he said, hurriedly dismissing the thought because it was pointless worrying when there might be no need. It could turn out that his inability to make a decision was all tied in with the fact that he needed to resolve things with Sophie. In which case, all his problems would be resolved at once.
‘We’re still very much at the planning stage—’ he began, then broke off when one of the ship’s officers came hurrying to meet them as they reached the lower deck.
‘Dr Kennedy?’
‘Yes. I’m Liam Kennedy and this is Sophie Patterson, the ship’s nurse.’
‘I’m glad to meet you, Dr Kennedy. You, too, Miss Patterson.’
The man shook hands then quickly led them along a corridor. ‘I’m Mike Soames, the chief petty officer. I’m still trying to establish exactly what happened but, basically, two of the crew started fighting and one guy pulled out a knife and stabbed the other fellow.’
‘Whereabouts did the knife penetrate?’ Liam asked, wanting some idea of what they could be dealing with.
‘In the chest,’ Mike informed him. He opened a door and stepped back. ‘Alexei—that’s the chap who’s been stabbed—is in here, but I thought it would be best to separate them so I’ve put Grigorio in the next cabin. The men who would normally use these cabins are bunking down in the crew’s lounge for the night.’
‘Good. I was hoping we wouldn’t have an audience,’ Liam said gratefully, turning to Sophie. ‘Will you check out the chap next door while I see to this fellow? If you’re happy that he’s not too badly injured then you can come back and help me.’
‘Of course.’
‘I’ll go with you, Miss Patterson,’ Mike Soames said hurriedly.
Liam went into the cabin as the chief petty officer accompanied Sophie next door. The patient was lying on one of the lower bunks and Charlie Henshaw—the steward who’d shown Liam to his cabin when he’d arrived—was with him. He looked relieved when Liam appeared.
‘I’m glad you’re here, Doc. I’ve done a bit of first aid in my time but this is way out of my league.’
‘Let’s take a look, then.’
Liam crouched down beside the bunk. He could tell immediately that the man was in a very bad way. His pupils were fixed and dilated and his breathing was extremely laboured.
He quickly removed the blood-soaked towel from the man’s chest and whistled when he saw the knife wound. Although it was fairly small, it was obviously deep. ‘That doesn’t look so good. How many times was he stabbed, d’you know?’
‘Just the once. One of the other guys managed to break up the fight.’ Charlie shook his head. ‘It all happened in a flash. One minute they were arguing and the next second Grigorio had pulled out a knife and stabbed Alexei.’
‘Well, it’s certainly gone in deep. There could be all sorts of damage to the major organs.’ Liam glanced round when the door opened and Sophie appeared. ‘How’s the other fellow doing?’
‘A few bruises and a bump on the back of his head but he’ll live.’ She glanced at the man on the bunk and pulled a face. ‘He doesn’t look too good, though.’
‘He doesn’t. Can you check his blood pressure while I get a line into him? He desperately needs fluids. It also looks as though he’s going to need to be intubated so I’ll give him an anaesthetic to relax his muscles once everything is set up,’ Liam explained, quickly tapping up a vein and inserting a line into the back of the man’s hand.
Charlie took the bag of saline from him once he’d set up the drip, and hung it on the end of the top bunk. Liam nodded.
‘Thanks. I need to establish an airway now but I could do with a bit more light so I can see what I’m doing.’
‘Leave it to me, Doc.’
Charlie hurried away and returned a few minutes later with one of the huge torches that were normally used for signalling to other ships. Liam smiled his approval as the steward angled the beam so that he could set to work.
‘That’s great. I can see where I’m aiming for now.’
He administered the anaesthetic then quickly inserted an endotracheal tube and established an airway. Once it was secured, he immediately started the patient on oxygen.
‘Blood pressure is dropping,’ Sophie warned. ‘Pulse is very weak, too.’
‘Could be a haemothorax,’ Liam said, taking a scalpel out of his bag. ‘The knife appears to have entered the chest at an angle so it’s possible the left lung has been damaged. I’ll see if I can relieve the pressure.’
He made a small incision under the man’s left armpit then used a pair of forceps to open the muscles between the ribs, but there was no sign of blood in the pleural cavity. ‘That’s not it. How’s he doing now?’
‘BP is still going down rapidly.’
Sophie suddenly leant forward and checked the pulse at the base of the man’s neck. Liam held his breath because he had a horrible feeling that she wasn’t going to find one.
‘No pulse. He’s arrested!’
‘It looks as though his heart must have been damaged, then,’ Liam exclaimed. ‘If enough blood has collected in the pericardium, it will have stopped his heart beating. We need to get him on the floor so we can start CPR.’
Sophie grabbed the man’s legs while Charlie gave him a hand to lift the seaman off the bunk. Liam turned to Sophie. ‘I’ll need you to give me a hand opening him up.’
‘You mean you’re going to do a thoracotomy?’ she exclaimed incredulously. ‘Here?’
‘I don’t have a choice. External cardiac massage won’t work if the pericardium is full of blood so I’m going to have to open his chest to do it. We don’t have the time to get him up to Theatre because his brain will stop functioning in three minutes without any oxygen reaching it.’
He didn’t waste any more time on explanations. Slipping the scalpel into the hole he’d made already under the man’s armpit, he sliced horizontally across the patient’s chest. Sophie was searching through his bag—finding scissors and dressings—and he breathed a sigh of relief. It was reassuring to know that he had someone with her experience to help him and didn’t have to explain every little detail to her. It left him free to get on with his job.
‘Oh, my Gawd!’ Charlie muttered as Liam took the pair of scissors from her and began to cut through the tough layer of muscle beneath the patient’s skin.
‘I know it looks brutal but it’s his only chance.’ He reached the breastbone and felt beads of sweat gather on his forehead as he struggled to saw through the bone. Every second that passed meant that the chances of the patient surviving were decreasing. He grunted in relief when he felt the last bit of the bone give way so that he was able to complete the incision.
‘What I wouldn’t give for some retractors,’ he muttered, struggling to see inside the chest cavity.
‘What’s
