“Yo no sé. Está en el suelo, como duerme. Pero yo no sé si puede respirar.”
Unconscious, on the ground. Status of her breathing unknown. “¿Sabe donde el hospital es?” She was asking the girl if she knew where the hospital was.
The girl nodded then pointed straight ahead on the trail.
“¿Es muy distante?” Very far?
The girl shook her head. “No.”
“Bueno. Por favor, corre al hospital, los dice lo que usted me dijo, y los dice que hay ya un médico con su madre, pero necesitan alguien que puede ayudar a conseguirla al hospital.” She was telling the girl to run ahead to the hospital for help, but the look on the girl’s face indicated she either didn’t understand or might be afraid to do so. “¿Lo que es su nombre?” she asked the girl as they made their way through the grasses.
“Valeria,” she said.
“Eso es un hermoso nombre.” Beautiful name.
“Agradecimiento.”
Valeria smiled politely with her thank-you, even though she was so scared. Shanna was impressed by the girl’s manners, especially given the circumstances. Grace under pressure. Something she needed to master. “¿Y qué es el nombre de su madre?”
“Su nombre está Ines.”
The mother’s name was Ines. Just as that little bit of knowledge sank in, they rounded a clump of tall pampas grass, where Ines was sprawled on the ground. Breathing, thank God! But barely.
Shanna dropped her bag to the ground, knelt to open it, then had second thoughts about snakes. Pit vipers were prevalent here. At least, that was what she’d read on the plane. That, and so many other disjointed facts about Argentina. So she stayed half upright, half bending, and grabbed the few medical supplies she’d been allowed to carry in. No medicines, just equipment. Which wouldn’t save the woman’s life. “Soy médico, Valeria. Pero debo ayudar. Por eso yo deseo que vaya al hospital.” I’m a doctor, but I need help.
Back home, help had been at hand with just the push of a button. Out here, she didn’t know. And as she wrapped her stethoscope around her neck and clicked on her penlight, she wasn’t even sure the kind of help she might have had back home would do much good, given what she was already seeing in Ines.
Truth was, if the bite had come from a pit viper, the only possible treatment was antivenin. “Debo ayudar.” Yes, she needed help, especially when her first take of the woman’s pulse revealed tachycardia. Pulse much too fast and starting to skip some beats. In addition, there was swelling on her left ankle where the bite area was, not only very puffy but red and hot to the touch.
Shanna imagined other symptoms had occurred while the child had waited there with her mother, probably hoping someone would come along to help them—difficulty with speaking, muscle weakness, dizziness before passing out, excessive sweating, blurred vision, maybe even some paralysis.
While she’d never had to treat a venomous snake bite as a family practitioner, she’d certainly studied them in medical school. Which was nothing like encountering one in front of her. Because what she remembered from her studies was that without fast treatment death followed coma. And the blue tinge developing around Ines’s lips was a precursor to death.
“¿Puede correr al hospital, Valeria?” Even though she asked Valeria again to run to the hospital, Shanna wasn’t sure it would make much difference. Time was elapsing and she had no idea how long ago Ines had been bitten. But the woman was still breathing, which meant there was still hope. Only at Ben Robinson’s hospital, though, and only if Ben stocked the right kinds of antivenin.
The child tugged on Shanna’s shirt. “Sí, puedo. Pero tengo a amigos cerca que puede ayudar a llevar a mi madre allí. Creo que sería más rápido.”
She had friends who could carry Ines there faster. Shanna kept her fingers crossed as she shooed Valeria off to fetch these friends. “Tan rápidamente como usted puede,” she urged the child, even though she didn’t know if Valeria’s fast would be fast enough.
In the meantime, Shanna kept vigil over Ines, washing the snake wound the best she could with bottled water. There’d been a time when making a tourniquet had been the field standard in care, but studies had proved that when a tourniquet was applied, the poison was likely to concentrate where the tourniquet was cutting off circulation, increasing the chances of amputation or even a faster death.
Then there was the idea that cutting the wound and sucking out the poison could improve things. Unfortunately, too many people had died from sucking the poison into their own lip or mouth cut.
So now she had to sit and wait, feeling as medically ineffective as she had that day when she’d promised her patient, Elsa Willoughby, a kidney transplant. Not a simple thing to promise, granted. But Elsa had been in a bad condition, which should have put her at the top of the list for an available kidney. What she hadn’t expected, though, had been the hospital’s refusal to allow the procedure once a kidney became available. A refusal that had come from her grandfather, and been upheld by her father and several other doctors bearing the Brooks name. It was like they’d turned into a wall of opposition because she’d had a patient who needed an operation they didn’t want to grant.
Your patient is too old, her grandfather had stated. That, and another dozen reasons that had got Elsa rejected from Brooks Medical Center, a conglomerate of three hospitals, nine clinics and fourteen other miscellaneous medical services.
Eventually, the county hospital had taken Elsa, but too late. Her condition had deteriorated to the point that she had no longer been a good enough candidate for a transplant anywhere. She’d gone back on dialysis to await her fate, which had come just four months later.
Shanna still had nightmares about the day she’d had to tell her patient she could do nothing for her, that the medical system she’d loved and trusted had failed her. She’d had a small breakdown, meltdown, whatever the term du jour turned out to be. Had spent the night alone, crying, angry, doubting everything about what she was doing.
Next morning she’d gone to her grandfather one more time, trying to persuade him to change his mind. But his was a mind that wouldn’t be changed. “Given your emotional involvement, you may be better suited in an administrative role than the actual practice of medicine,” her grandfather had said. An administrative role because she cared? It’s why she’d left medicine and had gone looking for a better way. Or a different way. Or any way at all that would define her place in medicine. And if it wasn’t out there, then what?
Ben Robinson. He proved it was out there. Everything she’d seen of him proved it. And to gain some of what he had, she’d do whatever she had to.
Except here she was again. Not being able to treat a patient. So she spent the next several minutes doing what she’d done with Elsa after she’d broken the news. She sat and held her patient’s hand, felt her own pulse jump every time Ines twitched, felt her own breath catch each time Ines’s breath went raspy. Heart-on-her-sleeve medicine. Even deep in the jungle she could feel the disapproval of the entire Brooks family.
Luckily for Ines, that wait wasn’t long for only minutes after Shanna had settled in she heard quite a clamor coming from the trail. Not just one or two people. Probably not even three or four of them. In fact, by the time she was on her feet, twenty or so people were standing in front of her, hefting a bed. Not a stretcher or some makeshift rig to transport Ines but a single-size bed, mattress, blankets, pillows and all. She’d never seen anything like it. So much response, so much concern…”Put her…” she started to instruct, but the will of the people took over, and before Shanna could blink, Ines was lifted into the bed, and the bed was being whisked down the trail. All she could do was follow.
Which