POCKET CHANGE 2: A GAME OF CARDS
by Sharon R.

Chapter Eight

The lightness in the air was suddenly broken by the reverberation of an explosion in the not so far off. Jumping to their feet, the four waited, almost frozen in place, for the ultimate screams of panic and ensuing chaos.

"Turn it off," Carter ordered Norman who remained in his seat, the look of fright stalling his ability to make a move. "Turn it off!" Carter walked over to the wall and yanked the CD player's power chord from the outlet. Luka opened the door of the office and stared straight down the center of the building at the two large swinging doors anticipating the horrors of war he hadn't seen since… since…

Several soldiers barged in carrying one of their own, blood dripping from one end and the poor man's screams from the other resonating throughout the empty building.

"He stepped on an old land mine," Othiamba yelled out, "I put a tourniquet on his leg."

The three doctors rushed out into the clinic area and directed the men to put the wounded soldier on a treatment table where they started cutting off his clothes and assessing his condition.

"I've got a traumatic amputation…," Luka had to step back to make heads or tales of the mutilated body before him. "… above the knee."

"Open tib-fib on the right," Carter was stripping the clothing away from the ankle up, "and soft tissue injuries to the buttocks and groin area."

"Maggie?" Luka was working to clamp off the bleeders on what was left of the man's left leg.

"Airway is clear, no external injury to the torso. Neck is clear… I think." No x-ray, no CT, no MRI, no labs. Diagnostic medicine was a gamble and the three doctors were playing blind. "What's your name?" She asked him while looking in his eyes and ears.

"Jabari," he whispered in a pained voice as he grabbed onto Maggie's wrist. "Jabari Mulefu. Please… please…" The patient became agitated, grabbing at Maggie in desperation and pain.

"Come on Maggie," Luka shouted at her as he struggled to gain control of the bleeding, "get two peripheral lines started."

The doctors strained to manage the care the patient needed without extra hands and proper equipment. While Maggie worked to get IV's in both arms, Luka and Carter continued their haphazard attempt to clamp and tie off the bleeders in the stump of the left leg. Carter put his head up long enough to scan the room for able bodied people to step in.

"Paulette, I need you to get three of the surgical packs, the big ones." The teenaged girl who so wanted to become a doctor was obviously shaken, but didn't hesitate to help out. "You've put them together, they're next to the autoclave. Bring them here, then stand next to his head and talk to him. Can you do that?" Paulette scurried around gathering what they needed before returning and gently stroking the man's face, calming him.

"Jabari?" Paulette's voice was sweet as she bent down and spoke into his ear. "Your name means 'brave' and 'fearless'." He took a deep breath as a tear rolled down past his temple onto the sheet. As Carter deftly inserted the foley catheter into the man's penis he let out another gasp and reached up to Paulette. "You must be a brave man to be a soldier - to take care of us." It was an easy task for Jabari to listen to the innocent young girl whose hands cupped his face from behind. "But I think it would be okay to be a little afraid. You can be brave and afraid. But these doctors are the best in the whole world."

"We need meds, Maggie," Luka continued. "Go back and see what you can find. IV antibiotics, pain meds, anesthetics, antibiotic flush. And lots of betadine." Maggie ran to the back of the clinic, not too happy at being relegated to nursing duties.

"Where's that blood coming from?" Carter moved back to the man's right side and lifted up the sheet that covered the remaining fractured leg where he found that the site of the protruding bones was oozing once again. "Shit, this needs pressure. I've got a pulse and we've got to find some way of reducing this in traction."

"Carter, I need you on this leg now," Luka shouted knowing that without blood for transfusions they had to work fast.

"Todd. Todd, over here," Carter called out. "Come on, I need your help."

Todd's apprehension steered his body backwards one step for every two he took forward. One glare from Carter and he fought his fear and broke into a run, eventually coming to a crash as his feet slipped in a pool of blood on the floor, his cell phone flying yards away from him landing next to the doctors. To his credit he quickly regained his vertical hold and scurried to Carter's side.

"Put your hand here." Carter roughly put the boy's hand on top of a large stack of surgical gauze pads covering the hole in the man's leg. "Now press down hard and keep it there."

