted every resource they’d had to him. And while that knowledge did nothing to placate the angry man who’d left the hospital, it helped to assuage her conscience. There really was nothing else she could have done for him. A half hour later, she’d returned the dirt, covering the man in his grave, and she placed a makeshift headstone on top, made from sturdy branches and twine. She was ready to get back to work, and just in time it seemed, because new patients had begun to filter into the hospital. There were at least half a dozen there now. Certainly, Abby and Alice could use her help. She returned the shovel to its usual storage place and headed back toward the hospital. All the while she tried to ignore the chill that shivered down her spine in the heat. She hurried across the plot of land and inside the hospital, doing her best not to think about the angry man’s threats and the murderous look in his eyes as he’d stormed out of the hospital. Certainly, the chill that had shivered down her spine was just an odd reaction to overworking her muscles. It couldn’t possibly be a premonition of what was to come. She didn’t believe in that sort of thing. It was ridiculous…at least, she hoped it was ridiculous.