No one had cared what happened to him in a very long time.
Hah! No one had ever cared what happened to him.
He’d been taught that indelible lesson six years ago, when the illusion of being a needed part of a relationship—a family—had been eradicated. When he’d stopped fooling himself into thinking he counted beyond what he could provide.
But Gulnar was showing him he did. As another human being only, sure, but she still did care. About a stranger, someone she’d just met. Just on principle. She was taking it very hard, the idea of endangering him, even to save the young man she was torn up over.
And her caring hurt him, breached his defences. He couldn’t afford that now.
Forget her. Forget yourself. Get this done.
Still clenching and unclenching his left fist to help the blood flow, he turned to Mikhael, reassessed his vitals. His pulse was slowing down, his breathing deepening. Good. Their measures were stabilizing his general condition. On to his specific injuries.
Dante undid the abdominal bandages, noted no renewed bleeding from the two entry wounds. He raised his eyes to Gulnar who had finished delivering the blood and rechecking Mikhael’s blood pressure.
She answered the question in his eye. “BP 100 over 70.”
Her whisper raised goose-bumps all over his body. She was dimming. But she’d carry on until she was extinguished. He knew nothing about her, yet he knew this, knew the lengths she’d go to for others.
He checked her pulse. Fast. Thready. He must do something about it, now!
She moved out of his reach, darting glances towards their captors. He’d totally forgotten about them.
About everyone.
The captives had slumped back into their despair now they’d understood who he was, how his presence would probably mean nothing to most of them. The militants had turned their backs on them, the occasional looks over their shoulders expressing how bored they were with it all, how they hated escorting him in to save even one enemy. But they had their orders.
“You need resuscitation.”
She shrugged. “Not more than any other uninjured person here.”
“But you are expected to help me. You’re no use to me if you faint. Just one liter of saline…”
She cut him off. “May mean life for one of the injured people. I’ll go give them blood and fluids.” She rose and moved away before he could say anthing else.
Dante turned to Mikhael, gave his wounds another careful palpation. He knew the bullets hadn’t caused much damage here. He’d finished a full exam by the time she’d got back.
She sank to her knees beside him, checked Mikhael’s BP again. “Holding. So—what do you think? Mikhael’s blood pressure is a strong indication there’s no ongoing intra-abdominal bleeding.”
He nodded. “Whatever blood loss he suffered from the abdominal wounds was hepatic in origin.”
Gulnar wiped the back of her forearm across her forehead, soaking her sleeve with more precious moisture. “I thought as much. The damage was to the tail of the liver’s right lobe. If the bullets had hit its blood vessels network, I doubt he would have lasted an hour.”
“It’s a relief. I wasn’t looking forward to performing a laparotomy under septic conditions. There’s nothing more I should do, at the moment, about his abdominal injuries, now that bleeding has stopped.”
Gulnar nodded and began cleaning the wounds. He helped her wrap the man’s abdomen in bandages again, and found himself asking, “I know the main info from the news and the officials. But I want you to tell me what happened here, in detail.”
She looked at him, her eyes impassive. “You see the result. What good are details?”
He didn’t know why he was asking either. He just needed to know. Then something else occurred to him. “If you’d rather not repeat what happened, relive—”
“It’s not that! It’s just…” She hesitated for one more second. Then she told him. All the details of the raid, the indiscriminate killings, the monstrous treatment afterwards.
He shouldn’t have asked.
But it blasted everything into perspective, made whatever he’d thought he’d suffered insignificant.
And made whatever he did pointless?
No. What he did couldn’t be pointless. He had to make it count. One life at a time snatched out of the jaws of death and cruelty. One lesser defeat, one less than total disaster.
He had to believe that. He had to.
It was all he lived for.
Gulnar closed her eyes against the sunlight slanting through the building’s high windows. Against Dante’s searing turmoil. There was no shying away from his frustration, his rage. Somehow, sharing distress with him halved it this time, as if he was absorbing it, diffusing it.
