The Heroic Surgeon

He said something again, and again it didn’t register. She only heard the drone of his dark, rich voice over the hot, thick throb of mortification in her ears.

He’d been stunned by her offer. He’d stiffened then had sat there unmoving, his arms no longer taking her, containing her, just limp around her, his eyes closed and his breathing erratic, until they reached the hospital. She’d been so distressed by his reaction, and more by causing it, she hadn’t even worked up enough co-ordination to move away. Sitting there, pressed to him, her every breath laden with his scent and agitation, her ears filled with the cacophony of their hearts’ thundering, that had been her first glimpse of true torment.

But none of it mattered now. Dimitri. Concentrate on him!

It was Dante who tore his eyes away first, cleared his throat as he headed for their patient in ICU. “I just asked if 3-D X-rays are available for me to review.”

Gulnar knew there weren’t. “I’ve seen only regular X-rays. I don’t think there is a 3-D facility in this hospital.”

He wasn’t impressed with the news. “Just get me every investigation and X-ray.”

Gulnar turned to the senior ICU nurse, translated.

“I need this bed turned around.” Dante stood back as his order was carried out. Gulnar stood beside him, horror sweeping her again at the sight of her dynamic young friend lying there like a gutted corpse, with his abdomen wide open and covered in plastic. And his face…

She was used to the worst. She’d had the worst. But when it was someone she cared about…! It was just another reminder not to care, never again.

What about Dante?

No. She could care about Dante. She did. So much—lord, so much. It was safe to care, she told herself, to let herself feel as deeply and as totally as she wanted. Then he’d be gone and she’d never know what happened to him.

Wouldn’t that finish her off? Losing him when he walked away?

She no longer cared what happened to her after he was gone. She wanted whatever she could have.

Dante had taken his position at Dimitri’s head, was giving his nightmarishly distorted face a long, assessing look. She could almost feel his diagnostic mind going into overdrive. Then he exhaled.

Gulnar winced. Please, let it be better than she thought. Let Dante, with his extensive experience, have a different, ameliorating opinion.

His gaze roamed over the rest of the ICU staff then back to her and Emilio, the only two English-speaking people around. “History, status and current measures?”

Emilio picked up the Azernian-written charts, looked at Dante. “He was in the debris for six hours before extrication. He’s been intubated and on bag-valve mask with 100 per cent oxygen since extrication. On the last recording, ten minutes ago, pulse was 128 with irregular ectopics, BP 90 over 60 and oxygen saturation 90 per cent.”

Dante absorbed the facts, started to examine Dimitri’s injuries by extra-gentle palpation, assessing the lacerations, pausing to feel the crackling of bone fragments and the give of undermined structures.

“GCS at the scene and all through until he was anesthetized?”

Gulnar looked over the rest of Dimitri’s deficient case file, filled with reports from everyone who’d handled him from the bombing scene onwards. This hospital was totally unused to and unequipped to handle mass casualty situations. It had been chaos, with so much disorganized and missing.

She sifted through the messy notes, not finding any mention of Dimitri’s Glasgow coma score.

She looked at Dante, exasperated. “He was conscious at extrication, so he couldn’t have been much less than fifteen at the scene. When I saw him immediately before surgery, six hours later, he was a six. Dr. Moya said that the debris pressure had stopped blood flow. Once it was lifted, abdominal bleeding increased, and he went into shock. He attributes Dimitri’s deterioration to that.”

And how she wished he was right! His opinion that Dimitri wouldn’t withstand the extended anesthesia of a lengthy reconstructive procedure, while on the surface conservative and pessimistic, was better than hers. Dante met her eyes. Seemed he shared her pessimism!

Her heart plummeted. Dimitri was too precious to lose. A rare and true source of hope around here. He made such a difference, so many people needed him. Like Dante…He just had to live—and live whole! But at the moment it looked he’d either deteriorate and die, or at best live deformed and disabled. The two possibilities skewered through her. Please, please.

Dante concluded his examination, looked at her. “Three walls out of four of both internal orbits are destroyed. Has there been no ophthalmological exam?”

Gulnar leafed through the reports. “Left eye only. Nothing mentioned about the eye’s condition, just that there was no optic nerve cupping. I guess this supports Dr. Moya’s diagnosis that there’s no intracranial injury or rise in pressure.”

Dante’s massive shoulders rose in irritation. “It tells me nothing. For all I know, his right eye is lost, and his left eye is, too, by now. A lot can happen in fourteen hours. It’s a sorry fact in mass casualty situations that seemingly non-life-threatening stuff gets overlooked and that as soon as a casualty looks stable, it’s on to the next unstable one.” Another exhalation. “Let’s take a look at his eyes, and his brain through them.”

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.