Читать книгу The Doctor's Lost-and-Found Heart - Dianne Drake, Dianne Drake - Страница 7

“I KNOW you’re familiar with the basic concept, but let me give you a little background on hospital-acquired infections,” Jack said, settling into a wooden chair across the table from Amanda, trying hard to regard her professionally. Not easy considering the way she looked.

“Believe me, I’ve been reading. And I think my brother has probably spent some time on his hands and knees trying to sanitize the ward. The thought of being sick because of something we’re doing … ” She shook her head. “We’ve got to stop it, Jack. Whatever it takes, we’ve got to stop it.”

“Might not be what you’re doing so much as what’s being done to you,” Jack said. “Everybody blames themselves, especially in smaller, more contained hospitals like Caridad, but these bugs, as I’ll call them for lack of a better definition, aren’t predictable, and just when you think you’re on to something … ” He shrugged. “Everything changes. Like life, in a lot of ways.”

He studied Amanda for a moment, saw absolutely no resemblance to Ben whatsoever. While Ben was fair, she was so … His guess would have been Argentinian, actually. Possibly from the Pampas region, Mapuche descent, which she wasn’t, of course. But maybe that was just what he wanted to see in her because her eyes were the same color as Rosa’s, and her skin the same tone. Odd, how coming back after all this time affected him, seeing Rosa everywhere he looked.

“Anyway,” he continued, shaking himself back into the moment, “internationally, the incidence of a hospital-acquired infection makes up nearly nine percent of all hospitalizations, with pediatrics being even higher than that. Unfortunately, in Latin and South America, more of these infections turn into critical situations than in most other areas in the world. And we’re talking things like methicillin-resistant Staphylococcus aureus, an Enterobacter species resistant to ceftriaxone, and even Pseudomonas aeruginosa resistant to fluoroquinolones. To name a few.”

Amanda pushed a can of soda in Jack’s direction, and leaned back in her chair. “So what do we do about Caridad to keep this thing from spreading? It won’t take much to shut our doors, and the area can’t afford to have us shut down for even a little while because the next nearest medical service is about half a day away.” She paused, took a drink of her own soda, then set the can down on the table. “This is killing my brother. He blames himself.”

“But it’s not his fault.”

“Logically, he knows that. He feels responsible, though. That’s the way he is, taking on everybody’s problems. I mean, the first time I ever met him, there he was all stalwart in his new brother duties, showing me around the house, the yard, the neighborhood. You’d have thought he was going to be my adoptive father and not my brother. Yet he has that sense of purpose ….”

She was adopted? So, maybe he was right. “It’s human nature to feel responsible when we’re sidelined the way Ben is right now. He sees his world falling apart and there’s not a damned thing he can do about it. But he’s lucky to have a sister who cares.”

“You have Cade.”

“Cade and I are only now becoming acquainted. I think that kind of relationship is a long way off for us.”

“I hope it happens, because you’re right. I’m lucky. Ben and I are as opposite as two people could be in most regards, which is pretty obvious, but we formed a tight bond almost instantly.” She laughed. “After he quit trying to find ways to get rid of me. He sold me a couple times, traded me, and then there was the time he simply took me down the street to the neighbor’s house and told me to wait on the doorstep until they came home, then tell them it was their turn to be my parents.”

“Did you?”

She nodded, and her eyes softened. “And Ben got in so much trouble. But he felt threatened, having this new sister just drop in from nowhere. Maybe if my parents had adopted me when I was a baby … ” Pausing, the slight smile of reminiscence dropped from her face. “Jack, you’re pretty straightforward. I don’t think you’d soft-pedal something to spare someone’s feelings.”

“That’s a pretty low opinion of me.”

“But I heard you at the hospital back in Texas, the way you talked to people, your interactions.”

“I’ve been accused of being blunt.”

“Then be blunt with me. Tell me what you see when you look at me. You’ve traveled extensively, lived in so many places around the world—South America, Africa, the Mediterranean regions. More than anybody I’ve ever known. So, when you look at me, do you see anything you recognize? A nationality? The hint of something you’ve seen before somewhere? Because of your background, I’ve wanted to ask you almost from the first time we met. But how do you simply blurt out something like that? And I’ll admit I’m a little afraid to know.”

“It wasn’t in your adoption records?”

She shook her head. “There weren’t any adoption papers, no records. Nothing.”

Jack swallowed hard. But didn’t answer.

“I’ve tried to find out. But the best I’ve come up with is that the adoption agency told my parents they believe I’m from some sort of Mediterranean background. Except …”

“Except you don’t believe that.”

