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Lauren Valentino

The moment I stepped into the clinic, I knew today was going to cause problems. The air felt heavier, charged with a strange electricity that made the hair on my arms stand up. Six months in Corazón had taught me to trust those instincts.

“Dr. Valentino!” Sure enough, Mariela, our local nurse, rushed toward me, her dark eyes wide with worry a few minutes later. “There’s been an accident at the mining site. Four men injured. They’re bringing them now.”

And there it was.

I nodded, already moving toward the treatment area. “Prep the rooms. Get the emergency kits ready.”

Our clinic—a converted schoolhouse with peeling blue paint and windows that never quite closed against the jungle humidity—wasn’t equipped for major trauma. We made do with limited supplies, questionable electricity, and an undying belief that something was better than nothing.

The familiar rhythm of preparation calmed me. I washed my hands methodically, counting under my breath as I had since med school. Twenty seconds. No shortcuts. Not here, where infection could kill as easily as trauma.

“Do we know anything?” I asked as Sophia Yang, one of my three fellow physicians, joined me at the sink.

“Explosion. Mining equipment malfunction,” she said, her voice steady despite the tension in her shoulders. “Local radio says one critical, three walking wounded. Williams and Martinez are out in town with other patients, so it’s just you and me.”

Before I could respond, the doors banged open. Two men carried a third between them, his face ashen beneath the dirt and blood. Behind them, another limped in, clutching his arm to his chest.

“Critical first.” I directed them, pointing to the main exam room. “Dr. Yang, can you assess the others?”

Sophia nodded, already moving toward the wounded who’d been able to walk themselves in.

The injured miner couldn’t have been more than twenty. His breathing came in short, pained gasps, and blood soaked through his shirt from a wound in his abdomen.

“I’m Dr. Valentino,” I said in Spanish as I cut away his shirt. “Can you tell me your name?”

“Miguel,” he whispered. “Am I going to die?”

The question hung between us as I assessed his injury. Penetrating trauma to the abdomen. Significant blood loss. Likely internal bleeding.

“Not if I have anything to say about it,” I replied, injecting confidence into my voice that I didn’t entirely feel. “Mariela, I need an IV started. Lactated Ringer’s, wide open.”

As Mariela worked on the IV, I continued my assessment. The object—part of the mining equipment—had penetrated his upper abdomen, just below the rib cage. The bleeding was steady but not arterial. What concerned me more was what damage lay beneath, invisible to the eye.

“Miguel, I need to examine your abdomen. This will hurt, but it’s necessary.”

He nodded, his eyes never leaving mine. I pressed gently around the wound, noting his grimace when I reached the upper right quadrant. His abdomen was rigid—a sign of peritonitis or internal bleeding.

“We need to get him stable for transport,” I told Mariela. “The hospital in Ciudad del Este?—”

“No hospitals,” one of the other miners interrupted, stepping into the room. “The company won’t pay. They say it was worker error.”

I felt the heat of anger rising in my cheeks, but I tamped it down. “He needs surgery. This isn’t something I can fix with bandages and antibiotics.”

The man shook his head. “There’s no money for the helicopter. No money for the hospital.”

I’d heard this before. Too many times. The mining company that employed half the men in the region was notorious for avoiding responsibility for accidents. Between them and the Silva cartel, it was a wonder anyone here survived.

I looked down at Miguel, so young, with fear clouding his eyes. Then I glanced back at his friend, standing firm despite his own obvious pain.

“Get Dr. Yang,” I said to Mariela. “We’re going to need to perform emergency surgery.”

Mariela’s eyes widened. “Here? But we don’t have?—”

“We have enough,” I interrupted. “We have to try.”

While waiting for Sophia, I explained to Miguel what needed to happen. “The object may have damaged your liver. We need to remove it carefully and repair any damage. I won’t lie to you—this is risky. But doing nothing is riskier.”

His hand found mine, surprisingly strong despite his weakened state. “I trust you, Doctor.”

Trust wasn’t necessarily going to be enough to keep him alive, but I squeezed his hand.

Sophia entered, her expression shifting from confusion to understanding as I outlined my plan. I waited for her to tell me all the reasons this was impossible.

“What do you need me to do?” she asked instead.

Relief flooded through me. This was why I respected Sophia. She saw the same impossible choice I did and chose to act.

“I know our limitations,” I said. “But he’ll die if we send him out untreated, and the company won’t pay for transport.”

“Then we work with what we have.” She was already mentally cataloging our supplies. “Let me call the hospital for guidance while you prep him. Maybe we can get through this time.”

“We’re racing against time here.”

“I know. But if we’re doing this, we’re doing it right.”

Surgery in our makeshift operating room was never ideal. The lighting was inconsistent, the equipment basic, and our anesthesia options limited. We had done difficult procedures before, but this would be the most challenging yet.

Once Miguel was sedated with our precious ketamine, I sterilized the area around the wound as best I could.

“Vital signs?” I asked Mariela, who had been trained to monitor patients during our improvised surgeries.

“Heart rate 110, BP 90/60. Dropping but still stable.”

I nodded, taking a deep breath. “I’m making the initial incision now.”

The first cut revealed what I’d feared—blood filling the abdominal cavity. Using suction and gauze, I worked to clear my visual field.

“More light,” I requested, and Sophia adjusted our surgical lamp—actually a modified construction light we’d rigged with a special bulb.

“There,” I said, finally locating the source of bleeding. “The foreign object has lacerated his liver. Clamps, please.”

For the next two hours, I worked methodically to repair the damage.

Sophia anticipated my every need, handing me instruments before I could ask, monitoring vitals, adjusting lighting.

We moved together with the kind of synchronization that came from months of working side by side in impossible conditions.

