The Heroic Surgeon

by Olivia Gates

  A few words from Emilio to the efficient ICU staff brought the instruments Dante would need in seconds. He thanked Emilio, turned to her. “Gulnar, retract the lid for me.”

  Her heart blocked her throat, her stomach rebelled. She could take anything, had taken far worse than this, but somehow the idea of handling Dimitri’s delicate, shredded flesh overwhelmed her. Just do it. Go to pieces later.

  She took her position at Dimitri’s head and applied extra-gentle, calibrated traction with the lid retractor, prying the swollen lids apart for Dante.

  He first measured the intraocular pressure and examined the insides of the eyes for injuries. The eyes were also windows to the brain—changes in the optic disc supplied reliable information about any rise in intracranial pressure.

  Dante pulled back on a sharp inhalation. “OK. First good news I’ve seen so far. Amazing, too. The eyes themselves are intact.”

  Gulnar heard Emilio’s exhalation a few inches away from her ear. So he, too, had been holding his breath.

  Dante raised his eyebrows at her. “Now I’d really like those X-rays.”

  Gulnar swung to the senior ICU nurse, who hurried out herself this time, came back in a couple of minutes handed Dante the films with a grim face. He thanked her in Azernian, made sure he caught the nurse’s eyes, gave her a soothing smile. Gulnar’s heart swelled.

  How considerate he was. How tender. Oh, Dante. Still here, but already lost to her.

  She clamped down on the tide of agony as he shook his head, looking at the X-rays. “Without 3-D X-rays or even CTs to visualize whole structure of the face and skull from all sides and in perspective, there’s no way to see the injury in detail. But I guess this will have to do. When was this taken?”

  “After surgery.”

  “Hmm. Emilio, Gulnar, come over here.” Gulnar darted to his side. Emilio’s surprise that Dante had included him made his movements slower. They both ended up hovering on either side of Dante. “Tell me what you see.”

  What she didn’t see chilled her. She had no solid arguments, no clinical evidence to back up her belief. It was instinct. And no one had agreed with it. If Dante didn’t either, her mind would be set at rest. She prayed he wouldn’t. She exhaled. “Nothing much. But judgements based on plain X-rays tend to under-diagnose the extent of injury. Dr. Moya was adamantly against doing anything about the facial fractures. He said we could always have delayed reconstruction when Dimitri is out of danger.”

  “But that’s not your verdict, hmm?” Dante probed.

  “No!”

  Dante released her eyes, pored over the X-rays again. And again both she and Emilio looked over his shoulders. “Here—where you can’t see it, but from my manual exam—is a pulverization of the naso-orbito-ethmoid bones constituting the whole mid-face. I thought that the frontal bone had been spared. It was only on palpation that I found out the posterior table of the frontal bone is also pulverized.”

  “But how can the posterior table be fractured without the anterior one?”

  Gulnar couldn’t blame Emilio for being skeptical. The frontal bone, making up the forehead, was made up of two layers, an outer one and an inner one. The inner one almost never fractured if the outer one remained intact.

  Dante shrugged. “It happens. Rarely, but it does. And this misleading intactness probably accounts for your doctor’s optimistic outlook. I wouldn’t fault him too much. As you said, X-rays aren’t useful in showing damage to the posterior table.”

  “So this is why he has a normal fundus,” Gulnar exclaimed. “There is no rise in intracranial pressure because he’s been leaking cerebrospinal fluid though the fracture all the time!”

  Dante’s lips twisted. “And the reason for his deterioration is neither shock nor direct trauma to the brain, but a spreading infection. If he weren’t sedated, he would have shown all signs of meningo-encephalitis.”

  “Oh, Dimitri!” Of course. His brain was exposed to the elements through the fracture. But in that case… “Oh, God, Dante, he’s been on massive post-operative corticosteroids—they can suppress immunity and promote infection!”

  Dante glared at Emilio. “You didn’t mention corticosteroids!”

  Emilio glared back. “You’re the surgeon. You should know what goes on post-operative medication orders!”

  “Well, you can strike them out at once!”