“Except when I look in the mirror and want to believe that I am, the image looking back at me doesn’t have a clue. But you do, don’t you? You’re trained to observe, and you don’t miss things. That’s what makes you the best in the world at what you do.”

“Hospital infections and what you’re asking me to do are two entirely separate things, Amanda,” he said, not sure what to do with this. “What I do with a hospital infection is make a logical guess based on what I see, then do the tests to prove I’m either right or wrong.”

“How often are you wrong?”

He shook his head. “Never,” he said, clenching his jaw so hard the ache was starting to set in.

“Then make a logical guess based on what you see.”

“Why me?”

She smiled. “Remember the first time we met? You asked for a list of my credentials, even though I’d already worked with your nephew for several months, and his parents were pleased with his progress. But there you were all big and blustery and none too friendly, making your demands. Then what I found out later … You actually called and checked me out. Asked every last reference on my list about me. Which was fine. I wish more people would do that when it comes to hiring the people who take care of their children. And while that really wasn’t your responsibility since you’re Michael’s uncle, not his father, I liked that you were so forthright. Pegged you for a man who would always be honest, maybe sometimes brutally so. And you have your suspicions about my heritage, don’t you?”

“I’m not even sure why you’d come to that conclusion.”

“Because of the way you look at me. Sometimes you stare, and it’s so … penetrating.”

“The way a guy stares at a gorgeous woman, you mean?”

She shook her head. “That’s not it. Oh, I’ve seen that look, more here than back in Texas. But that’s not what I’m talking about. You give it away in your eyes, Jack. Not for long, but there’s this flash … I saw it when I asked you. Saw it before that, actually.”

She was probably right. What had caught him off guard, and what he’d tried to cloak, was that he saw Rosa in Amanda. Same eyes, same beautiful wild hair, same delicate bone structure. It was a look he wouldn’t confuse with any other look in the world because the person he’d loved most had had that look. He’d come unglued, tried not looking, but sometimes couldn’t stop himself. He was like a moth attracted to the flame. So if Amanda had caught that flash in his eyes, she’d caught it correctly. “Maybe this is something you should discuss with your family.”

“I have. Too many times. Which is why I’m talking to you now. Why I’m asking you. Please, be honest with me, Jack. Respect me enough to do this one thing. When you look at me, who are you seeing?”

“A beautiful Mapuche woman.” They were words he shouldn’t have said, but words he felt bound to say because anything else bought into the lies that had cost Rosa her life. And for Rosa, he had no choice but to be honest.

“Mapuche?”

Nodding, he said, “Someone I loved once, a long time ago, was Mapuche. They’re an indigenous people from the Pampas. I lived with them for a couple of years, working as a doctor in some of the villages.”

“And you recognized that in me?”

“I did.”

“Then thank you for your honesty.”

“Amanda, I …”

She shook her head. “Just leave it where it is, Jack. I asked, you answered. It’s what I wanted.” More than that, it’s what she needed, and she was numb with it, didn’t know what to think, what to do. But Jack had given her something no one else ever had and for that she was grateful. “I think I always knew,” she whispered.

“Knew what?” he asked gently.

“That what my parents told me was … off, somehow. Doesn’t matter, though, does it?”

“Who we are always matters, Amanda.”

“Or who we aren’t? Anyway, I have a very important date in a few minutes, so back to the problem at Caridad. What’s your plan?” She needed time to think about this, to readjust. To let the emotion catch up. But not here, not now. “And tell me what we can do to assist you.”

“Are you sure? Because—”

She cut him off by nodding her head. “I’m sure.” Not said convincingly enough, but Jack understood. The tone of his voice, the sense of concern emanating from him—yes, he understood.

“Fine.” He paused, nodded. “But anytime you want to talk …”

“The hospital, Jack. Please, make this about the hospital now.” No matter how distanced she was feeling from everything she knew.

“Well, then, no more cleaning, to start with. I need to find the source of contamination before I do anything else, then culture it to see what grows. Which means I’ll look in all the usual places and get creative after that because in my experience the usual places don’t really yield what I want.”

“It’s an odd specialty.”

“But, as they say, someone has to do it.”

“Why?”

“Public health was always what I wanted to do. You know, take care of the people no one else wanted to take care of.”

“Because of Robbie?” she asked. Jack’s brother Cade had told her once about Robbie, about how his parents hadn’t wanted to raise a child with severe autism.

“You know about my brother?”