With the force of pressure from his hand, Todd could feel the edges of the snapped bones move. Jabari screamed and jolted in pain as his leg was pushed down causing Todd to release his hand and step back. He was shaking, breathing hard and sweat beaded up on his face.

Maggie had returned and was pouring the betadine over the wounds as Luka and Carter each took turns stepping away to gown and glove for the remainder of the procedure. Without general anesthesia, she used whatever local she could find, although she knew it wouldn't be near enough to control the onslought of pain.

"Get back there Todd," Carter spoke out. "You have to control the bleeding."

Todd was frozen as he took in the action around him. All too much for the bookworm who was afraid of blood. "I… I… can't…" His face contorted as he fought to keep the vomit from rising and the tears from flowing. Then the unmistakable ring as Todd's phone chattered on the floor.

Carter kicked the phone across the floor. "Get him out of here," he barked at Sean.

Sean put his arm around Todd, guiding him away from the trauma scene. "He's just a kid."

"He doesn't belong here."

"Carter!" Luka's patience crumbled. "You're exhausted, we don't entirely know what we're going to do here. But don't take it out on him." The two looked through each other as they continued to do a rough surgical repair on the man's stump.

"Paulette, can you come down here and do what Todd was doing?" Luka's gentle voice and eyes guided her to the foot of the bed where she carefully placed her two small hands on the stack of gauze. Pressing down, she looked to Luka when the man started to move around in pain.

"You have to press down harder," he told her as quietly as he could, but as she did so Jabari let out a scream as the bone fragments scraped against the nerve endings in his open wound. Paulette flinched but didn't move.

Maggie returned with another armful of supplies. "Only one vial of morphine and not very much in terms of IV antibiotics."

"That's impossible," Luka looked at her, "there was a tray of morphine we got last week from Gulu. And we should have plenty of antibiotics." Luka looked back at Carter who was into his third package of suture material. "Have you been trading again?"

"No. It has to be there. Look again, Maggie."

Maggie gave Jabari some morphine through his IV and the man started to relax. "We've got what we need for now, except a nurse," Maggie mumbled the second part hoping the two male doctors would catch on. "Let me take a look at what's left of this leg." With Paulette's help, Maggie irrigated the area and inspected the site. "He's still got a distal pulse. With traction and rods this leg could be saved."

"They don't have anyone but a glorified GP in Gulu who would just amputate it anyway and not very well at that," Carter contemplated. "Othiamba, you and Sean get on the satellite phone to the hospital in Kampala. Ask if they have an orthopedic surgeon who has the ability and equipment to do external fixation."

"What are you thinking," Maggie asked.

"This guy won't have any life here with no legs. The right one can be saved with pins and rods which we don't have here. And by the time we get him to Kampala the window of opportunity to close that wound and stabilize the bones internally without risk of infection will be long gone. But, if they use external fixation, they can treat infection locally."

"Let's just get him there anyway," Maggie said.

"No." Luka caught on. "Carter's right. If we send him there without knowing if they can use external fixation and they can't, they'll probably just use pins, plates and rods. He's bound to get an infection which will travel straight through the rod which is driven up the length of the bone. He'll die slowly."

"And if they don't have the external fixators?" Maggie asked knowing the answer.

Both men worked quickly and methodically as they tied off the bleeders, neither wanting to answer Maggie's question very loudly. Finally Carter looked at Jabari's face, then back at Maggie before quietly giving her the worst case scenario. "Then we take him to Gulu."

By the time they had moved onto the right leg and started cleaning and suturing the soft tissue injuries, Sean had come back into the treatment area. "Kampala's surgeons do perform external fixation. A military medivac chopper from Lira is on its way. Should be here in 30 minutes."

Having stopped the bleeding in the amputated left leg and the skin flaps sewn shut around some drains, the right leg wound was irrigated, packed and splinted. The chopper had landed with its medical crew and the wounded soldier loaded into the bus from the rear for transport to the airfield.

"Jabari, we're going to fly you to Kampala where they will set your leg using something called external fixation," Luka explained on their short but bumpy ride. "Screws will be inserted through the bones above and below the fractures. Then a device will be placed outside of your leg and attached to the screws. This way the doctors can treat any infection to this large open wound locally without much fear of it getting to your healing bones."

