The Forever Assignment

Intimately.

Trapezius, pectoralis major, deltoid, obliquuos externus…She made herself recite the names of all those muscles from memory, hoping it would help if she focused on some basic anatomy rather than the effect they were having on her. It worked to a point until another volley of shots suddenly cracked through the air. Yelping in fear, she buried her face in his chest and wrapped her arms around him. He felt so big and solid that she clung fast, using him as her rock in an unstable world.

‘It’s OK.’ His hand strayed from her mouth and her heart leapt again when she felt his fingers gently stroking her hair. ‘They’re not firing at us. Whoever they’re aiming at is in those trees over to our left.’

His voice rumbled up from his chest and she shuddered when she felt its vibrations rippling into her. Adam obviously misunderstood her reaction because his tone deepened, taking on the soothing cadence people use with the very scared.

‘They probably don’t even know we’re here, Kasey, so all we need to do is sit tight until it’s over. OK?’

‘OK,’ she muttered in mortification, because if she’d hoped to impress him with her sang-froid under fire she’d obviously failed.

They stayed where they were for another ten minutes, although it felt a lot longer than that to her. It wasn’t just the fact that Adam was squashing her with his weight that bothered her so much, but that she was enjoying the experience. She should have loathed this kind of intimate contact with him but although her mind knew that, her body didn’t. Every time he shifted his weight, she had to make a conscious effort not to respond so that it was a relief when he finally decided the danger had passed.

‘Stay there while I check out the lie of the land,’ he instructed tersely, easing himself away from her. He cautiously stood up, keeping well back into the shadows as he looked around for the gunman.

‘He seems to have gone,’ he said at last, glancing down at her. ‘Let’s get back inside but keep your head down and stay close to the bushes just in case.’

Kasey scrambled to her feet and brushed the grit off her backside, wincing when her fingers encountered a dozen different sore spots caused by being squashed on the stony ground. Adam took another quick look around then pointed towards the path, silently indicating that she should go ahead of him.

They’d almost reached the front doors of the hostel when a man suddenly appeared from around the side of the building. Kasey didn’t have time to react as Adam grabbed hold of her and thrust her behind him, using himself as a shield in case the man had a gun, but even as they watched, the stranger dropped to his knees then slumped face down onto the ground.

‘Looks like he’s the guy who was being shot at,’ Adam shouted as he ran forward. Kasey raced after him, dropping to her knees and staring in horror at the gaping wound in the back of the young man’s right shoulder.

‘He’s been hit, and more than once, by the look of it.’ Adam pointed to the twin exit wounds caused when the bullets had torn through the flesh. ‘I’m not sure how many bullets were fired so there might be others still inside him. I’ll have to check. There’s bound to be extensive soft tissue damage, though, and possibly some damage to the shoulder joint so it’s going to take some time to sort it all out.’

‘You’re going to operate?’ she exclaimed.

‘Of course.’ He frowned. ‘Although I’m not sure where would be the best place to use. One of the bedrooms would be easiest but the lighting is too poor for this kind of intricate surgery.’

‘You mean that you’re going to operate here?’

‘Yes. It’s far too risky to take him to the hospital. Matthias warned me that we mustn’t drive around at night so we’ll have to make do with whatever facilities we have here and simply hope for the best.’

‘I see,’ she murmured, trying to get her head round what was going on. Obviously Adam was less concerned about the injured man being a terrorist than he was about saving his life, so she made herself focus on the problem of finding a suitable place to use as a makeshift operating theatre. It would need to be somewhere with decent lighting, as he’d pointed out, and it would also help if they had access to water for washing.

‘How about the dining room?’ she suggested. ‘The lighting isn’t too bad in there and we have direct access to the kitchen. We can use one of the tables as a temporary operating table, too.’

‘Good choice. Can you get everything set up while I bring him inside? I just need to stop this bleeding before I move him.’

‘Here.’ She quickly unbuttoned her blouse and handed it to him, thankful that she’d decided to wear a T-shirt underneath and was still decently covered up.

Adam chuckled as he took it from her and bound it tightly over the wound in the man’s shoulder. ‘It should have been a petticoat, by rights, of course.’

‘Like in all those old western movies? Every time someone got shot, the heroine would start ripping up her petticoat for bandages. Unfortunately, it’s not quite what the modern woman wears,’ she told him pithily, and he laughed out loud.

‘Sadly not. Jeans and a T-shirt seem to fit the bill nowadays for most occasions.’ He smiled up at her, his green eyes sparkling with laughter, and her breath caught because the change it brought to his expression was enough to make her heart race. ‘Still, some women manage to look good no matter what they wear.’

Kasey wasn’t sure if the compliment had been aimed specifically at her or if it had been a general observation, and didn’t allow herself to speculate. There really wasn’t time to think about it right then, despite how tempting it was. She made her way back inside the hostel where she was greeted with relief by the rest of the team, who’d heard the commotion and had gathered in the hall.

