by Olivia Gates
Without another look at her, he assembled his laryngoscope and picked an endotracheal tube. She fidgeted. May as well give her something to do. Without looking at her, he said, “Assess circulation, gain venous access and start fluid replacement while I intubate him. Just a liter to boost his blood volume and improve his blood pressure. Too much fluid after such blood loss isn’t advisable because—”
She interrupted him. “Because it would dilute his blood and coagulation factors, leading to acidosis, hypothermia and coagulation failure. Death by over-zealous resuscitation.”
All right. Score one for her emergency medicine knowledge. She was for real, then.
She finished recording blood pressure. “Eighty over fifty. But since his shock isn’t due only to hemorrhage but also to dehydration, his remaining blood must be concentrated. In the absence of blood volume booster alternatives I don’t think we can afford not to give him more fluids.”
So not only for real, but real good, too. And absolutely right. But he did have an alternative. “I would’ve recommended far less fluid to start with if I hadn’t taken that into account. A liter is enough. He needs whole blood after that.”
“Whole blood? Where will we get that?”
“From me.” Her slanting eyes rounded. He elaborated. “I’m O-negative, the universal donor. And you’ll come in handy here. Better you than me drawing my own blood one-handedly. But first I’ll secure Mikhael’s airway and breathing.”
He moved towards the woman holding Mikhael’s head in her lap, tried to replace her—but the woman was having none of it. His soothing didn’t work this time. His glance darted towards Gulnar. “What did I do this time?”
Gulnar’s shrug was sort of apologetic. “I’ve taught her to perform a jaw thrust and told her to keep him like that, that if she didn’t he’d suffocate on his tongue.”
It was only then that he noticed—the woman was holding Mikhael’s jaw thrust forwards. The optimum position to keep a patent airway.
Gulnar turned to the woman, rapping out rapid Azernian, her voice riding the exotic intonations, making music of every stress and release in every syllable. It was incredible how she switched between languages like that, how each sounded so authentic, so effortless. So elegant. How many more languages did she know? Did Italian feature among her linguistic talents?
Finally the agitated woman slumped, slithered across the floor to let him replace her at Mikhael’s head, and sat a few feet away, whimpering. He raised one eyebrow at Gulnar as he positioned Mikhael’s head in his lap.
She sighed. “It took some convincing to make her believe you’re not with the militants, that you’re a doctor and would take care of Mikhael. I even had to lie a bit.”
“What about?”
“I told her your name and she said it sounded Italian and I took advantage of that, lied to boost her trust in you.”
“And the lie is?”
“That you’re related to the most famous humanitarian international operative the region has known, Lorenzo Banducci.”
Now, that was completely unexpected. An incredulous huff escaped him. “Lorenzo! Son of a gun. Is he still around?”
“He left the front line about a year ago.” Was that regret filling her sigh? Whatever it was, he didn’t like the sound of it. Not one bit. “He’s in Africa now, working with and married to Sherazad, a doctor who’s worked with us here.”
Dante turned his attention on Mikhael as he absorbed this, started suctioning his throat, and was stunned to find it clear. He raised his eyes to her.
She answered his unvoiced question. “I’ve kept his throat clear of secretions and his airway patent with a straw.”
“Very resourceful!” He injected Mikhael with a muscle relaxant in lieu of anesthesia as he was already comatose then introduced a nasogastric tube down his throat and into his stomach, decompressing it and guarding against regurgitation of gastric secretions into the respiratory tract.
“The tube isn’t yielding blood,” he commented.
“Great. So the stomach and intestines aren’t injured.”
He nodded, aligned Mikhael’s neck, tilted it backwards. “So you’ve worked with Lorenzo?” Which was the essence of stupidity as questions went, since she’d already said as much.
“Yeah, sixteen months. That’s counting the two months during which he’d been abducted.”
So she’d kept strict count of the months with and those away from Lorenzo!
