‘YOU SEE THE ulcer lies on the antrum of the patient’s stomach?’ Elle glanced at her student. ‘So what would you suggest?’
‘Wedge excision,’ Amir said confidently. ‘Closure of the consequential defect should be achieved fairly easily without significant deformation of the stomach.’
‘Good.’ Elle nodded. ‘And if the ulcer had instead been along the lesser curvature of the stomach?’
‘It would be more problematic. More prone to re-bleeding because of the rich complex of blood vessels from the left gastric artery.’
‘Anything else?’
Amir paused, and she couldn’t be sure whether it was the language barrier or a gap in his knowledge. Many of the local doctors here were on an extremely steep learning curve but she was continually impressed by their eagerness to soak up everything she and her team were teaching them. And having a CO like Phil, who didn’t just have decades of experience as a brilliant surgeon but was also an inspiring teacher, certainly kept Elle at her best. It was a challenge she usually relished.
But not today.
For the past couple of days all she’d wanted to do was stay in her army cot, lick her wounds, and hope that everything looked a little less grim when Fitz finally left the hospital camp and headed back to Razorwire.
That, obviously, hadn’t been an option. But at least she’d managed to avoid him since that awful day in his office, to give herself the chance to start thinking straight again. At first she’d vacillated between rage and mortification. Rage that he’d lifted the lid on their attraction and mortification that he’d shut her down so completely.
She dragged her mind back to the present and to Amir.
‘Okay, wedge excision of gastric ulcers along the lesser curvature of the stomach is harder to do and is much more likely to result in a deformed J-shaped stomach and luminal obstruction or gastric volvulus, which is rotation of the stomach by more than one hundred and eighty degrees...’
‘Yes, yes.’ Amir nodded vigorously. ‘Inconstant blood loss, obstruction of materials moving through the stomach, and sometimes tissue death.’
‘Okay, good.’ Elle smiled. ‘We’ll go over it again, it’s something you’re likely to come across often here. Right, let’s see what we can do for our patient here.’
She worked carefully, talking Amir through each step, until finally she was satisfied, taking half a step back and straightening her spine.
‘Did you ask your Colonel Duggan if you can continue here, or return on...what you call it, a back-to-back tour when this tour of yours now is over?’
Lifting her head, Elle glanced into the hopeful expression on Amir’s face. Having started this tour of duty at Razorwire, once her three months here were up, two more rotations of army doctors would take over during the course of the next twelve months, and Elle had hoped to be able to return on the last one. The fact that Amir also hoped she would return spoke volumes about her teaching style and Elle couldn’t help smiling proudly.
‘Colonel Duggan, yes. I did chat with him while he was here, unofficially of course. He considered the possibility of me returning within the year was quite high, but there’s no guarantee, of course.’
‘That’s wonderful news. You are so dedicated to your career, you sacrifice greatly to be a soldier doctor, yes? But it is your life, you are single-minded, and you are not needing anything else. It inspires much.’
‘Thank you,’ Elle managed graciously, trying not to frown. ‘Right, you recall the suture technique I demonstrated yesterday? Good. Because I want you to close up now.’
Amir nodded, clearly pleased, and stepped forward, leaving Elle, her eyes still on the surgery, to wonder if she wasn’t a little too single-minded.
How else to forge a career like this? Fitz must have done the same. Was that what he’d meant about not being good for her? She could hardly square the Fitz she’d met that night with the Colonel who was out here. It wasn’t so much like two sides to the one man as it was two completely different men. The man from that night who had told her things about his past, about his family, had been very different from the man who had stood in front of her the other day and lied to her. She was sure of it.
Clearly Major Howes knew Fitz well from the past and still liked and respected him, and, from what little she could tell, so did the rest of the men in the troop from Fitz’s regiment. And surely they should know—he was their commanding officer after all. He might only just be at the start of his two-year posting as their colonel but morale among them had certainly appeared boosted in the few days he’d been on site.
She couldn’t shake the idea that none of them had ever seen the Fitz she’d met that night. Neither could she shake the idea that there had been more between them that night than either of them had realised. Enough for him to tell her things he’d never told anyone. And after the way Stevie had lied to her, she valued honesty more than ever.