She quickly explained what had happened, carefully omitting any mention of how Adam had tried to protect her after that first gunshot. However, she saw the speculation on several people’s faces when they realised that she and Adam had both been outside when the shooting had started and knew they were putting their own interpretation on the facts.

Kasey didn’t attempt to correct them—she knew it would probably make matters worse if she tried to explain that they hadn’t arranged to meet in the grounds of the hostel—but it was unsettling to know that she and Adam were being linked together like this. It was an added pressure she could have done without but, fortunately, there was too much to do to worry about it. As soon as she’d sorted out some volunteers to help, she headed for the kitchen to get everything ready.

‘We’ll use one of the tables,’ she instructed, pointing to the largest of the refectory tables. ‘If you can move it directly under the central 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?’ She laughed scornfully. ‘Come on, Adam, at least have the guts to tell me the truth. We both know that you didn’t want me along on this trip and we both know why, too.’

‘And that has nothing whatsoever to do with my decision to take charge of this patient tonight.’

He brushed past her, his face like thunder as he stripped off his gloves and tossed them into the waste sack. Kasey followed him into the kitchen, too incensed to care if she was making matters worse. Maybe she should accept his decision, but how could she when it seemed to be yet another deliberate slight?

‘Then what does it have to do with? I think I deserve an answer, Adam.’

‘I don’t have to give you an answer.’ He gripped hold of the sink and she could tell that he was struggling to keep a rein on his temper. ‘I’m in charge of this team and it’s up to me what happens.’

‘I should have known you’d take the easy way out,’ she scoffed. ‘You’re very good at finding fault with people but you’re not so good when it comes to backing it up with cold, hard facts.’

‘I am not finding fault with you or your work!’

‘Then why won’t you leave me in charge of this patient?’

‘Because it’s too bloody dangerous, that’s why!’

He swung round and she took a step back when she saw the anger in his eyes yet she knew on some inner level that it wasn’t directed at her but at himself. Her heart began to pound so that it was difficult to hear what he was saying as he continued in the same biting tone.

‘I am simply not prepared to put your life at risk, Kasey. And if you don’t like it then there isn’t much I can do because nothing you say or do will make me change my mind.’

‘I didn’t realise…’

She stopped and swallowed because she couldn’t seem to find the right words to explain that she’d never expected him to be concerned about her safety. It seemed too incredible to believe after what had gone on between them, yet there wasn’t a doubt in her mind that he was telling her the truth.

‘If you could just make sure that he’ll be unconscious for the rest of the night that will be fine.’ His tone was less abrasive now, softer, and she took a deep breath as her anger suddenly melted away leaving her feeling incredibly vulnerable.

‘Of course,’ she murmured, turning to hurry back into the dining room before he realised how shaken she felt.

Adam followed her and her heart ached when she glanced up and saw him standing at the end of the table. He looked so tired and drawn, his skin tinged with the grey hue of fatigue, that all of a sudden she felt her eyes welling with tears. It was her presence that had caused him to look like this and it wasn’t what she’d intended. She’d come on this trip first and foremost to make the lives of the people they treated that bit better, not to make his life more stressful.

‘I’m sorry,’ she whispered, overwhelmed by guilt.

‘Because you stood up for yourself?’ He shrugged. ‘I’d have done the same thing, Kasey, so there’s no need to apologise.’

‘I’m sorry for making things difficult for you,’ she corrected, wanting—needing—to explain. ‘I never meant to do that.’

‘Didn’t you?’ His voice sounded flat, emotionless, and she sighed, understanding why he found it so hard to believe her.

‘No,’ she said briefly, because there was no point trying to convince him when he didn’t want to be convinced. She topped up the patient’s anaesthetic then checked his vital signs one last time and stepped away from the table.

‘He should be OK now but you can top up the anaesthetic if you need to. I’ve left everything ready for you.’ She pointed to the vials of drugs then made her way to the door. ‘Goodnight.’

‘Goodnight, Kasey. And thank you.’

She didn’t pause, didn’t turn back to ask him what exactly he was thanking her for, because she knew what his answer would be and that it wasn’t the one she really wanted to hear. Adam was thanking her for her work that night, for acting as his anaesthetist and doing her job well. Every surgeon she’d ever worked with had done that because it was what was expected of one professional to another. However, as she made her way upstairs, she couldn’t help wishing that Adam’s thanks had been a bit more personal, that he’d thanked her for being her, not just a colleague.

It made her see just how ambivalent her feelings were towards him, and how hard it was going to be to work with him because of that. She might be ready to fight tooth and nail to uphold her status within the team but it didn’t mean that she didn’t want Adam’s approval, did it?

All of a sudden it felt as though she’d come full circle and was back to where she’d been five years ago, when wanting and hating Adam had almost destroyed her. Would she survive this time?

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