She nodded. “The child nobody wanted.”

“After he died, I wanted to find a way to take care of people who were overlooked the way he was. He died because no one noticed him.”

“He ran off, didn’t he?”

Jack nodded. “No one saw that he had been missing for a while and he wasn’t found until it was too late. When I became a doctor I wanted to make a difference for people who, like Robbie, weren’t noticed until it was too late, which was why I chose public health. What I do now grew out of that as conditions in some of the places I chose to work in weren’t good. So, you’d cure the patient and find the source of the illness in so many cases—fleas, ticks, four-legged critters, bacteria.”

“But you quit or, at least, you’ve stepped away for a while, haven’t you? That’s what Cade told me. He said it’s why you were hanging around Big Badger, why you were thinking about working with them at the hospital they were starting.”

“You’re right. I’ve stepped away. Not sure if I’ll go back and work at the hospital, or not. Haven’t decided … personal reasons. It’s complicated.”

Personal reasons he wouldn’t divulge. She could see it in his eyes, like she could see the well-practiced resistance there, as well. Jack had given her what she’d wanted and now it was her turn to do the same. She’d broached a subject he didn’t want to talk about, so she wouldn’t pry. As a psychologist, it was her second nature to ask, especially when she saw so much distress. But for Jack she would go against that nature. It was the least she could do.

“Okay, well … You have free rein here, Jack. Whatever you need to do is fine, and if I can help you, let me know. We do have some funds … ” She stood, then spun around to the beat-up old refrigerator behind her, opened it and grabbed a pitcher of juice—apple-pear mix from Patagonia. “But not a lot. So whatever you can do to be conservative would be appreciated. And right now I’m going to go have juice in the garden with Maritza Costa. Ventricular septal defect. Congenital.” Meaning, a small hole in her heart. “She’s feeling better today, and I think a nice walk in the fresh air will do her good.”

“You’re treating her how?”

At the mention of a child with a heart condition Jack’s face turned to stone. Amanda saw it, saw the visible change come over him. Such a drastic turnabout, it made her curious. One curiosity among many, she was only beginning to discover. “With medicine only, for the time being,” she explained. “And observing her. She got sick, probably a cold, and it lingered, so her parents brought her in and that’s when Ben made the discovery. She’s been a normal, healthy little girl, without any cardiac problems. So we’re being cautiously optimistic we can keep her regulated with the most conservative treatments, because we can’t convince her parents to let us send her to another facility for more sophisticated testing, maybe even surgery.”

“What about a cardiac cath? They use them more and more these days to close small holes, and it’s a safe procedure. Proving itself worthy of the task.”

“Maybe it is,” she continued, “if we had the means to perform a cardiac catheterization, which we don’t. That equipment’s on the list of things we hope to be purchasing in the next year or so.”

“So in the meantime …”

“We keep a close eye on her and try to keep her as healthy as we can.”

“Or go argue some sense into her parents.”

“Believe me, Ben would have done that months ago if he’d thought it would work. But we have to maintain the balance here, because the people … While they want the medical help, they’re always a little suspicious of outsiders.”

“A little?” he snapped. “They’d let that child die because they’re a little suspicious?”

“She’s not critical, Jack. And we’re doing the best we can.”

“But what happens when your best isn’t good enough anymore?”

It was a rhetorical question. She knew that, and decided to let it pass. “Look, it makes me angry, too. And my brother paces the floor he worries so much. But that’s the way we have to do things here, because we want to get along. It’s for the good of everyone, including Maritza. Things are changing here in the way we’re accepted, and those changes have their own pace. I mean, you lived here, so you already know that. Probably better than I do.”

“Look, I’m sorry. You have a nice facility here at Caridad, I’m not criticizing it. And I’m not criticizing either you or Ben. What you have works, and it’s none of my business how you treat your patients, so forget what I said because I’m not the one trying to take care of medical services on so many levels with so few means.”

Amanda stepped closer to Jack. “I appreciate the concern. No apologies necessary for that. And, Jack … thank you for earlier, for telling me who I might be.” She bent and kissed his cheek, her voice catching as the words came out. “Sincerely, thank you.”

As she was leaving, Ben was entering, and she gave him a bye-bye wave as she flitted out the door like a butterfly on a light breeze.

“She’s … ” Jack shrugged, not able to come up with the right word to describe her.

“A force,” Ben supplied.

