A couple of times Yasmeen dragged her away to a small sitting room, where exhausted staff sat silently as they refuelled on coffee and biscuits. Sandwiches appeared and were eaten on the run, staff aware they had to eat but their minds always on the patients.
At some stage Kal walked past and she remembered something else that needed checking.
‘Eschar on joints, too,’ she said to him. ‘Sometimes you need to cut along the outer surface of a limb at wrist, elbow, knee or ankle joint. Mobility is a huge problem for burns victims later, and sometimes we can prevent problems by releasing burnt tissue early. Again, the wounds will bleed a lot but cauterise them this time.’
Kal nodded and walked away, and Nell knew every patient in ER would be checked for any burnt tissue that might be constricting movement of a limb.
Uncountable hours later, the scene in the ER looked less like a vision of hell, though torn wrappings from dressings and instruments still lay ankle deep on the floor. They had transferred fourteen critically injured patients to the new burns unit, two of these to the burns ICU, and another eleven were in wards throughout the hospital. Twenty-one less badly injured had been treated and either sent home or put up in hotels, and another ten, who were members of a football team from a neigh-bouring country, had been flown home in the ruler’s private plane, to be treated at the main hospital in their capital city.
The small child had been the first of six patients they hadn’t been able to save and Nell was still in the ER, still fighting for the life of the man who’d been left for dead.
‘Let someone take him up to the ward,’ Yasmeen pleaded, her face cleaned of soot but now grey with exhaustion. ‘We can make room for him there and the nurses are fresh—they can watch him for you.’
‘I won’t move him till he’s stable,’ Nell muttered, checking again on the test results she’d just got from the lab. ‘His acid base status is all over the place. It has to be to do with inhalation injury, although his lungs show clear on the X-ray. He’s not pink so it’s not carbon monoxide, and with a tube in place it can’t be swelling to his lower trachea, although that rarely happens because the vocal cords effectively stop heat going further.’
Once again she found herself thinking out loud, but if she expected help from Yasmeen she was disappointed. The other doctor simply repeated her advice that Nell should hand the patient over and get some rest.
‘But—’ she began, then another voice cut in.
‘We’re taking him up to the ward.’
Nell glanced up from the infuriating puzzle that was this patient to see Kal standing in the opening of the curtained-off treatment room, and though his statement had been an order, not a suggestion, she had to argue.
‘He shouldn’t be moved.’
‘He has to be moved,’ Kal said firmly. ‘You’ve done all you can and you’re so close to exhaustion you could make the mistake that kills him.’
Shocked by his blunt words, Nell opened her mouth to continue her argument, then read the implacability on his face and closed it again.
‘Yasmeen,’ Kal continued smoothly, ‘I’ll find someone to go with him and make sure he has a nurse to watch him. You go home and get some rest. I’ll see Dr Warren to her quarters as soon as I’ve arranged the transfer.’
Nell opened her mouth again, this time to protest that she could find her own way—a protest so stupid it was just as well no sound came out. Not that Kal would have heard. He’d disappeared.
‘Come on,’ Kal said roughly, returning minutes later. He took her arm and guided her firmly away. ‘You’re dead on your feet.’
Realising resistance was futile, Nell plodded along beside him, her legs apparently understanding what he’d said, as they became so heavy she could barely lift them.
Beside her, Kal muttered words that seeped dimly into her consciousness—angry words from the tone.
Was he telling her she was a fool? He used to tell her that when she meekly accepted the worst shifts during inhospital training stints. Or when she’d lent her notes to friends who’d skipped lectures.
‘You’re smiling?’
His voice was so incredulous she couldn’t stop her smile from widening.
‘It must be tiredness because I rarely think about the past, but I was remembering how you used to call me a fool,’ she said, turning to face him and looking into his eyes for the first time, scanning his face for similarities and differences, seeking something of the serious young man she’d loved to distraction in the tired, hard, angry, unshaven face.
