His fingertips located the exact point of pain, spread relief, and longings she’d thought she’d forgotten.
She wouldn’t moan. She wouldn’t! She gasped instead, “Are you saying these people mean their threat?”
He flashed her a harsh smile. “They can mean it all they like. I’m not about to leave a man to die because of idiotic threats. And I’m not about to let them near you either.”
A harsh thrill shot down her spine. This chivalry had to be an act. “Oh, so you’re not included in the threat?”
“I can take care of myself, minha Jóia.”
Her lips compressed. “And you think I can’t?”
“Not like I can.” Before steam vented from her ears, he caught her hand. “And then I have something you don’t…” He dragged it inside his multi-pocketed vest, over his rocklike abdomen, then lower. Before she could snatch her already burning hand away, she felt it. A gun. A monster by the feel of it.
Her eyes rounded. “Are you into black ops now?”
“I just find it moronic to parade unprepared into areas where known danger lurks.”
“We do have armed guards on our expedition. And they’re right behind us in that Jeep.”
He cast said Jeep an amused look. “And I should do what, in your opinion? Squeal for their help if the need arises?”
A laugh burst out of her at the incongruous image of all this virility squealing for any reason. He laughed with her. Then just as suddenly he sobered. Time and space warped then vanished. She no longer registered the men who sat huddled and apprehensive at the other end of the truck or her assistants, who were watching her and Roque in utter fascination.
His eyes overflowed with something that accessed all the uncontainable passion that had once swallowed her whole. Tension blasted off him, congealing the air around them, sending awareness like she’d never felt, even with him, shrieking down her nerves, tangible and tormented.
“We’re here, people.” Madeline’s voice shattered her trance. Then everything else crashed back into her awareness.
They’d come to a stop in a huge clearing surrounded by huts. Dozens of men and women dressed in a haphazard mix of modern clothes and tribal beads and paint were already ringing their truck, faces and hands anxious, hurrying them along.
And she was panting, trembling. Roque was breathing hard, too, his eyes as disturbed as hers must be.
An endless moment later he finally rasped, “Later, Jewel.”
Then he freed her from his thrall, snapped up to his feet, bent to assist her. This time she gave him the hand he demanded eagerly, let it drown in the safety and support of his all the way to their emergency.
Why not, when there’d be no later? When this was an outtake from time that would end as soon as the unnatural extension of the emergency did?
Then he’d be gone and she’d rebury his memory, along with the miscarried baby she’d borne him.
CHAPTER TWO
ROQUE had to hand it to Jewel. She could bury anything.
She’d once buried her true nature so deep he hadn’t even suspected it. She’d buried her opinion of him so well it had been a devastating shock and a lasting scar when it had resurfaced. And now she’d buried her agitation so completely he wondered if he’d imagined it. But no—he had gotten to her.
If not as badly as she’d gotten to him. He hadn’t expected this, had he? He hadn’t even intended to do this, to approach her this way, to taunt her—to touch her. But he’d laid eyes on her and hadn’t been in control of his actions ever since… Get to business, idiota! And take control this time.
As the far more experienced doctor, he was the triage officer here, and should decide how to handle their patient, delegate responsibilities. It wasn’t the first time he’d been forced to rely on unknowns in the field, and he’d had everything from disastrous to outstanding incidental assistants. He had no reason to believe Jewel would be on the favorable side of that spectrum. She seemed to have good theoretical knowledge and came well prepared with GAO’s comprehensive kits, but that augured nothing for her clinical powers.
Not that she lacked confidence. In the seconds they’d been in Qircamo the shaman’s hut, she’d already started resuscitation, not even thinking of deferring to his superior experience. From her attitude so far, it seemed she didn’t believe that existed, or was relevant here. She seemed to believe surgeons lacked the necessary skills to handle emergencies. While she did, of course.
It also seemed her assistants shared her confidence in her abilities. Or maybe they were obeying their medical hierarchy programming, with nurse always deferring to doctor. Inácio Lima, a fellow Brazilian he knew to be a trauma nurse packing an extensive ten-year field track record, had already crouched into her assistant’s position unquestioningly.
It left him with a choice to pull rank, take this part of management over, or let her do the preliminaries and tend to the bite site himself. Which was no choice really. Any medic could handle the ABCs. His expertise was better reserved for handling the trauma. And he’d better get to that before Madeline O’Brien, Jewel’s other nurse, took it on herself to do it.
He took his place by Qircamo’s legs, murmured to Madeline delineating his needs. As she jumped to it, at once recognizing a more specialized medical person, he heard Jewel murmuring hers to Inácio. In flawless Portuguese.
His eyes snapped up in shock. Had that effortless flow really issued from her? During the five months of their marriage, she’d barely learned two dozen words!
So, it seemed once she’d left him, learning Portuguese hadn’t remained the painful obligation it had been when he’d tried to teach it to her. And he couldn’t believe the gush of disappointment this knowledge provoked.
He suppressed the stupid reaction, dragged his focus back to his patient as Madeline exposed the patient’s leg. Then nothing could have torn it away from the sight of one of a surgeon’s worst nightmares—a bloated, discolored limb. And nothing could ameliorate his dismay at seeing the reason for it. A tourniquet!