"Will I walk again?" the patient asked pessimistically not really understanding the doctor's explanation.

Luka told him the truth. "With a prosthesis in place of your left leg I think you'll do fine. But there's always a chance of complications and your right leg may not be able to be saved. But I'm feeling good about it, and so should you."

As Jabari was loaded into the chopper he held his hand out and took hold of Maggie. "Thank you. And thank the little girl for me."

Othiamba drove the bus back to the camp area while Maggie and Luka opted for the more comfortable stroll.

"Hey Kovac, I just want you to know that I am capable of handling more than nursing duties during a trauma."

"I'm sure you are. Carter says that you are a top notch doctor. However, I'm also sure that it's been a long time since you ran a trauma like that." Luka paused expecting Maggie to have something poignant to say about that. Surprisingly enough to him, she just listened. "We didn't mean to insinuate anything but you know very well that without the nurses here that stuff had to be done. Carter and I work very well together - we kind of read each other during traumas. We didn't have time to sit down and hand out duties."

With the chopper back in the air and the excitement over, the children took back their fields getting in one last game. An errant ball landed in front of Luka who took the chance to show off his rusty soccer skills and dribbled it back onto the field where he passed it off to Mbuto. The children cheered for Dr. Luka as he raised his arms in mock victory. Leaving the field to join a smiling Maggie - a rarity - he gave Joseph a high five.

"It's amazing," Maggie said as she looked Luka up and down.

"What?"

"Those kids. You are absolutely covered in blood and it didn't even phase them. A hell of a way to grow up." The two walked further in silence before Maggie asked what was really on her mind. "What was with Carter?"

"What do you mean?"

"During the trauma. What got him all on edge?"

Luka shrugged his shoulders. "He's tired. He has a lot on his mind."

"He was all over that goofy college kid. Almost mean spirited." She didn't even want to think that. "I worked with him for a couple years and I know him and he's not like that."

"He can be." Luka was uncomfortable beating around the bush with her. "Look Maggie, it's been five years since you've seen him. Things happen and people change. I'm sure you have too. You've spent a lot of time with him since you got here. Has he talked much about those five years?"

"No. Not really. Why?"

Luka stuffed his bloodied hands in his pants pockets and focused downward as they got back into camp. "Nothing. We really shouldn't be talking about him behind his back."

To achieve anything in this game, you must be prepared to dabble on the boundary of disaster -Stirling Moss 1929-, British Motor Racing Driver

Once Jabari was taken from the clinic the sudden silence was almost shocking. Carter stood in the middle and turned around in a circle looking at the chaos that that one trauma had created and left behind. Clamps, hemostats, needle drivers, suture material, gauze pads and rolls - all strewn over the floor. The discarded wrappers for the IV lines and fluids, rolls of partially used tape, empty vials and used syringes - and Jabari's clothes. All blood soaked. Removing his surgical gown and gloves he found just as much dried blood on his clothes and hands having had no time to get protective gear on when the patient first arrived. Carter snickered to himself at how much panic everyone would have been in back in Chicago had this much blood come into contact with a doctor, yet the HIV rate in Africa far surpassed that of home.

"You docs are damn good."

Carter wasn't even phased by the surprise voice in the corner sitting at the intake nurse's desk. "So are you, Bob. You are the best lurker I know. By far."

"Don't want to get in the way."

"You aren't. We're kind of getting used to you." The two traded very faint, but very reluctant smiles.

"Did he get off okay?" The doors swung open sneaking shards of sunlight into the building. "The bus took a tear across the camp." Sean stepped over blood drenched rags on the floor, having had years of exposure to scenes worse than this - but not much.

"He has a chance."

"It's a good thing he's military. I'm not sure we would have gotten air transport if he weren't." Sean took out a piece of paper and handed it to Carter. "While you were working in here, we got a delivery of supplies. This came for us from the office in Kampala."

Carter read the letter addressed to both him and Sean from the Ugandan government regarding the VetScan blood chemistry machine. Under no circumstances would they approve the transport of such a valuable piece of medical equipment along the Karuma/Pakwach corridor by land or air.