‘A long time ago,’ she added quietly, then, because the young man was there and because her heart told her she still loved him, she turned away before he could read it in her eyes and her quest became more complicated than it need be.
She continued down the corridor beside him with no idea of where they were. Still in the hospital, she assumed, although they’d walked along a high, windowed bridge from one building to another.
‘Were your bags sent up here?’
The question didn’t make sense.
‘My bags?’
‘Suitcase! Belongings! I assume you came with spare clothing and a toothbrush at least.’
Nell stopped walking and looked around vaguely. She had her handbag over her shoulder, having slung it across her chest as she’d run to help, managing to keep hold of it until Yasmeen had put it in a locker while she herself had been in ER.
‘I left my suitcase at the airport when the siren sounded. Yasmeen wanted me to wait, but I knew I should help.’
Kal made another exasperated noise.
‘You never did have any common sense,’ he grumbled, walking on again so she was forced to follow. ‘Tucking lame ducks under your wing, taking in strays—you’d give away your shoes if someone needed them.’
‘Well, now I have, I suppose,’ Nell said, trying to lighten Kal’s angry mood, although she was feeling so exhausted she wondered why she bothered. ‘That’s if the person who picked it up did need them and didn’t just take the case for the sake of it.’
Kal made a growly noise under his breath and stopped at a door. He pulled a ring of keys from his pocket and fitted one in the lock.
‘This is a master key and I can’t give it to you, but if there’s no key on the table inside, I’ll get someone to bring one to you in the morning.’
In the morning?
‘Isn’t it already morning?’ she asked.
‘Tomorrow morning,’ Kal said gruffly. ‘It’s close to midnight, local time. You’ve worked through a night and day.’
He opened the door on a pleasantly furnished living room with a small kitchen at the far end. ‘Bedrooms and bathrooms through there.’ He waved his hand towards a door off to the right. ‘You’ll find toiletries in both bathrooms and bathrobes in the bedroom cupboards.’
‘First-class hotel stuff,’ Nell said lightly, wondering how soon he’d leave. Tiredness swamped her and she wasn’t sure she’d have the energy to shower before she collapsed into bed.
‘First class doesn’t begin to describe the job you’ve done for us since you arrived,’ he said, and a gruffness in his voice made her turn to look at him. The pain in his eyes hurt her heart and she swayed towards him, wanting more than anything to hold him and ease away that pain.
He caught her shoulders and held her away, still looking at her, his face hardening, the pain shrouded behind his heavy eyelids.
‘Unfortunately we’ll need more help from you—at least until we can get some other burns experts here—so get some sleep.’ He spoke harshly, as if he resented the fact she was needed, and in her exhausted state this attitude confused her.
‘I don’t mind helping,’ she offered.
‘Get some sleep,’ he repeated, then his hands dropped and he turned and walked away, swinging back to face her as he opened the door.
‘If you need anything lift the phone and press one for the apartment block’s reception office. They’ll send up food now if you want it, or when you wa
ke. Press four for me. My apartment is next door but if I’m not there, the call will be switched to the office, and whoever answers will page me.’
The door closed behind him but, tired as she was, Nell couldn’t move. For a long time she stared at the door—at where he’d been—then with a shrug of her shoulders she headed not for the bathroom but for the phone. With a six-hour time difference, it would be early morning in Australia. She’d stolen time from patients and phoned from downstairs to let the family know she’d arrived safely and to assure them she hadn’t been involved in the accident. This time she needed to phone to check on Patrick before she had a shower.
Patrick!
She turned and stared at the door again, while a shiver of presentiment feathered along her spine.
There’s a reason she’s here and I’m not going to like it.
The words echoed in Kal’s head as he made his way back down to the ward to check on the patients one last time before he, too, grabbed some sleep. The other thing he didn’t like was the way his mind seemed to be producing a running commentary on the situation, not the accident situation—he was handling that quite well—but the Nell situation.