Either way it was irrelevant. She shook the thought away irritably. She was never going to get the chance to find out. Fitz had made it more than clear that as much as he was still attracted to her, he wasn’t interested in opening himself up to anyone. As for her, she’d obviously let herself get too emotionally involved to be any good at no-strings sex. And the wounds from her years with Stevie were still too fresh, she wasn’t ready for another relationship. Not that it was even on the cards with Fitz.
So where did that leave her?
With your career, she reminded herself firmly. When all else failed, she’d always have her role as an army doctor to rely on. She drowned out the little voice that suggested that she might have liked to have known Fitz just a little better. As he’d said, he wasn’t the man she’d imagined him to be.
She shrugged off her gloomy thoughts and leaned in to check Amir’s sutures.
She might have nothing back home, but she had her career and hadn’t that always been the most important thing to her? And right now she had command of a hospital that, partially destroyed or not, brought different cases every day.
While Royal Engineers and logistics units worked on building, rebuilding and refitting the old hospital so that some of the major international charities would send teams out over the coming years, her job was to keep the medical side running in the meantime. Local communities were desperate to be able to use the hospital again, instead of having to make the hazardous four-hour drive across the border to the next closest hospital. No one wanted to risk the drive if they could avoid it, with the unsafe roads and dangerous checkpoint crossing, not to mention the fact that, out here, it was down to the men to allow their wives or children to seek medical help, so the more accessible it was, the easier that would be.
But with so few surgeons and doctors there was no place for specialties and the experience was testing and refreshing her knowledge all the time. Elle found it both exciting and challenging, with patients ranging from babies to the elderly, and from victims who’d stepped on old, forgotten landmines to women having labour problems. In fact, the latter accounted for a huge percentage of her operations, given maternal mortality was so high out here, all of which was a far cry from the combat trauma she’d been doing in other postings over the last few years. She couldn’t afford to let Fitz ruin what was otherwise a unique career opportunity for her.
What had Fitz said? That he destroyed everything? That he’d destroy her?
She was beginning to understand just how close to the mark that was.
Shaking the bleak thoughts from her head, Elle concentrated on her task of watching her student work, commenting if necessary but trying to take a step back as much as she could. Amir’s work was neat and clean; he picked things up quickly but he also listened well and watched closely. He would likely be a real asset to the hospital in very little time, which was good since he’d have his work cut out for him.
Finally, he was closing up on the perforated ulcer patient.
‘Nice job,’ she congratulated him. ‘How would you feel about heading up a mobile team on your own this time? We’re due to carry out a round of measles and polio vaccinations for infants in some of the outlying communities.’
A surprised look crossed the young doctor’s face, swiftly replaced by a proud one.
‘I’d like that very much.’
‘I’m not sure but I heard something about a sandstorm being due in the next couple of days,’ one of the voluntary aid nurses interjected apologetically. ‘Of course you can never be sure, and there’s every chance you might get out and back before it even hits, but...’
‘But you can’t be too safe.’ Elle flashed her a bright smile to reassure her. ‘Then we’ll hold back for now but pick your team and as soon as we get the all-clear you can go, Amir.’
‘Thank you,’ he nodded. ‘I will.’
‘Major?’
Elle craned her neck around as one of the designated liaison soldiers stood at the edge of the privacy screen, evidently having heard the exchange and concluding he wouldn’t be disturbing them. He could have been there for any length of time, waiting patiently while they carried out the operation.
For the moment, the simple screen set-up was the only thing to separate the delivery room from the open ward. In a few months it would all look completely different and would be significantly more sterile and high-tech. For now, it was all they had.
‘What is it, Corporal?’ With a final check on Amir’s work, Elle stepped around the screen.
‘Colonel Fitzwilliam asked if you were available to go through a couple of design modifications with him and Major Howes for the power and water supplies to the hospital.’
And just like that, her heart slammed against her chest wall. He’d had the presence to include Major Howes in the message but she couldn’t work out whether it was a good thing or a bad one. They would have a buffer, true, but there would be even more pressure to act normally—whatever that meant—around Fitz, and she wasn’t sure she was enough of an actress to pull it off.
‘We’re almost done here.’ Elle had no idea how the words came out, as strangled as they sounded to her ears.
The corporal, however, didn’t seem to notice anything amiss.
