And here it was, suspicion loaded into the one word the skipper had called. He’d said castle like another might have said poison. ‘We’ll take them to the hospital, no?’
‘No. The castle’s set up for triage. You know we’ve been working to get it ready, and tonight we’re using it. Bruno, Freya and Carla and our nurses are all there. Just go, Angelo.’ One of the dinghies was alongside now and there was no time for more persuasion. ‘Make sure every airway’s clear and there’s constant water running over burns. Go.’
And Angelo cast him a look of disbelief—but then moved to obey.
Trust, Leo thought. How hard it had been to earn and how important that he have it. The hatred of all things Castlavaran was bone deep in all islanders. They’d seen what Anna was doing. They’d heard of what she’d done to help save Carla, but centuries of mistrust couldn’t end in months. They were all waiting for the drawbridge to slam down. For Anna to show her true colours.
But tonight he’d demanded trust and he had it. The Marika was heading for the castle, mistrust of Anna or not, and he had to focus on his own work.
The fisherman pulled from the water wasn’t dead. Not quite. He’d swallowed water, however, lots of it, and had probably breathed in burning fumes. It took all Leo’s skills to resuscitate him. He was sending him on to the castle on one of the fishing boats as he heard a hail from across the water.
‘Doc, we’ve found Giulio. He was trying to swim to shore. He doesn’t look good.’
That was an understatement. What came next was thirty minutes’ intense, heartbreaking effort and at the end he lost.
What adrenalin charge had enabled a burned, shocked fisherman to try and swim to shore? Giulio was well into his seventies. He had a weakened heart already and he should have had a valve replacement years ago. ‘But where’s a man like me to find money for a stay in a foreign hospital? I won’t put my family in debt. No, this old heart will give out when it decides.’
It decided tonight.
The final boat took Leo to the castle jetty, with Giulio’s body. He stood beside the shrouded stretcher and felt the weight of isolation, of poverty, of the responsibility of being a doctor in charge of a nightmare.
There’d been forerunners of nights like this on the island before, disasters with multiple casualties, and each had left him with the same sense of helplessness. His hospital wasn’t geared to cope, and people had died because of it.
What was new? He’d felt helpless from the day his father had died, of appendicitis, of all things, an appendix ruptured because there’d been no doctor, no hospital. Twenty-four hours of agony.
He’d vowed that no one would die that way again. But now he was stuck on a boat and who knew what was happening in the castle? Bruno and Freya were young, inexperienced, full of good intentions but they should be supervised. Carla had come back to work after her illness but she lacked the decisiveness of the old Carla. Her hands shook a little. She faltered when there was no room for faltering.
Which left Anna.
The castle loomed above them as they neared the jetty. Its presence was vast, dark and forbidding.
What had he done, suggesting they use it? Would it create more confusion?
He was depending on Anna, depending on her promises, and he, of all people, should know that promises meant nothing.
Memories were suddenly, inappropriately, flooding back. One amazing night.
‘We’ll have children, practise medicine together, have an awesome life. Anna, will you marry me?’
And then that appalling dinner with her mother...handing back the ring and walking away.
Hell.
There were shouts from the jetty, torches beaming out over the water, guiding them in. Locals, who before Anna had arrived had never been permitted within the castle confines. She was making a difference.
He glanced down at the shrouded shape of what once had been Giulio. A life well lived, but a useless, stupid death.
That was how he felt right now. Useless. He’d vowed to make a difference to this island but people were still dying.
People would still die and they’d die tonight. He’d seen enough of those who’d already been shifted to the castle. It’d take a miracle, and what Anna was providing...
It was no miracle. She was doing her best but the long legacy of the Castlavarans remained intact.
History couldn’t be changed.
* * *
She couldn’t help.
He was twenty-three years old and he was dying under her hands.
She had the emergency room set up just as she’d envisaged it. She had staff working as a team. They’d cooled every burn, at least twenty minutes under running water. They’d administered pain relief. They’d coped with immediate shock and blood loss, treating lacerations and breaks from the impact itself. They’d made sure, as much as possible, that pain levels were under control.
Bruno and Freya were wrapping burned limbs with plastic film, which protected as well as helped with pain. Carla was coping with a fractured arm that, if not splinted, could well block circulation.
She had no idea what Leo was facing. What he was coping with on his own.
But she had little time to think of Leo. She was adjusting the oxygen on the fisherman she was starting to think she’d lose.
His name was Tomas. Bruno had recognised him when they’d admitted him, though how anyone could recognise the blacked figure was beyond her.
‘He’s my kid brother’s best mate,’ Bruno had told her, visibly distressed. ‘Anna, I can’t...’
None of them could. Bruno and Freya were nurse-practitioners whose experience of severe burns was almost nil. Carla had treated burns, but since her stroke she’d become increasingly unsure.
Family medicine hadn’t prepared Anna for this. She was upping oxygen, trying desperately to think what to do next, but there was no option in her grab-bag of emergency training. She was watching Tomas fighting for each breath, listening to the rasping in his chest, watching him almost visibly losing the fight.
And then Leo walked into the room and she could have wept with relief.
