Sheikh Surgeon

by Meredith Webber

  ‘Oxygen, too, Yasmeen,’ she said, lifting her head briefly so Kal had an impression of pale eyes in a blackened face. But it was her voice, although raspy with the smoke and soot she’d inhaled, that sent a shiver down his spine, and out of nowhere came an expression he’d heard while studying in Australia—something about a ghost walking over a grave.

  He stepped back to make room for Yasmeen, then two men were lifting the stretcher, and the stranger was walking beside it, holding an oxygen mask in one hand, just above the injured man’s nose, and the heavy oxygen bottle in her other hand.

  Kal raced ahead of them to open the doors of the helicopter and prepare it to receive the stretcher, then, after giving orders to the men about how to strap it into place, he climbed forward into the pilot’s seat and prepared to take off, checking with Air Traffic Control that he was cleared to take off.

  Above them planes would be circling, unable to land. Most would be diverted to nearby airports, or turned back if they were on short flights. He had no doubt one of his brothers would be in the control tower, making sure everything was being done efficiently up there, while another brother would be handling questions from the media as news of the disaster spread beyond the narrow confines of his country.

  But as the little helicopter rose easily into the air, staying below the level of the circling planes, he turned to look back into the cabin, where a dirty, dishevelled woman knelt beside an injured man.

  It couldn’t be…

  ‘I can’t get a tube in,’ Nell muttered to Yasmeen. ‘His airway’s compromised. Hold the mask just slightly above his mouth and nose so it doesn’t stick to his burnt skin. I’ve got pure oxygen flowing out so whatever he manages to breathe in—No! Damn! He’s not breathing by himself at all now. This is what can happen—suddenly his airway collapses altogether or oedema closes it.’

  She switched tubes so she could bag the man, forcing air into his lungs while Yasmeen held the mask, but the man’s chest failed to move.

  ‘He needs a tracheostomy so we can insert a tube into his trachea, but because of the oedema and because the lungs might have suffered major damage, the pressure of pumped oxygen could…’

  She was thinking out loud, but knew the tracheostomy was the only way to go, although it carried severe risks for burns patients. Yasmeen had brought a medical kit out to the helicopter, and Nell found a packaged scalpel and another package with tubing in it.

  Yasmeen touched her hand.

  ‘Do it,’ she said, but the man’s clothing had burnt to the skin on his neck and Nell’s fingers faltered as she sought the tracheal rings through which she could plunge the scalpel.

  In the end she took a chance on the position and was relieved to hear a release of air. Once a small tube was in place to keep the gap open, she saw the man’s chest rise and fall.

  He was breathing by himself!

  She took a deep breath herself, then Yasmeen leaned close to talk above the noise.

  ‘That’s the hospital up ahead. We’ll land on the roof. Strap into a seat.’

  And leave this man who’d been left for dead once already?

  ‘I’ll hang on tightly,’ Nell told Yasmeen, taking the oxygen mask from the other doctor and holding it close to the tracheostomy tube, still worrying about the extent of lung damage her patient might be suffering and whether too much oxygen would exacerbate it. Lungs were delicate—pressure could burst them. Inhaled heat and particles of noxious gas would already have damaged the fine tissues…

  At least worrying about her patient stopped her worrying about the man flying the helicopter. His glance had done no more than pass over her earlier, and for that she was sincerely thankful.

  OK, she had to talk to Kal some time—that was why she’d come. But exhausted from travel, shaken by the emergency and covered with soot and ash? Hardly!

  The little craft touched down lightly, then he was there again, kneeling right beside her.

  ‘A tracheostomy on a burns patient—contraindicated surely,’ he said, his voice stern with disapproval.

  ‘He wasn’t breathing and we couldn’t force air into his lungs,’ Yasmeen said. ‘Dr Warren tried. She tried everything before she resorted to cutting him.’

  The fluid catheter was leaking along the patient’s arm and Nell’s head was bent, trying to find a new site, while this conversation took place. It was a measure of her involvement with the injured man—of her determination to keep him alive—that she could stay focussed on what she was doing, aware of Kal only on the periphery of her conscious mind.