‘Ma’am.’
‘Will you inform the Colonel I’ll be there within the half-hour?’
‘Yes, Major.’
She watched him leave and stood motionless long after the double doors had closed and stilled behind the lad. Her hands felt sticky, her heart was racing, and none of it was due to the searing temperatures inside that operating area. She’d performed two Caesareans and overseen the perforated ulcer operation pretty much back to back this morning, and yet one mention of Fitz and she was instantly flustered. It didn’t bode well for their future working relationship.
Finally, almost jerkily, she managed to get her legs moving again and rounded the screen to help Amir finish up. The last suture was put in place as a strange rattling began and the ground felt like it was shaking beneath their feet.
Earthquake. Not uncommon out here and probably some distance away, but it was certainly a strong one. She grabbed hold of the bed, more concerned that the patient didn’t fall to the floor.
It seemed as though the very earth was mirroring her uncertainty out here. She snorted quietly to herself and waited for the quake to end.
* * *
‘So the Colonel and I thought we could extend this part of the facility...’ Carl tapped the plans with the tip of his pencil ‘...and move the ICU to where the ORs would have been, and therefore demolish the block where the ICU is currently planned to be.’
‘That won’t work.’ Elle shook her head, keeping her focus firmly on Carl, as she had during the entire briefing.
If she allowed herself to look at Fitz, even once, she was afraid she would crumple, but now she could see him in her peripheral vision, moving forward in his chair.
‘Why not, Major?’ he demanded tightly.
She bristled. That steely part of her core that had been AWOL for the last few days started to hum back into life. She composed herself and faced him.
‘The ICU would still connect to the ORs, Colonel,’ she acknowledged, ‘but that’s a long way around for one of the wards. In an emergency it would take too long and I’d end up having to rush men to Theatre through the women’s ward, or vice versa.’
‘Ah, I see.’ She could almost hear his tone relax.
Had he been as apprehensive about this meeting as her?
Somehow, that made her feel a fraction better.
‘Then there’s another option.’ Fitz moved his hand across the plans and she shivered, stopping herself from recalling quite how that strong palm had felt on her skin. ‘If we moved the ORs to this location we could put the plant room for the medical gas supply system here. The ICU would go here and the wards could be there, or there. The generators would then go here and we could even tap into the aquifer with a new pipeline to ensure the running water for the facility is as clean as it possibly can be until the government builds a new waste management plant next year.’
Quickly, she ran it over and over in her head. It looked promising, although her sixth sense told her there was one area that could be improved from a medical point of view, but which they couldn’t have foreseen as engineers.
‘Would that work for you, Major?’ Fitz asked.
‘It looks like a viable solution and I like the sound of it,’ she mused. ‘I might like to make a couple of tweaks to the internal layout designs if it’s to work optimally. How long do I have to go over it?’
‘How long do you need?’
Fitz’s voice was so flat she couldn’t work out what he was thinking.
‘Not long. I’d like to get it back to you by the end of today, as long as we don’t get an influx of emergencies. With Colonel Duggan back at Razorwire, we’re down a surgeon and a teacher.’
‘At the moment we’re still going through the hospital itself to make the last structural repairs to the east wing, such as it is.’ Carl smiled. ‘But I’d like to start on the external foundations this week. I’m heading out with a logistics convoy to inspect the ongoing railhead operation in the north and won’t be back until tomorrow, so what if I leave the plans with you overnight and then go through them with you when I return?’
Her body numbed.
If Carl was going off-site then it meant that if there were any issues needing immediate discussion or resolution she’d have to deal with Fitz directly. The thought of having to work on anything one on one with him set her stomach churning with fear.
‘I’m heading a medical convoy out into the communities myself tomorrow.’ She sent out a silent apology to Amir for taking his place after she’d just offered it to him. ‘I’ll be gone for a few days.’ She feigned apology. ‘I could look at it tonight and then pass it to my second-in-command to go through it with you?’
Fitz spoke before Carl could answer.
‘Major Howes, if you could ask Staff Sergeant Bell to start on that area of ground we discussed this morning?’
‘Colonel.’ Carl dipped his head, heading quickly out of the door.
Fitz waited for it to close before confronting her.
‘Why are you taking a mobile medical unit into the communities?’
