“Better than you. Move—I’m doing this.”
She protested but he’d already snapped on gloves and was taking the scalpel and tube out of her hands. He wasn’t breathing much easier, but she was sweating. Not the stuffy sweat expected with the heatwave that was ending March, Argentina’s last summer month, but the cold, sick sweat of depletion. Bright pain had settled in her right side. Gray mist had crept up over the rest of her a couple of times back there. He was probably in better condition than her. She made way for him.
Flopping into the attendant’s seat, she watched him recline the cot so that their restrained patient lay in a 50-degree reverse Trendlenburg position with her legs down. Both that and the incision between the ribs in the mid-axillary sixth intercostal space made for best drainage of blood. In deft, sure moves, he punctured the intercostal muscles and pleura with a curved hemostat clamp, advanced and secured the track with his finger and inserted the tube into the pleural cavity. Blood gushed out, just as she’d predicted. He secured the tube with a suture and tape and connected it to an underwater-seal bottle, attaching it to the suctioning device.
She busied herself with a secondary assessment of the woman’s vital signs. Breathing down to 24 and blood pressure up to 110 over 70. Measures working. She told him. He nodded. “Let’s look her over,” he said.
Apart from a multitude of bruises, a quick exam for dysfunction and a full exposure didn’t reveal further significant injuries. Eyeing the bottle for the collected blood, Armando frowned. It was over 900 ccs.
“A lot,” she said.
He gave a slight shrug. “But it has almost stopped coming. She’ll be OK. Load me 10 mg diazepam while I decompress her stomach.”
“But her GCS is 5—6 at best!” Centrally depressant drugs were contra-indicated when consciousness was compromised and scoring on the Glasgow coma scale measuring responsiveness and alertness was below 8. “How can you consider sedating her?”
“I believe she lost consciousness with respiratory distress and shock, not from a head injury. If you hadn’t noticed, she’s lightened up.”
“What if she has? Why not just let her wake up, extubate her and put her on positive pressure ventilation with a face mask?”
“She’s a cervical spine injury suspect. If we need to operate further, and it turns out she does have a cervical injury, this ET is our one safe chance of having one in. I want it left in.”
Laura mulled this over, watching his every move as he slipped in the nasogastric tube and emptied the woman’s stomach. Incisive, ultra-efficient.
And right.
Damn him.
In seconds, she’d slipped the diazepam into the woman’s drip, hooked her to the cardiac monitor and raised her head. She found him watching her in turn, something like surprise in his bloodshot eyes.
He shook his head, made a strange, wheezy sound—an incredulous laugh? “Good work!”
He was surprised, double damn him! How dared he be surprised?
But really, why should she be surprised? She should be used to his opinion of her medical competence, of her worth in general, by now.
Still biting her tongue, she watched as he checked their patient one last time, then rummaged for a syringe, loaded it with an ampule diluted with saline and injected himself subcutaneously.
“Ventolin,” he rasped, then muttered something else under his strident breath.
So he did need a bronchodilator and… What had he said?
It sounded too much like Laura Loca to her. Crazy Laura.
“What did you say?”
“So you heard me, huh?” His shrug was careless as he crossed to the driver’s compartment, throwing a calm “Good” over his shoulder.
In seconds he was revving the engine loudly and putting the van in gear, forcing her to scramble to the passenger seat.
“I’m crazy? I’m not the one driving a car fifteen minutes after being zapped with tear gas.”
“One of us has to and apart from my eyes stinging like hell and my skin and lungs feeling about to combust, I’m in a far better condition than you—Laura Loca!”
“You’re saying it again!”
“Don’t mention it. What the hell do you expect? What did you think you were doing, running out like that? Was reporting me such a desperate priority that you didn’t mind risking your life to do it?”
“Reporting…? Listen here, Salazar—”
“No, you listen here, Laura Loca. You didn’t have to sneak behind my back. You wanted a report delivered to GAO’s central liaison office, I would have delivered it for you myself, even if you’d painted me black in it, even if you’d lost me GAO’s backing. And no matter what else you think of me, I’m your surgeon and I, and only I, say when you can leave your hospital bed. When I do, it won’t be so you can go on another death-defying escapade. This one almost got me killed. Your last one did manage to kill Diego!”
CHAPTER TWO
“NOBODY asked you to come after me!”
And nobody had asked Diego either. She’d told him she’d had nothing more to say to him. But he’d intercepted her. Just giving her a lift, he’d insisted. He’d tricked her, again, had been so confident he’d talk her out of leaving, seduce her into forgetting what she’d come to realize. He’d been incensed when he’d failed. Then he’d crashed the car.
“And my death-defying escapades?” She hissed her outrage at the blatant lie. “Diego was driving, if you remember! Without a seat belt. And he almost killed me, too.”
“My point exactly. Yet you walked out today as if all you’d suffered a week ago was a sprained ankle, and not a lacerated liver and abdominal aorta with a hemothorax and intraperitoneal hemorrhage to make our patient’s here look like a minor leak. I won’t even mention your facial wounds, or the ten units of blood we pumped into you, or the six-hour operation to gain hemorrhage control—”
“It was only a limited laparotomy.”
“Only? Oh, yes, you were damned lucky. But don’t be so smug. That I didn’t have to open you up from your neck down was a piece of luck that, along with surviving today, used up all your luck—for this lifetime at least. You walked out of hospital today against every rule in the book.”
“You removed my drains three days ago. It was perfectly all right for me—”
He interrupted her again. “Every moment you’re on your feet you’re compromising your healing, inviting complications.”
“Early ambulation is good for healing,” she objected.
“Ambulation as in getting out of bed, walking around the room then getting back into bed.”
“I’m a surgeon myself, no matter how you might like to forget that, and if I feel anything alarming—”
“If you don’t listen to reason, you might still die! You do know how many complications can set in, don’t you?”
This morning, she’d been confident she’d been well enough to discharge herself, against his orders. But that had been then. She hadn’t expected to be sucked into a nightmare. The sting of every ram and blow she’d suffered was a grim reminder of yet another catastrophic miscalculation. Complications were now a definite possibility. She’d concede that. Just not to him.
When she