by Olivia Gates
It took her only seconds to comply, all the time hearing Mikhael’s lover’s rising sobs. Seeing her man reduced to a draped body, with only the field of surgery exposed, must be adding to her indelible trauma.
Dante’s authoritative voice snatched her attention back to where it counted. “Top up the muscle relaxant, and inject 10 milligrams of morphine direct into the cannula. That will have to do for anesthesia.”
He waited for her to finish then made his first incision three inches above the site of injury, exposing the external iliac artery. “Here’s where I deal with your clot worries. I’ll occlude the vessels above and below the site of injury, so that a hemorrhage doesn’t obscure the operating field. And the clot will have nowhere to go. Clamp!”
She handed him a non-crushing vascular clamp, watched him applying it gently to the artery. “Why didn’t you use slings?” She’d learned from experience that a special surgical shoelace-like string passed twice around an artery was the best way to occlude it.
He answered without raising his eyes from his task. “A sling may be the method of choice with every other artery, but not the aorta or iliac arteries. There’s too much risk of injuring the lumbar and iliac veins.”
She hadn’t known that.
“It’s incredible that you know about slings in the first place. Most schools of thought advocate non-crushing clamping as the only method of vessel occulsion.” Was he letting her off the hook after she’d boasted of her vast experience in trauma medicine? No, it had sounded like praise.
Heat rose inside her. Embarrassment? Gratitude? More? Whatever it was, it spread in places long untouched, believed untouchable, dead…
Dante was now incising the skin three inches below the site of injury, exposing the continuation of the femoral artery. This time he took the sling she handed him, wound it twice around the artery.
With hemorrhage and clot control now assured, she undid the bandages for him, anticipating his need.
His lips tugged. “Thanks. On to debriding the wound.” Now he’d dealt with the haemorrhage it was time to clean the wound.
Without him asking for it, she placed two self-retaining retractors strategically to open the surgical field. This time he didn’t thank her, but she felt his approval. She couldn’t remember the last time anything had felt so good.
A tap on the back of her hand attracted her attention. “See this? Vein is hanging by a thread and artery is transected. We’re very lucky it got severed below the origin of the collateral branch.”
A closer look showed both ends of the severed femoral artery had recoiled into the surrounding tissues. Dante dissected extensively to find the edges. “Do you think you will need to graft?” she asked.
He exhaled, pulled on one edge. “The vein can be directly sutured, thank God. As for the artery, that depends. If there has been too much tissue loss, or if I have to cut enough tissue that the ends won’t meet without tension, I’ll have to have a graft.”
Attached under tension, the reattached artery would die and probably cause gangrene or even a fatal hemorrhage.
Minutes later he sighed. “No use. Let’s harvest that graft.”
She nodded, swooped to inject both ends with saline to assess the potency of the artery and the vein, then reported. “Return rate indicates an extensive thrombus formation. Do you have a Fogarty catheter?”
He pointed without raising his head, picking a scalpel. “It’s with the other catheters.”
In seconds she’d cleared both ends of vein and artery of clotted blood. “Shall I flush it out with heparinized saline?”
That brought his eyes up and something like a smile to them. “Remind me to thank every mentor you’ve ever had, Gulnar.”
She glowed with pride. It wasn’t a sane reaction, but an unstoppable one.
He’d already moved to Mikhael’s other leg, made an incision at the groin identifying the greater saphenous vein. He began harvesting it through an incision over the course of the vein. He stopped at the inner knee. “I will need only this much. No need to extend the incision into the calf,” he explained.
After exposure of the required length of vein, he deepened his dissection then looked at her. “Need your help here, if you’re done.” She nodded eagerly. “Mix me 120 milligrams papaverine in 250 ccs Ringer’s.”
For a few seconds she couldn’t see where the papaverine was in the bag. Then she spotted it, snapped it up, but still couldn’t understand what he needed it for. Just hand the man what he asked for.