  Emilio strode to the ICU nurse, relayed the new orders, anger clenching his every muscle.

  Gulnar interrupted their sparring, still thinking, all the pieces falling into place. “So there was no cerebrospinal fluid leaking from his nose because he’d been on his back, with his head extended backwards!”

  Dante came to stand beside Gulnar, his eyes sweeping her with appreciation, respect. Yes, but there was more. Regret. Sadness.

  He nodded. “Another misleading lack of evidence. You were absolutely right to suspect the worst, to get me here. It was uncanny how you felt his danger against all evidence.”

  She held herself rigid, swallowed a barbed lump of agitation and longing. “But why aren’t the antibiotics doing their job now?”

  “Not even broad-spectrum antibiotics are good at crossing the blood-brain barrier, at least not at the concentration needed to treat such an acute and severe infection. And, anyway, the area has very poor blood supply right now. Not much antibiotic-loaded blood is making its way there.”

  Everything made perfect sense, the explanation to her instinctive diagnosis. “Do you think there is a dural tear, too?” If the frontal bone was fractured, it might have torn the outer brain covering attached to it as well.

  “Very likely.”

  “If antibiotics aren’t working, he could die of a cavernous sinus thrombosis.”

  Dante’s eyes widened. A leap of admiration lit his eyes—he was impressed. This shouldn’t be a time for such pleasure, but she couldn’t help it. She craved his approval. And by tomorrow there would be no more of it.

  “That’s one of many things that could happen if his facial fractures are left untreated for any length of time. Which brings us to our catch-22 situation. We can’t operate because he can’t withstand the lengthy anesthesia and the multiple reconstructive procedures. We can’t not operate because waiting would also kill him.”

  A feeling of impotence shuddered through her. What would they do now?

  “So, Gulnar, where are those mini-plates?”

  She blinked at his change of subject. “I ordered them the minute we arrived.” He’d asked for the mini-plate and screw systems, the latest techniques to hold together small bone fragments. She’d thought he just wanted to have them handy, in case he decided to proceed with the reconstruction. “They didn’t have any left, so they sent for them from Srajna’s other main hospital.”

  “I just hope they make it by the time I need them to start stabilizing the bone splinters.”

  Her heart lurched. “You mean you will go ahead with the procedure?”

  The corner of those lips lifted. “Let’s scrub.”

  “Let’s end this!”

  Emilio’s note of urgency rang in Dante’s ears.

  Dante knew he was pushing it, that Dimitri could stand no more. He still didn’t know how the guy had held on that long—four hours of surgery and some of the most intricate and extensive reconstructive work he’d ever done. But there had been no way around it. On exposure, Dimitri’s fractures had turned out to be far more catastrophic than even he and Gulnar had thought.

  “Guerriero, just close him up. Finish this later!”

  He couldn’t. Dimitri was dead anyway if he didn’t complete reconstruction. If not on the table now, then a week from now—maximum. There would be no other secondary surgery at a later date. It was now or never. He’d rather have Dimitri die in his hands as he fought for his life than die because he’d given up the fight.

  But he could sympathize with Emilio’s distress. It must have been too much for even him—a man who lived on the razor edge of violence and desperati
on, and by choice, seeing his buddy’s face a dissected nightmare with Dante’s hands and scalpels deep inside it. Emilio had reached his limit after Dimitri had flat-lined. What about Gulnar?

  She was holding in her distress better than Emilio, murmuring encouragement to Dimitri.

  Emilio was silent for a dozen heartbeats then hissed again, “Pulse 185, BP 70 over 40. We’re losing him—again!” Emilio still didn’t miss a beat of the flawless surgical routine they’d fallen into, handing Gulnar the cautery probe and preparing the next set of mini-plates.

  “No, we’re not.” Gulnar’s voice trembled as she cauterized and swabbed for Dante. Then it was time for the most important step, the frontal sinus ablation.

