cover it. I know it’s not ideal but given the circumstances… Give me a stool in Theatre and let’s move.’
He gazed down at Carla and saw no response. No glimmer of recognition. He looked again at Anna and she met his gaze with a determination that was almost steely. Treat me as a doctor, her gaze said. Get over your prejudices.
She was still a patient. He could hardly ask.
There was no choice.
‘Thank you,’ he said simply. ‘If you’re sure.’
‘I’m sure. Let’s move.’
The surgery sounded simple. Anyone with a decent handyman’s drill should be able to do it—in fact, Leo had heard of doctors in emergency situations using just such an implement.
Luckily he didn’t have to resort to such measures. Most of their of equipment was second-hand but it was functional. Leo had kept up with a lot of doctors he’d met during training, and when they had been purchasing shiny new medical toys they often remembered him and sent on usable older things. The X-ray department had been set up almost completely via donations from a friend he’d met in final year med school. For the rest they’d scraped and saved and cajoled the community, which meant the theatre he was working in was fully equipped.
And he had excellent staff. Maria, his chief nurse, was rigid about standards and ongoing training, and she ruled her nursing staff with a softly gloved fist of iron.
The only hole in the team was his lack of a trained anaesthetist and that hole had been plugged. In Anna he had an anaesthetist he could trust. From the moment he’d nodded his acceptance of her offer she’d turned almost instantly from patient, from heir to the powers of Castlavara, from his past lover—into a crisp, competent professional.
‘Do you have access to Carla’s medical history? I need to know what she’s taken, allergies… Family? Is someone on their way?’
‘Her husband died ten years back,’ he told her. ‘Her son’s in Italy. But we have her history. Maria…’
‘Onto it,’ Maria said, and so was Anna. Ten minutes later they were in Theatre.
‘Glasgow scale deteriorating,’ Anna told him. ‘I’m losing any eye response.’
He didn’t need telling. He knew the pressure would be building.
He needed to focus.
A handyman might be able to operate a drill but what was needed here was precision, care, knowledge. And confidence.
Confidence that Anna could keep Carla alive while he worked.
And strangely the trust was there.
If another doctor had walked in right now, someone he didn’t know… If they’d offered to help… Yes, he’d have had to accept their help but there’d be caution. He’d be checking all the time. He’d be torn, though, because the procedure he was performing was out of his comfort zone. He needed to work fast with skills he hardly knew he had.
Anna helped. Somehow just knowing she was here helped.
Carla was in the supine position, facing up. As soon as Anna had the IV line in, as soon as she was sure Carla was under, Maria did a quick shave.
Then it was over to Leo. Two small holes to expose the dura, then careful, painstakingly draining. Hell! The scan had showed a build-up but it shook him to see just how much fluid was in there.
He inserted a temporary drain to prevent more build-up. He’d rather not have—it increased the chance of infection—but with this amount of fluid and with the speed of onset of symptoms, he had little choice.
Then closing.
It sounded straightforward. It seemed the hardest surgery he’d ever undertaken. Why? Because the huge unknown was how much damage had already been done. Had they been fast enough? Had the pressure already caused irreparable harm?
He fixed the drainage tube, dressed the wound and finally stood back from the table.
He’d done all he could do.
Carla was his friend and he felt ill.
What would have happened if Anna hadn’t been here? Would he have had to administer the anaesthetic himself? Have Maria do it?
Or wait for evacuation?
He was under no illusion as to what waiting would have meant. Even now, as Anna reversed the anaesthetic, he was aware that they might have been too late. Cerebral haemorrhage was the most frightening of medical emergencies.
‘We’ve done everything we can,’ he said wearily. ‘A neurosurgeon will need to take over. We’ve put in a call for evacuation but that’s still hours away. Meanwhile, we just have to hope.’
Anna had finished reversing the anaesthetic. She’d removed the intubation tube. Carla was breathing for herself again, but would she wake up? And if she did, what damage had been done?
‘You went in as fast as you could,’ she said, maybe sensing just how close to the edge he was. ‘She has the best chance you could possibly have given her.’
‘Partly thanks to you.’ Then, almost huskily, ‘Thank you.’
‘Don’t thank me.’
He nodded, dumbly, as the imperatives of surgery faded and the fear for his friend flooded back. What if the damage from pressure was irreversible? What if Carla didn’t open her eyes again, or, if she did, what life would she be facing?
Surely they’d moved fast enough.
With this level of bleeding, with the speed with which things had overtaken Carla, there was no way of knowing.
There was nothing more he could do but wait. The pain he was feeling was fathoms deep.
‘The Italian neurosurgeons will take over,’ he said roughly. ‘We don’t have the facilities to do more.’ While there’d been medical need, he’d been able to put distress aside, but now there was little to do for Carla but wait, that distress was impossible to hide. ‘I need to speak to her son. Our receptionist will have contacted him already and he may well be on his way. But enough. Anna, you need to go home.’
‘Leaving you alone.’
‘Bruno will be back later today. He’s one of our nurse-practitioners but his six-year-old fell out of a tree last week. Comminuted fracture of his femur. He needed specialist orthopaedic care.’
‘So he was evacuated, too?’
‘Yes, but Bruno should be back.’
‘But he’s not a doctor.’
‘He’s good. Anna, you need to leave. I’ll take over here.’
‘And leave you to worry about Glasgow scores on your own.’
‘You’re
