Enemy Within: A heart-wrenching medical mystery (British Military Thriller Series Book 3)

by Nathan Burrows

  “Adams?” a fresh voice said behind him.

  “Raj,” Adams replied. “She’s in trouble. Stab wound inferior to her left scapula. I’ve had the cardiothoracic reg fast-bleeped. Trevor?” With a look of relief, the paramedic started his handover, no doubt relieved that he was soon to be stood down.

  “Thanks, Adams. Single stab wound as described. Approximately one inch in length. No major haemorrhage, no bubbling or frothing seen. She was initially conscious and responsive but went off quickly so we decided to just get here ASAP. Couldn’t get a BP in the back of the wagon, but she’s tachycardic and tachypnoeic. You can see the peripheral cyanosis.” Trevor paused and took a deep breath. “Other than shoving a dressing over the wound, we’ve not had time to do anything else in terms of treatment.”

  “Thanks,” Raj said, his voice reassuring. “Scoop and run was definitely the right call. Absolutely the right decision.”

  Adams looked at Trevor’s expression as he said this. The relief was obvious. The paramedic finished the rest of his handover as Adams got an intravenous line into the woman’s arm. While Hannah was placing the electrocardiograph stickers on the patient and wrapping an automatic blood pressure cuff around her arm, Adams filled some small bottles full of blood from the cannula before attaching a line of fluids to it. He rolled the valve so that it was dripping steadily. There was no point pouring fluids into her until they knew what was going on. Not like in the old days, when he had been training. Back then it was just get as much fluid into casualties like this one as was possible.

  “What’s the BP, Hannah?” Raj asked quietly as the monitor beeped urgently. Adams looked at the line showing the ECG, recognising the various parts of the electrical rhythm. The woman’s heart was beating very quickly.

  “I can’t get one,” Hannah replied as she stabbed at the buttons on the monitor to re-inflate the blood pressure cuff.

  Adams’s hand shot to the patient’s neck. He slid his fingers into the soft tissue, where he should have found a carotid pulse. There was nothing.

  “I can’t get an output, Raj. She’s in PEA.” He looked up again at the monitor. The electrical function of the woman’s heart was still showing, but there was no actual heartbeat with it. Pulseless electrical activity.

  “Shit,” Raj muttered. “Hannah, get me a milligram of adrenaline, and can someone start CPR?”

  Adams kicked a stool out from under the trolley and stood on it, leaning over the patient. With a silent apology, he ripped her blouse open. Before the buttons had even settled on the floor of the resuscitation room, he had his hands in the right position on her sternum and had started compressions. As he counted them in his head, Adams tried very hard to ignore the fact that the bra the woman was wearing was very similar to the one Lizzie had been wearing the previous evening.

  “Hypoxia, hypothermia, hyperkalaemia, hypovolaemia,” Raj muttered under his breath next to Adams, almost as if he was in prayer. “Tension pneumothorax, thrombosis, toxins, tamponade.” His words were straight from the bible on resuscitation and listed the causes of PEA.

  “My money’s on tamponade,” Adams said to the doctor. “Possibly a tension.”

  “She’s in trouble, if you’re right,” Raj replied. “Haemorrhagic tamponade is pretty much unsurvivable.”

  Adams paused for a few seconds to allow Hannah to deliver two rescue breaths via the bag and valve mask she had pressed over the woman’s face. An oxygen line ran from the end of the bag to a meter on the wall that was turned up full.

  “Where’s the cardiothoracic reg?” Adams asked Hannah.

  “No idea, but they’ve been fast-bleeped,” she shot back as Adams recommenced the compressions.

  “Someone go and fast-bleep them again,” Adams said, looking down at the casualty’s face. She was young. Lizzie’s age, give or take a year in either direction. He knew that the only thing that was going to save his patient’s life was an emergency thoracotomy—a brutal procedure that was effectively open heart surgery performed outside an operating theatre. It wasn’t something Raj could do. It might not even be something the cardiothoracic registrar could do.