She’d glanced up as she heard one of the nurses greet him but almost immediately her attention went back to Tomas.
‘What’s happening?’ Miraculously he was beside her. Directed by the nurse? Everyone in this room knew how tenuous was Tomas’s hold on life.
‘Leo.’ Even saying his name stilled her panic. ‘Tomas and I could use your advice.’
Heaven only knew the effort it cost to keep her voice calm. What she wanted was to scream for help, tell him she was out of her depth and drowning, but Tomas was still conscious. The last thing an injured patient needed was their doctor confessing she didn’t have a clue what to do next.
‘Tomas, Dr Aretino’s here,’ she told him, unsure what Tomas could or couldn’t see through his swollen eyelids. ‘I’ll give him a quick summary of what’s happened to you. Leo, Tomas has oropharyngeal and neck burns. I’ve intubated but he’s still struggling. We’ve cooled and wrapped the burns. We’ve administered pain relief and fluids. I’d have expected the intubation to assist.’
She paused then, and said nothing more. The next word, the most logical word in her description was ‘but’. But nothing’s helping.
She didn’t say it. Tomas didn’t need to hear it, and to Leo it would be obvious.
She stepped back a little so Leo could see.
The nurses had helped her soak, strip and cut away Tomas’s charred clothing. If she’d had to guess she’d say he’d borne the brunt of the explosion. His chest was a mess, with impact wounds as well as burns.
Intubation should have made a difference, but it hadn’t brought the immediate relief she’d prayed for. There was reduced oxygen saturation, a delayed capillary refill. His chest was hardly moving—there was shallow respiratory ef
fort and limited abdominal wall movement. It was as if he was so badly burned inside that nothing could work.
She watched Leo do a fast visual assessment and then she saw his hand close over Tomas’s undamaged wrist.
‘Tomas. You’ve got yourself in one hell of a mess,’ he said. ‘But, hey, you’re the first patient to be treated in Dr Anna’s Amazing Castle Hospital. How lucky are you? We have brand-new operating theatres, every state-of-the-art tool for any impressive piece of surgery we want to perform, and Anna and I are aching to try out our new toys. You’re our guinea pig.’
It was a scary concept but Leo’s voice was warm and strong and reassuring and Anna saw the tiny slump of relaxation, the lessening of the flight and fight reaction that told her Tomas trusted Leo.
Leo was known. He was an islander.
She’d never be that.
But this was hardly the time to think that. Leo was looking at her, signalling her with his eyes. To back him.
‘Tomas, the plan is now to put you to sleep in one of Dr Anna’s great new theatres,’ he told him, but he was still watching Anna, sending a silent message to follow his lead. ‘Something hot has banged hard into your chest. In the long run you’ll have a really impressive scar to show your grandkids, but right now it’s created a band of tissue that’s injured and swelling. It’s acting like a corset, restricting your chest and making breathing harder.
‘You’ve seen those old movies where the lady faints because her corset’s too tight? That’s what’s happening to you. What we need is to give you another neat scar while we loosen the restriction. It’ll be like cutting the corset’s laces. It’s a quick procedure under anaesthesia so you won’t feel a thing and it’ll make your breathing a whole lot easier. Is that okay with you?’
Tomas hardly moved but his body seemed to slump. Letting go? Placing his fate into Leo’s hands.
Which was pretty much how Anna was feeling. She was ceding to Leo.
She’d never seen anyone with this extent of burn and injury. What Leo was intending to do... The procedure was called escharotomy. She’d learned of it in her training—the slicing of injured flesh to relieve pressure—but she’d never performed it. And here was Leo, acting as if it was common-or-garden normal.
‘Let’s go, people,’ Leo said quietly, as if there was no rush at all, but minutes later they were in Theatre. The Castle Hospital Theatre. Never used until now.
What good fairy had made her work herself almost to exhaustion to get this ready? Anna wondered. She’d checked and double-checked to have everything in readiness, even though she hadn’t expected patients for weeks or even months. She’d paid for a surgical colleague to come from England and check it with her. The theatre was big, airy, superbly lit and right now it was fully staffed. Bruno had brought the drugs they needed, plus back-up equipment from the old hospital. Maria was acting as head theatre nurse and a younger nurse was working as her assistant.
Anna’s role was to give the anaesthetic. That took all her skill and more, because giving anaesthetic to such a severely burned patient was way beyond her area of expertise.
Leo was operating as if this was entirely within his skill set.
He was also keeping a respectful eye on her.
‘Is there anyone else who’s more competent?’ she’d whispered as they’d scrubbed, but he’d shaken his head.
‘Carla’s still unsteady. She knows her limits and she wants you to do it. You can do it, Anna.’
‘Leo, with this amount of respiratory distress...’
‘Just haul up everything you know and then some,’ he told her. ‘And if you want back-up, ask.’
‘Ask you?’
‘We’ve never had a qualified anaesthetist,’ he told her. ‘Carla and I have struggled through. We’ve read, teaching ourselves until we can spout oxygen saturation levels, respiratory flows in our sleep. But even before this last illness Carla’s been slowing down, becoming unsure. Her arthritis has made her fingers stiff and it’s knocked her confidence. I’ve been starting to share, backing her decisions at every turn. So if you have any questions, ask. I won’t be judging.’
