Sheikh Surgeon, Surprise Bride. Josie Metcalfe
already buzzing around in her head, Razak had been contacted for an urgent consultation on a patient in the emergency department and she had found herself running in his wake when he had suggested she come, too.
‘Sir, listen to this,’ exulted a very young doctor as he reached out towards the blood-spattered body on the trolley in front of him. ‘You can actually hear the bones grating when you spring the man’s hips.’
‘Don’t!’ snapped Razak, before he could make contact, the word like the crack of a lash. ‘How many times have you already done that?’
‘A couple,’ he admitted, then smiled almost innocently. ‘It’s the first time I’ve actually heard a break when I’ve done it and I—’
‘And you could be responsible for killing the man,’ Razak interrupted fiercely. ‘What’s his blood pressure doing? If the sharp edges of the broken bones damages one of the pelvic arteries he could bleed out in a matter of minutes. Your job here is to stabilise his condition so we can get him up to Theatre, yes?’
‘Yes, sir,’ he agreed, clearly crestfallen. ‘Do you want to use an external fixator before he’s transferred?’
‘Have X-rays been taken yet to show the position of the fracture?’ Razak demanded briskly. ‘If there’s more than one break we may have to. Otherwise, if you can guarantee not to make him any worse while he’s transported to Theatre, we’ll do it upstairs while we do an open reduction and internal fixation.’
Even as he was speaking, the radiographer was positioning the equipment above the moaning patient and there were so many members of staff noisily occupied in taking care of him that Lily wondered for a moment whether they would even hear the radiographer’s warning countdown to the first exposure.
At the last second the last nurse whipped her hands off the body and stepped back smartly, only to step forward just as swiftly as soon as that view had been taken.
The whole process had to be repeated several times to build up an accurate picture of what was going on inside, and all the while the members of the resus team were going about their tasks. Machines were monitoring the patient’s blood pressure and airway but one of the nurses was specifically detailed to document each dose of painkilling drug and every procedure as it was done while another was keeping up a soothing running commentary in the hope that it would make everything just a little less frightening.
At least the hospital had the latest digital X-ray technology, so there was no long wait while old-fashioned plates were hurried away to be developed. With this state-of-the-art equipment, as soon as the shot was taken it was available for viewing on the monitor with the touch of a button.
Razak muttered something vehement under his breath when he saw the first view, and even without knowing his language Lily could tell that he’d sworn. She certainly felt like it when she saw the damage the man had sustained.
‘Definitely an external fixator,’ she murmured as she stepped aside to reach for the wall phone. ‘Who should I ask for to bring the kit down?’
‘Can you see if Colin Wetherall’s free at the moment?’ Razak asked. ‘Tell him what we’ve got here and that I’d like him to do a demonstration for you.’
‘A demonstration?’she murmured under her breath, while someone up in the orthopaedic department checked to see if Colin was still in Theatre. He’d had two operations scheduled that afternoon, a knee and a shoulder. If everything had gone well, he should be nearly finished. But why should she need Colin to demonstrate the fixator kit? It wasn’t as if she hadn’t used it before, although, admittedly, not very often.
Was calling him down Razak’s way of saying that he wasn’t impressed with her level of skill? She didn’t think she’d made any mistakes today, their only disagreements having been over matters of personal preference for various prosthetics.
‘I hope he is free,’ Razak said suddenly, his voice right behind her telling her that he’d come far closer than she’d realised. ‘He spent some time in Russia at the institute where this particular fixator system was developed and he’s nothing short of brilliant with it. The best in the department, I think.’
Lily hadn’t known the man long, but she had a feeling that Razak didn’t give praise easily, so it was with an unexpected feeling of anticipation that she waited to see what would happen. For the moment, her role was more of a passive observer, but that could change at any moment.
To the uninitiated, the external fixator kit that arrived just before Colin might have been confused with a rather sophisticated construction toy with its various shiny rods and connectors, but in the hands of someone who had obviously been taught by masters how to use it best, it was a revelation.
Using the X-rays as a guide, Colin swiftly tightened the special screws into position in the bones then fitted the rods between them, tightening them only when the pelvis had been restored to the correct shape.
‘How’s his blood pressure?’ Colin demanded, without even lifting his head from the last titanium rod, his movements swift and accurate, while Razak automatically braced the unstable pelvis for him.
‘No sign of hypovolaemia so far, but blood is being cross-matched and sent up to Theatre.’
They sounded so calm, but those few words were a measure of the potentially deadly nature of this particular injury. There were so many veins and arteries in this area and this sort of bony injury was often accompanied by massive soft-tissue injury and a more than fifty per cent chance of dying of massive blood loss.
So far, their patient had been lucky. His blood pressure was holding fairly steady, indicating that there was no great dip in his blood volume. He also seemed to have avoided any apparent injuries to his kidneys, bladder or urethra as there was no sign of blood in his urine or on the ultrasound scan that had largely replaced the need for peritoneal lavage.
Now, with Colin straightening up from his completed task and the pelvis stable enough for the patient to make the journey up to Theatre safely, it was just a case of opening him up on the table and performing an internal fixation of each of the fractures. Only then would the bones have a chance of healing normally so that the patient could walk again.
‘Do you want me to finish the job off?’ Colin offered. He tried to sound diffident but Lily had the feeling that this was the sort of case he thrived on. She’d known other surgeons who found the never-ending stream of joint replacements stultifying, only really enjoying the adrenaline rush of repairing life-threatening traumatic injuries.
‘Do you have enough theatre time left?’ Razak asked. ‘You’ve already been operating this afternoon.’
Lily knew what he was asking. Their standard sessions were three and a half hours and this wasn’t going to be an easy job or a quick one. If Colin had already operated on two patients that afternoon…
‘One of mine didn’t make it into Theatre this afternoon, unfortunately. She had a CVI on the ward just after she took her pre-med. She’s up in ICU now.’
‘In which case, be my guest,’ Razak said with a smile, standing aside as the trolley set off towards the bank of lifts. ‘Call me if you need another hand on the screwdriver.’
Lily felt a tremendous sense of anticlimax as everyone dispersed, leaving just the nurses to gather up the debris and get the room cleaned and restocked for the next emergency. She’d honestly believed that Razak would be operating on the patient and had been gearing herself up for the probability that she would be in the theatre with him.
‘Don’t be impatient!’ he teased, and she wondered with a jolt whether he was also a mind-reader. ‘I promise you’ll have your chance tomorrow morning. I’ll be putting you through your paces then.’
The anticipation was different this time, a mixture of excitement that she would be doing what she loved and dread lest he find her skills lacking.
But even as she followed him out of A and E and shared a lift with him up to the orthopaedic department to retrieve her