Sheikh, Children's Doctor...Husband Page 7

  He wondered if he should mention the leopards and for a moment regretted that he and Bahir had nagged their father into setting up the protected national park area for them and instigating a breeding programme.

  No! He wouldn’t mention the leopards—not yet.

  Alex began with the unconscious child, again feeling all around her head for some displacement in his skull and finding, this time, a small swelling behind her ear, as if something had struck her there.

  She looked up to find a man who’d been squatting a little distance away had moved closer.

  ‘You are her father? Daddy? Papa?’

  The man nodded, anxious eyes asking questions Alex couldn’t understand, let alone answer. Although she could guess at their content—would she live, his daughter? Was she in pain? Why did she lie so still?

  The girl had been awake earlier, she remembered, just unresponsive, but feeling the lump she realised that whatever had struck her had hit her hard enough to cause external swelling, which meant that internally her brain would have been jolted against her skull and the likelihood was that her intracranial pressure was raised. Alex thought with longing of all the tools she’d have at her disposal in a hospital to assist in a diagnosis, but this was emergency medicine at its most basic.

  Azzam was setting up a children’s hospital! Did it follow he was a paediatrician?

  She called his name and he was beside her within seconds, kneeling to examine the little girl, feeling as Alex had felt, around the skull.

  ‘We need to handle her carefully,’ he said, and she knew he was talking to himself as much as to her, running through the protocols for head injury. ‘I’ll lift the head a little and we need to keep it straight to decrease pressure on the jugular veins.’

  Although it was some time since she’d worked with children, Alex knew what he was thinking—the sticks she’d used to make a neck brace could be adding pressure to the blood vessels, so she unwrapped them, making a pillow out of Azzam’s now-filthy gown instead.

  ‘Slip it under her head when I lift it, then pad some of the material against her temples so she can’t turn her head,’ Alex told her.

  The father, seeming to understand what she was doing, put his hands beside the little girl’s head, holding it steady.

  Azzam spoke quietly to the man, no doubt explaining the injury and what they would have to do.

  ‘Should we intubate her to keep her airway clear?’ Alex asked, her mind moving through the stages of what was little more than first aid—all that could be offered here.

  ‘She’s breathing well herself but if you can find a small face mask, we’ll deliver oxygen through that.’

  How could he be so calm when her fingers were shaking as she delved into the medical supplies, seeking the smallest mask she could find? She’d been in situations like this before and surely her hands hadn’t shaken?

  Now, consciously steadying them—thinking only of the task in hand—she fitted the mask over their patient’s face, relieved to find it sealed well. Azzam had already adjusted the flow on the oxygen tank’s small dial and now he secured the outflow tube to the mask, the father watching every move they made, the anxiety he was feeling evident in his anguished eyes and the tension of his body.

  Thinking medically to block out all other thoughts, Alex’s mind raced through different scenarios. But she wasn’t alone here—she had Azzam!

  ‘Swelling in the brain—should we restrict fluids?’

  ‘The child needs some fluid,’ he responded. ‘Let’s try thirty per cent of a maintenance dose for a start. She’d weigh, what? She’s so slight. Twenty-five kilos?’

  Alex understood he was asking her as a colleague, a fellow professional, and the idea steadied her, although why she’d imagined he wouldn’t she had no idea.

  ‘I’d say twenty-five kilos,’ she responded, doing the sums in her head. ‘You’ve started five drips—how much fluid do we have?’

  ‘Enough,’ he told her. ‘We have to give her diuretic drugs to relieve the pressure on her brain and we can’t do that without giving her some fluid. I think you’ll find another bag of fluid in the kit by that tree. I’ll find some mannitol in this bag and we can titrate it into the fluid.’

  He paused, then said quietly, ‘She’ll need to be watched through the night. If the pressure builds, we might have to release it manually.’

  Manually?

