by Olivia Gates
Saeed translated her question to the foreman. The man stammered out the answer. From one to three hours.
“And how long ago were they rescued?” she pressed.
The answer was the same.
She reached the same conclusion he did, announced it to her team. “We have to assume they developed crush syndrome.” At the hesitant looks from those whose specialties had nothing to do with trauma, she elaborated, “After being crushed for more than an hour, on being released, crush syndrome develops, resulting in severe hypotension, renal failure and irreversible shock.”
“So they might have only managed to kill them by pulling them out?” Steve Mittman asked. Malek didn’t like the way the big, blond man was looking at Janaan. Didn’t like it at all.
Janaan nodded. “Rescuing people from underneath rubble, without initiating aggressive fluid replacement during or right after the rescue, is termed ‘rescue death’.”
“At least we’ll be right here when the rest are being pulled out.” That was Hessuh, his pride and joy, prototype of the new breed of female Damhoorian doctors. She’d gotten so close to Janaan, gotten to share her trailer, breathe the same air. He envied her so much, he couldn’t bear looking at her.
And there was Janaan, exchanging that look of unspoken understanding and camaraderie with her, not with him!
“For now, regardless of other injuries,” Janaan said, “some may be beyond reach if the six-hour window when the syndrome becomes irreversible has passed. So here’s the treatment plan.” She rose to her feet, still not looking at him. “Pick a patient, then bilateral peripheral lines, glucose-saline, two liters over the next hour, two more over the next two, twelve in all today. Then airway management, ventilation and examination.”
Then she fell to her knees between two of the casualties.
She behaved as if he wasn’t there. Was she abiding by his order, or was she punishing him for it?
No—that would be manipulation and by now he was sure she didn’t have a manipulative cell in her body. Maybe she knew they could deal with this, that his expertise would come later.
“Let me help.”
Steve. With his boyish good looks and hot eyes. Advancing on Janaan, offering assistance, declaring interest. Hunger.
Janaan looked up, gave a tiny smile. A smile. Of acceptance, encouragement …? W’Ullahi ma beyseer!
By God, he wouldn’t let it be. He fell to his knees by her side, growled up at Steve, “If you don’t have a patient, help in the rescue efforts. The helicopters will be here any minute.”
He dismissed Steve from his focus, turned his eyes on Janaan. Her face was still averted, scrunched up in … was it concentration? She cut off her patient’s sleeves then reached for IV giving sets. He closed his hand over hers, taking one from her hand.
Her gasp blasted through him like a hot desert gale, her soft, capable hand going limp in his and letting both sets fall.
Still keeping her eyes off him, she withdrew her hand, turned to the others. “Elaine, Alyaa, Miguel, place catheters, then monitor urine output and pH. If it’s dark brown or red then it has myoglobin. To flush it out to keep the kidneys working, we need to achieve a diuresis of at least 300 millilitres per hour with a urine pH of more than 6.5.”
They nodded, got to it at once. They clearly considered Janaan their triage officer, even in Malek’s presence. Janaan had really won his team’s unswerving respect and obedience during the past two weeks.
And how couldn’t she? Her knowledge was extensive, her work ethic impeccable, her people skills inimitable. Everyone recognized that and was giving each talent and asset its due.
He felt her eyes darting to him now, or rather to his hands, felt their gaze along his every nerve ending as she took in that he’d already started fluid replacement on one patient.
He looked up at her, needing that gaze to mesh with his, needing the connection. She didn’t look back, turned to the other patient. He gritted his teeth, kept on working.
Ten minutes later, resuscitation was over and everyone reported the condition of their casualties. Then the helicopters were there and Janaan rushed after Malek to organize the airlift.
He directed his men’s efforts while she directed their medical team in resuscitation before extrication.
It took over three hours of grueling work, and not a few accidents, the worst resulting in one of his men fracturing his femur, to get everyone out and resuscitated.
With triage sorted out, they loaded casualties on gurneys in preparation for transferring them to the ambulances or OR. Rafeeq went to ready the anesthesia station.
