by Amy Andrews
There was a brief exchange as Richard ran an IV line through. ‘Since before lunch,’ confirmed John.
Holly got a flashback and almost sagged in relief. Her hands were shaking so much she was sure she was going to stuff it up. ‘When was the last time he passed urine?’ Richard didn’t look up from his task.
A further exchange. ‘Yesterday.’
Holly glanced at Richard in alarm. Fumradi was in renal failure. His infected wound had obviously given him blood-borne septicaemia and had caused his kidneys to stop working. Untreated sepsis followed an ugly but predictable path, which usually led to multi-organ failure. His liver would be struggling too and his heart battling to keep it all together.
‘OK,’ said Richard, connecting the fluid to the cannula and jumping up from his squatting position. He opened the giving set up full bore. The two flasks of volume expander they were going to administer would help Fumradi’s flagging circulation. And the triple antibiotics he was drawing up might temporarily knock the rapidly multiplying bacteria that were storming the man’s system. He needed more than one dose but Richard didn’t carry any more so it would have to do.
Holly hooked up her IV line and got it running. Richard handed her a syringe with an antibiotic in it, and she inserted the needle into the side port of the plastic line and pushed the drug into the drip. He did the same on the other side and as she watched the yellow fluid mix with the colloid solution, she crossed her fingers that it would buy them the time Richard was hoping for.
‘Hold a mil back,’ Richard said to her as he gave the last of the medication.
Holly didn’t query him in front of an eagle-eyed John but she did look at him questioningly.
‘I’ll spray it into the wound,’ he said. ‘See if we can get a topical response.’
Holly blinked. OK, she’d never seen it done before with an intravenous preparation but Richard was the combat medicine expert. Or was he just clutching at straws?
‘Shall we do the wound next?’ Holly asked, changing her gloves.
‘Yes,’ he said, following suit.
Richard watched as Holly cut the dirty bandage away from their patient’s thigh. He saw her nose wrinkle at the putrid smell and her shudder as the full extent of the infection was revealed. Pus oozed from the jagged wound that was about the size of an orange. Old clotted blood clung to the edges and the flesh looked dull and greyish. The stench intensified now the fabric barrier had been fully removed.
‘Let’s get it clean,’ said Richard, straightening to remove himself from the potent aroma.
Holly sat back on her haunches, trying to mentally prepare herself. She was obviously going to have to work holding her breath. It was that or end up vomiting into the wound. Not that anything could make it any worse. The smell really was nauseating.
Richard pulled out a small sterile, single-use pack and opened it on the bed. There were two towels, several gauze squares, a small plastic bowl, a pair of long-necked forceps and a stitch holder. He filled the bowl with sterile saline and opened up some more gauze.
Holly turned her head and took a deep breath of relatively fresh air behind her, then moved reluctantly back towards the festering wound. She put the gauze into the bowl and watched as it soaked up the liquid. She picked up a square, squeezed out the excess saline and set about cleaning the wound.
The gauze glided across the rough surface of the deep wound, the tissue slippery beneath her fingers. As she discarded each piece of gauze she noted the greeny-yellow slime that coated them. Richard pushed around the edges of the wound, expressing pus that had become trapped in the jagged tissue.
Holly shifted away again, satisfied that the wound was as clean as she could get it, and sucked in some deep breaths of clean air. She watched Richard mix the remainder of the antibiotics together in one syringe and then add some saline to make the quantity up to ten mils.
Richard knew he was going to have to probe the wound. He didn’t have the use of an X-ray machine to see if any shrapnel had been left behind. But he knew, given the amount of pus, that there had to be something still in there.
He put on another pair of gloves over the pair he was already wearing. Double gloving was essential for the procedure he was about to perform. It wasn’t uncommon for foreign bodies such as shrapnel to cut through gloves. Two glove layers gave added protection in case the first glove was breeched.