  “Adams, stop compressions for a second,” Raj asked softly. Adams did so, and the team stared at the monitor. Where there had been electrical activity before, there was just an almost flat line. “She’s asystolic,” Raj said, his voice quiet as Adams recommenced compressions. The two men exchanged a glance, both knowing that the only thing pumping blood around her body was Adams’s efforts.

  There was a difficult decision to be made.

  14

  Titch grimaced as he swigged his protein shake. One day, he thought, he was going to invent something that mixed up whey protein properly and didn’t leave chalky lumps like the one he had just swallowed. He’d make a fortune.

  He swirled the remnants of the shake, which was supposed to be banana flavoured but tasted like no banana he’d ever eaten, and swallowed the last mouthful. Titch had spent the previous hour doing a home gym circuit he’d devised for himself in his room. It included one-legged squats and bodyweight squats as well as the more standard exercises like push-ups and as long in the plank position as he could manage. It couldn’t replace a proper workout in a gymnasium, but it would keep him going until he’d done his induction. The burn from the workout was like eating a milder curry than expected. Not quite as good as the real thing, but good enough.

  Titch went into his small en-suite bathroom and rinsed his whey bottle out. He regarded himself in the mirror as he did so, looking at the myriad of tattoos across his torso. They were all esoteric, their true meaning known only to believers. Believers like the two people he had been speaking to the previous evening. Titch knew they would understand the symbolism behind the artwork. The ornate rune in the centre of his back was the one of which he was most proud. When he’d been having the Viking symbol intricately detailed, complete with fourteen words in a semi-circle around the outside, Titch had felt like a Yakuza. The words were in Latin so that non-believers wouldn’t understand their significance. The meaning wasn’t for them. It was for people like Titch.

  He had just picked up his toothbrush and turned the tap on when there was a knock at his door. Titch frowned. He’d not spoken to anyone in the building since he had arrived and didn’t know anyone on the base. Besides, he realised as he glanced at his watch, it was getting late.

  Titch threw on a T-shirt over his jogging bottoms and, after turning the tap off and replacing his toothbrush, he took a few steps to the door of his room. When he opened it, there was a large man he didn’t recognise standing in the corridor. Behind him were two other blokes of a similar size, and Titch could see a further three at the end of the corridor.

  The man in front of Titch was wearing gym kit and had his arms crossed over his chest. Titch knew the pose well. He used it often enough as it emphasised his biceps. The visitor was taller than Titch by some distance, had his blonde hair in a crew cut, and was wearing a deep frown on his face.

  “Can I help you?” Titch asked, deciding not to try to close the door. He had a feeling that if he tried that, it wouldn’t help. When his visitor replied, Titch caught the smell of fresh alcohol coming from him in waves.

  “Who are you?” the visitor asked.

  “Corporal Robert Hunter,” Titch replied, keeping his voice even. “And you are?”

  “You’re not regiment.” It wasn’t a question, it was a statement.

  “No, I’m a weapons tech. I just got posted in from High Wycombe.”

  “This block’s only for our regiment squadron.” As he said this, Titch’s visitor leaned forward slightly, and the two men behind him smirked. “You’re not regiment, nor are you in our squadron, so you’re in the wrong block.”

  Titch considered his options. He could argue, but couldn’t see the point of that. Whoever this bloke was, he didn’t look as if he wanted to have a discussion about Titch’s career options. He couldn’t fight six of them, and certainly not in a corridor.
Titch would happily have taken on any of them on their own and thought he’d probably be able to handle two at a time. But six? Not a chance. So the only option left was to do whatever these muppets wanted.

  “Perhaps we can come to some sort of arrangement about the issue in that case?” Titch replied with a half-smile to let his visitor know he knew what was going on. Although technically banned, most units had some sort of initiation ceremony. Usually involving copious amounts of alcohol. There had to be some sort of regiment bar somewhere on the base.

  Titch would much rather turn up for his first day of work with a hangover than with two black eyes, or worse. Although he drank little, he could handle his alcohol well enough and, from the smell coming from in front of him, this lot had quite a head start.