Elle raised her eyebrow. They both knew the question wasn’t within his remit as commanding officer of the Royal Engineers. She could have challenged him, but instead she chose to play it straight down the line as strictly professional.
‘I have a wave of IPVs to administer.’
‘IPVs?’
‘Inactivated polio vaccines. Part of the medical role out here is to ensure every child under the age of ten has been vaccinated against polio and measles. We can’t guarantee the husbands will make the trip to me for their children so until the charities arrive to begin the grandmothers’ health groups, we stand more chance of getting the men to agree if we go to them.’
‘And the grandmothers’ health groups are...?’
‘Like many of the places the charities have worked, out here it’s down to the men to decide whether their wives and children can get medical help. Over the decades they’ve found that the most effective way to encourage attitude change is to teach the grandmothers. They are some of the most valued and respected people within their communities and they have more influence over their sons and sons-in-law than the young wives do over their husbands.’
‘I see. But until we’ve completed a lot of the rebuild, the charities aren’t going to be out here. So going into the communities makes them more amenable?’
‘Sure. A lot of it is more about lack of information and advice than anything. Not all families have the means, or inclination, to get to the hospital, so I go to them. We try to educate them on why getting their child immunised is so important, and describe symptoms such as acute flaccid paralysis so that they know what to look out for and when to bring their child to us at the hospital.’
‘Which communities?’ he bit out.
‘Say again?’
‘When you head out tomorrow, which direction?’
‘South-west.’ She frowned. ‘I don’t see—’
‘Is that entirely necessary? The region isn’t safe at the moment,’ Fitz cut her off, oblivious. ‘There are severe dust storms in that area at the moment, advancing walls of dust and debris that can be miles wide and thousands of feet high.’
‘Yes, thank you.’ She bit her tongue from giving a flippant retort and battled to keep her voice even. ‘This isn’t my first tour of duty, I have come across dust storms before.’
For a moment she thought she saw a flash of concern on Fitz’s face. Then it was gone.
‘Good, then I shouldn’t need to tell you that heading into the local communities right now is a bad idea. There are wide expanses in that direction, the roads are barely roads and the risk of RTAs is much higher.’
Her irritation, her discomfort all dissolved as a wisp of empathy curled its way up from her stomach. She recalled that haunted look in his eyes from the first night, pained and helpless, when he’d told her how his family had died in a crash. His father, drink-driving. A murmur escaped her lips.
‘This is about the crash, isn’t it? You’re worried about a convoy crash?’
There were units driving in and out of the site all the time, especially logistics convoys as they ferried supplies. So, perhaps more accurately, he was worried about her convoy being caught by a rapidly moving wall of dust.
She was absurdly touched, even as his face turned deathly white. Abruptly his eyes burned with fury, searing her to the spot, a snarl twisting the features she’d touched, kissed, tasted.
‘Why would you say that?’ he rasped, his anger bouncing off the walls, making the tiny room throb.
Anyone else might be intimidated. Elle refused to allow herself to be. Instead, she peered at him.
‘You don’t remember telling me about your mum and sister?’
‘I remember,’ he ground out, as if waiting for her to say something else.
She licked her lips, steadying herself.
‘I think you feel somehow responsible. Maybe for not being there. Maybe because they died and you lived. But because you couldn’t control that situation, you’re concerned about my convoy going out tomorrow.’
The silence swelled and the small space felt even more stifled, like a pressurised can left out in the sweltering sun. But she wasn’t about to back down.
‘That’s it?’ His bark of laughter rang out, a hollow and unpleasant sound.
‘Isn’t it enough?’ she asked softly.
And then, oddly, she could have sworn relief flickered in those eyes, swiftly chased by disdain.
‘I suppose it is.’ He shrugged. ‘But, no, telling you about my family was a combination of factors from that night; let me assure you it wasn’t anything special about you. I was merely concerned about your team in Colonel Duggan’s absence. So, if you’ve quite finished psychoanalysing me...’
It was all she could do to stay upright. His words were as cutting as if he’d taken her out by the knee, winding her and humiliating her in one smooth strike. What a fool she was for thinking he’d been worried about her. When was she going to get it through her head that whatever they’d shared that night, in Fitz’s head it was over and done with?