The Sheikh Surgeon's Proposal

Then the top of the car was torn off and she and Malek pounced on the boy, a little angel of around seven, with silky black hair and fine features, the olive of his skin fading along with his life force.

Trembling, she fitted him with a cervical collar and Malek an oxygen mask. With a shared nod they carried him to the gurney. In the periphery of her vision she saw Malek’s men extracting the dead man and woman from their death trap. Her insides twisted.

They took the boy inside and Malek barked, “Rafeeq, ready OR, Alyaa, prepare CT, Lobna, expose the patient as we work.”

His eyes slammed into Jay, who’d just snapped on gloves, and without words each took a chore.

Just as she finished intubating the boy and started positive pressure ventilation, she heard Saeed’s subdued words in Malek’s ear.

Malek nodded as he finished hooking the boy to the cardiac monitor and oximeter, reported his findings. “Pulse 45, BP 70 over 30, oxygen 80 percent.”

Lobna finished cutting the boy’s clothes off and Jay pounced on him for a quick survey.

“No gross injuries,” she muttered. “God, Malek, his coma and vital signs depression are probably due to brain injury.”

Malek gave a grim nod, then let out a heavy exhalation. “They were his mother and father, Shabaan Abul-Hamd and Kareemah El-Swaifi. He is Adham.”

Adham. Black. Like his silken hair and lashes.

She compressed her lips against pity, calling on the hard-earned distancing techniques she’d developed through years of discipline so she’d be of use to her patients, to her mother, letting herself feel devastation only when they no longer needed her. But they’d never stopped needing her and she’d had her distance program perpetually on.

Then she’d met Malek, then all this had happened and she could now barely locate it, let alone turn it on.

She gritted her teeth, swung her gaze up, groping for Malek’s support.

He gave it, his voice when he spoke, his words, their intensity and import, almost breaking her control. “He won’t share their fate. Not if we have anything to say about it.”

A cold fist in her chest melted, scalded her. Yes. Please.

He turned to Adham and she jumped to join him in a thorough exam. They found no signs of internal injuries. That supported the head-trauma scenario.

Raising his blood pressure to raise his cerebral perfusion took on a new urgency. She announced her intervention method as she implemented it. “I’m giving Adham a 250 c.c. saline bolus. Will continue with a rapid drip for two more liters.”

Malek nodded, making her heart bob in her chest with the approval in his eyes. Then he rose as soon as Rafeeq walked back to them. “Rafeeq, give me vitals every five minutes. I’ll check preparations.”

“I’ll get a GCS,” she called out after him, gliding her hands over the boy, translating his reflexes. Soon she called out her bleak assessment to Malek. “It’s six. One-three-two.”

Malek strode back to them, frowning. “Status?”

“BP 80 over 40, pulse 50, oxygen at 85 percent,” Rafeeq said.

Malek’s huff was eloquent. “Let’s see what’s keeping our measures from working properly.”

He pushed the trolley to the CT machine. In seconds he had Adham inside it, with both Jay and Rafeeq making sure his oxygen and fluid supplies weren’t interrupted.

As Malek put the machine in motion, a terrible realization gripped her.

“Malek—he also has a unilaterally dilated right pupil, with ipsilateral third cranial nerve paralysis. Do you think …?”

Malek grimaced. “His brain is herniating.”

Jay jerked at his corroboration of her new-formed fear.

Her own brain felt about to burst. Adham might have to have a craniotomy to relieve the building pressure inside his skull and if they didn’t have a surgeon qualified for such hazardous surgery, they would have to reduce Adham’s intracranial pressure long enough to reach someone qualified to operate on him.

With unspoken co-operation they applied the measures to do just that, with Jay administering mannitol and Malek hyperventilating him.

She finished as he did and muttered, “If it doesn’t work …”

He sighed. “We have to give him a chance to stabilize without surgical intervention. He may not need a craniotomy.”

His words failed to bolster her. The doubt tingeing them made her heart itch, constrict. C’mon Adham, please.

Malek turned those potent eyes on her, intent on absorbing her agitation. “If he doesn’t respond, we’ll operate.”

“Wh-who’ll operate?” she croaked.

“I will,” he said simply.

He was a surgeon?

And he claimed she was “of the ceaseless surprises”?

She couldn’t believe she hadn’t realized he had to be a surgeon when he’d asked Rafeeq to prepare OR! Soggy cotton had replaced her brain. And if he talked about performing a craniotomy in their circumstances with such assurance, he wasn’t just any surgeon but a superior one.

And she believed he was. Believed he could do anything, was delirious with gratitude he was there to do it.

She only hoped he’d let her assist him. She’d trained for six months in trauma surgery before changing her direction for a predictable specialty, shift-wise, for her mother’s needs.

The need to lean on him was overwhelming. As if he felt her need, he drew her back against him as they watched CT images forming on the monitor. She breathed in his scent, absorbed his steadying power, her mind racing to process the opacities pinpointing hemorrhage and diffuse tissue swelling.

Then his voice broke over her, filled with compassion and somberness as he discussed diagnosis and possibilities.

The CT machine whirred to a stop and Malek reversed the gliding table. As he saved and printed out the results, Jay examined Adham, reassessing.

A minute later she raised her eyes to Malek’s and choked, “The deficit’s increased. Malek, you have to operate.”

Malek held her gaze, her hand. “We will.” He searched her eyes. “You do want to assist me, don’t you?”

Malek moved the suction probe to and fro over the subdural hematoma. “A bit more irrigation here, Janaan.”

But she was already gently irrigating in conjunction with his suction to loosen the clot.

By now he knew he didn’t need to give her directions. She was a flawless, intuitive assistant. The best he’d ever had.

They now worked together as if they’d worked together every day of their lives, handling the most delicate part, removing clots that had collected between the inner and outer coverings of Adham’s brain, then delving deeper into the brain to remove clots formed there and closing bleeding arteries.