Janaan stood there taking stock. He approached her, needing some contact, some response. She still refused it.
Suddenly she asked, “Who will you start with?”
He didn’t answer right away. Not because he hadn’t made a decision but because he needed to bring the debilitating spurt of joy and relief at her acknowledgement of him again under control.
“This man.” He pointed to the moaning man on the second gurney from where she stood. “His crush injury is the worst.”
Her nod told him she thought so too. So had she only been making sure his judgment was the same as hers? Or had she been trying to initiate conversation?
No. Janaan didn’t resort to things like that. That had been a legitimate question. To which he hadn’t given a complete answer.
He had to add, “I may have to amputate.” At her gasp, he rushed on, “I won’t know until we have him on the table. But I just need you to be ready for the possibility.”
She nodded, her color at high level. And he couldn’t deny his need. He needed her with him.
“Will you assist me?” he rasped.
Her eyes swung up to him, letting him in again, blazing her relief to be included, her eagerness to be of help. To be with him again?
“Hada abbi.”
Both Malek and Janaan jerked around at the adolescent voice, found a boy of no more than thirteen standing two feet away from them, covered in the yellowish dust, as if he too had been pulled from the rubble, undernourished, underdeveloped, swaying.
Malek took a stride towards him, his hand held out to support him, and the boy hiccuped a sob and stumbled back.
“Aish beeh? Aish rah t’sa’woh b’abbi?”
Malek closed the gap, took the boy by the shoulders, gently, carefully, talked to him, low and soothing. And the boy’s sobbing escalated into all-out weeping.
“Malek?”
Janaan’s trembling whisper touched him before her hand did. He first called Saeed, gave him orders, turned the boy over to him then turned to Janaan.
“This man is Aabed, Nabeel’s father. Nabeel told me he was standing next to him when the cave-in happened. He pushed him away at the last moment. Nabeel has six younger brothers and sisters and he said he’s too young to be the man of the family.”
That vast compassion flared in her face, burned him. “What did you tell him? What did you tell Saeed to do?”
“I told him he has nothing to fear. I told Saeed to take care of him. Now we’ll take care of his father.”
“Is he under yet, Rafeeq?” Malek asked.
Rafeeq adjusted his anesthetic/oxygen delivery then raised his eyes. “Go ahead.”
“Administer cephalosporin, please, Rafeeq.” Malek raised his head at the moment’s silence that greeted his order. “Yes, now, and tetanus toxoid. Infection with the state of circulation in his leg is taking root as we speak. We can’t be too aggressive or too early in treating it.”
He returned his eyes to the field of surgery, Aabed’s left leg. It was blue, cold and pulseless. Not to mention grossly swollen up to the groin.
Jay eyes followed Malek’s, the only thing she could see of him now, and shivered at the terrible intensity that prowled in their depths, like a caged lion pondering a way out.
She couldn’t bear it. “What will it be, Malek?”
Malek was silent for a moment more. Then he exhaled.
“I’ll start with a fasciotomy. If we don’t get definite distal pulses at the end of the procedure.”
He’d have to amputate. Then Aabed would lose his ability to stand on his own two feet, his only means of supporting his family. And Nabeel would lose his childhood to the struggle of keeping his family from starvation.
“He won’t.”
Her heart fired at Malek’s whisper. Had she muttered her fears out loud?
As Malek held her gaze, she knew he only shared her thoughts, was reaching out with the promise. Nabeel, like Adham, would get the best chance at life. He’d make sure of it.
Then he moved his eyes back to his task, made a transverse incision across the thigh, dissected the subcutaneous tissue to expose the iliotibial band, made a straight incision through it in line with its fibers. She carefully reflected the fascia for him, exposing the intermuscular septum, watching the poetry in his every move, the genius and healing flowing from his fingers.
“Cautery, please, Janaan.”