She did, just as he explained. “I’ll irrigate the vein with it, to prevent spasm and to distend it to a suitable size for grafting with the wider femoral artery.”
He then tied the major tributaries of the vein and cut them. Once he’d removed the vein segment embedded in surrounding tissue, he prepared it further for grafting.
After he’d examined the graft segment and deemed it dilated enough, he grafted it in place.
Throughout the delicate procedure, it was as if she’d always worked with him. She anticipated his demands, handing him materials, providing him with better access, swabbing blood, cutting sutures just as close or as far as he needed.
Satisfaction flooded her, as unlikely as it was in their conditions. But she couldn’t help savoring it. There was nothing better in life, nothing more worthwhile, than being part of the restoration of another human being. And Dante was indeed a miracle worker. She’d only ever seen one surgeon who possessed such speed, such unerring, almost prophetic skill. Lorenzo. Still, Dante had something over him, an artistic quality to his every move, a gentle, esthetic flair that went beyond precision, was above uncanny skill. This was talent.
He put the last suture into the arterial repair and exhaled. “What I wouldn’t have given for intra-operative angiography. But I guess we’ll just to believe you’ve cleared all the clots and prevented re-formation.”
She prayed so, and saw as fierce a hope in his eyes. She wasn’t up to facing such intensity now. She looked away, examined Mikhael’s leg. Her heart thumped. “His leg is swelling. Could he develop compartment syndrome now?” This which would cut off the blood flow and cause gangrene!
He nodded.
Without another word she handed him instruments and he performed a fasciotomy, cutting bone-deep through the thigh separating its compartments, the only way to relieve the build-up of pressure there.
He sighed when he was done. “I’m not happy I added more trauma, increasing risk of infection, but the alternative—”
She shuddered and administered the highest possible dose of antibiotics and tetanus toxoid, then rechecked Mikhael’s leg. Though it looked horrifying, she knew Dante had managed to save it. There would be scarring, but Mikhael would walk on it, probably run again. If they survived this.
She was applying a dressing to the limb when Dante made a strange sound. She raised her eyes, sought his. She didn’t find them. Just blank whites staring back at her. Then his lids slammed shut just before he slumped to the floor.
CHAPTER THREE
“DANTE! Dante!”
A shrill sound slashed through the darkness. Something shook his immovable body. He wanted to make it stop, to leave him alone in the dark. He couldn’t. He had no voice. No muscles. He should be worried, but he wasn’t. Then it wasn’t dark any more, but a painful red burning on the backs of his eyelids.
Suddenly it dimmed and he ventured to open his eyes. He stared into forest-lush green. Eyes. Gulnar’s. That was her name. The woman who belonged in dreams. In abandoned fantasies. What was she doing in this nightmare?
Now she was pouncing on him, stinging him. He heard a protest. His. “Ow. That hurt…”
He remembered snatches of…surgery? A vascular repair, a fasciotomy…Had he finished? Yes—yes, he guessed so. The last thing he recalled was watching dainty hands in surgical gloves wrapping Vaseline gauze around a mutilated limb, then there were flashes of blue and purple and intense, nauseating yellow. Then everything blinked out.
<
br /> He’d fainted.
She’d been right. He didn’t have enough blood to spare. Pathetic. Just a liter and a half of blood and his system had shut down. They’d forgotten to initiate his fluid replacement, had gotten sidetracked tending to Mikhael. And he’d lectured her about not being of any use to him if she fainted!
Now she was rectifying their oversight. His arm throbbed where she’d shoved the cannula without any finesse this time. She hooked it to the line of the Ringer’s solution bag.
She heaved herself up to her feet to hold the bag up so the fluid would flow—and staggered. She would have fallen if he hadn’t somehow summoned enough strength and co-ordination to get to his feet and catch her.