“A force,” he repeated, just a little bowled over by Amanda’s passion. She was so out there about it. In his life those kinds of emotions were kept hidden, and he wasn’t used to being around someone like her, who showed all of it so naturally. It was a little off-putting to that self-admitted stodginess in him he tried to sustain. But it was also fascinating, much more than he would have expected. Still, should he have told her who she might be? It bothered him, made him uneasy being put in that position. Part of him was already realizing, though, that turning her down in anything she asked was going to be tough. Maybe damn near impossible. Because she was a force.

“Anyway,” he went on, trying to shake Amanda from his mind, “about this hospital-acquired infection you’ve got going …”

“Seven diagnosed cases right now, all of them limited to the children’s ward. General symptoms but not that serious—abdominal pain, nausea, vomiting, malaise.”

“Fever? Cough?”

“Not yet. And the good news is we can do a limited amount of cultures here. But the bad news is, since we’re not really set up for it, I’m not sure I’d totally trust the results, if we were getting results, which we aren’t.”

“Which means everything’s turning up negative?”

“No positive test results for anything we’ve cultured. We’re set up to treat patients, and our lab, well … Let’s just say you’re not going to be impressed with it. So let’s just get this tour over with so you can figure out what to do with what we’ve got.”

“You mean Ezequiel’s tour wasn’t a real tour?” Jack asked, smiling. “Great kid, by the way. Smart.”

“We’re fond of him.”

“It’s good you let him hang around. Gives him a purpose.”

“And a home,” Ben commented.

“He lives here?”

“For a little over a year now. His mom brought him with her when she came for treatment, but she died from cancer, and we couldn’t find anybody who knew Ezequiel, let alone wanted him. No relatives, no family friends. So we set up a room for him … turned a large storage closet into a room, actually, and we all keep an eye on him. Make sure he’s fed, clothed.”

“Then he’s one of the lucky ones,” Jack said, thinking about Amanda, who’d also been one of the lucky ones. Thinking about Rosa, who hadn’t been.

“Lucky maybe, but he’s not getting a proper education, which is a problem. We’re each taking turns teaching him, but there’s no consistency to it. And he’s not with a family, not getting that kind of nurturing, which is an even bigger problem, because all kids need that. Yet if we turn him in to the authorities we might as well give him up for good. He’s too old to be adopted, probably wouldn’t do well in an institutional situation, which is where he’d end up if he didn’t run off. So we just …”

“Look the other way and hope for the best.”

Ben cringed. “When you put it that way, it sounds bad, doesn’t it?”

“No. Not really. I’ve worked in a lot of difficult situations and seen these lost children everywhere. Ezequiel’s sharp. A real survivor. You’re giving him more than he would have any other way, and he’ll make it through.”

“Let’s hope so, but he deserves better. Anyway, welcome to our lab,” Ben said, pushing open a door to reveal a closet-size space, set up with a table and two antiquated microscopes. “Like I said, don’t expect much. I found these in storage in a public hospital in Buenos Aries. They’d upgraded, and told me to help myself. So I filled our communal Jeep with everything I thought we might be able to use, which makes us, officially, a hand-me-down hospital.” Said with a big smile.

“I think the term today is repurposed.” Jack stepped in, took a quick look, and decided it would work. Not well, but well enough for some basic cultures. “So, Amanda said I have free rein, which means I’d like to start by examining the ward where the kids have been infected.”

“Well, since pediatrics is Amanda’s specialty, she’s going to assist you once she’s done with Maritza. Oh, and while you’re here, I’ve taken the liberty of adding you to our clinic schedule, if that’s okay with you.”

“You’re good, slipping that in there when you think I’m focusing on something else,” Jack said, laughing.

“We take our advantages where we can.” He patted Jack on the back. “Anyway, I’m glad you’re here, and until I hear otherwise, I’m going to consider you on call for general duty, starting tonight.” Ben pointed to the door at the opposite end of the hall. “My sister’s out there, when you’re ready for her.”

Jack didn’t respond. Could anyone every really be ready for Amanda?

Slipping into a pair of plum-colored scrub pants, Amanda cinched the drawstring at the waist and headed for the pediatric ward. Actually, it wasn’t a ward so much as one large room, sparse with equipment and other medical accoutrements. But there were beds, and sick children, and a growing problem that worried her.

Funny how Jack’s mere presence brought with it peace of mind. She couldn’t deny it, particularly since some of that peace was oozing into her. Peace in her medical life and, oddly, peace in her personal life. It was better knowing she might be Mapuche, she’d decided. Painful because that knowledge caused uncomfortable questions, but better. Although she owed him an apology because clearly he hadn’t wanted to be involved in the disarray she called her personal life. Yet he’d allowed himself to be dragged in, which wasn’t at all what she’d expected from him.

