Chapter 1 #2
Alex studied Katie—or at least the tip of her nose where it poked out of her mummy sleeping bag. She could be a serious problem. She’d had already shown decent intuition and was much smarter than he’d first thought. Not to mention, she was easy on the eye. The first thing he’d noticed about her was the lush, brunette hair falling in soft waves around her pretty face. And her bright blue eyes. And her attractive, athletic figure.
What really drew him, to her though, was her smile. It was warm and genuine and filled a room.
A rock clattered outside. He froze, every sense abruptly on full alert. Silently, he shed the sleeping bag he’d wrapped around his shoulders and eased into a dark shadow beside the front tarp where the stove’s light didn’t reach. With a flick of his hand, he released a razor-sharp knife from its wrist sheath and let it slide into his palm.
Voices whispered nervously on the other side of the canvas front of him. Female voices.
He slipped the knife back in its sheath and moved swiftly to Katie’s sleeping bag. To give her shoulder a sight shake. “Wake up.”
“Wha—” She mumbled pushing back the sleeping bag to peer blearily at him. Heavy sleeper. Must be nice to be so na?ve. It had been a long time since he’d thought the world was safe enough to sleep like that.
“We have company.”
She tried to get out of her sleeping bag but the nylon bag got stuck in the zipper. She struggled inside the cocoon, flailing around like a cat in a burlap bag
“Ow!” she exclaimed as she banged her head against the granite side wall. She rolled away from the rock, and he dove forward to rescue the lit propane stove.
She stilled suddenly, appeared to roll over inside the tight confines of the sleeping bag, and crawled out the top of it on her hands and knees. Her hair was all over the place, and her sweatshirt and sweatpants were askew when she finally freed herself. Whether it was exertion or embarrassment staining her cheeks, he couldn’t tell.
He pulled back the tarp to reveal two women, swathed in black robes and head scarves, huddled together. A blast of cold air made him shiver. And to think, Katie’d said the tarps weren’t holding in any heat. Hah!
He gestured with his free hand for the local women to enter. The pair’s faces lit when they spied Katie, and the much older woman of the two spoke rapidly to Katie in the local dialect, explaining that the girl with her was her granddaughter, who was in the middle of having a baby.
Katie murmured soothingly that the granddaughter was in good hands.
Doctors Unlimited gave all its staff crash courses in the languages they would encounter where they were posted. Apparently, Katie had a knack for foreign tongues, for she’d understood the woman’s rapid Zagan and had replied credibly well in it.
“How old is your granddaughter?” he asked the grandmother.
“Fourteen. Her first baby.”
A first-time mom barely into her teens? This could get dicey. He sighed. He knew women were considered marriageable at age thirteen in the more backward corners of this country. Grandma put her arm around the girl’s shoulders and held her up as the contraction gripped her.
He told Katie, “I’m going down to the Land Rover to get a cot and more medical supplies. While I’m gone, get her out of her clothes and wrap her in my sleeping bag. We need to keep her warm.”
“Bring up the other heater, too,” she murmured as she moved to the girl’s side.
He said in English, “Break it to her that I’m going to be looking at and touching her lady parts, but she won’t get in trouble for letting a male doctor deliver her baby. I’ve done it before in this country.”
“Gee. Thanks for giving me the fun job,” Katie murmured.
“This is why you’re here. She’ll take the news better from a woman. Tell her you are here to chaperone me the same way her grandmother is here to chaperone her.”
Katie smirked at him as he ducked out of the tent into air so frigid his teeth felt like they might crack. This was his second season in the field, so he knew how to pack the Land Rover to have fast access to a variety of boxes, each labeled and pre-packed to handle a specific type of medical emergency. Grabbing a folded cot and the birthing box, he mentally thanked his last-week self for labeling the kits so clearly.
He trudged back up the hill and deposited his load inside the crowded space between the boulders. Katie helped him unfold the cot, taking up most all the remaining space. While she spread their foam sleeping pads and her sleeping bag on the cot, he dug out disinfectant gel and two pairs of sterile surgical gloves.
He ducked back outside. Squirting a big glob of the gel in his palm, he meticulously scrubbed his hands with it.
The girl moaned and he glanced at his watch, noting the time.
Doused in wet gel, his hands went numb fast and his fingernails turned blue. How was he supposed to deliver a baby safely in these primitive and unsanitary conditions?