And not just any tourniquet, a tight one, midway down the thigh, hoping to stop the flow of a poison that had long been circulating in the man’s system by the time they’d applied it. All it had achieved had been the current dismal-looking prognosis. This was compartment syndrome that was teetering on the edge of gangrene.
“Scissors.” His growl made Madeline jump, brought every eye in the hut, starting with Qircamo’s people, who’d insisted on attending their treatment, slamming into him. He sheared off the catastrophic piece of meticulously applied fabric and almost roared at the sight of the messy, suppurating wound. Dammit. All signs said he could be too late…
Damn the signs. And damn these people. If they didn’t know how to manage snakebite they should have at least have known how not to compound its dangers! Had their tribal medicine knowledge vanished totally?
His blood tumbled in futility. He knew the answer to this one. They’d been corrupted, cut off from their origins with no new knowledge to replace that they were losing, or had already lost. Most of the shamans and medicine men, the living repositories of their knowledge, were over seventy years old, with no one left in their tribes interested in taking on their mantles. As they died out so did everything vital to those people’s survival. And here lay Qircamo, one of those precious people, dying, thanks to his flock’s ignorance and confusion.
Madeline noted the extensive bruising around the wound and the bleeding from his mouth and nose, indicating severe hemotoxic envenomation. He didn’t need to hear Inácio announcing the blood-pressure reading to know the shaman had severe hypotension, didn’t need bleeding-clotting tests to know coagulation was shot to hell.
“Any chance the antivenin might reverse the symptoms and compartment syndrome now?” he heard Inácio murmuring to Jewel.
Good question, as it usually did. Just not this late in the day. Before he could say so, Jewel delivered her verdict.
“Not this long after the bite.” So she
knew it, too.
Roque shot off a list of all the instruments he’d need to resolve the compartment syndrome by deeply incising between the leg’s muscular compartments to relieve the building pressure inside them that was cutting off circulation. He sat back on his heels as Madeline spread his requested items on a double layer of prepacked surgical towels, his focus back on Jewel.
She’d already handed back the battery-operated suction machine to Inácio. She must have already cleared the airway of secretions. He now watched her deft movements as she assembled the laryngoscope, asking for a specific size endotracheal tube.
Not going for rapid-sequence anesthesia before intubation, eh? Sound decision, Roque decided. The man’s consciousness was depressed enough, he wouldn’t resist or gag on the ET. And it would be foolish to test his precarious general condition by adding potent drugs to the mix. That was also why he was going for a local anesthetic nerve block for his procedure.
He rummaged through the syringes for various needle lengths. Hmm. No six-inch needles. He’d have to do with a four-inch one, then. He hoped it would be enough to reach the sciatic nerve through the swollen limb. He filled the syringe with lidocaine and snapped a look up. And did a stunned double-take.
It had been less than thirty seconds and Jewel had already intubated Qircamo. And had a gastric tube in, too. Very good.
Then she began delivering positive pressure ventilation with one hundred percent oxygen, and how she did that took his assessment of her emergency medicine skills from very good to superior. Not enough field doctors knew the necessity of initial hyperventilation to maximize oxygen saturation, or of giving ventilations slowly, over two to three seconds each. She did it all with textbook precision.
Having taken care of airway and breathing, she turned to Inácio who was handling circulation. “That’s A and B. How’s C?”
Inácio shook his head. “His veins are totally collapsed.”
Jewel pursed her lips. “OK. Let’s get central.”
Unease raced down Roque’s spine. It was true that if peripheral access through superficial arm veins, the method of choice to rehydrate shocked patients, failed, nothing was faster than central venous access. Yet an easier and far safer way was a venous cut-down. Cutting the skin over a superficial vein in the ankle needed far less expertise and had none of CVA’s risks of injuring the major arteries and nerves that ran intimately with deep veins. He could do a CVA blindfolded. And he would.
It surprised him that he didn’t relish the idea of stepping in and taking over. And before he did so, he wanted to know why she opted for the hard route. Handling intubation—and not a particularly tricky one—was all well and good. CVA was tricky at the best of times. This was one of the worst times on record.
“Why didn’t you opt for a cut-down?” he asked.
Jewel’s eyes rose briefly at his question before they lowered to her chore once more. “I’d rather not traumatize his healthy leg. And having a central line in would enable us to monitor his circulation in response to our intervention far better than other pressure measurements. As I’m sure you know.”
Her challenge sent a spurt of stimulation fizzing in his blood, which made him counter, “We’ll inject him with a megadose of antibiotics and tetanus toxoid so the possibility of infection in his uninjured leg will be beyond minimal…”
“But there, nonetheless.”
He plowed on. “And cut-down is far less problematic.”
“Not in his specific condition. He may lose one leg. I’d rather keep the other one untouched.”
She’d defended her decision well. Was she really up to it?
He challenged her again. “You have to consider the high possibility of injury to arteries and nerves. An arterial injury now can be fatal. In inexperienced hands…”
Her eyes flashed gold. “There are none of those here. Why don’t you see to the part you took over? Better still, why don’t you try again to take our audience outside and I’ll finish access in a minute and do the procedure myself?”
