200 Harley Street: The Tortured Hero Page 9

  Olivia shut her eyes, trying to block out the demons that had dogged her for so long.

  ‘I dreamt about how they must have died for months afterwards. How terrifying it must have been. How terrified they must have been... I know they would have been thinking about me...worried about me...’

  Ethan sucked in a slow ragged breath. He could tell her the smoke would have rendered them unconscious first. He could say it would have been quick—so quick. Those fires moved at a horrendous pace.

  But she knew all that. She was a doctor. Except when she shut her eyes.

  Then she was a daughter.

  ‘I’m sorry,’ he said again.

  Olivia opened her eyes. She didn’t want him to be sorry. She wanted them back. But Ethan couldn’t do that. Nobody could. And she was damned if she was going to vent her spleen to a guy with shadows in his eyes who had rebutted every effort she’d ever made to get him to open up to her.

  She shrugged, clawing back her composure. Reaching for the reserve she wore now like an armour against the things that threatened to cut her off at the knees.

  ‘I guess that goes in the bad luck basket, huh?’ she said, her voice still husky with emotion as she raised her glass in his direction.

  Ethan’s gut clenched at her faux flippancy. ‘Olivia... Don’t... You can talk to me...’

  ‘No, Ethan. You and I...we don’t talk.’

  ‘Maybe we should.’

  Olivia snorted. Like that’s going to be a two-way street. ‘Okay, then,’ she said, her voice heavy with sarcasm. ‘You go first. Tell me, Ethan...’ she leaned in closer to him ‘...what happened to you while you were in the military that made you even more screwed up than before you left?’

  Ethan shook his head. ‘Olivia—’

  ‘Bum-bah!’ Olivia hoped that sounded like a game show buzzer. ‘Wrong answer.’

  ‘Olivia.’

  She ignored the note of warning in his voice. She was riding a surge of anger that she thought had been resolved a long time ago.

  Obviously not.

  ‘Oh, no, Ethan. No, no, no. You don’t get to hear my sob story and then just stay all stoic and clammed up. You don’t get to have all of me and keep all of you to yourself like last time. That got me burned bad.’ Olivia gave an hysterical little laugh at the irony of her word-choice.

  Burned.

  ‘You want me to talk to you? Well, that’s a two-way street and we both know...’ she paused and threw back her wine in three long swallows ‘...that’s not the way you play the game.’

  Then she placed the glass on the table and stood. ‘I’m going to check in on Ama before I go home. I’ll see you tomorrow.’

  Ethan stood too. ‘I’ll come with you.’

  Olivia glared at him. ‘No,’ she said. ‘You will not.’

  CHAPTER SEVEN

  ETHAN STOOD IN the corridor just outside Theatre Nine the next morning, watching Kara and Olivia scrubbing up through the glass window in the swing door that led into the scrub room from outside.

  They were chatting—not that he could hear what they were talking about. He wondered if it was about Kara’s revelation last night. About Olivia’s parents. Or maybe about the ball again.

  Although he doubted it. If he knew Olivia it would be about Ama, about the surgery. She liked to go over the game plan as she scrubbed. He’d forgotten that about her, but working with her on his recent surgeries had brought it all back. She’d want to be focused on today, on the surgery. She’d be going over and over the plan in her head.

  The last thing she’d want was to be in a bad emotional place. She was going to need all her concentration for today and she wouldn’t want to have any distractions.

  He admired that about her, and working side by side with her these past few days he’d been impressed by what a first-class surgeon Olivia had become. He’d always known she would be—she’d been impressive a decade ago, when her surgical skills were in their infancy—but he was pleased to see that his predictions had come to fruition.

  Pleased that he’d had the opportunity to see her in action again.

  Pleased that nothing seemed to faze her.

  Her front line experience had shaped her into a mighty fine surgical all-rounder, as it had him, and no matter what surgery he was doing she’d scrubbed up and joined the fray, Ama’s schedule permitting.

  ‘Excuse me,’ someone said from behind him.