An argument broke out inside the shelter and Katie eventually called out to him, “She doesn’t want you to examine her or help unless things go badly.”
He ducked back inside, donning a pair of surgical gloves. “How am I supposed to know things are going badly if I can’t examine my patient?”
Katie sighed. “She wants you to tell me what to do.”
“That’s absurd. While I appreciate that you do have obstetric experience, I’m the doctor.”
“That’s what I told her. But she’s adamant.” Katie lowered her voice to add, “She’s embarrassed.”
“She also doesn’t speak a word of English,” he pointed out dryly. “No need to lower your voice.”
That earned him an eye roll. Katie said. “She’s a young, terrified girl who has zero understanding of what’s happening to her body, right now. I’ll bet she doesn’t even know how she got pregnant. Cut her some slack.”
“Why did she come here if she’s not going to let me help her?” he demanded low.
Katie came over to stand directly in front of him. Her blue eyes were beseeching as she answered, “Because she’s scared her baby will die.”
“It’s my job—my sworn duty as a physician—to save them both.”
Katie turned and repeated what he’d just said to the girl.
The patient said clearly in Zagan, “No care for me. But save my baby. You promise me?”
He looked over at Katie, who stared back at him worriedly. “What am I supposed to say?”
“You’re the doctor,” she replied soberly.
Tremendous weight was packed into those three little words. Responsibility for this girl’s life. For that of her unborn child. To his Hippocratic Oath. To his medical license. Hell, to himself. When he got out of prison, he’d vowed to live in a way that he could look himself in the mirror every morning.
He huffed. “This sucks.”
“Welcome to life as a female in the twelfth century,” she said lightly.
“We’ll do it her way for now. You and I both know she’s not going to give a damn who sees her private parts when she hits late-stage labor.”
“True,” Katie murmured.
“All right then. I’m confident you know how to do this. But, to ease our patient’s fear, I should probably go through the motions of telling you what to do.”
Katie nodded and smiled encouragingly at him.
He assumed a lecturing tone. “Step one is to see if the baby’s presenting head first. You’ll may need to use a flashlight since it’s so dark in here.”
While Katie gently explained what she was going to do before she did it, he turned his back and busied himself lighting the second propane stove. They didn’t have enough fuel to burn both stoves for the whole time they were scheduled to be on the road. But tonight was an emergency.
The patient moaned again, and he glanced at his watch. The contractions were a few seconds under two minutes apart.
“How far is she dilated?” he asked Katie.
“About seven centimeters.” She added lightly, “We’ve got a problem. The baby’s breech.”
He swore under his breath. “It’s way late in her labor to turn the baby. And she she’s on no painkillers, but you’ve got to talk our reluctant patient into letting me try.”
Katie really did try to convince the girl. But to no avail.
He tried to argue with her next. No go.
He appealed to the grandmother, and she tried to bully her granddaughter into letting him help her. But the girl refused to budge. She was having no part of letting him touch her.
It was outrageous that he had to stand here and do nothing when he could be attempting to turn the baby before it entered the birth canal. Granted, given how young and small the girl was, he wasn’t at all sure he could turn the baby. He needed to consider performing a C-Section sooner rather than later.
“Tell her we need to consider a C-Section.”
Katie got out one sentence about cutting the baby out of her belly before the girl completely lost her shit, sobbing and wailing. Abruptly, he was grateful for the howling winds that would drown out the girl’s noise.
Grandma wasn’t keen on the idea, either. She reluctantly confessed she hadn’t told her granddaughter’s husband she was bringing the girl to a western doctor. Granny wouldn’t be able to hide what she’d done if her granddaughter came home with a neatly sewn up incision in her abdomen. The woman thought her grandson-in-law would kill her and his wife for going to a male infidel for help.
Alex threw up his hands in disgust. “This is no way to practice medicine.”
Katie said quietly, “And to think. This is still better than what’s otherwise available to this child.”
He and Katie traded grim looks.
The tension in the tiny space mounted over the next hour as the girl’s labor dragged on and her moans turned into sharp cries of pain. “Don’t let her push!” he ordered. “At all costs, she mustn’t push.”
The cries turned into screams muffled by the grandmother’s head scarf that the woman twisted into a rope and pressed between the girl’s teeth for her to bite down on.
God, this is barbaric , he thought.