  “Perhaps we can.” Titch’s visitor turned, and the two men behind parted to let him through. “Follow me.”

  Titch did as he was instructed and fell in behind the big guy. As he did so, he felt his arms being gripped by the other two men. Not uncomfortably so, but tight enough to let Titch know they meant business.

  “Where are we going?” Titch asked the man holding his right arm, a stocky lad with bright ginger hair and acne scarring on face.

  “No questions,” the big guy said over his shoulder. “You’ll find out when we get there.”

  Outside the front of the accommodation block was a white transit van with its engine running. Titch squinted to see who was behind the wheel, but it was too dark. The side door to the van was open, and Titch let himself be pushed into it unceremoniously. A few seconds after that, the van lurched as it made off. Titch was the only occupant in the back of the van, which had been locked after the side door had been slammed shut.

  After no more than five or six minutes, the van halted. The side door flew open, and Titch felt himself being grabbed by more hands. These were different people than the committee that had arrived at his room. He relaxed, letting himself be pushed along. He could see a large aircraft hangar in front of him. As he walked through the door, he saw in the centre of the hangar a single wooden office chair, complete with armrests. It was surrounded by at least twenty young men who were standing in a silent circle around it. Titch was pushed toward the chair, watched by the occupants of the hangar.

  “Strip.” Titch recognised the voice as the big guy’s. “Or be stripped. It’s your call.” Titch took his clothes off, pausing for a second when he got to his boxer shorts. “All of them,” the big guy commanded. Titch took them off, ignored the muffled laughter from the circle surrounding him, and sat on the chair. At least it wasn’t cold. He felt his arms and legs being tied to the chair with zip ties and, as he looked down at his wrists, he could see that they weren’t ones he could break easily.

  When Titch looked up, the big guy was standing in front of him. In his left hand he had a bottle of cheap-looking whisky. In his right, a funnel.

  “So, Corporal Hunter,” the big guy said, “it’s time to see if you’re man enough to be an honorary member of our squadron.”

  15

  As Lizzie turned off the main dual carriageway that led from Norwich to the rest of the country, she flicked her headlights to full beam. The trees on either side of the road started arching across to form a tunnel, reducing what little light there was left in the sky. Beyond the trees were miles upon miles of open farmland. She shivered involuntarily. This was the part of the journey she hated the most, and the thought of her car breaking down in the middle of nowhere with no phone signal and only thousands of pigs for company petrified her.

  She peered into the blackness beyond her headlights, knowing that running into a stray deer was far more likely than her car breaking down, and eased up on the accelerator. While the trees flashed past, she tried to take her mind off the final part of the journey from Adams’s flat back to her accommodation at RAF Honington by thinking back to the presentation she’d been to that afternoon.

  The young woman giving the lecture, Claire, had been quite inspiring in an unexpected way. In a sense, she reminded Lizzie of a younger version of herself. Claire had obviously benefited from the experience, both on an emotional and psychological level, and Lizzie had pretty much made her mind up even before Doctor Lobjoie had spoken with her.

  Knowing that there was a sharp bend coming up in the road, Lizzie eased up even more on the accelerator. On more than one occasion, she had seen cars on their sides or roofs in the deep ditch. Lizzie negotiated the turn and was rewarded by a faint glow in the distance. It was the lights of the RAF base she would only call home for a few more weeks.

  Ten minutes or so later, Lizzie turned into the main entrance for the base and dipped her headlights as she drove toward the gate. Standing next to the barrier was a Senior Aircraftman in combat fatigues with an SA80 rifle slung across his chest. He was also wearing a high-visibility tabard, which, in Lizzie’s opinion at least, made wearing the combats pretty pointless. Lizzie got her identification card and car pass ready for him and pressed the button to lower the window.

  “Evening,” Lizzie said with a smile as she raised both documents for the airman to examine. He gave them a cursory glance before reaching back into the booth to press a button and elevate the barrier. As Lizzie eased the car forward and through the gate, the airman gave Lizzie a sullen nod. “Nice talking to you,” she muttered as she closed the window and headed for the Warrant Officers’ and Sergeants’ Mess.