  ‘Sorry,’ Ethan said, stepping aside as one of the scout nurses carrying a sterile tray of instruments pushed open the swing door and entered.

  Ethan felt his muscles ache slightly at the sudden movement. After Olivia’s news he hadn’t got much sleep last night, and he’d hit his home gym around midnight, hoping to cause enough exhaustion to cure his insomnia.

  It had been that or the bottle.

  He’d been working on his physio every night since he’d begun spending his days working side by side with Olivia. He’d been suffering from a restless energy when he got home each night and it helped.

  He’d always welcomed the quiet of his apartment, but it seemed oppressively so after a day with chatty Olivia. She seemed always to be in his head, and alone with his own thoughts—thoughts that usually involved Aaliyah—he’d been desperate for something to drive her out.

  So he’d been exercising. Hard to think of anything other than pain when he had to push himself through. Still, he was already feeling the benefits in the strength and stamina of his quads.

  And it was a much better option than what he would have chosen not that long ago—liquid denial.

  Kara and Olivia finished up their scrub and headed for the Theatre, arms out in front of them. Ethan quickly pushed open the door and stepped into the scrub room.

  ‘Olivia,’ he said, and both women stopped and turned around to look at him. ‘Can I have a moment, please?’

  Olivia stifled a sigh. She’d thought it would be too much to ask to just get through this day without some kind of post-mortem over last night. Kara had already apologised three times during their scrub.

  Olivia turned her head and smiled at Kara. ‘Go on ahead,’ she assured the junior surgeon. ‘I won’t be a moment.’ When Kara was gone she turned back to Ethan. ‘I don’t want to do this now, okay?’

  Ethan nodded. He’d suspected as much, but he didn’t want her going in there with any kind of unspoken stuff between them—they needed to be a team. Best to clear the air now. ‘I just wanted to—’

  ‘I know what you “just wanted to,” Ethan,’ Olivia interrupted impatiently. ‘But not now, okay? Can we just get through Ama’s surgery? Can today please just be about Ama?’

  Ethan shoved his hands on his hips. Clearly she was in the zone and did not want to be yanked out of it. ‘Okay.’

  Olivia nodded. ‘Good. See you in there.’

  * * *

  The surgery was involved. They began with removing the protruding teeth that had been warped and buckled by disease, then they cut away all the old scar tissue. Bone was harvested from Ama’s hip to replace the missing section of maxilla and plated and screwed into place. Then a thick piece of skin was removed from her arm and used as a graft to cover the gaping hole in Ama’s face.

  Such a large piece of grafted skin required a blood supply, so they used a small artery and vein from the neck to provide this. Lastly they were able to rebuild the mouth, using what Ama already had and reshaping it to the way it had been before she’d fallen victim to NOMA.

  Five hours later Ama’s face was finally whole again. The surgery was done and she was on her way to the High Dependency ward, where she would be closely monitored for the first twenty-four to forty-eight hours.

  ‘That was incredible,’ Kara said, her eyes sparkling as she degowned and tossed it in the bin.

  Olivia
nodded, relieved and very happy with the result. ‘Yes.’ She grinned. ‘It was.’

  Ama’s face would always be different from everyone else’s. Her cheek would look a different colour and consistency to the rest of her face, with an obvious demarcation around the graft, and her lip line would always be just a little bit deviated.

  But she’d be able to swallow, eat, chew and talk properly. And, more important, she’d have a more socially acceptable face. She could go to school. She could make friends and play with the other children.

  She could be a child.

  ‘You guys were awesome,’ Kara continued as she and Olivia headed to the change-room.

  Olivia wanted to get up to the HDU as soon as possible—Ethan had gone with Ama.

  ‘You didn’t even really talk to each other but you both seemed to know what each other needed. It was like you’d been operating together for years!’

  Olivia had been so engrossed, so in the zone, she hadn’t really noticed. But, looking back, she realised Kara was right. She and Ethan had worked together like a well-oiled machine. But then they’d always been very compatible—in every way.

  ‘It’s just practice,’ Olivia dismissed. ‘You do this for long enough and it becomes second nature.’