"But the Gates Foundation said they would pay for it. Hell, I'd pay for it out of my own pocket." Carter was livid. "What more do we have to do?"

"I was afraid this would happen. I'm sorry John." Sean gave him a comforting pat on the shoulder.

"But why not even by chopper? They certainly didn't mind giving Luka and me the four diamond tour."

"The government knows that nothing flies around up there without someone down here knowing about it," Bob commented as he stepped into the conversation. "If it's something of value and it can be salvaged from a wreck, they won't hesitate to shoot it down. This country is flourishing certainly beyond it's previous war torn dictatorship. But those choppers and the people who fly them are valuable to the military. Your blood machine isn't."

Sean walked back to the office and turned to leave the heavy news reporting to Carter. "Would you tell Maggie and Luka for me when you see them?"

"I'll, ah, I'll tell them after dinner." Yet another roadblock.

After washing his hands and arms, Carter grabbed some fresh scrubs and headed outside to the shower area. Even a cold shower had its appeal. In the distance he saw the lights of the military chopper on the airfield and stopped to gaze that way getting one last look at his patient, even though he was really too far off to actually see. He grimaced as the muscles of his lower back stiffened making him arch his back in response. Something he had gotten use to, though it had regressed a bit since the Congo. Great, I'm getting old. What's next?

Carter stretched his arms over his head as he turned to go to the showers. Out of the corner of his eye he spied a figure sitting on the ground against the side of the Midway in the shadows of the setting sun.

"You okay?" he asked, looking down on Todd.

With his knees to his chest, the red of the late day sun bearing down on his face, Todd kept his eyes closed wanting to just shut down. He didn't want to answer, he couldn't. Carter turned around, but before he could get far his inner voice guided him back to the young man where he slid his back down the side of the building joining him on the ground.

"What is it that scares you most?" Carter asked as Todd continued his silence. "Is it the blood? The faces?" No reaction. "The pain?" He made a measure of the frightened boy beside him. "Is it failure?"

Todd's head emerged from between his knees as Carter mentioned the 'F' word.

"Ah, well I can understand that."

Todd was stunned both by Carter's own admission of weakness and the shear fact that he was talking to him. "Failure? But you're a Carter."

"So?" Carter chuckled. "The fear of failure has no boundaries and doesn't discriminate between social class." Carter's thoughts quickly went to his own family. "So what are you afraid of failing?"

"More like who."

"Oh. I see." He looked at Todd to see if he could get a rise out of the closed up kid. "What is it your father wants you to do that you don't want to do?"

"How did you know?"

"We're not that different, Todd."

"He wants me to be a doctor. That's why I'm here." Taking off his cap, he fiddled with the visor bending it back and forth. "He thinks that with my undergraduate degree I'm a shoe-in for med school. When I told him what I wanted to do, he blew up. Said that I needed to experience the real world. That maybe if I looked tragedy and adversity in the face I'd be a stronger person. It's such bull shit. That kind of stuff just doesn't happen."

Carter leaned his head back on the wall of the building as he listened to Todd's rant. It was the first time he had heard more than three well spoken words from the kid at one time. "Well, I can't speak for your father and you certainly have to learn from your own experiences, not others'. But I can tell you that you do learn from adversity and it can change you. Only, you decide how it changes you."

"Yeah, right," Todd mumbled dismissively. "I don't know how it could get any worse than this. I never imagined hell, but I'm close to thinking this is it."

"First of all, this place - the whole picture - isn't about you, Todd." Carter pointed in the direction of the field with all of the tents erected. "It's about them. They know a hell I doubt you will ever know. And for the record, it can get a lot worse than this. I think when you get back home you'll see that the decisions you have to make there will be a whole lot easier."

"I bet you always wanted to be a doctor."

"Yep, I did. But it's not what my family wanted me to do." This got Todd's attention. "They fought it. My dad wanted me to get my MBA at the Wharton School. I was the appointed Carter child expected to take over the reigns of the family empire. By the time I had graduated from med school, they stopped trying to change my mind. Instead they pushed me to choose Cardiology as a specialty, not the lowly unglorified field of emergency medicine."