  After she had parked her car, Lizzie made her way to her room with the overnight bag she’d taken to Adams’s. She would have to time doing her laundry right. Most of the occupants of the mess were male, and Lizzie didn’t want any of them seeing what was in her bag. Lizzie smirked as she remembered the look on Adams’s face when she revealed what was in it. She’d been wearing the contents at the time, but not for long.

  It was almost eight in the evening by the time Lizzie had sorted herself out. She had tidied her living accommodation. It hadn’t taken long to straighten up the small bedroom and living area that she called home. Lizzie was duty medic for the next week, starting at ten that evening when she would have to be in the medical centre for her handover. Technically, as a sergeant, she didn’t have to do the duty, but when she was more junior, she’d hated it when the Senior Non-Commissioned Officers didn’t chip in and do their part. The day she put her third stripe up, Lizzie had resolved not to be that SNCO the juniors all bitched about.

  Lizzie knew Adams finished at about half nine, and she wanted to talk to him about the secondment before making a final decision. Knowing he wouldn’t be at his flat before ten, she decided to nip to the bar on the ground floor to see if any of the few mates she had on the station were there. It was unlikely to be busy on a Sunday evening, but she knew the Station Warrant Officer often nipped in for a pint or two. Sure enough, when she walked into the bar, he was sitting in the corner with a full pint of lager and a newspaper spread out on the table in front of him.

  “Evening, Tom,” Lizzie said as she approached the table. “Do you need a hand with any of the long words, or are you just looking at the pictures?” The SWO looked up and glared at her before replying. He was wearing his trademark wasp-chewing expression, which Lizzie knew was a carefully designed mask to hide his true nature.

  “Piss off, Jarman,” he said gruffly. “Go and get yourself a drink and put it on my tab. Then come back and we’ll try and have a civilised conversation.” He turned his attention back to the football reports he was reading in the paper, but not before Lizzie caught a faint smile on his face.

  Warrant Officer Fowler, as the most senior SNCO on the station, had to be a figurehead for the juniors. Lizzie remembered being terrified of the SWO at the first station she had worked on, but when she had arrived at Honington, the broad-shouldered warrant officer had taken her under his wing to an extent. Lizzie wondered at the time whether it was because of everything that she’d been through in Afghanistan. Although much of what had happened had been classified since, Tom Fowler knew what comba
t was like. He wore his prosthetic leg like a medal of sorts, as if to show everyone that although the Taliban had taken his right leg off below the knee, he was far from beaten.

  Lizzie returned to the table with a fresh pint for Tom, even though he had barely touched the other, and an orange juice and lemonade for herself.

  “Cheers,” she said as she raised her glass in his direction.

  “You not drinking?” Tom replied after repeating the salute.

  “Duty medic.”

  “Oh, okay. More fool you.” Lizzie sipped her drink, knowing he was referring to her doing a duty she didn’t have to. Tom looked at her curiously, his bushy eyebrows knitted together. “What’ve you been up to, Lizzie?” he asked her. “You look like the cat that’s got the cream.”

  Lizzie’s cheeks instantly coloured. When she had left Adams’s flat, she’d called into a newsagent to get a bottle of water for the presentation and the shop owner had looked at her with a similar expression. Did she have an invisible sign on her forehead that read Guess what, I had sex today?

  “Do I?” Lizzie replied, taking another sip of her drink to hide her discomfort. Tom, who was either oblivious to her blushing or just didn’t care, pressed on.

  “Who is he then?” he asked. “Or she?” Tom added a few seconds later.

  “Someone’s done their inclusivity and diversity training, I see,” Lizzie replied with a grin.

  “Yeah,” Tom said. “That’s two hours of my life I’m never getting back. Nice try, though.”

  “How d’you mean?”

  “Nice try at changing the subject. Who’s the lucky fella?”

  “Mind your own business. How did Arsenal get on this afternoon?”

  Tom didn’t reply, but just stared at Lizzie with a fixed smile that slowly faded when she didn’t answer.