  Or maybe her concentration was a coping mechanism.

  She felt the slight pop as the needle entered a vein and, holding the catheter in place, she reached with her free hand for tape. Long slim fingers pressed what she needed into her hand—not Yasmeen’s fingers, which were blunt and slightly chubby. The touch was cool—impersonal—and though her conscious mind had lost the battle to keep Kal at bay and her body was quaking with an apprehensive dread, she calmly taped the catheter into place and reattached the drip tube.

  ‘We can move him now,’ she said, keeping her back to the man who knelt beside her, looking instead towards the group of people gathered at the open door of the helicopter.

  ‘Dr Warren?’

  Kal’s voice, familiar enough to send shivers up her spine although her name was unfamiliar on his lips.

  ‘I’ll go with the patient,’ she said, fussing with the tube, battling for emotional control. Deliberately rude, but so tense she feared she’d shatter into a million pieces if she turned to face Kal now.

  Then an image of Patrick’s face rose up in her mind. She couldn’t risk getting off on the wrong foot with Kal.

  Her heart hammered with panic, a thousand butterflies fluttered inside her, and her knees and fingers trembled with uncertainty, and fear, and dread, and some other emotion she didn’t want to think about. But she was a grown woman, with a son who needed help, so she lifted her head, met his eyes, forced a facsimile of a smile to her lips, and said, ‘Hello, Kal.’

  But before he could reply the man on the stretcher gave a convulsive lurch and became the focus of her attention once again. She leant across him, holding him still, checking that the incision she’d made in his throat was still open.

  ‘Yasmeen?’ The woman had come to the opposite side of the stretcher as it was lifted, and Nell spoke across the patient. ‘Do many of your staff speak English? Will the nurses understand me if I ask for things?’

  ‘Yasmeen will stay with you to translate until a nurse who speaks English can be found. It shouldn’t take long as most of our staff are bilingual.’

  So much for not getting off on the wrong foot. His voice would have frozen fire!

  He delivered this reply then strode away, a stranger in a smoke-grimed white robe, pulling off his headdress, grabbing scrubs from a trolley as he passed, turning from the desert chieftain she’d seen emerge from the helicopter into a doctor once again.

  Why, after fourteen years would she turn up in his country?

  Coincidence?

  He didn’t think so.

  But he couldn’t think of any reason for her to have come. She’d assume he was still married so it couldn’t have been some mid-life crisis to reclaim her youth.

  Could it?

  No, not Nell, who was sensible and pragmatic and who’d understood his position from the start.

  Besides, she was married, too—her name was Warren, not Roberts—though she wore no rings…

  Kal shook his head as he ducked into a side room and pulled off his robe, seeing sand from the desert spill on the floor, staring at the last reminder of his hours of freedom as he tried to get his head back on track. He pulled on the loose scrubs. He was a doctor again—a doctor with a huge emergency in his hospital and a strange feeling in the pit of his stomach. No way could he let his thinking be distracted by Nell’s presence in his hospital. If anything, he should be grateful—the Dr Warren he’d expected was a burns expert and
if ever one was needed, it was now.

  Dr Warren!

  She must have married…

  Why ever wouldn’t she?

  He had.

  But pointing this out to himself didn’t make him feel any better about Nell marrying, though he knew it was irrational to be thinking about Nell at all—let alone about her marital status…

  ‘We’ve sixty-two victims in the ER so far.’ Lalla el Wafa, his A and E nurse-manager, met him as he came out of the elevator on the ground floor. ‘The doctors on duty haven’t been able to do more than check their status, make sure their airways are patent and that they’re getting fluids and electrolytes.’

  ‘We take one patient at a time and do what we can. What we don’t do is panic,’ Kal told her.

  They’d paused in the passageway and now had to stand against the wall to allow the wardsmen wheeling the injured man Kal had transported to pass. Nell was still beside him, bending over him to hold a mask close to the tube in his throat.