Oh, grow up! And say something neutral. “Lorenzo and I crossed paths a few times, swapped a lot of notes, and it was good to let rip in Italian again. But we can’t be related. I’m only Italian-American.” OK, that didn’t sound too neutral. Lorenzo was more than a passing acquaintance. He was a friend, for heaven’s sake. It wasn’t his fault Gulnar had clearly had an eye for him. And the man wasn’t here any more. Happily married, too. He hoped.
Stop it!
He passed the endotracheal tube down Mikhael’s trachea, inflated its cuff to secure it against slipping out and started delivering 100 per cent oxygen. He picked his next words more carefully. “Though, come to think of it, we are probably related. My family comes from Florence and all Florentines are related somehow.”
A smile warmed her eyes. “So I was more of a clairvoyant than a liar.”
Her warmth went right through his chest. “You can be anything you like as long as you’re my translator.”
He inserted a Foley’s catheter. No blood came with the urine. He heaved a sigh of relief. No urogenital injuries either.
With his first measures complete, he allowed his gaze to linger on Gulnar’s face, found concentration knotting her elegant eyebrows as she placed the cannula in Mikhael’s arm, connected it to the IV line, handed the saline bag to Mikhael’s lady friend to hold up, and set the drip to maximum.
Placing the cannula must have been hell. Mikhael’s veins were long collapsed and with the way her left arm was pressed to her side—why was she holding it like that…?
The realization, the memory hit him. The knock she’d taken! Was her shoulder injured? It must be…
Reach out for her, examine her—enfold her…
He barely stopped his impetuous move towards her, squashed the roiling urge and the end of a tourniquet between clamped teeth. Not a good time. And it never would be either. He was done reaching out. Never again on a personal basis. He’d finish this and move on. And on. He’d sworn it. He’d continue living on the fringes, alone and separate.
He’d die the same way.
CHAPTER TWO
“NOW—blood.”
Gulnar’s eyes swung up at Dante’s terse command. He wrapped the tourniquet around his arm and snapped it hard in place, hoping the lash of pain would end his wandering thoughts.
If only it were that easy. He sighed and presented Gulnar with his arm turned upwards, exposing his bulging veins, handed her the line of the blood bag, capped needle first. She hesitated.
He exhaled. “Now what?”
She chewed her lower lip. “We can’t just do a transfusion without checking your blood. But we can give him more fluids and he’s more or less stable…”
“Trust me, I’m clean. You can’t imagine how clean. And I’m bursting with packed red blood cells and clotting factors.”
Gulnar bit into her lip and he exhaled, feeling his arm going cold and numb with the tourniquet’s constriction. He could have done without the aggravation. Could have done with Gulnar’s help. One more thing he’d have to do without, then.
He reached for the needle and she resisted. His hand fisted in exasperation. Blood hissed in his ears. He snapped another bag up, snatched the cap off its needle with his teeth. “Even if you don’t believe me, don’t you think it’s worth the risk to save Mikhael now? And what possible reason would I have for lying? For infecting him with—what? AIDS, presumably? Aren’t you taking this paranoia too far?”
He raised his eyes to flay her with his irritation, met her magnificent eyes and it was h
e who flinched.
“When you wake up one day, Dr. Dante,” she snarled, “and find the neighbors you’ve lived with all your life have turned into enemies, when they take over your home, make you run for your life, when the people you think will offer you sanctuary kill everyone you know and love, when you’ve survived fifteen years of war and displacement, it’s not very hard to see how one can end up paranoid!”
He gaped at her, his heart constricting, his throat closing.
“From what you described, it’s a miracle to only end up paranoid after all that. But, paranoid or not, I will do this with or without your consent. You can help me or you can go back to your corner and stop hindering me.”
At his vehemence something leapt in her eyes, settled there. Something softening, acquiescent. His body lurched, his head tightened. Hell. He’d take her antagonism any day.
His breath eased only when her eyes released him and she took the needle from his fingers.