His baritone sent its gentleness through her on an almost un-containable wave of longing. She clamped down on the tremors, coagulated all vessels in the now pale, spongy muscles. She withdrew, fell back into the reality of his nearness, the feeling that he seemed to be seeking her again, still afraid to believe it, expecting it to end at any moment.
She watched his every move as he made a two-centimeter incision in the fibrous septum, releasing the building pressure in the muscle compartments of the thigh which were now cutting off circulation and causing the starting necrosis of the whole limb.
“Metzenbaum scissors, please, Janaan.” It was in his hand as he uttered its name. He used it to extend the incision. “OK. Anterior and posterior compartments released. Please measure pressure of the medial compartment.”
She did, bit her lip. “Elevated,” she rasped.
He inhaled, nodded, made another incision to release the adductor compartment. After two minutes he said, “And now?”
She measured again, felt her heart boom at the reading.
“Pressure within normal limits,” she gasped.
He let out a long exhalation. Relief made audible.
“Your turn,” he murmured.
She jumped in, making sure she didn’t leave one bleeding artery uncauterized.
“That’s perfect, Janaan. Now feel for distal pulses.”
She felt for the pulse in Aabed’s foot as Malek felt for the femoral and popliteal, bracing herself. A flutter tickled her fingertips. She moaned. “Oh, God.”
He came around her, felt where she had then dragged off his mask. “Pack the wound open, Janaan, and apply a bulky dressing.”
“You mean.”
He turned heavy, full eyes on her. “Yes. This is a supreme case of guddur w’luttuf. God decreed adversity but was merciful with it.” He turned his eyes to Aabed’s leg and her eyes gushed with their loss, with fear he’d resume his distance, her deprivation. She blinked tears away, got to work.
“He’ll be returned to OR for debridement until no necrotic tissue is left before we close the wound. But I believe he’ll walk again.” He looked at Rafeeq. “Great job, Rafeeq. Bring him round. Take him to IC then prepare for the next procedure.”
Management and surgeries continued non-stop for the next fifteen hours. Four patients were beyond help, five were still critical, but the remaining would survive with minor or no handicap. All would have died without intervention. Saving twenty-five should have felt good. It didn’t.
Malek had remained within those three feet of her, his eyes on her every second he didn’t have them on his job, seething with so much that distressed her, that she couldn’t fathom.
It was noon by the time they returned to their convoy. Their team was exhausted, physically and spiritually, as they made their way to their trailers. Malek walked her in silence to hers, seemed about to say something when Hessuh caught up with them and climbed inside before Jay.
After a long moment of hesitation, he only rasped, “Get some rest.” Then he turned away.
She stumbled inside, found Hessuh in bed, fully clothed, eyes closed. Jay fell face down on her own bed, the last flicker in her receding mind an image of Malek as he’d left her.
Janaan moaned and burrowed into a wonderful feeling.
Hot, male, encompassing. Malek.
Only he made her feel this protected and cherished. This hungry, this incredible, and this miserable!
She opened her eyes, expecting the echoes of their night together to dissipate, leaving her cold and empty and alone—alone forever. And he was there. Then he didn’t vanish.
Malek. He was really there. Stretched out beside her. Like that night in her hotel, drenching her in caresses. Disoriented, she blinked, at him, around the trailer.
“I asked Hessuh to leave us alone,” he answered her unspoken question, the richness of his voice twisting in her heart, in her loins, the spike of sensation so severe her teeth rattled with its force. The drugged tinge to his gaze suddenly lifted, a dull bleakness replacing it. Then he was leaving her!
He staggered up to his feet, seemed to sway before he stood up straight. Or maybe it was her world that was churning, would never right itself again.
“Habibati, samheeni—forgive me, I saw you sleeping and I couldn’t—couldn’t … Ya Ullah-hada w’Ullahi tholm.”
Tholm. Injustice.
What was? That he was, that he made her feel all this?
She shakily swung trembling legs over the side of her bed, sat staring up at him with her hands helpless and cold in her lap, sick electricity flooding her body as he drove his hands in his hair like a man about to lose his mind.