She wasn’t considering his opinion of her. She wasn’t beginning to think he was judging her. She knew he was simply grateful that he had a pair of hands with medical skill.
He’d do whatever it took to protect his islanders.
Hadn’t she learned that the hard way?
There it was again, history, surfacing when she had no time to give it space and no inclination either. It had been with her for the full six months of her stay, in consultation meetings, when they were focussed on the complexities of getting this place up and running, when they were talking staffing, when he was striding through the building site, snapping questions... And now, when he was all doctor, with every fibre of his being focussed on keeping Tomas alive...
That was what she was, too, a doctor operating outside her skill range, dredging up every last thing she’d been taught in medical lectures so long ago.
And all the while she was conscious that this was Leo. Not just a colleague. Leo.
It was almost as if her body had an inbuilt warning sign and it was flashing red. Do not think about how much he cares for his people. Do not admire the skill of those amazing fingers, or admit that Leo is simply...
Someone she loved?
She shoved the thought away as she focussed on the dials that told her Tomas’s heart continued to beat, his oxygen saturation was rising, he might just possibly make it.
Thanks to Leo. And Leo’s decision to return here.
Which was why personal history had no place here.
Blessedly the technicalities of what she was trying to do took over. Leo was cutting through the constricting, charred outer layer of flesh. He worked with an assurance Anna could only wonder at, cutting skilfully along the mid-axillary line of the chest. There were so many constraints he had to be wary of. The last thing Tomas needed was more damage, but not for a moment did Leo act as if he was unsure.
And almost the moment the cut was made, Tomas’s chest started falling and rising with less restriction, moving naturally as it needed to if Tomas was going to breathe on his own.
Finally Leo started cauterisation, sealing the wound to stop the bleeding. He was working swiftly, not with the painstaking care that he’d use if the scar he’d made would be the scar Tomas would carry for life. There’d be more scars on this chest, months if not years of treatment to get Tomas back to anywhere near normal. Skin graft after skin graft. An instant’s carelessness in the harbour would be followed by years of regret.
Maybe everyone in the theatre was thinking that. The silence in the theatre was suddenly loaded.
‘We need to leave him in an induced coma,’ Leo said into the stillness. ‘The brain needs to focus on healing rather than shock and pain. He’ll be on the first transfer out.’
She nodded. She knew by now how much the islanders hated leaving the island for treatment but with burns this severe there was little choice. They’d done all they could for Tomas. ‘I’ll stay with him,’ she told Leo. ‘You head back to the fray.’ And then she hesitated. She’d heard reports of what had been happening out on the water. ‘Giulio?’
‘He died,’ he said roughly, and she heard grief and exhaustion in his words. One of the nurses fought back a sob and Leo’s face reflected it.
These were his people. His home.
‘Any man’s death diminishes me.’ She used to think of the quote from John Donne when someone in her small English village died, someone she’d cared for, but she hadn’t been born there, raised there. She hadn’t gone to school with the locals, shared their backgrounds. She wasn’t entitled to share their grief.
She watched as Leo’s shoulders slumped as he told them of Giulio’s death, and then she watched as he braced and headed back to treat whoever was left.
And stupidly she felt bereft—for herself.
Tomas couldn’t be left. He needed intense nursing and none of the nurses had the skills to care for him. She stayed in the now almost empty theatre and she watched as Tomas’s chest rose and fell, rose and fell.
He’d live because of Leo.
There’d be no regrets this night, she decided, or none from her. The bigger picture was that Leo had come back to do what was right for his country. The bigger picture was that she could keep this medical centre growing, help Tovahna free itself from the shackles of poverty.
They were huge things, and they shouldn’t leave one inch spare for the moments of emptiness that wouldn’t go away.
CHAPTER NINE
THE LAST HELICOPTER left at dawn. There’d been three, all manned with medics trained in trauma medicine. Tomas had been evacuated first. The others had followed. Every one of them had suffered burns. Every one of them would need treatment by overseas specialists.
The choppers had used the castle roof to land. That had been another thing Anna had done over the months she’d been there, clearing debris, removing any impediment to a large chopper landing.
She should feel good that it had worked, she thought, as she watched the last chopper lift and head into the rising sun. Instead she felt empty. She was watching Leo. He’d done the handover to the chopper’s medical staff. Now he stood back. His shoulders were slumped. He looked...gutted.
‘They’ll all make it.’ She said it quietly, because his body language spoke of solitude and she wasn’t sure she had the right to intrude. ‘Even Tomas. His arms and legs are okay. His throat was swollen but his face doesn’t seem too bad.’ He must have fallen to his knees as the explosion hit, she thought, as the flames had formed a band of burned flesh around his chest. The rest of his wounds seemed relatively minor.
‘But at what cost?’ Leo was still staring at the disappearing chopper. ‘Have you any idea...?’ He broke off. ‘Sorry. There’s nothing you can do.’
Second Chance with Her Island Doc Page 12