He placed his latex-protected index finger into the wound, moving it around, pushing quite firmly, trying to locate any obvious retained fragments. Fumradi moaned slightly and Richard was surprised. Was the colloid having an effect already? The local woman tending the leader rushed to his side and mopped his brow again.
Richard thought he felt a large solid lump just below the surface in the centre of the wound. Ignoring the overpowering smell and his necessary proximity to it, Richard picked up the forceps. Not exactly the right tool for the job but they were all he had.
He inspected the wound closely and found a small opening in the bed of the wound. He pushed the forceps into it and probed around until the instrument hit the solid object. He closed his eyes as he manoeuvred the tips to grasp the foreign body. He wiggled it out slowly, encouraged by Fumradi’s groans.
If he was responding to pain, their treatment was starting to have some effect. Richard knew it would only be a temporary rally, but it would give them some time and that was all he needed.
The offending object finally pulled free and Richard held it up to the light. A partial bullet fragment—no wonder the wound had been so full of pus, with this acting as a constant irritant. He dropped the metal object into the bowl with a dull thunk.
‘Impossible,’ said John. ‘I told you, we got the bullet out.’
‘Well, you left some behind,’ said Richard, feeling a smugness he shouldn’t have in the situation and a certain pleasure at John’s loss of face.
‘Let’s dress it,’ said Holly, jumping in as she felt the tension between the two men reaching a dangerous peak.
Richard broke his eye contact with John and got back to the task at hand. ‘I’ll just irrigate the wound with this,’ he said to Holly as she prepared some soaked gauze. He squirted the antibiotic solution he had prepared earlier onto the surface of the wound and made sure he instilled it well into the area where the bullet fragment had lodged.
Holly grimaced as Fumradi protested the bite of the antibiotics on his raw, exposed flesh. She’d spilled enough antibiotics on paper cuts in her nursing career to know Richard’s treatment would hurt like hell. When Richard had finished she placed a wad of wet gauze into the depression and Richard helped her bandage it in place.
He looked at her as she stuck tape to the bandage. She was holding up well under the pressure. He had no doubt that she knew the implications of failure. The fact they were going to fail was as immaterial as it was inevitable. They just had to do a convincing job.
Richard shuffled up closer to his patient’s head. ‘Fumradi,’ he called in a firm voice. He shook the man’s arm. ‘Fumradi,’ he repeated.
The man’s eyes flicked the second time. Richard placed his thumbs beneath either eye and pulled down on the skin to expose the insides of the leader’s bottom lids. He opened his mouth next and inspected the mucous membranes. He also picked up the leader’s hands and inspected his nail beds.
Fumradi was desperately anaemic. Probably a combination of the blood Fumradi had lost through the initial wound to his leg and the septic process that chewed up red blood cells as quickly as they were made. The man needed a blood transfusion. Actually, he could do with several bags of blood but one could at least buy them some more time.
‘He needs a transfusion,’ said Richard.
Holly tried not to look at him like he’d grown a second head. A blood transfusion? Well, da, of course he did. She’d just go and check the blood fridge! ‘Right? And we do that how?’ she asked him quietly.
‘I have the stuff in my kit but I’ll need your help,’ he said, and looked a
t her assessingly. She looked like she was only just managing to keep it together. But this was only the beginning. Later tonight he was going to ask so much more of her. If she baulked at this there was no way she’d be able to cope with being on the run. Being hunted. ‘You up for it?’
Holly looked into his coal-black eyes and knew he wasn’t just talking about the transfusion. Was she allowed to say no? That she was scared and she didn’t want to die and that she loved him? But as she gazed into his eyes she saw his strength and his confidence and she knew that he needed her to have those things as well. That he’d get them out but she needed to put everything aside and concentrate on one thing only. Survival.