  Alex shuddered as she stood up to fetch the fluid. Manually meant boring a hole into the child’s skull, not exactly the kind of operation you wanted to carry out in the dark on a bare patch of earth that was likely to tremble any time.

  Had the father understood some of the conversation that he was looking more anxious now?

  This was a child—a loved child. She deserved a chance at life, so of course if they had to operate they would do it.

  Alex watched as Azzam, with infinite gentleness, swabbed the little hand, found a vein, and eased a cannula into it, attached a tube, fitted the other end to the bag of fluid, calibrated it to drip in slowly and added the mannitol to filter slowly into the girl’s blood.

  He passed the bag to the father, picked up a hunk of masonry and spoke to the man, obviously indicating he should build a small stand for the bag, but the father shook his head and held it high, understanding what was needed but determined to do this small thing for his daughter.

  ‘In a hospital we’d be measuring fluid output as well,’ Azzam said quietly, the rest of the sentence, but we’re not in a hospital, left unspoken.

  Alex moved on to the next child, one she hadn’t found an injury on earlier, although the child had been huddled by the teacher. He’d been totally unresponsive, this little boy, and he was still limp, now held across his mother’s lap, her fingers moving restlessly against his skin, smoothing his face and hair, her dark eyes filled with despair.

  Alex touched the woman gently on the arm before beginning her examination, and the woman nodded to her.

  The boy’s stomach was distended, his pulse racing now, his breath coming in shallow gasps.

  Internal bleeding?

  Alex moved his mother closer to the light so she could see the child more clearly but could find no sign of bruising on his skin. She was pressing gently on his ribs when the little body went into a violent spasm and she knew he’d died, drowned in his own blood perhaps, or his heart compressed by the fluid inside him to the stage where it stopped beating.

  Azzam was by her side in an instant, no doubt having heard the woman’s wail of despair. He took the little boy and laid him on the ground, his finger checking the mouth was clear of obstruction, listening for breathing, blowing two quick breaths into the child’s open mouth, before his hands moved to the small chest, delivering thirty quick compressions before breathing for the boy again.

  ‘Let me do the breathing,’ Alex told him, shifting to the child’s head, vaguely ashamed she hadn’t acted faster, but she’d been so struck by Azzam’s immediate reaction that she’d watched instead of moving.

  They worked together, Alex counting the compressions out loud now, willing the little boy to live, but eventually the mother moved, taking Azzam’s hand, speaking urgently to him, all but pushing him away from her son.

  ‘She says it is the will of God,’ he whispered to Alex, and she heard the despair of defeat in his voice.

  Standing up, she took his hand, squeezing it as she helped him to his feet, keeping hold of it as the woman lifted her son into her arms, rocking him against her body as she swayed back and forth, moving to her harsh cries of grief.

  Azzam removed his hand and walked away, and Alex could only watch him go, aware of the burden he was carrying but not knowing what to say or do to ease it.

  ‘You did try,’ was all she could offer. ‘And even if we’d got him breathing again, with no facilities to operate and fix whatever was injured inside him, he would surely have died before reaching hospital.’

  Azzam ignored her words, walking on to where most of the inju
red adults had been assembled, close by a gnarled old tree.

  Alex watched him for a moment then moved on to the next child—the boy with the broken humerus. Beside him sat his sister, the baby in her arms. The baby was asleep but would surely wake hungry. How to tell the girl to take it to where the uninjured villagers were gathered so they could both get some food?

  Using sign language, bringing her hands to her mouth to indicate eating, then pointing towards the palm grove, she urged the girl away, but the child had no intention of deserting her post. Alex bent and kissed her head, thinking of her own brother—Rob—whom she had loved just as devotedly, and whom she couldn’t hate no matter how much he’d hurt their mother, or how much chaos he’d left behind him.

  But it was this child she had to treat—this boy she had to consider! He was in shock, trembling all over, and she found the scarf she’d discarded after coming out of the hole with the baby and wrapped it around him, carefully avoiding his arm, which she’d bound against his body earlier.