The liver laceration was serious but fixable. I removed the foreign object—a piece of metal roughly the size of my palm—and repaired the damaged tissue with careful sutures.

“BP’s dropping,” Mariela warned as I was placing the final sutures. “85/50.”

“Almost there,” I said, working faster. “Prepare another IV. We need to replace more volume.”

“That’s our last bag,” Sophia reminded me, but she was already moving to set it up.

“Then we’ll make it count.”

As I finished closing, Miguel’s blood pressure stabilized—low, but no longer falling. I stepped back, rolling my shoulders to release the tension that had built during the intense concentration.

“Good work, everyone,” I said, allowing myself a small smile. “He’s not out of the woods, but we’ve given him a fighting chance.”

“Beautiful suture work,” Sophia said quietly as we transferred Miguel to our recovery area. “I’ve seen trauma surgeons in fully equipped ORs do worse.”

While Mariela stayed with Miguel, I spoke with the other miners, now all treated for their less-severe injuries.

“He’ll need careful monitoring for the next forty-eight hours,” I explained. “If complications develop, we’ll have no choice but to transfer him to Ciudad del Este, regardless of cost.”

“The company will fire him if he causes trouble,” one man said, his eyes downcast.

“Then they’ll have to fire me too,” another replied, his jaw set. “I’ll tell everyone what happened. How they refused to fix the equipment even after we reported the problem.”

I placed a hand on his uninjured shoulder. “Focus on Miguel’s recovery first. Then we can discuss how to address the company’s negligence.”

Nobody here wanted to bite the hand that fed them, but that hand also abused them on a regular basis, so there were never any good options. But we weren’t here to fight the mining company or the cartel. We were here to do what we could for people who otherwise wouldn’t have any medical help at all.

After the guys left to sit with their friend, I retreated to the small office I shared with Sophia. My hands trembled slightly as the adrenaline ebbed. I’d performed emergency surgeries before, but never one quite so complex with such limited resources.

Sophia entered a few minutes later, carrying two cups of coffee. “That was either the most brilliant or most reckless thing I’ve seen you do,” she said, handing me a cup. “Possibly both.”

I accepted the coffee gratefully. “What choice did we have?”

“None. That’s what made it brilliant.” She settled into the chair across from me, looking as drained as I felt. “Though, I have to admit, there were a few moments when I thought we might lose him.”

“Me too. But you were incredible in there. I couldn’t have done it without you.”

She waved off the compliment, but I caught the pleased flush in her cheeks. “Your parents called again yesterday. They want you to come home.”

I set down my cup harder than intended. “Chicago isn’t home anymore. This is where I’m needed.”

“I know. But they’re worried about you.” Her voice was gentle, understanding. “The political situation is getting worse. The cartel is expanding its territory. Even the hospital director in Ciudad del Este is talking about closing their satellite clinics.”

“All the more reason we need to stay. Who will help people like Miguel if we leave?”

Sophia was quiet for a moment, and I could see her wrestling with something. “Lauren, I need to tell you something. I’ve been offered a position. Emergency medicine residency program in Seattle. Full ride, excellent hospital.”

My stomach dropped. “When?”

“They want an answer by next month.”

“Are you going to take it?”

She stared into her coffee. “Maybe. I’ve got to think about it.”

I studied my colleague—friend, really—across the desk. Sophia had been here longer than any of us, had seen more, endured more. If anyone had earned the right to pursue her dreams, it was she.

“You should take it,” I said finally.

“What?”

“Seattle. You should take it. You’re too good a doctor to waste away in a place where you’re not sure you want to be.”

“And you?”

I shrugged. “I’m not leaving, Sophia. I can’t. Not as long as I have any choice. Not when we’re the only medical care within fifty miles. We keep going until there’s no other option.”

She studied me with those perceptive eyes that had seen through too many of my defenses over the months. “Just… be careful. Your determination to help everyone might be your greatest strength, but it’s also what scares me most.”

Sophia had been here twice as long as me. She was ready for the next chapter of her life, and I couldn’t blame her for that. I’d found purpose for the six months I’d been here. Just like I’d found purpose when I’d worked in remote areas of Uganda for eight months before that.

Purpose. Not running. I could almost convince myself of that.

A knock at the door interrupted us. Mariela leaned in, her expression serious.

“Dr. Valentino, we need you in here. Miguel’s fever is rising.”

I was on my feet immediately, doctor mode reengaged. “Coming.”

As I followed Mariela to the recovery area, Sophia fell into step beside me. Whatever decisions lay ahead for either of us, right now, we had work to do.

Miguel’s feverish eyes found mine as I entered the room. Despite his pain, he smiled.

“You saved me,” he whispered.

I checked his wound—no signs of major bleeding, but the area was hot to the touch. Infection setting in despite our precautions.

“We’re not finished yet,” I told him, already calculating dosages of our limited antibiotics. “But we’ll get through this together.”

His hand caught mine, surprisingly strong. “My sister, she has a baby coming soon. Because of you, I will meet my nephew.”

The simple statement hit me with unexpected force. This was why I stayed. Not for some abstract ideal or rebellion against my privileged upbringing or because of interpersonal heartbreak. But for moments like this. Life continuing because I refused to accept death as inevitable.

“Rest now,” I said, my voice softer than usual. “I’ll be right here if you need me.”

And I would be—regardless of cartels, corporate negligence, or my parents’ disapproval. This was where I belonged. Where I was needed. Where my skills meant the difference between life and death.

I wasn’t running. Wasn’t hiding. I was making a difference.

I settled into the chair beside Miguel’s bed, preparing for the long night ahead. Outside, dusk was falling over the jungle surrounding our little clinic, bringing with it the chorus of night creatures and the distant rumble of thunder. Another storm approaching.

I was ready for whatever came next.