  ‘Well, you call it what you want,’ Kara said as she pushed open the change-room doors. ‘I call it synchronicity. And it was pure magic to be a part of it, so thank you.’

  Olivia didn’t know what to say to that. Everything had gone very smoothly—no rabbits out of hats required. ‘You weren’t so shabby yourself,’ she said.

  Kara blushed and looked at Olivia, her face glowing from the compliment. ‘Really?’

  Olivia laughed. ‘Yes, really. Now, stop fishing for compliments and let me get dressed so I can go see our patient.’

  Kara gave a cheeky salute. ‘Yes, ma’am.’

  But she left Olivia in peace and Olivia was dressed and heading to the HDU in ten minutes.

  * * *

  The first couple of hours post-op Ama was pretty out of it. Olivia, Ril and Dali sat quietly by her side, talking occasionally but essentially maintaining a silent vigil. Ethan checked on her a couple of times, with Olivia assuring him that she’d page him when Ama woke or if any complications occurred.

  It was in the third hour that things started to go wrong. Ama awoke in a great deal of distress and pain. She was clearly frightened and thrashing around the bed, pulling off her oxygen mask, calling for her mother.

  She was given a bolus of painkiller intravenously and her morphine infusion rate was increased. It worked temporarily, but she became more agitated and distressed again over the next hour—crying and at one stage, before Olivia leapt up to stop her, clawing at her face, blindly beating at it.

  Ril was becoming distressed by her daughter’s condition as more pain relief was given, the infusion increased further and some sedation added in on top. And both Ethan and Olivia were worried she would damage some of the reconstructive work they’d done with all her thrashing around. They were particularly worried about the viability of the graft. They checked beneath the dressings, but whilst it was oozing there didn’t seem to be any excessive blood and the graft still appeared intact.

  Nonetheless neither of them wanted to take a chance, and Ethan ordered arm restraints which wouldn’t allow Ama to bend her elbows. A nurse wrapped them around her arms and Olivia felt better knowing that Ama wouldn’t be able to reach her face any more if she remained unsettled.

  When next Ama woke she was talking gibberish.

  ‘I don’t know what she’s saying,’ Dali said to Olivia, and there was fear in her eyes for her young charge. ‘They’re just words that don’t make sense and then she talks crazy stuff about spiders on the ceiling.’

  Both Ethan and Olivia looked at each other. ‘It’s the morphine,’ she said.

  Ethan nodded. Of course he should have thought about the possibility of Ama reacting badly to the morphine—the spider hallucinations were a clear sign of that—but the language barrier made everything so much harder.

  ‘We’ll change it to another opioid.’

  A different infusion was started, and a bolus of it given, but Ama was in a significant state so was started on an infusion of a drug to keep her sedated, which finally managed to settle her completely after another half an hour.

  By early evening she was sleeping heavily, although responding briskly to stimuli, and everyone was exhausted. Ril had fallen asleep in a hard plastic chair beside the bed, holding her daughter’s hand, her head on the mattress at an awkward angle. Dali was also dozing.

  Olivia looked at the monitor. All Ama’s vitals looked in good shape and the oxygen mask was firmly in situ. The figures blurred before her eyes as she felt her eyelids drooping. It had been a long and exhausting day. After the smoothness and success of the surgery none of them had planned for this kind of stormy post-op course, although things like reactions to opioids weren’t uncommon.

  It had been draining. And awful to see such genuine distress and terror in Ama, who was usually so bright and sunny despite all the reasons for her not to be.

  Add to that the tumultuous events of last night that had led to very little sleep, and Olivia was finding it hard to keep her eyes open. The room was so quiet and the steady beep, beep, beep of Ama’s monitor was strangely hypnotic. Despite the hard plastic of the chair she was sitting in, it was bliss to shut her eyes. Just for a moment.

  * * *

  Olivia wasn’t sure how long had elapsed when the trilling of Ama’s monitor woke her. She was disorientated at first as she looked at her watch—almost 10:00 p.m. Her back and neck protested as she squinted to focus on the monitor and identify the alarm in the darkened cubicle.