  ‘I’ve thirteen serious injuries, patients who, if they survive the night, will have to be airlifted out.’

  Azzam had returned and his words sent shivers down her spine. Two, maybe three, people could be lifted out at a time, the helicopter flying back and forth, maybe two helicopters, but would they have the support staff, paramedics, necessary to staff two?

  ‘So I should splint and bandage the boy’s arm to hold the bone aligned until he can be taken in an ambulance?’ She looked up at Azzam as she spoke.

  His face was shadowed, the light behind him, but she’d heard the horror of what they were experiencing—and the death of the child—in his voice and knew that, as these were his people, he would be feeling the pain of the disaster even more deeply than she was.

  ‘We’ll only airlift out the most severely injured,’ he agreed, then knelt beside her, her response to his presence gratitude that he’d returned to share the decisions that had to be made, nothing else.

  Or so she told herself!

  ‘I will help you with the boy,’ he said. ‘It’s easier with two, and there is nothing I can do until more survivors are brought out of the rubble.’

  The little girl scuttled sideways to make room for him, but now watched both adults, her gaze switching from one to the other, a pint-sized guard ready to defend her brother should they attempt to do him any harm.

  ‘Can you tell her where to go to get some food, and if possible some milk for the baby?’ Alex asked him, nodding at the child. ‘Maybe do your prince thing,’ she added, smiling at him, although there was little to smile about in this place of devastation.

  Azzam saw the smile and felt his heart lift, the hopelessness that had been creeping on him dissolving like desert mist before the sun.

  He didn’t question what the woman had that could make him feel this way, just accepted the gift of optimism she’d handed him.

  ‘Prince thing?’ he queried.

  ‘My helper by the school was most impressed by your standing, repeating your name and saying “He is the prince” in tones of absolute awe.’

  ‘I would rather be a doctor,’ he muttered at her, but he did speak to the little girl, telling her to take the baby to the date grove.

  The child left, reluctantly.

  ‘You can’t be both?’ Alex asked as she unwrapped the cloth—her scarf, he noticed—from around the boy’s fractured arm.

  ‘I doubt it,’ he answered, although a simple ‘No’ would have been more truthful. ‘Maybe, later on, when I know the duties expected of me and can see a path forward—maybe then I can give some time to the project of my heart.’

  Project of his heart? Was it the circumstances in which they found themselves that he was telling this stranger—this female stranger—something he’d never said aloud, not even to Bahir? Oh, Bahir had known his brother was obsessive about the new hospital, but hadn’t understood it was for people like these mountain folk, who feared the city and its ways, that he’d wanted to build the special hospital for children—a place where the whole family could stay beside their sick child—a place where they would not feel intimidated by machinery and uniforms and strangers tending their child.

  Fortunately Alex didn’t hear the phrase, or, if she did, she forbore to question it. She’d found some morphine in the kit, worked out a dose and administered it to the child while Azzam’s mind had drifted far from the job in hand.

  Concentrating now, he took the boy’s arm, aligning the bone as best he could by feel, Alex holding the splints in place while he bound it.

  She looked up at him and smiled again.

  Alex—a woman he’d met less than, what, forty-eight hours ago? Yet her smile—several smiles now—had shifted his world…

  The exhaustion still dogging him had caused the shift, not the smile! He had trained himself to not respond to female smiles, the hurt inside still too raw to want to trust his feelings.

  Although was the hurt still there?

  He tried to think when he’d last felt that stab of pain.

  Maybe his lack of interest in seeking out female company lately had been more because of his immersion in his work than the fear of new heartbreak.

  Heartbreak?

  Did he really believe that?

  Hadn’t his pain been hurt pride more than anything else?