Why shouldn’t it be that she was simply the best person for the Brisbane hospital to send? Or that their relationship had prompted an interest in his country and curiosity had brought her here?
Not for one minute do you believe either of those explanations! the voice in his head said, and a queasy feeling in Kal’s stomach told him his instinct agreed.
But this wasn’t the time to be looking a gift horse in the mouth—Nell was here and from what he’d seen of her at work today, they couldn’t have had a better person helping out.
Yasmeen arrived only minutes after the breakfast Nell had ordered—laden with bags and parcels.
‘The chief sent me to the shops,’ she said in an awed voice. ‘He said I was to get you clothes. He said good quality and to get you slacks so you wouldn’t feel out of place in the hospital, but some loose dresses for you to relax in at home, and some nightclothes and underwear. I bought different sizes and can take back what doesn’t fit.’
Nell shook her head as a porter followed Yasmeen into the apartment, with more parcels in his arms and carrier bags dangling from his fingers.
‘It’s a wonder he didn’t bring the whole store to me,’ Nell muttered.
‘Oh, he was going to,’ Yasmeen said, totally serious, although Nell had been joking. ‘But I said I didn’t think you’d like it. That you’d be embarrassed. So he phoned a place and got it to open early, and I was the only person there.’
‘That must have been fun and, yes, I would have been embarrassed,’ Nell assured the anxious woman. ‘But I can’t try on all this stuff now. I’ve slept for hours longer than I intended. I need to be in the burns unit.’
‘You’ve slept for about six hours,’ Yasmeen reminded her. ‘Same as me. But I didn’t have a long flight from Australia before the accident sent us into chaos.’
‘Good thing we’re doctors and used to lack of sleep,’ Nell said, emptying parcels onto the lounge and fishing through them for clothes that might be suitable. ‘It’s underwear I need. I can just wear scrubs until my suitcase turns up.’
‘It won’t turn up,’ Yasmeen told her, handing her a bag with underwear in it. ‘And if you don’t wear the clothes I bought, the chief will blame me.’
‘Blackmail?’ Nell said, but yesterday’s emergency had forged a bond between them and she smiled as she said it, then grabbed a pair of navy slacks and a loose fitting T-shirt, took the bag of underwear and headed for her bedroom.
The female staff she’d seen yesterday had been in navy slacks and tunic tops, and she’d realised that was acceptable dress code for women who when they went out in public would probably wear long robes over their house clothes. She should show respect for their customs by dressing the same way.
‘You can’t have slept for six hours if you’ve done all this shopping,’ she said, pulling her hair into a tight knot behind her head as she came back into the living room, dressed and ready to go.
‘I left the hospital before you,’ the other woman said, then she smiled and Nell knew she, too, felt the bond between them, a bond that had bridged the boundaries of nationalities and cultures.
They walked swiftly back across the other bridge—the one between the living quarters and the hospital—Yasmeen leading Nell to the new burns unit, where the state-of-the-art equipment made Nell feel envious.
‘The fifteen we have here will all need grafts. I’ve taken uninjured skin from some of them and the lab is already working on growing it. We’ve two types of interactive burn dressings we can use in the meantime—the new ones that promote wound healing of the body tissues—but we’ve been waiting for your advice on which patients to treat with which dressing.’
Kal delivered this information. He was standing right in front of her, a trolley laden with equipment by his side.
‘We have a treatment room, a small theatre and bathing facilities here in the unit, and rooms where family members can stay. We’re arranging to fly in a family member for all the patients who aren’t local so they have emotional support.’
One look at him was enough to tell Nell he hadn’t slept, although he was clean-shaven now except for the very short, neatly trimmed beard and moustache around his mouth.
Traditional, she knew, from the time long ago when she’d tried to persuade him to shave it off so she could see how he looked without it!
‘You’ve done well,’ she assured him, then, not daring to suggest he needed sleep, she said instead, ‘With your permission, I’ll take over now. I’ll check the status of each patient and prioritise them again for surgery.’
