LITMIR.BIZ

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ones you had to worry about most. Children who cried or played had to be fit enough to react to their environment. Those who lay limply in their mothers’ arms were almost always the most in need of urgent attention.

      On her first morning, she’d been allocated her duties by the medical officer in charge and she’d had her nose to the grindstone ever since. As the only paediatrician, Cassie was responsible for all the children the nurses referred to her at the daily morning outpatient clinic. She also had charge of the small but well-equipped children’s ward and special-care facility on board and, in addition, she would assist with paediatric cases in Theatre whenever her help was required.

      None of it fazed her in the slightest. She’d done a year as a surgical resident as part of her paediatric training and although didn’t want to specialise in surgery had enjoyed her time in Theatre. In fact, the more challenges, the harder the work, the better.

      She stopped for a moment to drink some water. In this heat it was important to keep hydrated. Suddenly, she heard a commotion in one of the other lines. Although the patients had to wait for hours in the burning sun they rarely complained so any disturbance had to mean something was wrong. With a quick word to the nurse who was assisting her, she went to see what it was about.

      When she reached the point in the line where the cries had been coming from, the patients stood back. A young woman, perhaps no more than seventeen, was lying on the ground, clutching her swollen stomach and moaning with pain. Cassie dropped to her knees. Judging by the size of her abdomen, the woman was close to giving birth. Then Cassie saw something that instantly put her on red alert. There was a pool of blood soaking the woman’s dress.

      ‘Get help!’ she shouted to the chattering bystanders. She instructed some of the women to form a shield and lifted the woman’s dress. Her thighs were covered in blood. This was a possible placental abruption—an obstetric emergency—and not Cassie’s area of expertise. Unless the woman had a Caesarean in the next few minutes and was transfused, she would die.

      As Cassie lifted her head to shout for a stretcher, someone crouched down next to her. It was the man from the gangway—Dr Ballantyne. Apart from that first day, four days ago, she hadn’t spoken to him. She’d seen him about, of course, he wasn’t exactly the kind of man that blended into his surroundings, but, as she’d promised herself, she’d gone out of her way to avoid him. Why that was she wasn’t quite sure. Only that he unsettled her—and she didn’t like being unsettled.

      ‘Hello again,’ he said quietly. Without Cassie having to say anything, he took in the situation at a glance. ‘Looks like a possible placenta abruption,’ he said grimly. ‘There’s no time to take her to Theatre on board. We’ll have to get her inside and operate here.’

      Cassie looked around. They could do with some help—a nurse and an anaesthetist for a start. But most of the doctors and nurses had stopped for lunch and retreated to the shady, cool dining room on the ship.

      ‘We need a stretcher over here,’ Leith called out. Cassie breathed a sigh of relief when two nurses emerged from the interior of one of the huts. One of the local volunteers brought a stretcher and working together they loaded the stricken woman onto it.

      ‘I need an anaesthetist,’ Leith said. ‘Like now.’

      ‘They’re all on board,’ the nurse said. ‘Do you want me to send for one of them?’

      ‘Yes. Go!’ As soon as the nurse had taken off, Leith looked at Cassie. ‘Even if she finds someone straight away, by the time they get here it will be too late. Have you ever given a spinal?’

      Cassie nodded. She brought up a mental image of a medical textbook. Luckily she had an almost encyclopaedic memory, one of the few benefits of a childhood spent mostly with books.

      Although she’d been warned that working on the Mercy Ship might mean stepping out of her own area of expertise, she hadn’t expected to be assisting with a case of placental abruption quite so soon after her arrival. She was glad that Leith was there and appeared to be taking it all in his stride.

      As he prepped the patient’s abdomen, Cassie loaded a syringe with local anaesthetic. Then they turned the woman on her side and Leith held her firmly while Cassie cupped the expectant mother’s hips, feeling for the bones of the pelvis. Bringing her thumbs towards the middle line and on either side of the spine, she found the space between the L3 and L4 vertebrae. She moved up to the next space. It was important to take her time. If she gave it in the wrong place, the woman could be paralysed, but in the end the spinal went every bit as smoothly as she’d anticipated.

      While they waited for the anaesthetic to take effect Leith took blood for cross-matching and gave the sample to the nurse to take to the ship’s laboratory. Waiting for the results would take time—when every minute could mean the difference between life and survival.

      In the meantime, the midwife had returned, bringing some bags of saline back with her, and Leith immediately set about putting up a drip.

      ‘They are preparing a theatre for you,’ the midwife said.

      ‘It’s too late,’ Leith replied. Cassie ignored the flutter of anxiety in her abdomen and made sure to keep her expression noncommittal. Another skill she had mastered in her childhood.

      As soon as she was satisfied that the woman couldn’t feel anything below her waist, she nodded to Leith, who started to operate. With Cassie keeping an eye on the woman’s breathing, he sliced into the abdomen and a few minutes later pulled out a small, perfectly formed baby, who was, however, disturbingly limp and still. Cassie stepped forward and as soon as she had checked that there were no secretions blocking the airway of the baby girl, she immediately began to breathe into the newborn’s mouth. Go on, little one. Breathe for me. If not for me, for your mummy. Come on, you can do it.

      To her relief, after a few breaths the child gave a gasp and a cry. When she glanced at Leith he grinned and gave her a thumbs-up. She smiled back at him. They’d saved this baby.

      They weren’t out of the woods yet. The neonate needed to be taken on board the Mercy Ship and straight to the special-care nursery.

      Thankfully, just at that moment another two nurses, pushing a portable incubator, rushed into the room. Now the baby would get the mechanical support she required and once she got to the ship she would have the all help the singing and dancing tiny special-care unit could give her. As the midwives transferred the baby to the incubator, Cassie glanced back at the baby’s mother and was alarmed to see that blood had pooled in her abdomen.

      ‘Damn. I’m going to have to do a hysterectomy,’ Leith said. ‘But she’ll need to be fully anaesthetised first. That isn’t something I can do here. We need to get her to Theatre.’

      As Leith started to pack the pelvis with swabs, one of the other doctors hurried into the room. Knowing that she would only get in the way if she stayed, Cassie left the mother in their hands and accompanied the baby and incubator back on board.

      Once the baby was settled, Cassie handed over her care to the neonatal nurse. Although the baby was slightly smaller than Cassie would have liked, she was breathing well on her own. As soon as the mother had recovered from her anaesthetic, a nurse would bring baby to her to have a feed.

      By now it was after one and Cassie had to return to her clinic to see the patients still waiting, and after she’d finished there she was due in Theatre to assist with an operation. Knowing it was unlikely that she would have time for a sit-down lunch, she grabbed a sandwich from the hospital canteen before making her way on deck for a five-minute break.

      She closed her eyes and let the sea breeze cool her cheeks. Immediately an image of Leith filled her head. Whenever she’d seen him on the ship, he’d been playing cards or teasing the nurses, as if medicine was the last thing on his mind. Occasionally, he’d glance her way, but she avoided his eyes and always found a seat as far away from him as possible.

      Which one was the real Leith? The flirtatious, I-know-I’m-sexy-doctor of their first meeting or the one who’d been so focussed on his patient he’d barely noticed her? She shook

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