  All through the first step of the procedure, Gulnar continued her murmurings to Dimitri between Dante’s hushed requests for instruments and assistance. Then Dante sighed as he moved away from the surgical microscope. “Gulnar, I’ve removed all sinus mucosa. Sort through the removed bone slivers and fat pads, form me squares of one centimeter each. I will need them to obliterate the naso-frontal duct.” It was where the infection was finding its way into the brain.

  That took another ten minutes and Emilio announced again. “60 over 20. You’ve done the most important things. Anything else isn’t life-threatening and we’ve already shocked him once. How many times does his heart need to stop before you end this?”

  “Emilio!” Gulnar’s warning mutter was almost inaudible. “Dimitri doesn’t need to hear your doom-mongering!” Louder, she resumed talking to Dimitri, bolstering, tender—teasing. “You don’t, do you, Dimitri? You’re fed up with all that doom-and-gloom stuff, huh? You’ve held up all through this when everyone kept saying you wouldn’t. You’ll do this, won’t you? You’ll get through this so we can finish our chess game. I want to beat you and get one of your fabulous caricatures.”

  Dante’s eyes darted from Gulnar’s hands, as she helped him gain exposure of the central nasal bone fragments, to the monitors. Dimitri’s pulse was slowing down, his blood pressure inching its way up.

  It had to be Gulnar. The man had been hanging on all that time to please her. He just knew it. And he knew the feeling. He’d done it before.

  “Good man. We’re almost there,” Dante murmured.

  “Hear that, Dimitri?” Gulnar helped Dante as he reduced and stabilized the superior and inferior orbital rim fragments with mini-plates. “If—and that’s a very long shot—you beat me, I’ll set you up with Magdalene. Yes, I know, and the good news is she feels the same. Now, all you have to do is get back on your feet…”

  Dante ended up by reconstructing the nasal bone with a cantilever bone graft secured with a mini-plate. He finally tightened the last screw then sat back.

  It was done. They’d put Dimitri’s face back together. And not only was he still alive, he was stabilizing. And Gulnar was still murmuring to him, congratulating him, praising his effort.

  Dante suddenly felt the need to communicate with him, too. He took the needle holder from the relaxing Emilio, picked up the threaded needle from Gulnar and smiled beneath his mask down at his patient. Dimitri would hear—feel his pleasure, his confidence. He hoped. “Thanks Dimitri. It’s been an honor fighting through this with you. We’re closing you up now. And don’t worry, I promise you the best esthetic result possible. Once the swelling and bruises disappear, the fair Magdalene won’t even notice any scars.”

  He felt Gulnar’s eyes swinging up to him, hotter than a cautery probe. He wondered if they would leave scars.

  He looked at Dimitri as he restructured his facial muscles and closed his skin. If it hadn’t been for Dimitri, Gulnar would have come tomorrow on her usual morning visit to find Dante gone. He would have walked away with minimal regret, minimal scars. At least compared to now.

  Now walking away from her would do more than scar him. Still, it was far better than what he’d suffer if he stayed.

  What he’d make her suffer.

  CHAPTER NINE

  “DON’T you think I’ve suffered enough?”

  Gulnar leaned back against a column in the scrubbing-gowning hall, struggling with the pain clamping her whole body.

  Dimitri’s nurse and anesthetist finished scrubbing for yet another procedure and cast another glance at her and Dante on their way out.

  “What are you talking about, Gulnar?” His eyes darted to hers in the murky mirror above the wall-to-wall sink then darted away instantly.

  “You’re leaving me in suspense and it’s killing me. Why don’t you tell me what you are doing, Dante?”

  “I’m dead on my feet, that’s what I’m doing.”

  This wasn’t exhaustion. She didn’t know what it was or why. She didn’t understand why he’d shut her out so completely, so suddenly. And she didn’t have to. Didn’t have time to. For whatever reason, he was just ending their liaison now, and not tomorrow. Tomorrow…

  Knowing he intended to leave tomorrow had changed everything. When she’d thought she still had time with him, in any form, she’d laid off, given him his space, left it up to him to conduct their relationship. Even when he’d told her he’d return to the US as soon as he was healed, she’d still thought she had at least a month with him. But she had no more time and she had to be with him those last hours. She had to have tonight!