  The oxygen saturations had fallen into the eighties. She also noted there was some tachycardia, and Ama’s blood pressure was a little on the lower end—but it had been anyway, since the sedation had begun.

  Olivia stood up and went over to Ama’s bedside. The oxygen mask had slipped off. She went to place it back on but her hand stilled when she noticed the pallor of Ama’s lips and the gurgly sound of her breathing.

  ‘Ama?’ Olivia said, reaching for the girl’s hand to give it a squeeze. The hand was cold and clammy. Olivia frowned as she placed the mask and called, ‘Ama!’ again, giving her the firm shake of the shoulder to which she’d responded briskly just over an hour ago—nothing.

  Ama’s nurse arrived. ‘The ICU registrar is a couple of minutes away,’ she said. ‘Ama’s been getting increasingly tachycardic the past fifteen minutes, and her sats are starting to drift, so I want him to check her out.’

  Olivia nodded, pleased the nurse was on the ball. ‘Can you page Ethan too, please?’ she asked.

  The nurse went off to do Olivia’s bidding. Ama’s saturations had barely improved, so Olivia turned the oxygen up.

  ‘Ama?’ Olivia said, applying a painful stimulus to the girl’s sternum, using the knuckle of her index finger and rubbing hard. Still nothing. Olivia reached over and paused the infusion of sedation, which she noticed had been decreased significantly since she’d drifted off to sleep.

  Ama should be responding.

  The tone of the saturation trace dropped and Olivia glanced up to see they were only eighty per cent now, despite the extra oxygen.

  She also noticed the respiratory trace was slowing right down. A very bad feeling welled in the pit of Olivia’s stomach as she flicked on the light and assessed the movement of Ama’s chest. It seemed to be barely moving at all.

  Ril woke up, blinking as bright light flooded the cubicle. So did Dali. They were speaking to each other in their language, and Dali was asking Olivia questions, but Olivia was back at the ABCs of medicine.

  Airway.

  That was always priority number one in medicine, and Olivia was
beginning to think Ama’s was compromised. The gurgling she could hear was a concern, and Olivia leaned down, her ear to Ama’s mouth, as she used her index finger to give Ama some jaw-thrust. Blood welled out of Ama’s mouth and Ril looked horrified, pointing and crying and talking rapidly to Dali.

  ‘What is wrong, Olivia?’ Dali asked. ‘What is wrong?’

  Now Olivia was certain Ama was bleeding, but had no idea to what extent.

  The feeling of foreboding increased.

  ‘I’m not sure,’ she said, reaching for the Yankaeur sucker jammed under the pillow, ‘but Ethan’s coming and we’re going to take good care of her—do you hear? Please take Ril along to the parents’ lounge and I’ll come and explain everything as soon as I can.’

  Olivia had a feeling this was going to get messy. And the thick blood slurping noisily into the tubing from Ama’s mouth confirmed it.

  Olivia was aware on a peripheral level that Dali and Ril were having a heated exchange but she shut it out. Ama was her concern.

  Come on, little girl. Don’t do this.

  Do not do this.

  ‘Dali,’ Olivia said as the blood kept coming and Ama remained unresponsive, despite the very potent stimulus of a large plastic sucker hitting the back of her throat, ‘get her out of here now!’

  The nurse returned as Dali led a wailing Ril away. ‘She needs a twenty mil per kilo bolus of whatever you have running,’ Olivia said. ‘And get some of her blood from the fridge.’

  They’d cross-matched six units for surgery but had only used one during the operation because the blood loss had been so minimal.

  Ama was making up for it now.

  Two more nurses entered the cubicle area as the registrar arrived. And Ethan about thirty seconds later. She’d never been more pleased to see him. She was aware that she was quaking on the inside but her training was taking over. Later she’d probably throw up, but right now she was in the zone.

  ‘She’s bleeding,’ Olivia said, not looking up from Ama.

  Ethan felt the same surge of adrenaline he always felt when an emergency evolved. He used it to his advantage to focus himself, to hone his intuition.