He really shouldn’t be enjoying this, and so much. Not now. Later, he planned on reveling in the unexpectedness of it all. Yet the very devil rode him to say, “That’s a surgeon’s job.”
He could almost see her sticking out her mental tongue. “I’m sure that’s what you’ve been always told in the exalted seclusion of your surgical realm.”
With that she dismissed him and turned back to her procedure. His eyes clung to her every move as Madeline prepped the surgery field and draped Qircamo, ready to intervene at the first sign of trouble. What he got was trouble breathing.
With a confidence that could have been born of nothing but extreme familiarity with the procedure, she blindly located the subclavian vein with the needle. Not even going for the internal jugular, eh? She went for the better but far harder choice, and in less than a minute had the catheter in and secured in place.
Roque let out the breath he’d been holding, inhaled another to order the administration of a mannitol bolus to expand Qircamo’s blood volume rapidly. The words slid down his throat unuttered. She was doing just that. This was getting weird.
As mind-boggling as it still was, he’d long known Jewel had become a doctor and had been roaming his country with GAO for three years now. But doctors came in all levels of skill and he’d had no reason to believe she’d be a skilled one. He’d even worked it out that her being with GAO was against her, not the other way around. In today’s world they were so desperate for every volunteer that their once highest standards could be slipping. But that had been unequivocal skill he’d just witnessed. And then some.
And it left him more confused than ever. He’d already been at a loss to explain how the top model he’d known, or the traumatized girl he’d married, had become a doctor at all. The best explanation, and a shaky one, was that she’d been around doctors so long after her accident, had learned so much, that she’d just decided to become one and be done with it…“All ready, Dr. er…”
His gaze dragged back to Madeline. They hadn’t had time for the barest of introductions. She and Inácio had taken their cue from their boss, assuming she knew what she was doing, inviting him along, must have gathered she knew him intimately…
“Dr. Aguiar Da Costa at your service. But that’s just for reference. Call me Roque.” He felt the electrifying caress of Jewel’s gaze sweeping him. He raised eager eyes for a direct feel, and there it was again—that blast of affinity. And he’d spent eight years reassuring himself he’d always imagined it!
He couldn’t resist asking. “I’m going to perform a double-incision fasciotomy. Would you like to assist me, Jóia?”
She gave a tiny start at his offer. Then her eyes narrowed. She suspected his motives. What did she think? That he wanted to prove she’d overstated her abilities? She wouldn’t be far from the truth. The average internist would at best have knowledge of fasciotomy but no experience with performing it. And though average and Jewel couldn’t be put in the same sentence together, this was beyond her expected skills, no matter how good she was.
Her eyes searched his for the trap for two more seconds then she nodded to Madeline. The latter made way for her at once, handing her a mask and gloves. They were a good team. Fluent, at ease, yet keeping the correct amount of respect and distance for each other’s respective expertise and position.
Jewel donned her surgical garb and settled into position facing him. “What kind of nerve block are you going for?”
“What kind would you go for?”
One dense, dark eyebrow arched up. “What’s this? A test?”
“If I’m going to be counting on your assistance, can you blame me for wanting to assess your capabilities?”
She gritted her teeth. “There’s no time for your nonsense.”
“We haven’t and we aren’t wasting time,” he countered. “It’s been exactly eight minutes since we stepped in here.”
She exhaled as she snatched the syringe out of his hand. �
��Why don’t I give you a demonstration?” She crowded him until he made way for her. “Maybe I can teach you a thing or two about a combined sciatic-lumbar plexus three-in-one nerve block.”
Stimulation kicked higher in his blood. “Teach me, then.”
And she did. Taught him she was even better than she’d boasted.
After she’d injected the anesthetic, they used the time until it worked to reassess resuscitation and prepare the plaster splint they’d need at the end of the procedure. Then it started.
He made a six-inch incision over the anterior leg to provide adequate visualization. Then he dissected the subcutaneous tissues for wide exposure of the leg compartments while Jewel blotted out blood and oozing fluid, anticipated and interacted with his needs and moves with a fluency that brought his eyes back to her mask and cap-covered face over and over again.
After he’d finished the first stage, she murmured, “Going for a transverse incision to expose the lateral intermuscular septum and superficial peroneal nerve?”
Another spurt of surprised approval tugged at his lips beneath his mask. On impulse, he made room for her to perform that step. Without missing a beat, she took over and did it. No doubt about it. She’d done this many times before. He wondered when she’d had the time to amass such experience.
As soon as she was done, he took over again. As he made more incisions, releasing pressure, restoring circulation, Jewel retracted veins and nerves, cleared his field and helped him prepare for his next move as if they’d always worked together, until he almost forgot they hadn’t always done so.
He ended the surgical part of the procedure, asked, “What next?” Post-procedural measures were critical to prognosis and it was usually where physicians slackened. This was where he might uncover a chink in her knowledge. And he couldn’t believe how reluctant he was to uncover any. He should relish it!
One Night In Collection Page 84