  And he was pushing her away.

  It hurt and humiliated her. It confused her and made her want to curl up in the dark and never rise again. But it didn’t matter. Nothing did. She had to have those hours.

  “Gulnar, not only am I dead on my feet—”

  “So let’s get out of here. Let me take you away, you can rest and sleep—”

  A harsh bark erupted from him. “Sleep? You think we’d sleep?”

  “We’ll do anything you want. I did promise anything before and I still do. Anything and everything we want. If you want to sleep, I want to hold you while you sleep.”

  He held up his hands and squeezed his eyes, an exasperated order for her to stop! “Gulnar, I’m walking out of here and checking into a hotel for the night. Then first thing in the morning I’m leaving. I’m never coming back. Do you understand this? You want a lover? It isn’t me. There. That’s your answer. Satisfied?”

  “No. It doesn’t make a difference, you leaving, not to me. And if you ever come back—”

  “I won’t. You’ve got to believe that.”

  Oh, she believed it. It was why she was desperate, why this was possible. “Then I want tonight, Dante. Don’t you want it, too?”

  His simmering sidelong glance said he did. But, then, he would want any female who stood there begging for anything with him.

  Fine. She didn’t expect an exclusive relationship. Wouldn’t know what to do with one if she had one. Didn’t want one.

  She just wanted tonight.

  He turned from her, bent down to lower his head to the sink. He held his breath and let cool water pour over his head.

  The sight of water sluicing over his polished bronze skull thudded in her heart, behind her eyes, in her loins. An endless minute later, he straightened to his full height, water rivulets running down his head and neck, merging with the sweat darkening the green of his surgical scrubs.

  Suddenly the space between them had disappeared.

  “Gulnar…” His arms moved to push her away and convulsed around her instead, squashing her into his body. She melted immediately. The next second, he exploded away in disgust. “Dammit, Gulnar. Don’t do that to me—not now.”

  “Later, then? My place? Your hotel?” Say yes. Promise me tonight.

  “Gulnar!”

  He dipped his hands under his scrubs, snatched his headscarf out of his pants pocket and in two violent movements wiped and wrapped his head, cornered, angry. “You’re a hazard, Gulnar. For God’s sake—you have no idea what you’re asking for!”

  He snatched the scrubs over his head, volleyed them into the laundry bin, exposing his massive chest and ridged abdomen. But even his beauty didn’
t distract her from the searing sight of his healing wound.

  He turned away, heaving in steadying breaths. Her arms wound around his chest back to front, her fingers digging into his solid muscles, her lips quivering where the bullet had almost taken him from her. Her eyes brimmed with unspent tears, her body quaked into his precious flesh with all the horrific could-have-beens.

  “Say yes, Dante.”

  “No.” He tore at her hands, stumbled away and snatched open the locker they’d been given to keep their clothes in.

  He put more distance between them, eyeing her as he prowled in slow, tense figure eights, buttoning his shirt. A caged lion taking stock of his tormentor.

  Had she misunderstood it all? She’d thought their shared ordeal gave her some special status in his eyes, that he shared her attraction—however partially. It didn’t seem so any more. She couldn’t pretend any longer not to understand his withdrawal, his rejection. He didn’t want her, not in any way, no matter how fleetingly. She was the one dishonoring and erasing anything that they’d shared.

  Oh, hell—what had she done!

  Then something even more crippling hit her.

  “I just realized—I know nothing about you. I don’t know whether you’re married, or involved…” She stopped, shame shriveling her up.

  His sharp inhalation suspended her agitation. The next second stretched out, the eternity before the verdict. Then he exhaled. “No. I’m not. Not any more. And I never will be again.”

  Air disappeared. She groped for it and it came, tearing, burning inside her chest.

  He’d been married? Or deeply in love?

  Of course he had been. He hadn’t just emerged into existence the moment she’d lain eyes on him. He had to be in his late thirties, and…

  It hurt to imagine someone, another woman, loving him, his body eager for hers, his eyes telling her what she meant to him, his heart racing, welcoming her.