She opened her eyes and saw him in control again, removing the pressure bandages around the top of Mikhael’s thigh.
She clung to his hand. “If he’s stabilizing now, shouldn’t we just inject him with a massive dose of antibiotics, give him a tetanus booster and monitor him?”
Those eyes still crackled with aggression, unmeant for her yet still daunting. They ignored her and her protest, turned to his task. Her eyes followed his exploration. Her stomach quivered at the fist-sized wound blasted in Mikhael’s thigh. Handling it in the heat of the moment, bathing in his blood, she hadn’t had awareness enough to dwell on the horror. Three days since it had happened, it looked far worse. How bad did Dante think it was?
Whatever his diagnosis, his lips twisted on it. He reapplied a fresh pressure bandage, announced his verdict. “I have to tend to his vascular injury now or he will lose his leg even if we save his life.”
“Oh.” A flash of agony seared her. “I guess I put off thoughts of complications and prognoses, knowing there was nothing I could do about them.”
“It’s lucky his leg isn’t gangrenous by now. But there’s a lot of damage to his common femoral artery and vein.”
Every catastrophic complication reared its head now she’d let herself think. “But if there is the slightest chance intervention could dislodge a clot and cause an embolism, shouldn’t we choose between life and limb?”
“No.”
Just no? “Care to elaborate?”
Evidently not. He started spreading his surgical instruments on a pre-sterilized surgical towel. She tried again. “What can you do here?”
“I’ve done vascular repair in worse conditions.”
Her eyes darted to the filthy floor, the limited instruments. “Worse conditions?”
“A trench with raining shrapnel, with your operating arm almost out of order are worse conditions, don’t you think?”
She had to agree.
He continued. “And I didn’t have a grade-A surgical nurse to assist me then.” He turned away, produced disposable surgical drapes, large swabs and a bottle of povidone-iodine. “Help yourself. I need both his legs prepped down to his feet.”
It took her only seconds to comply, all the time hearing Mikhael’s lover’s rising sobs. Seeing her man reduced to a draped body, with only the field of surgery exposed, must be adding to her indelible trauma.
Dante’s authoritative voice snatched her attention back to where it counted. “Top up the muscle relaxant, and inject 10 milligrams of morphine direct into the cannula. That will have to do for anesthesia.”
He waited for her to finish then made his first incision three inches above the site of injury, exposing the external iliac artery. “Here’s where I deal with your clot worries. I’ll occlude the vessels above and below the site of injury, so that a hemorrhage doesn’t obscure the operating field. And the clot will have nowhere to go. Clamp!”
She handed him a non-crushing vascular clamp, watched him applying it gently to the artery. “Why didn’t you use slings?” She’d learned from experience that a special surgical shoelace-like string passed twice around an artery was the best way to occlude it.
He answered without raising his eyes from his task. “A sling may be the method of choice with every other artery, but not the aorta or iliac arteries. There’s too much risk of injuring the lumbar and iliac veins.”
She hadn’t known that.
“It’s incredible that you know about slings in the first place. Most schools of thought advocate non-crushing clamping as the only method of vessel occulsion.” Was he letting her off the hook after she’d boasted of her vast experience in trauma medicine? No, it had sounded like praise.
Heat rose inside her. Embarrassment? Gratitude? More? Whatever it was, it spread in places long untouched, believed untouchable, dead…
Dante was now incising the skin three inches below the site of injury, exposing the continuation of the femoral artery. This time he took the sling she handed him, wound it twice around the artery.
With hemorrhage and clot control now assured, she undid the bandages for him, anticipating his need.
His lips tugged. “Thanks. On to debriding the wound.” Now he’d dealt with the haemorrhage it was time to clean the wound.
Without him asking for it, she placed two self-retaining retractors strategically to open the surgical field. This time he didn’t thank her, but she felt his approval. She couldn’t remember the last time anything had felt so good.
A tap on the back of her hand attracted her attention. “See this? Vein is hanging by a thread and artery is transected. We’re very lucky it got severed below the origin of the collateral branch.”