"Are you still fighting them on that?"

"No. Time and age, and events, change how you see things, especially your loved ones. As much as you don't like being here, I think it's a good thing that you spend this time away from your parents. They tend to appreciate you more when you're not there." Carter noticed Todd's phone on the ground and picked it up, wiping the dried blood from it with the only unsoiled corner of his shirt. "How's the phone? Did I break it?"

"No. I guess it's fine." Todd sneaked a little smile. "Embarrassing, but fine."

"Well, at least your mother cares enough to want to hear your voice. Mine - I hardly know her. Saw her between her extended trips around the world and my boarding school semesters if I was lucky."

The awkward silence was interrupted by the returning bus as it rambled by. Someone was playing music nearby and diner's voices wafted through the window of the Midway above them.

Carter smiled first before he asked the next question, remembering a conversation he had with Luka back in the Congo. "Todd, what did you dream about when you were a kid?" The puzzled look on Todd's face didn't help as Carter tried to get him to talk more. "What is it you dreamed about doing?"

"I played soccer. First summer league, then the travel team. I even played varsity." He stretched his legs out and opened up at the mention of soccer. "It's the only thing I was good at outside of the classroom. I used to want to grow real long hair and play soccer in some foreign country where it was appreciated."

"Well, I can't help you with the first part, but for a lot of the kids here soccer is their only form of escape, and they need a mentor."

"Oh no." Todd waved his hand as he tried to repel the thought of being alone with a group of children." I… I, uh, don't relate well to kids. I don't know how to talk to them."

"You don't have to do much talking. Just listen and play the game. Tomorrow go find the kids and do what you do. So, go get cleaned up and join us for dinner. Okay?" Carter got to his aching feet and once again started to make his way to the shower.

"That was quite a show you put on in there today." Up on the porch of the Midway, Colleen sat in a rocking chair one of the elderly refugee men made for the staff. Soft music was coming from the beat up CD player she had hijacked from the office.

Carter stopped and rested his arms against the porch. "Well, yeah, that's not something you see every day," he said as he looked up at her. "Not a whole lot of landmines in downtown Chicago."

"Nice to see you give the kid the time of day."

"You in the habit of listening in on other people's conversations?"

"Only when I can't help it."

Carter walked up onto the porch and sat on the top step. "Nice music." The voice on the CD was soothing - something needed after what everyone had just gone through. "Who is it?"

"Joss Stone. A very special person back home sent it to me." Colleen joined him on the step and the two listened to the deep, rich singer's voice as every once in a while a camp member walked around them to get into the dining hall. "Can you believe she's only seventeen years old?"

(Lyrics to a few lines of Fell in Love with a Boysung by Joss Stone, previously properly attributed, deleted as per new regulations by site administrators 5/3/05. The complete original text of Pocket Change can be found at LUKAFIC)

"Wow," Carter thought aloud as he enjoyed that mellow, mature voice, the lyricsironically centered around a red headed girl,"how is it that someone so young has such an old soul?"

"I don't know, you tell me." Colleen elbowed Carter a little as she made her point. "So, are you married or otherwise committed?"

"No and no."

"Really? Well," Colleen was in a rare place where words were not coming easily to her, "um… how do feel about red heads?"

Carter smiled and even let out a small nervous laugh, happy that the setting sun was behind Colleen and he couldn't turn to look her in the face without blinding himself. "If you just made a pass at me I'm a pretty lucky guy. But…"

"But?"

"Some people come with baggage," Carter explained as he somewhat nervously picked at the dried muck on his pant leg, "I come with steamer trunks. Very large, and very full. I'm just not in a good place in my life right now to be in a relationship."

"I didn't mention anything about a relationship. That's a… that's a dirty word sometimes."

"You are very beautiful and smart, don't get me wrong. Just…" Carter stopped knowing she got it. "Well, thank you anyway."

"You really do have an old soul."

As Luka and Maggie walked back into camp their stomachs grumbled, the steady stream of people heading into the Midway reminding them what time of day it was. Sitting on the Midway steps, close together so as to let people come and go, were Carter and Colleen.