  Was she worried about lung damage that she hadn’t attached the tube directly to the oxygen tank? He must ask her later. Since the explosion at an oil well three months ago that had prompted him to open a burns unit at the hospital, he’d been reading up on treatment of burns victims. It had changed so much since his training days when he’d dealt with an occasional burn in ER, and he still didn’t know as much as he needed to know. Neither had he been able to find a suitable specialist doctor to employ as head of the unit.

  Maybe he could persuade Nell to stay.

  Are you going mental?

  The group disappeared through the doors at the end of the corridor, but Kal still stared in that direction. As the doors had slid open Nell had lifted her head to speak to Yasmeen and he’d noticed the clean-cut profile, with a long straight nose.

  A nose Nell Roberts had always thought far too long for her to ever be considered beautiful…

  A nose he’d kissed a thousand times…

  Chapter 2

  He caught up with Nell as the man was wheeled into a curtained alcove, but the sight of sixty-two—no, sixty-three now—patients in the ER stopped him following her—and demanding answers to all the questions in his head. Blackened, blistered, wailing with pain, the injured lay against the wall, and were slumped on chairs, while those tagged more urgent were on trolleys, which were in lines four or five deep.

  ‘Have they been sorted into priorities?’ he asked Lalla, who had followed him and was still hovering by his side.

  ‘Someone at the airport toe-tagged them and we’re working off that classification.’

  Kal guessed who the someone was. He looked at the patients lying on makeshift stretchers along the far wall—tagged less urgent but they’d be in pain, and would be suffering shock. A young doctor was yelling for more fluids, while another was lifting an injured man in his arms, obviously desperate to get him to a treatment room, but they were all full, with staff rushing in all directions—a scene from hell.

  He and his staff could handle burns cases—they had before and they knew the current emergency procedures—but they usually handled one person coming in with burns—six with the oil fire. Not sixty-three, a lot of them foreign, and a lot of them so severely burned he wondered if they’d live.

  ‘Kal, I don’t want to be telling you your business, but you have to do this systematically.’ Nell emerged from the curtained alcove and stopped in front of him, delivering this opening foray without a hint of apology in her voice. ‘Staff should calculate the total body surface area burned using the rule of nine. Any patient with more than twenty per cent TBSA should be given fluids—Ringer’s lactate for the first twenty-four hours. We’ll work out electrolyte balance later. They should be catheterised and their fluid output measured. Ideally it should be evaluated for haemoglobin, which would show a breakdown in red blood cells and could lead to kidney failure. At the first sign of red blood cell breakdown, they’ll need a diuretic to clear the fluid faster to protect the kidneys.’

  Kal stared at the woman standing in front of him, telling him what to do, as if this was the most natural thing in the world. Did she feel nothing of the emotional chaos he was suffering? Or was she just far more capable of separating her emotional self from her practical one?

  ‘Tell them to dress the wounds with whatever sterile dressings you have available—we’ve time later to do excisions and skin grafts and fancy stuff. That can wait at least twenty-four hours post-burn—even up to five days if necessary—but right now we have to stop fluid loss through bleeding or wound seepage and stabilise the patients as best we can.’

  ‘Pain relief?’ he asked, as the crying, wailing and moaning broke through the turmoil in his mind. Of course Nell should be telling him what to do—it was her field of expertise. And, of course, he too could separate his emotional self from his practical one—hadn’t he been doing it for years?

  ‘Morphine’s the best. IV. They’ll all be getting fluids anyway. Then I need someone—you, probably, as Yasmeen says you’re a surgeon—to check the wounds for bands of eschar—circumferential burns on the chest or extremities.’

  ‘Cut through them?’ Kal asked, pleased to find he was able to talk to the suddenly reappeared Nell as if she was just another doctor.

  His body didn’t think she was just another doctor, though why his body should be responding to anything but the medical emergency he had no idea.

  She nodded.

  ‘You won’t need anaesthetic. It only happens in third-degree burns and the nerve endings in the skin have all been destroyed so it doesn’t hurt the patient, but you’ll be opening up more surface area to infection, so a topical antibiotic and a clean dressing should be applied.’

  ‘Will one cut suffice?’

  The pale eyes studied him, a frown gathering between her neatly arched brows.

