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 them, Doc?’ Charlie asked curiously.
‘Great big metal clamps that you use to open up the chest,’ he explained. ‘Where’s that torch? Thanks.’
He peered into the chest cavity while Charlie held the torch for him, and immediately spotted the cause of the problem. As he’d suspected, the pericardium—the sac surrounding the heart—was bulging with blood and preventing the heart from beating.
‘Definite signs of tamponade.’ He grasped the sac with a pair of narrow forceps and managed to cut through it. However, when it came to removing the blood clot, it proved impossible. His fingers were just too large to fit through the limited amount of space he’d been able to make.
He turned to Sophie. ‘See if you can get those clots out of there, will you? Your hands are smaller than mine.’
She quickly changed places with him and he saw the tip of her tongue poke between her teeth as she inserted her fingers through the opening in the chest wall. Liam felt a wave of heat rush through him and looked away because it shocked him that he should be so responsive to her at a time like this.
Why hadn’t he allowed for this when he’d taken the job? he wondered incredulously. He’d been attracted to Sophie from the first moment they’d met, when she’d been a student nurse and he’d been a brand new houseman, yet it had never crossed his mind that he might still feel the same about her. Why should it have done when he was committed to Julia?
His heart began to thud because that question had naturally led to a second, one it was even more difficult to answer.
If it was Julia he loved then why did he feel this desire for Sophie?
Sophie held her breath as she inched her fingers through the narrow gap. If anyone had told her she’d be helping to perform major surgery on the floor of a cabin, then she would have laughed out loud. But if Liam thought they could save the man’s life, she would give it her best shot.
Relief swept through her as she finally managed to reach the blood clot. She scooped it out of the way and dropped the bloody mass on the floor beside the bunk.
‘Got it!’ she declared triumphantly, glancing up. She frowned when she saw how abstracted Liam looked. He looked as though he was miles away, a worrying thought in view of the seriousness of what was happening.
‘Liam?’ she prompted anxiously, and saw him jump.
‘You’ve got it out? Good work!’ He made an obvious effort to collect himself. ‘Now, see if you can encourage the heart to start beating again. There’s not enough room to massage it so try flicking it with the tip of your finger.’
Sophie followed his instructions and felt her excitement mount when the man’s heart suddenly fluttered. She tried it again and laughed when she felt it start to beat. ‘It’s working!’
‘Right, we need to get him up to Theatre, stat.’ Liam was all business once more as he got up. ‘We need something to use as a stretcher. Can you sort it out, Charlie?’
‘No problem, Doc.’
The steward hurried away as Sophie sank back on her heels. ‘Do you think he’ll make it?’
‘With a bit of luck, but we’re going to have to stop that bleeding.’ He frowned in concern as he watched a few drops of blood ooze out of the man’s chest. ‘That wound needs stitching as soon as possible—can you get everything ready in Theatre? I don’t want to have to waste precious time setting up once we get him there. It’s going to be touch and go as it is.’
‘Of course.’ She scrambled to her feet and stripped off her blood-soaked gloves and dropped them on the floor then grimaced when she saw the mess they’d made. ‘This place is going to need a thorough cleaning before the crew can use it again.’
They both looked round when the door opened and Charlie appeared with Mike Soames in tow. Sophie saw Mike turn a delicate shade of green when he saw all the blood, and sympathised with him. The cabin must look like a scene from a horror film to the uninitiated.
‘Did you find us something to use as a stretcher?’ Liam demanded, oblivious to the petty officer’s distress.
‘I’ve commandeered one of the kitchen trolleys,’ Charlie explained. ‘It’s too big to get it in here so we’re going to have to carry Alexei outside.’