Holly felt her spine straighten. She’d do whatever was required of her to get the hell out of this godforsaken jungle and be able to tell Richard that she loved him. He wasn’t going to accept it while they were still captive, so that was her goal. To get out, to survive, so she could start taking care of the man who stood before her. The tough-guy soldier with a bleeding heart and a damaged soul. Whether he knew it or not, he needed her and she’d be damned if she’d die in this jungle now.
‘Ready when you are. Tell me what you need.’
Richard suppressed the ‘good girl’ compliment that sprang to his lips and pulled a fourteen-gauge needle from his pack and one of two sterile empty blood bags.
‘Who are we going to bleed?’ she asked.
‘Me. I’m O neg.’
O negative—the universal donor. It didn’t matter what blood type Fumradi was, it was safe to give him O-negative blood. Richard also knew, as soldiers were screened before going away to places such as these, that he was clean.
He had no communicable or blood-borne diseases that could be passed onto another person. The army did it as a matter of course to ensure they had a known clean source of blood donations at their fingertips within their own forces.
Of course, he could have bled anyone here but not being able to check their blood type, plus the unknown factor of communicable disease, left Richard with little choice. Not that the disease angle was a huge issue for a dying man—Fumradi would be dead before he caught anything from a transfusion of questionable blood.
There was also another angle. If John could see that Richard was willing to give his own blood to save the rebel leader, that might win him some brownie points. Still, he had to weigh that against the fact that a sprint through the jungle would be better accomplished with all his current blood supply. Whatever way he looked at it, the fact remained—a transfusion would buy them valuable time.
The process of taking blood and starting the transfusion into their patient would take about half an hour. He handed Holly the tourniquet, sat on the edge of Fumradi’s low bed and held his arm down at his side. She knelt before him on her haunches, and he gritted his teeth as her fingers stroked his skin, trying to find a vein.
She didn’t really need to, she thought as a huge vein rose before her eyes from the constrictive pressure of the tourniquet. But contact with him made her feel more assured and…he had very nice arms.
‘Just a scratch now,’ she murmured, forcing herself to concentrate on the job. She didn’t know why she’d said it. Habit?
She slid the large-bore needle into a bulging vein at the crook of his elbow. Richard clenched and unclenched his fist and they watched as his dark blood flowed down the tubing and into the empty bag that sat on the floor, using gravity to their best advantage.
‘What are you doing?’ asked John, watching them suspiciously.
‘He is anaemic. He needs a blood transfusion. I’m giving him some of mine.’
John stared at them both for a while and Holly thought she could see admiration melt some of the ice in John’s eyes. Then he laughed and they both looked at him.
‘So you will be blood brothers?’ And he laughed some more. ‘An Australian army medic and his enemy, a rebel leader? Come, now, Sergeant, you must see the irony in that.’ Further laughter escaped his thin lips.
‘I told you already. I treat everyone who needs my medical expertise the same. Who you are or what you’ve done doesn’t come into it.’
Twenty minutes later Holly was setting up the giving set and hooking the donation up to their patient—talk about fresh blood! She set it to run fairly quickly. The bag was as full as it could get so she figured there was probably five hundred mils in total. It should be complete in an hour which, given Fumradi’s demand for fill, wouldn’t be too fast.
‘We’ve done all we can for now,’ said Richard, turning to John.
‘He looks better already,’ said John.
Richard had to admit he did, too, but he also knew that the rally would only be temporary. Fumradi was too ill for such simple interventions to have an effect. It was just that after days of having no medical care at all Fumradi was bound to respond to basic fluid resuscitation measures. He had to feel a hell of a lot better.
‘What happens now?’ asked John.
‘The blood transfusion should be finished within the hour. After that we wait. You should know it’s not too late to get him to a hospital.’
‘Tsk, tsk, tsk.’ John smiled. ‘You really need to have more faith in your abilities. You can stay with Fumradi,’ he said to Richard. ‘Holly, would you like to freshen up? I know how you women like to pamper yourselves.’
Holly looked at Richard.
‘Where are you taking her?’ demanded Richard.