  Frown lines—she’s got frown lines!

  ‘It usually does, but you’ll be able to tell if one cut’s enough. With extremities—eschar on the arms or legs—you’ll get a pulse in the wrist or ankle once you’re done. With chest constriction, you might need two cuts—one midclavicular and one transverse. You’ll see the chest rise and fall once it’s free.’

  Yasmeen called to her and she turned away—then swung back to call after Kal, ‘Don’t tie off bleeders on the limbs immediately. Let them bleed three to five minutes to release pressure, but holding the extremity above heart level. Then tie them off or coagulate. And tetanus prophylaxis—conscious patients will be able to tell you their tetanus status. And nil by mouth on all of them—paralytic ileus.’

  Kal nodded, knowing that, but also knowing she was right to remind him—to remind them all—of the basic treatment. One burns patient coming in would be treated quickly and efficiently, with all these reminders Nell had issued in the forefront of the ER doctor’s mind, but, faced with so many patients, it would be easy for a doctor, anxious to do everything for everyone, to forget something of the basics.

  Kal moved away, aware of Nell going not to the man they’d airlifted to hospital, but to check a very small patient on a trolley by the far wall. Yasmeen was bent over the trolley, talking anxiously to Nell, but Nell’s frown told Kal it was too late. That he was looking at the first of the hospital casualties.

  ‘Even if we could have saved him,’ Nell told Yasmeen, ‘he wouldn’t have survived very long. Look at his little body—can you see a bit of it that isn’t burned? Adults with more than sixty per cent burns to their bodies have little chance of survival, so what hope would this tiny soul have had?’

  She put her arm around Yasmeen’s shoulders and led her away, reminding her they had living patients to tend. Reminding herself of the same thing. Her mind argued that she shouldn’t have spoken to Kal as she had, giving orders, but although all ER doctors knew the routine for treating burns patients, she’d been in emergency situations before and was aware that the sheer volume of patients at a time like this threw normal thinking into disarray.

  She moved on t
o the man who’d been left for dead, catheterised him then sent a urine sample to the lab for testing, checked the oxygen level in his blood—still too low—fiddled with the oxygen valve to produce more flow, then knew she had to move on. There were too many patients for her to be spending time with one man.

  ‘You’ve always got to be aware of carbon monoxide poisoning with burn victims,’ she explained to a young doctor who seemed mesmerised by a patient with the tell-tale cherry-red colouring. ‘The blood carries carbon monoxide far more easily than it carries oxygen—for some reason haemoglobin has an affinity with the carbon monoxide molecules. So, as well as the patient breathing in the deadly fumes, the blood’s too busy shunting the wrong gas around the body to be bothered with oxygen.’

  ‘Is that why the patient’s unconscious? Carbon monoxide poisoning rather than burns?’

  Nell looked at the patient, reassessing the percentage of injured body surface area.

  ‘Most probably. Pump one hundred per cent oxygen into him, but watch for a change in his level of consciousness. Do you have a hyperbaric chamber?’

  The young doctor looked puzzled. ‘Like we use for divers with the bends?’

  Nell nodded.

  ‘Yes. We have a lot of tourists coming here to dive, so we’ve always had one in the hospital.’

  ‘Well, if he’s still unconscious in, say, an hour, we should put him in there. The situation is similar to someone with the bends. We need to get the carbon monoxide out of his blood using pressure, then force oxygen in.’

  She glanced up from writing this advice on the chart to see Kal had joined them.

  ‘We’ve others affected by carbon monoxide. I’ll make sure all the staff know to check the level of consciousness of their patients.’

  He disappeared again, but from time to time, as she worked, Nell was aware of him nearby. Sometimes he’d ask a question or direct her to a particular patient.

  Nell moved among the doctors and nurses fighting for the lives of these badly injured people, aware of how different this type of doctoring was. No one was taking records of past illnesses, and in a lot of cases they didn’t know the patient’s name or nationality. It was enough to know a human being in terrible distress lay on the stretcher in front of them, and to do everything possible, firstly to save that person’s life then to ease their pain and keep infection at bay.