So she’d decided to trust him, huh? Good to know. Too good. It felt even better to surrender to her ministrations as without another word or glance she slipped the needle into his vein. He didn’t even feel it piercing his skin, didn’t feel the tourniquet being snapped off. A soothing touch, a perfect approach. He sighed, watched his blood filling the collection bag and handed her one more bag to add to the one she already had.
Her eyes sought his as he pumped his hand. “Three bags?” He nodded. “You can’t donate all that blood. Those bags have to be a pint each!”
“Five hundred ccs actually. I’m a big man, I have lots to spare.”
“Excuse me, but you don’t look as if you do!”
He couldn’t say it surprised him. He wasn’t back to normal, and wondered if he ever would be. Normal…It felt like another man’s life when normal had even been applicable. But he wasn’t thrilled to know she thought so, too. In fact, it chafed. More, even, than Roxanne’s revulsion.
A surge of despondency and irritation wouldn’t be contained. “Just hook Mikhael to the first unit, give him 400 ccs for now. Save the rest for afterwards. He’s bound to lose more blood when I explore his injuries and during definitive repairs. I’ll take care of the rest.” She opened her mouth. His taut words closed it. “Allow me the courtesy of assuming I know my own limits.”
A heartbeat later she hurled back an equally tense rejoinder. “It’s against all safety protocols, donating more than 750 ccs of blood! What if—”
“If I’d been shot, I would have lost far more than 1500 ccs, and I wouldn’t have had the luxury of replacing the blood volume, like I will now.”
“But Mikhael may not need all that blood!”
“If Mikhael doesn’t need it, someone else will.”
Her grudging concession was in her every move as she unhooked the blood bag from his needle and hooked it to Mikhael’s cannula, her motions precise with suppressed annoyance and resignation.
He hooked the second blood bag on. Fumbled it on, more like. Something warm and weakening was seeping through his limbs, shooting his co-ordination to hell. He could deal with everything. Danger, violence, madness. Desperation, terror, agony. But not what Gulnar was offering him now. Caring.
No one had cared what happened to him in a very long time.
Hah! No one had ever cared what happened to him.
He’d been taught that indelible lesson six years ago, when the illusion of being a needed part of a relationship—a family—had been eradicated. When he’d stopped fooling himself into thinking he counted beyond what he could provide.
But Gulnar was showing him he did. As another human being only, sure, but she still did care. About a stranger, someone she’d just met. Just on principle. She was taking it very hard, the idea of endangering him, even to save the young man she was torn up over.
And her caring hurt him, breached his defences. He couldn’t afford that now.
Forget her. Forget yourself. Get this done.
Still clenching and unclenching his left fist to help the blood flow, he turned to Mikhael, reassessed his vitals. His pulse was slowing down, his breathing deepening. Good. Their measures were stabilizing his general condition. On to his specific injuries.
Dante undid the abdominal bandages, noted no renewed bleeding from the two entry wounds. He raised his eyes to Gulnar who had finished delivering the blood and rechecking Mikhael’s blood pressure.
She answered the question in his eye. “BP 100 over 70.”
Her whisper raised goose-bumps all over his body. She was dimming. But she’d carry on until she was extinguished. He knew nothing about her, yet he knew this, knew the lengths she’d go to for others.
He checked her pulse. Fast. Thready. He must do something about it, now!
She moved out of his reach, darting glances towards their captors. He’d totally forgotten about them.
About everyone.
The captives had slumped back into their despair now they’d understood who he was, how his presence would probably mean nothing to most of them. The militants had turned their backs on them, the occasional looks over their shoulders expressing how bored they were with it all, how they hated escorting him in to save even one enemy. But they had their orders.
“You need resuscitation.”
She shrugged. “Not more than any other uninjured person here.”
“But you are expected to help me. You’re no use to me if you faint. Just one liter of saline…”
She cut him off. “May mean life for one of the injured people. I’ll go give them blood and fluids.” She rose and moved away before he could say anthing else.