Something had changed him, though. She’d seen it happen. Seen the incredible struggle when it had flashed over him. But he had been so quick to grab it back, put it away. Leaving her wondering about the person he’d loved. Someone Mapuche. Perhaps a woman? The love of his life?

It occurred to her Jack may have returned to Argentina bearing some kind of pain, simply because she’d asked. “Who are you, Jack?” she asked, as her scrub top slid into place. “What kind of man are you?”

The kind who would fight to keep her from figuring him out. That was the answer that came to her on her way to meet him in Pediatrics. He wanted his distance, and she wanted … Well, she wasn’t sure about that. Maybe all she wanted was to understand him. After all, their worlds did intersect in more than one place, so why wouldn’t she want to understand someone who threaded in and out? Yes, that was it. A perfectly good reason for having Jack on her mind almost constantly. Which had turned into the case.

All thoughts led to Jack, but that was okay, because all she wanted was to understand. That was some mighty fine logical reasoning leading up to a half-believed conclusion. Who was she kidding, though? Because peel back all that logic and she just plain liked his gruff exterior, even his distance. That was what Argentina did for her, gave her different freedom than she was used to. Changed her perspective. It happened every time she was here, maybe because deep down she’d always felt the innateness of who she was. Or wanted to be.

“Anything going on other than what’s being recorded in the charts?” Jack asked from his casual seat behind the old wooden desk that sufficed as the hub of the ward. One desk, one swivel chair, a rusty file cabinet, all of it tucked into the corner, out of the way. And Jack’s size overwhelmed everything. An immense man in a small space made the man look even more immense.

Amanda noticed that, fought to keep her gaze steady. “Not really. Symptoms are mild, nothing you wouldn’t expect. No one critical or even in danger.”

“And you don’t think that this might be some run-of-the-mill hospital infection, one that’s not going to cause any real trouble.” It was a statement, not a question. “Ben’s downplaying it, so he’s not the best one to go to for an objective answer. You, though, got me here, which means you’re worried. So what’s your assessment?”

“That’s just it, Jack,” she said, perching herself on the edge of the desk. “I don’t know. Ben’s been fighting this HAI for a few weeks now, it’s isolated, but it’s not going away. Not getting better or worse, either. With the way things mutate … and I’m not the expert on this, so bear with me. But you read how these various strains, bacterial and viral, mutate, and how so much of what we thought would stop the spread is rendered ineffective very quickly. My brother is smart, and he’ll do whatever it takes to protect the hospital. Me too, because I’m also involved in this, and I believe you’re what it takes or else I wouldn’t have asked for your help.”

“Well, for what it’s worth, every hospital known to man runs some sort of HAI strain through it, Amanda. These kids have gastrointestinal flu-like symptoms. That’s all. And according to what I’ve read, they’ve all been cured pretty easily.”

“But per patient, our percentage is huge. One third of them are coming down with something we’re giving them and that statistic, if nothing else, should be a warning. It’s just that I don’t know what the warning is about.”

“Then it’s a good thing you called me because warnings are my specialty.” He glanced up. “So, it’s time for me to meet the ward.”

“Not the children?”

“Nope, not at first,” he said, standing. “Sometimes not at all. I seem to have a better rapport with the contaminant than I do patients, so I try to keep to where I’m better received.”

“Such a low opinion of yourself,” she said.

“Or a high one, depending on your perspective. Anyway, with the symptoms that are manifesting themselves, the scope of what could be infecting the kids should be pretty limited, so I like to look at everything from a fresh perspective, which includes culturing areas that wouldn’t normally be associated with what we’re seeing. In other words, wear a sturdy pair of suspenders along with a belt, just in case.”

“Overreacting?” she asked, smiling.

He didn’t answer her at first. Instead, he merely stood and stared at her, eventually giving in to a half smile, then finally, “Reacting.”

“Okay, then. If you’re intent on reacting, did you bring the testing supplies with you, because we don’t have—”

“I come prepared. Might even have another trick or two up my sleeve.” He grabbed his white lab coat off the back of the chair, which she hated seeing because she liked his look now … cargo pants, and a crisp, white T-shirt. But everybody had something to cover up, didn’t they? Jack covered something dark and despairing. Her parents covered something that scared her. She covered up so many things in herself, as well.

But what would happen once the covers started to peel back? That was a question she couldn’t answer. And wasn’t sure she wanted answered.