body was already starved of oxygen. They had to supplement as much as possible.
One of the physician’s assistants put his hand in the man’s pocket and pulled out a wallet. ‘Akio Yamada.’ He frowned as he calculated in his head. ‘I make him forty-four.’
Avery leaned over the man. His eyes were tightly closed and he was wincing, obviously in pain. He put his hand gently on his shoulder. ‘Akio, I’m a doctor. I’m going to do something that will help your breathing. It might be a little uncomfortable.’
This wasn’t a pleasant procedure but the effect would be almost instant relief. Air was trapped and had caused the man’s lung to collapse. As soon as the pressure was relieved and the lung reinflated he’d be able to breathe more easily again. Katsuko gave a nod that she’d finished translating.
There were specially manufactured needles designed just for a tension pneumothorax. Avery held out his hand. ‘Fourteen-gauge needle and catheter.’ He’d done this on numerous occasions in the past. It only took a few seconds to feel with his fingers for the second intercostal space, at the midclavicular line. It was vital that the needle be inserted at a ninety-degree angle to the chest wall so it would be positioned directly into the pleural space. Any mistake could result in a chance of hitting other structures—even the heart. But Avery was experienced.
The room was silent during the procedure. In a few seconds there was an audible release as the trapped air rushed out and the tension was released from his chest. Avery removed the needle and disposed of it, leaving the catheter in place. He secured it with some tape as he watched the man’s chest. Sometimes the lung inflated again immediately, sometimes it took a little time. The patient would need to be monitored.
He pulled off his gloves. ‘Can we keep an eye on his sats for the next few hours and get a portable chest X-ray?’ The man’s eyes flickered open.
Avery put a hand on his shoulder. It didn’t matter that the patient couldn’t understand him. ‘You should feel easier now. Just relax. We’ll keep a close eye on you.’
Katsuko’s gaze met his and she translated again. At least, he hoped she was translating. The truth was she could be saying anything at all and he’d never know. In a way it frustrated him. When he’d thought he was being shipped out to Portugal and Italy he’d learned a few words and phrases that he could use in clinical situations to reassure patients. He’d need to try and learn some basic Japanese.
‘Doctor?’
A clerk was standing at the door. ‘Yes?’
She waved an electronic tablet at him. ‘I’ll need you to write some notes on the two patients you’ve seen and fill some orders.’ She hesitated for a second. ‘Because you’re not officially on duty yet I’ll need to get another doctor to sign off on your cases.’
He met her worried gaze with a smile. ‘No problem.’ He could almost hear her inaudible sigh. Was she really worried he’d be offended? Of course he wasn’t.
He turned back to the patient. The male African-American nurse he’d met earlier had appeared back in the room. This time he held out his large hand towards Avery. ‘Frank Kelly, pleased to meet you.’ Avery had thought he was big at six feet two, but this guy was a giant. With his regular runs and gym workouts he normally felt pretty fit, but Frank would make a professional wrestler shrink away.
‘I’ll take over, Katsuko,’ Frank said confidently. ‘The other two majors are fractures, one a femur, the other a humerus and shoulder displacement. Do you want to check them over? Katia is triaging the walking wounded.’
Katsuko paused. He could see her hesitation to hand another patient over. Didn’t she let anyone else take charge?
He tried to hide his smile and he turned back to the patient. The colour in his cheeks was gradually improving.
He scribbled some instructions on a chart for Frank. ‘I’ll write him up for some pain relief and order a chest X-ray. Can you monitor his obs every ten minutes for the next hour?’
Frank nodded. The smile seemed to remain permanently on his face. Avery’s gaze followed Katsuko as she washed her hands and left the room. He turned back to Frank, whose knowing smile had got even wider.
‘Watch out, new boy, she bites.’
The professional thing to do was to pretend he had no idea what Frank was talking about but somehow he knew that wouldn’t wash. Besides, he was curious.
‘What’s that supposed to mean?’
Frank shrugged and pushed the button on the machine to inflate the blood-pressure cuff. He was laughing away to himself.
‘Frank?’
Frank shook his head. ‘Just remember who her father is.’
Now he was really curious. ‘Why? Who is her father?’
Frank raised his eyebrows. ‘That would be Donald Williams.’ He paused for a second. ‘Major General Donald Williams. Our commander.’
Avery couldn’t help his head flicking sideways. It didn’t matter that Katsuko’s retreating back was nowhere in sight.
Of course. That was why the Major General had been looking at her. A giant of a man, notoriously strict, he’d commanded this base for over ten years. He also had pale skin.
There was no family resemblance at all.
‘Donald Williams is Katsuko’s father?’
Frank nodded. ‘Sure is.’ His eyes gleamed. ‘And watch out because he bites too, especially anyone who looks at his daughter the way you do.’
A TEN-HOUR SHIFT had turned into a fourteen-hour shift. There was no way she was going back home when the ER waiting room was so full that patients couldn’t find seats.
After a few hours some of the local police arrived to collect statements and details of injuries. ‘Any idea what happened?’
The first one nodded. ‘Delivery mistake. Chemicals for the printing factory had been mislabelled. They got mixed together as they normally do and...boom.’
Katsuko sucked in a breath. It all seemed so matter-of-fact. She’d seen exactly the damage those mislabelled chemicals had caused. The man who had been brought in by helicopter had died. Mahito was currently in their paediatric ICU. It would be a few days before they’d even attempt to wake him up from his induced coma.
Her paperwork was finally finished. The next shift had come on duty and all patients were currently being seen.
There was a nudge at her shoulder. ‘How about you show the new guy where he can get some food?’
Avery. That was his name. These US doctors rolled in, dated their way around every department and rolled back out without a second glance. Did he really think he was the first new doctor to show a spark of interest in her?
He leaned against the wall next to her, folding his arms, his Indiana Jones style hat back on his head.
‘I can’t believe you actually walk about like that.’
He tipped his hat at her. ‘What can I say? It’s a precious family heirloom. I don’t leave home without it.’
At some point he’d changed into a set of obligatory pale green scrubs. They suited him, matched his pale green eyes. There was a borrowed stethoscope around his neck and his military boots were still in place. His feet must be aching.
His blond hair was longer than normal for the military—most of the men had buzz cuts around here. She resisted the temptation to smile. Her father would have a fit. As soon as that tiny bit of forward-flopping hair touched his eyebrow there would be memos flying about the base.
He