and it put her on her mettle as she began anaesthetising the patient. Without the aid of artificial ventilation equipment, she couldn’t administer a muscle relaxant otherwise the patient wouldn’t be able to breathe, so she opted for an anaesthetic agent and pain relief, administering the drugs via a cannula in the back of the man’s hand because it would be easy to top up the drugs throughout the operation.
The lack of modern equipment also meant that she would have to rely more heavily on physical signs to ensure the patient was maintained at a suitable level of unconsciousness. Increased sweating and salivation, irregular breathing, changes in muscle tone and eye movement were all indications that a patient was receiving an inadequate level of anaesthesia. She would also need to monitor his general status through his heart rate and blood pressure, so she would be kept busy, but she had no doubts about her ability to do the job. She was a first-rate anaesthetist and she intended to prove that to Adam and everyone else on the team.
‘I’ll just get this mess tidied up first.’
Adam snapped on a second pair of gloves as he came over to the table. They were all wearing a double layer of gloves because they’d been warned about the dangers of HIV. He quickly debrided the torn flesh surrounding the exit wounds then removed some splinters of bone that had sheared off from the shoulder joint. He delicately probed the trajectory the bullets had taken with his finger and shook his head.
‘No sign of any more bullets lodged in there, I’m pleased to say.’
Kasey nodded, not wanting anything to distract her as she checked the patient’s BP. It was a little on the low side, which wasn’t unusual considering the amount of blood he’d lost, but she still reported her findings.
‘BP’s a bit low. I’ll increase the drip.’
‘Fine.’ Adam barely glanced at her as he began the delicate task of repairing the torn shoulder muscle. He shook his head. ‘There’s a tear right through the deltoid. It’s going to need a lot of physio to get this arm moving properly again.’
Once again Kasey didn’t say anything. She was too busy checking her patient. His skin was dry to the touch and there was no sign of an increase in his temperature, which were both good signs.
‘How’s he doing so far?’
She looked up when Adam spoke to her, feeling her tension lessen just a little when she saw no sign of concern in the green eyes that were watching her over the top of his face mask. ‘He’s stable at the moment. BP has levelled out and his temperature is normal. Pulse rate and breathing are both within acceptable levels.’
‘Good.’
He gave her the ghost of a smile, only visible by the slight lifting at the corners of his eyes, and she huffed out a tiny sigh of relief at having passed muster. June handed him a scalpel then winked at her, and Kasey chuckled. June had obviously noted the small improvement in his attitude towards her so all she could do now was hope that it would last.
They carried on in surprising harmony after that until Adam nodded. ‘That’s about all I can do for now. I’ll just pack the wound and leave it open to drain. Infection is always a major problem with this type of injury because the bullet carries all sorts of gunk into the body, but we’ll just have to deal with it as and when it happens. There might be other damage, of course. A high-velocity gunshot injury causes shock waves to pass through the body but we’ll have to wait for the X-rays before we can know for certain what’s happened.’
‘Will you do the X-rays here or at the hospital?’ Kasey asked.
‘Hospital. We’ll have him moved over there tomorrow if he’s fit enough to withstand the journey.’
Adam slid a drainage tube into the wound, packed it with layers of gauze then covered it with a light dressing before they rolled the patient onto his side so he could dress the entry wounds, which were far smaller—no bigger than a couple of ten-pence pieces.
‘It might be best if we kept him sedated tonight,’ he told her when he’d finished. ‘We have no idea who he is and I don’t want to take the chance of him wandering around during the night.’
‘I’ll sort it out,’ she assured him as June went to fetch some more dressings from the storeroom. ‘And I’ll stay with him, of course, to make sure there isn’t a problem.’
‘There’s no need. I’ll do it myself.’
He turned away but if he thought she was letting him get away with that, he could think again. She grabbed hold of his arm, her blue eyes filled with a mixture of pain and injured pride as she stared into his face.
‘What is it with you, Adam? Do you get a thrill out of undermining me all the time? Or are you hoping that I’ll crack if you keep on pushing me? I know I hurt you—’
‘It has nothing to do with what happened between us,’ he said curtly, shrugging off her hand.
‘No?’ She laughed scornfully. ‘Come on, Adam, at least have the guts to tell me the truth. We both know that you didn’t want me along on this trip and we both know why, too.’
‘And that has nothing whatsoever to do with my decision to take charge of this patient tonight.’
He brushed past her, his face like thunder as he stripped off his gloves and tossed them into the waste sack. Kasey followed him into the kitchen, too incensed to care if she was making matters worse. Maybe she should accept his decision, but how could she when it seemed to be yet another deliberate slight?
‘Then what does it have to do with? I think I deserve an answer, Adam.’
‘I don’t have to give you an answer.’ He gripped hold of the sink and she could tell that he was struggling to keep a rein on his temper. ‘I’m in charge of this team and it’s up to me what happens.’
‘I should have known you’d take the easy way out,’ she scoffed. ‘You’re very good at finding fault with people but you’re not so good when it comes to backing it up with cold, hard facts.’
‘I am not finding fault with you or your work!’
‘Then why won’t you leave me in charge of this patient?’
‘Because it’s too bloody dangerous, that’s why!’
He swung round and she took a step back when she saw the anger in his eyes yet she knew on some inner level that it wasn’t directed at her but at himself. Her heart began to pound so that it was difficult to hear what he was saying as he continued in the same biting tone.
‘I am simply not prepared to put your life at risk, Kasey. And if you don’t like it then there isn’t much I can do because nothing you say or do will make me change my mind.’
‘I didn’t realise…’
She stopped and swallowed because she couldn’t seem to find the right words to explain that she’d never expected him to be concerned about her safety. It seemed too incredible to believe after what had gone on between them, yet there wasn’t a doubt in her mind that he was telling her the truth.
‘If you could just make sure that he’ll be unconscious for the rest of the night that will be fine.’ His tone was less abrasive now, softer, and she took a deep breath as her anger suddenly melted away leaving