She glanced at the trolley.
‘You’ve pressure bandages as well as the artificial skin, but will there be enough?’
‘More of everything is being flown in, and a group of Spanish doctors and nurses should be on the way this afternoon or tomorrow.’
Nell nodded. It was now common practice for specialist doctors from other countries to help in medical emergencies worldwide.
‘I’d like to see all the patients,’ Nell said, because although she’d suggested it earlier, Kal had not agreed. Now he nodded.
‘Yasmeen and I will accompany you. I have surgeons standing by if you want to start debriding burnt tissue.’
‘It will depend on the patient’s status,’ Nell reminded him. ‘Some will be able to withstand the trauma of surgery but with others we might have to wait. Three to five days post-burn is still acceptable for surgery, although current thinking is to get it done as soon as possible.’
Yasmeen led the way, and they went from bed to bed, Nell impressed by how efficiently the patients were being nursed, with one staff member to every patient and computerised records up on a screen beside each bed.
‘I’ve removed blisters on this and several other patients,’ Kal told her when they stopped by the bed of a teenage girl with severe second-degree burns to her face. ‘I know it’s a contentious issue, whether the blistered skin aids healing, but my experience suggests the prostaglandin in the blister fluid promotes deeper burns, and on her face—’
He broke off, obviously anxious, and Nell was quick to agree she’d have done the same for the girl. She checked the computer screen.
‘The dry dressing is great and I see you’re using aspirin for its anti-prostaglandin effect. I’d have gone the same way. What is important is that nurses know to keep cutting back the dressing as the wound heals so the patient isn’t tempted to play with a loose edge or pull at it to peel it off. The same goes for the dressings we’ll put on grafts, although the dressings on them are harder to get to as we have to immobilise grafted areas.’
While Nell explained this to Kal, Yasmeen was talking to the patient in her own language. As tears welled up in the girl’s dark eyes, Nell turned enquiringly to Kal.
‘Her parents and brother didn’t make it,’ he s
aid, his voice hard with frustrated anger. ‘We’re looking for other relations, but it’s difficult with just the plane’s manifest to work from. Many people book their seats over the internet these days and although the airline company has contact phone numbers, the number, as in this case, is often of the family home.’
‘And no one’s there to answer,’ Nell said quietly, touching the girl’s bandaged hand.
She moved on, knowing there were patients who needed more of her attention. She had to decide which ones might be stable enough to begin the lengthy, painful business of debriding burnt flesh and attaching skin grafts.
‘Tell me about the grafts,’ Kal said, as they looked at the legs of a woman who had severe burns on the fronts of her legs, particularly around her knees. ‘This woman has good skin on her back and buttocks we can use, and we can mesh the skin to make it go further, but we can’t use mesh on some places, can we?’
Nell studied the patient, thinking of the instrument called a dermatone that could divide the skin into infinitely thin layers, and how these layers could then be meshed—cut and stretched to go further.
‘We never use mesh on the face because it doesn’t heal as well.’ Nell answered part of the question while examining the woman’s arms. ‘Generally, we use split-thickness skin grafts on the face or neck or areas where it’s in the patient’s interests to have a cosmetically good result. Skin from the back or buttocks is good for grafting, but I wonder if in this case we shouldn’t take skin from her arm. Could you explain to her I want to push her sleeve up?’
Kal spoke to the woman, taking her hand and looking into her eyes as he introduced Nell and explained.
The woman patted his hand, as if she’d been done the favour, and pushed up the long sleeve of the hospital gown.
‘The problem is,’ Nell said, running her finger over the woman’s smooth, unburnt skin, ‘that the graft site—where we take the skin from—is always more painful during recovery than the wound site and just as susceptible to infection. So if we take skin off her back and immobilise her legs to stop the grafts shifting, how’s she going to lie?’
Sheikh Surgeon Page 3