light fitting, that would be best.’
Daniel and Alan Jones, their radiographer, immediately set to and moved the heavy table into position while she and June went to find some theatre drapes and dressings. Their equipment had been piled into one of the empty storerooms off the kitchen and it didn’t take them long to sort out what they needed. Kasey also collected a set of sterile surgical instruments, although she didn’t break open the pack but just placed it on a nearby table. Adam could open it once he was ready to operate.
‘Everything sorted?’
Adam came into the room with the injured man draped over his shoulders. Daniel and Alan helped him lie the man on the table then he looked round. ‘Right. I don’t need all of you here so I’ll just take a couple of volunteers. June will you do the honours? And, Daniel if you could cover the anaesthetic?’
‘Excuse me?’ Kasey stepped forward, barely able to contain her annoyance at the way he had deliberately cut her out of the proceedings. ‘There’s no need to involve Daniel. I’m perfectly capable of handling this.’
‘You had a shock tonight,’ he replied curtly, walking into the kitchen and turning on the old-fashioned, hot-water geyser. ‘I suggest you get a good night’s sleep and give yourself time to get over it.’
‘Was that a suggestion or an order?’ she demanded, following him into the room.
‘It’s simple common sense.’ He pumped a handful of antiseptic solution out of the dispenser she’d placed there for them to use and lathered his forearms.
‘In that case, wouldn’t it be sensible if you excused yourself as well?’ She stared back at him, experiencing a pang of regret when she saw the flicker of annoyance that had lit his green eyes. There was no sign of amusement in them now. ‘You were shot at, too, Adam, don’t forget, so you had just as big a shock as me. If I’m not up to handling this job, neither are you.’
‘I shall decide whether or not I’m fit to operate.’
‘And I shall decide whether or not I’m fit to act as your anaesthetist.’
She stared back at him, knowing that if she lost this battle it wouldn’t be worth her staying on in Mwuranda. If he didn’t trust her to do her job then she would have to go home. Maybe she could put up with his hostility on a personal level but she refused to compromise when it came to her work.
‘Fair enough.’
He inclined his head in brief acknowledgement then spun round on his heel. Kasey let out her breath in a small sigh of relief, only then acknowledging how important it was to her that she should be allowed to stay. She quickly scrubbed up and put on a gown then went back to the kitchen. June had set up a drip and was now cleaning the injured man’s shoulder with antiseptic solution. The rest of the team had gone back to bed, so all she could hope was that Adam’s apparent lack of faith in her hadn’t caused any long-term damage. It would be difficult to work with the other members of the team if they had doubts about her ability.
It was a sobering thought 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?’