Dante turned to Mikhael, gave his wounds another careful palpation. He knew the bullets hadn’t caused much damage here. He’d finished a full exam by the time she’d got back.
She sank to her knees beside him, checked Mikhael’s BP again. “Holding. So—what do you think? Mikhael’s blood pressure is a strong indication there’s no ongoing intra-abdominal bleeding.”
He nodded. “Whatever blood loss he suffered from the abdominal wounds was hepatic in origin.”
Gulnar wiped the back of her forearm across her forehead, soaking her sleeve with more precious moisture. “I thought as much. The damage was to the tail of the liver’s right lobe. If the bullets had hit its blood vessels network, I doubt he would have lasted an hour.”
“It’s a relief. I wasn’t looking forward to performing a laparotomy under septic conditions. There’s nothing more I should do, at the moment, about his abdominal injuries, now that bleeding has stopped.”
Gulnar nodded and began cleaning the wounds. He helped her wrap the man’s abdomen in bandages again, and found himself asking, “I know the main info from the news and the officials. But I want you to tell me what happened here, in detail.”
She looked at him, her eyes impassive. “You see the result. What good are details?”
He didn’t know why he was asking either. He just needed to know. Then something else occurred to him. “If you’d rather not repeat what happened, relive—”
“It’s not that! It’s just…” She hesitated for one more second. Then she told him. All the details of the raid, the indiscriminate killings, the monstrous treatment afterwards.
He shouldn’t have asked.
But it blasted everything into perspective, made whatever he’d thought he’d suffered insignificant.
And made whatever he did pointless?
No. What he did couldn’t be pointless. He had to make it count. One life at a time snatched out of the jaws of death and cruelty. One lesser defeat, one less than total disaster.
He had to believe that. He had to.
It was all he lived for.
Gulnar closed her eyes against the sunlight slanting through the building’s high windows. Against Dante’s searing turmoil. There was no shying away from his frustration, his rage. Somehow, sharing distress with him halved it this time, as if he was absorbing it, diffusing it.
She opened her eyes and saw hi
m in control again, removing the pressure bandages around the top of Mikhael’s thigh.
She clung to his hand. “If he’s stabilizing now, shouldn’t we just inject him with a massive dose of antibiotics, give him a tetanus booster and monitor him?”
Those eyes still crackled with aggression, unmeant for her yet still daunting. They ignored her and her protest, turned to his task. Her eyes followed his exploration. Her stomach quivered at the fist-sized wound blasted in Mikhael’s thigh. Handling it in the heat of the moment, bathing in his blood, she hadn’t had awareness enough to dwell on the horror. Three days since it had happened, it looked far worse. How bad did Dante think it was?
Whatever his diagnosis, his lips twisted on it. He reapplied a fresh pressure bandage, announced his verdict. “I have to tend to his vascular injury now or he will lose his leg even if we save his life.”
“Oh.” A flash of agony seared her. “I guess I put off thoughts of complications and prognoses, knowing there was nothing I could do about them.”
“It’s lucky his leg isn’t gangrenous by now. But there’s a lot of damage to his common femoral artery and vein.”
Every catastrophic complication reared its head now she’d let herself think. “But if there is the slightest chance intervention could dislodge a clot and cause an embolism, shouldn’t we choose between life and limb?”
“No.”
Just no? “Care to elaborate?”
Evidently not. He started spreading his surgical instruments on a pre-sterilized surgical towel. She tried again. “What can you do here?”
“I’ve done vascular repair in worse conditions.”
Her eyes darted to the filthy floor, the limited instruments. “Worse conditions?”
“A trench with raining shrapnel, with your operating arm almost out of order are worse conditions, don’t you think?”
She had to agree.
He continued. “And I didn’t have a grade-A surgical nurse to assist me then.” He turned away, produced disposable surgical drapes, large swabs and a bottle of povidone-iodine. “Help yourself. I need both his legs prepped down to his feet.”