She was limp, shaking like a leaf. It had to be from starvation and dehydration. Concussion. But what if it was more? What if an artery had ruptured inside her head? What if all that life, all that beauty was being snuffed as he watched, helpless, useless? Like he would watch all those others…
He heard her gasped words from a long, narrowing tunnel of panic. “Stood up too suddenly, got light-headed…”
He tightened his arms around her when she swayed again.
“And postural hypotension is becoming the constrictive type now.”
What?
“You’re cutting off my circulation.”
His frantic gaze swept her incredible face. Was she joking?
She was!
So was she OK? Dared he relax?
Dante pushed Gulnar down beside the emergency bag. “I’m examining you. And you’re getting fluid replacement, too, whether you agree or not.”
“Yes, Doctor.”
He couldn’t believe it. She was teasing him. And he wanted to whoop with laughter. He must have snapped. She must have, too, long before him.
He shone a penlight into her eyes. Good. Equal, brisk pupillary reflexes. No cupping of the optic disc, no hazing of the retina. Normal fundus, if a little pale. That had to do with her dehydration. Probably anemic, too. But no brain swelling. Her reflexes were all fine. OK. No detectable sequels to the blow. On to fluid replacement.
Ready with a cannula, he pushed up her sleeve, revealed her creamy, supple forearm.
Hell! What was wrong with him when, in a situation as dire as this, all he wanted was to close those eyes and open those lips, taste her, drown in her life, drain all horror and desperation in her passion and compassion?
It was probably a stress reaction. That made no difference to its impact. Probably intensified it. After his accustomed apathy it was jarring to experience such searing urgency again. Again? Had he ever felt anything like that?
Not that he remembered.
He inserted the cannula, hooked the line, watched the fluid coursing through it and into her, willed it to revive her. He would die, and more, to see her safe, saved.
The most wonderful sound tickled him. Her giggle. “You have to admit, we look ridiculous, each hooked to a line and holding the other’s bag up.”
“We do look like broken-down machines in Maintenance.”
“We are.”
“You’re right. But what else are you? You’re not Azernian or Badovnan. And though your English is near perfect, it isn’t your mother tongue, is it? Right now I can’t access my geography and history, can’t think which country has been in a fifteen-year war and whose people have been displaced.”
She caressed an apology to the darkening stain where she’d shoved his cannula. “Don’t exert your memory. I’m Azerbaijani. Twice blighted since I don’t belong to the Muslim majority. During the last days of the Russian rule we moved to Armenia but when war came we shared the fate of our fellow Azerbaijanis there. I guess I’m still counted among the million who remain homeless and internally displaced in Azerbaijan. Not that I should any more. Ever since I left the refugee camp and joined GAO, that has been my home.”
Such a concise account. Such nonchalance. He’d thought her an enigma before, now…he just didn’t know. Couldn’t think. It was too much to take in. Impossible to imagine. Her life. A fifteen-year chunk of it. She must have been no more than thirteen or fourteen when it had all started. Had she lost her family? She’d said everyone she knew and loved. So she had. She’d been homeless and terrorized and abused, alone.
And there she was, surviving one war only to plunge, voluntarily, into another. Whatever her reasons for doing this, they had to be even more bizarre than his.
The fluid in both their bags had run through. She detached both lines, left the cannulae in and got up, avoiding his eyes. He watched her gathering instruments and supplies from his emergency bag and heading for the other casualties.
Dante felt the tug of oblivion, was tempted to just close his eyes and surrender to it. He couldn’t. He’d saved one of the lives he’d been allowed. He still had another.
Gulnar. That was the only name that filled his awareness now, the only face he saw. Hundreds of people, all lives worth saving. But he had to choose one. He chose her. He had to.
A hand on his shoulder made him flinch. “It’s me.” He knew that. His body had thrilled to her touch. He’d know it anywhere now. She sank to her knees before him, exhaustion pinching her open face, hunching her strong shoulders. “I checked all the injured people and gave them antibiotics and tetanus boosters. Your blood seems to be of premium quality, too. They’re reviving. And they all thank you. One told me to tell you that no matter what happens to them from now on, in her book you’ve saved them.”