‘Relax, Sergeant. Just because we live in a jungle doesn’t mean we are without class. Fumradi’s house is very well appointed. I am showing Holly to the shower.’
Holly felt her spirits lift. What bliss. A shower? Really?
‘She showers alone,’ said Richard, a harsh edge to his voice.
Her spirits dropped like a stone. She hadn’t even thought of the shower being anything other than her, a cake of soap and running water. She swallowed.
‘But of course, Sergeant,’ said John, his voice steely. ‘I am insulted that you would think otherwise.’
Holly followed John, apprehensive now. She glanced at Richard and he smiled at her to ease her concern. She need not have worried. Aside from the vague creepy smile he gave her, John was as good as his word, showing her to the room next to Fumradi’s and telling her this was where they would sleep. It was basic but had low beds and was a vast improvement on hard earth.
Then he took her to a room with a rudimentary shower. He showed her how to pull the lever and she watched as water sprayed out. He pointed to toiletries on a wooden shelf—soap, toothpaste and shampoo—and then left her.
Holly stood still for a moment, quite unable to believe the luxuries before her. And then she stripped. She had her clothes off so fast and was under the spray so quickly her teeth rattled. The water was cooling on her sweaty body and the soap and shampoo, although obviously not bought from an expensive boutique, felt wonderful against her skin and in her hair.
She was standing on an elevated slatted platform and the soapy water ran straight through the slats. Through them she could just see the forest floor beneath. She scrubbed her knickers under the shower. OK she was going to have to get back into them wet but it wouldn’t be the first time this ordeal that they had been saturated. In fact, they had rarely been dry. At least they were clean and wet!
She wanted to stay longer, stay for ever, under the wonderful spray but the urge to return to Richard was stronger. She reluctantly pulled the lever and the stream cut off. She towelled herself quickly and got back into her clothes.
There was no toothbrush so she used her finger and no hairbrush so she used her fingers again to comb her short tresses into order. Then she noticed a smallish mirror and hesitantly inspected her face in it. Oh, God! She looked a wreck!
She threw the mirror down in disgust. There was absolutely nothing she could do about it now and if they ever got out of this alive and she managed to convince Richard to take a chance, he couldn’t say he hadn’t seen her at her worst.
Holly made
her way to Fumradi’s room. She passed a window that had no glass and noticed Tundol lugging heavy wood onto the pile near the fireplace. She was struck again by his solemnity. For her, he typified the typhoon crisis. It was about people. People such as little Tundol, who had been left alone to fend for himself.
He looked up and his solemn brown gaze met hers. They stared at each other for a few seconds, both captives in a strange environment, and then she smiled at him and waved. He stood by the fire, unmoving, and then she saw the barest smile touch his lips and he waggled his fingers at her ever so slightly.
Someone yelled for him and he broke contact, dropped the wood and scampered away. Her heart broke for him and she felt her earlier conviction return tenfold. She would not leave this camp without him. If they were going to escape then they had to offer him that chance as well. There could be people out there, looking for him.
She made her way to Fumradi’s room and felt her heart pick up in tempo as each step drew her closer. What would she find? She pushed his door open with great trepidation. She stopped in her tracks when she saw him propped up in bed, talking to John.
She glanced at the almost empty blood bag. And then at Richard. He shrugged, plainly as amazed as she was. They had thought he would rally, but this much? True, beneath his illness he looked young and fit, but Holly would never have thought he’d improve this much.
John said something to the local woman who had been tending to Fumradi and she bowed and rushed out of the room, her eyes alight with joy and happiness.
‘Our leader has returned to us,’ he said to Richard and Holly. ‘Tonight we celebrate with a huge feast. You may leave us now. Retire to your quarters. I will speak with you presently.’
Holly and Richard backed out of the room and she showed him where they would sleep next door.
‘Did I really just see that?’ Holly asked once they were behind closed doors.