"Looks like Goldilocks is getting closer to Baby Bear's bed," Maggie thought aloud to Luka.

Luka couldn't miss how well the two of them got along as they were talking quietly now between themselves. Carter and Colleen - it even sounded right, in a sick high school-ish sort of way. She was a flirt, alright, in her own sarcastic, brush way. And no man was safe from it, except Sean, that is. He irritated the hell out of her and it was fun to watch. But Luka just didn't see her as Carter's type. At least he didn't want to.

"You really do have an old soul," Luka heard her tell Carter.

"I've heard that about him." Luka stepped into their picture from the haze of the orange ball of sun dipping below the horizon behind him. "Heading in for dinner?"

"Ah, she is," Carter stood looking down at his grubby clothes, still hanging onto the bundle of clean scrubs he had grabbed in the clinic. "We really should get cleaned up before joining the rest of civilization in there."

"Yeah. Hey, are we going to have time to… you know, do that white envelope thing?" Luka tried to code talk with Carter.

"You two are full of secrets," Colleen wrinkled her forehead wanting to get in on the action. "How about sharing it with a beautiful, smart red head so she doesn't explode from curiosity."

"Oh, brother," Maggie smirked, "I'm going to go try and straighten out the drug inventory. Save me a plate, would ya?"

Colleen hopped off the steps and squeezed between the two doctors who were walking away now, preserving their secret.

"I don't divulge secrets," Carter gave Colleen playfully as she linked her arms with both doctors. "Besides, I would think a journalist is the last person to keep a secret."

"Okay. But I'm warning you two. It better be good." Pulling herself away to allow them to finish their stroll to the showers alone, Colleen headed back to the Midway. As the two walked away, Luka stole one last look back over his shoulder at Colleen… who was doing the same.

"So are you two…"

"What?" Carter pretended not to know what Luka was getting at as he hoped that the conversation wouldn't turn to…

"You know. You - and Colleen - interested in each other."

"Uh-huh. And the answer is no."

"When are you going to move on away from Abby? Because being alone just," Luka struggled with the appropriate feelings, in guy terms, "sucks."

"I don't know. I don't know if it's Abby, or the break-up, or me, or maybe just me wanting to gain my own confidence back again without having to step lightly around someone else's emotions."

"So a passionless life is where you want to be right now?"

"Passion has its place. Just not here. Not with me, here. I, ah, tend not to think rationally when passion is stirred up inside me, and…" Carter stopped short of the canvas covered shower stalls. "Okay. This is getting weird, Dr. Ruth. I'll see you at dinner."

Within a couple days, the camp learned that Jabari had arrived safely at Kampala and had undergone surgery to his legs. They had been able to save his right leg with external fixators and were now waiting to see how his recovery would go. The clinic was overwhelmed and understaffed as an influx of new arrivals descended on them. Carter still spent time at Gulu hospital when he could paying off his "debt" for the transfusions. He also racked up more debt using their laboratory facilities as it became more and more necessary.

"You really ought to carry a gun on you when you travel that road," Maggie advised him one day as he was leaving the camp. Carter now drove alone during the daylight hours.

"Yeah? Maybe I should just take Norman and use him as a shield." He winked at Maggie as Luka approached the Land Rover.

"What's up?" Luka asked.

"I think John needs to arm himself for protection when he goes to Gulu." Maggie answered Luka, but stared directly into Carter as if to make her point again.

"Look Maggie, I've only shot a gun once in my whole life, at that indoor firing range."

"I know," she remembered, "I was there."

"Really?" Luka was amused and surprised. "How'd you do?"

"The clock didn't stand a chance," Maggie was more than happy to announce to Luka. "He maimed it."

Carter shut the door and revved the engine. "I rest my case."

In the predawn hours of the morning, Carter, Luka and Maggie were awakened by the sudden roar of the wind and a shuffling of feet outside their bedroom doors. Although they took turns being on call for emergencies, they had become light sleepers with their rooms being right off of the clinic at the end of the hangar. They almost ran into each other as they exited their rooms into the darkened hallway. Following their eyes to the back door which had just latched closed, they stepped outside and focused their eyes and ears on an eerie sight.