Dante’s insides clenched. No, he hadn’t. He wouldn’t. In his book, all he’d done was torture them with false hope, prolong their suffering.
She cocked her head at him. “What now?”
Dante’s focus relinquished his internal agony for Gulnar’s eyes. Could there be anything more beautiful? Was this why he’d decided on making her the lottery survival winner? Was he that basic?
No. She was more than a rarity of divine art. She was also a blinding manifestation of good. Few people had the capacity, the willingness to make a difference, to put themselves on the line for others. If he had to choose, it stood to reason he would choose the one most of use…
What was he thinking? How did he know that every other person here wasn’t as useful in his or her own way? Who was he to decide who would do more good, who was more needed, more valuable?
It was more than cruel. Beyond monstrous. To be forced to choose. But he had to…
“Dr. Dante? Are you all right?” Her solicitous stroke over his hand spread through him, the simple contact dousing him in unlikely, untimely sensations. Peace, pleasure. Arousal. It was just too funny to rediscover his libido now. But it wasn’t why he wanted to save her. It wasn’t!
He caught the hand covering his, stroked it back. “I’m all right. Are you?”
Answering contentment softened her face, tightened her hand on his. “I’m alive and conscious. So I’m all right.”
He nodded, groping for a way to disclose his grisly verdict.
He didn’t have the chance. A probing expression invaded her eyes. “I told you what I am. You told me who you are, sort of, but you didn’t tell me how you were allowed in here. The rebels have so far answered any approaches with a hail of gunfire and threats. It’s why I thought you were with them in the beginning.”
So she’d saved him the effort of stumbling through explanations, given him the shortcut to come clean after all. Answering her would still lead to confessing. “I have a…special deal with their leader.”
Those eyes widened on astonishment and what else—suspicion? No. Just curiosity. “How so?”
So she didn’t consider it even a possibility he was affiliated with the rebels! Good to know. “Two years ago, during an Azernian raid on his village, his wife and oldest child were almost fatally injured. I was roaming the area with another aid organization at the time and I happened to be in the right place in the right time. I saved their lives.”
Gulnar gave a slow, thoughtful nod.
“Have yo
u ever heard of Molokai?” Dante asked.
“Ah! It’s almost common knowledge now that his group is the one that was responsible for Lorenzo’s abduction, and the jet hospital’s attempted hijacking.”
That was something Dante hadn’t known. More and more crimes, then. Dante gave the now seated militants a long look.
“When I heard about this attack and that he’d already announced he was responsible for it, I put a call out through his connections. He agreed to give me an interview, taking every precaution, of course. I demanded that he let me help the victims of this attack as I did his family.”
“And he just granted your request?”
“I am here, am I not?”
“You mean he actually has a sense of fairness to appeal to? A sense of honor?”
“You’d be surprised how ruled by posturing and macho nonsense those people are. He made the mistake of having his right-hand man, the only one who speaks English among his men, present when he saw me, and I made sure the man knew what Molokai owed me. I think the fact that his men knew was the only thing that made Molokai agree to settle the debt, giving a speech about how he refused to be in debt to a foreigner who has no sympathy for his cause. He granted me two lives in return for his wife’s and child’s.”
Gulnar’s stare widened. Her words, when they came, were slow, realization tinging them with horror. “But you saved many more than two lives. At least twelve people would have eventually died without your intervention and your supplies.”
She understood, but still needed him to spell it out. What the hell? He had to sooner or later. “They will all still die. He doesn’t intend to let anyone, including his people, walk out of here alive.”
He watched her eyes filling with terrible understanding. “And his people know that? That this is a suicide mission?”
“No, they don’t. His plan is to stretch this out, get the most screaming tension out of the situation, the most international media coverage. Eventually his people will realize that the cavalry charge isn’t coming—and that they will be left to die.”