  Azzam shut off the stupid thoughts racing through his head, concentrating instead on the job in hand. He finished binding the boy’s arm and fashioned a sling to hold it against his chest, his mind still muddling over motives and reactions—in all honesty, it would be easier to be considering the leopards.

  ‘We should keep watch tonight.’

  The words brought him out of his thoughts and he looked up to see the headman of the village had approached them. Welcoming the distraction, Azzam stood up to talk to him and to listen to tales of recent leopard sightings near the village and how the villagers now kept their animals inside at night to prevent attacks.

  ‘I’ve been thinking about the leopards,’ Azzam told him, unconsciously using not the local word, nimr but the English word so that Alex looked up, repeating it.

  ‘Leopards? Leopards out here? You can’t be serious? Don’t leopards live in Africa? Don’t they sprawl on the limbs of trees ready to drop on unsuspecting passing animals? Where are trees here?’

  She sounded so indignant he had to smile.

  ‘Arabian leopards live in the mountains—they climb rocks and cliffs to drop on their unsuspecting prey. They were close to extinction twenty years ago, but a good breeding programme means the mountain areas have been restocked with them.’

  ‘Great!’ she muttered. ‘Here I was thinking that the worst thing that could happen was another earth tremor and the mountain would fall on us, but now you tell me a very large and probably hungry cat could cart me off into the night!’

  Azzam found himself chuckling now, then he translated her words to the headman who also laughed, though he quickly added, ‘But she is right, they’ll smell blood and could prove a danger.’

  ‘We’ll set a watch. Keep everyone together, light fires if we can find fuel, and do whatever is necessary to keep the people safe. I don’t want to move the injured, so perhaps we should set up camp close by where they are, although the date grove would provide better shelter.’

  ‘We can make shelters,’ the headman told him. ‘We have tents for the goat and camel herders who move the animals to different pastures. We have not lost our traditional ways, not all of us.’

  The man departed and before long the uninjured began to gather on the grassy area, close to where the injured lay but not too close.

  Alex watched the survivors drift like shadows through the night, heard the quiet chatter as they settled around the area where she sat with the children. Some men, and possibly some women, were still removing debris and she could hear their voices, warnings sounded and sometimes cries that told of joy—another person rescued.

  ‘Who will protect the workers on
the rubble from the leopards?’ she asked Azzam when he returned with the headman and began to organise the erection of temporary shelter over the area where the wounded lay.

  ‘I will call them in shortly,’ he told her. ‘It is too dangerous both for them and for anyone who might still be buried underneath for people to work at night, and the generator only has so much fuel, so it’s best to conserve it for emergencies.’

  ‘And these three children—the boy and his sister and the baby? Isn’t it strange no adults have come looking for them? In a village, wouldn’t someone be related to them?’

  Azzam frowned down at the little boy.

  ‘Of course there should be someone who would care for them. I will ask.’

  You didn’t have to be a prince to be efficient, Alex thought to herself as he walked away. But did the aura of the ruler add weight to his suggestions and advice? Did him being here bring solace and comfort to people who had lost everything, including, in some cases, a loved one?

  Men and women seemed to share the chores, erecting tents, finding food, lighting fires, and now the scent of the frankincense she’d first found in the shampoo perfumed the night. Was it special, as Hafa had said, because it protected the people? Or because it was from some plant native to this country?

  The little girl returned, the baby in her arms and a baby’s bottle, miraculously found somewhere, full of watery-looking milk. She settled beside her brother, and once again Alex’s heart ached for the three children—the little that remained of the family. The child lay down beside her brother, obviously exhausted for her eyes closed and the baby slipped from her grasp.

  Alex picked up the infant, awake but uncomplaining, and used her now-filthy scarf to tie it to her chest. She could work among the injured knowing the baby was secure, but she didn’t want to move too far from the children either—not until someone had claimed them.

  Azzam, too, returned.

  ‘You should sleep, but first you must eat. I have brought some bread. It isn’t much, but with water it will make your stomach think it’s been fed.’