Oh, God—was something wrong with him?
Then he suddenly growled, the sound of a man at the end of his tether, “My name is Malek ben Muraad ben Amjad ben Munsoor Aal Hamdaan.”
She stared at him. Why was he telling her his.? Oh.
Oh God.
No. No. He couldn’t mean …
From a long distance she heard a wavering rasp.
“Muraadben … He’s—he’s …” She stopped, stared at Malek.
“Damhoor’s king, yes. My father.”
CHAPTER TWELVE
DAMHOOR’S KING. Damhoor’S king. Yes. My father. My father.
The words ricocheted inside Jay’s skull, building up to a cacophony that almost burst it apart.
It was all just too—too.
And she suddenly howled with laughter, hysterical, agonizing, bone-rattling laughter.
She laughed until her lungs shut down, until her eyes were wrung dry, until her insides twisted together in a knotted mess.
He watched her all through it, his eyes heavy, grim.
At long last the first enormity of shock and realization abated. It left her trembling, limp.
She finally rasped, “And to think you called me Janaan of the ceaseless surprises. First you’re a sheikh, then a surgeon, then the Health Minister. Now you’re a prince.”
He made a frightening sound in his throat. Then he almost spat out, “I’m not a prince. I’m the prince. The crown prince.”
Silence crashed down again.
Numb now, Jay finally gave a short, stunned giggle. “It just keeps getting better, doesn’t it?” Then a distant memory struck her like a lightning bolt. “But … over a year ago, when my father started saying he’d get me a job here, get my mother a home, I researched Damhoor, and the crown prince’s name was—was …”
“Majd,” he muttered. “The Glory of Aal Hamdaan, as he truly was. My elder brother. He died of a ruptured brain aneurysm ten months ago.”
His loss. This was it. The loss behind the hot empathy that had permeated her when she’d related her loss of her mother the day they’d first met, seemingly many lifetimes ago.
He suddenly closed his eyes, inhaled. He opened them a moment later, but she’d seen it. The spasm of anguish that had contorted his very being.
“We were just walking out of a squash court a
fter a grueling match where he’d trounced me. And he just collapsed at my feet. I forgot everything, seeing him there—there was not a single medical shred left in my mind. For a whole minute. Then it was a blur of trying to keep him alive till I got him to the OR. He died before I got him into an ambulance.”
She kept watching him, breathless.
He inhaled another breath. “I ordered the autopsy, attended it. My father begged me not to do it. I disregarded him. I knew a massive subarachnoid hemorrhage was the cause of death, but I had to ascertain exactly how and why—that there was no suspicion of foul play. I think it hit my father harder that I cut Majd open than that he’d died. He grew old and infirm in front of my eyes those hellish days. Then he accused me of causing Majd’s death.”
She surged up, shaking with horror, her hand begging permission to approach, to defuse the shock waves of his revisited anguish. He caught it, buried his face there, nuzzling her clammy flesh with the fierceness of a tiger seeking solace, the blackness of his voice, his pain, lancing through her.
“Majd was far frailer than I am, always pushed himself to fill his big-brother role.”
“Aneurysms don’t rupture on exertion and you know it!” Her vehemence was instant, final.
His let go of her hand, let his fall to his side, his lips twisting in self-revulsion. “If I didn’t tire him to death, I caused his death in a different way. I’m the doctor in the family. Ever since I became one the whole family has let me take care of their health, make their every medical decision. Majd was not only the brother I worshipped, he was this land’s crown prince. I should have checked up on him routinely. A simple CT or MRI to the brain would have detected the aneurysm in time to do something about it. He trusted me, and he died because of my negligence. I failed him.”
This was what he lived with?
She caught his hand and squeezed it. She had to stop him doing this to himself. “You can’t even let yourself think that. Since when are CTs and MRIs routine or done without serious indications? If he didn’t have symptoms to warrant them, you know it’s contraindicated to have them! There was no negligence on your part. You didn’t fail him. It was fate.”