“I can set an epidural. Administer painkillers. At least let me put the portable heart monitor on the baby,” he said urgently to Katie But as she relayed the suggestions, the girl, wrenched in agony, shook her head in the negative.
“Katie,” Alex ground out, “find a way. Make her understand that she and her baby are in danger. This is why she came to me. Let me do my job!”
His impotent fury mounted as the girl’s screams turned into low, hoarse groans indicative of exhaustion. He didn’t need Katie to tell him the girl’s labor was not progressing.
He finally turned to the grandmother and said sharply, “How will your grandson-in-react if you let his wife and child die? For the love of God, let me do my job. If I don’t do something now , you’re going to lose them both.”
Grandma stared at him for several long seconds of indecision. She nodded abruptly and bit out, “Help her.”
Thank God . As he expected, the girl was so far gone in the agony of a difficult birth that she barely noticed him working frantically to shift her baby into some sort of birthable position.
Katie leaned over the girl, making a production of wiping sweat off the girl’s face, but mainly using her body to block sight of him from the girl. Smart.
Although he doubted the patient was paying the slightest attention at this point. Her body heaved as another contraction hit, and he went to work fast. He was able to loop two fingers around the baby’s ankles and guide them into the birth canal. He didn’t feel umbilical cord wrapped between or around the baby’s legs, which was a blessing.
He waited for the next contraction, which was only seconds in coming, and grabbed hold of the baby’s ankles firmly—which was a challenge, because babies were slippery.
The baby’s tiny feet cleared the birth canal. Now for the hard part. Delivering its shoulders and head through the girl’s immature pelvis. On the one hand, young bones were flexible. On the other hand, this girl wasn’t fully grown, herself.
The contraction ended, and he hung onto the baby desperately until the next contraction.
It came, and he pulled for all he was worth. It sickened him to think of the damage he was doing to this poor girl’s body. The girl let out one long continuous scream as he forcibly extracted the child from her body.
But it was that or risk the baby suffocating in the birth canal.
Working fast, he suctioned the infant’s nostrils and rubbed its back and chest vigorously. Finally, the baby drew a shuddering breath and let out a weak wail. Alex winced. The birth cry should be big and loud, But hey. The baby was alive.
“It’s a boy,” he bit out.
He cut the cord and thrust the baby at Katie to clean up and keep warm, instructing, “Monitor his breathing like a hawk.”
“I’m on it.”
Good. Because he had bigger problems at the moment.
This girl was too narrow-hipped and too damned young to be having babies, and the delivery had torn the crap out of her. She was bleeding heavily, and one supply he and Katie had not been able to haul in had been refrigerated whole blood.
Her uterus wasn’t contracting anymore, but it should be. She still needed to deliver the placenta. If even part of it was retained in the uterus, this girl would die, if not from blood loss, then from infection.
Placing one hand on her abdomen to stabilize the uterus, he reached inside her and prayed the placenta was sitting in the cervix. It wasn’t. Of course, it wasn’t. Everything that could go wrong with this delivery was.
“Give the baby to Grandma. I need you to inject two milliliters of fentanyl intravenously into the girl, stat.”
Katie’s eyes widened as she realized what was happening, but she nodded and moved fast, finding the powerful pain killer, loading it in a syringe, and locating a vein in the girl’s elbow. She inserted the needle and swore. She tried again, and he breathed a sigh of relief as he saw her thumb push the syringe’s plunger down.
The drug took effect fast, and he went back to work, stabilizing the uterus with his left hand while he reached into the girl’s uterus as gently as he could and manually detached the placenta from the uterine wall.
Even with the fentanyl racing through her system, she screamed in agony.
He worked fast, racing against time. The girl’s screams quieted. Not that he wasn’t causing her unbearable pain. She was merely bleeding out. Dying.
“Tell her to fight,” he ordered.
Katie leaned down to speak in the girl’s ear.
“Say it like you mean it,” he growled.
Katie raised her voice and demanded that the girl open her eyes. That she live for her son. While Katie tiraded like a drill sergeant, he fought like hell to do what he had to do.
It took about five minutes to remove the placenta and a few to verify it had come out intact. Finally. Something had gone right in this disastrous delivery.
He bagged the placenta and turned around to repair the external damage to the girl and stared in shock. Katie had an IV needle in her own arm attached with surgical tubing to a matching needle in the girl’s arm. Dark red blood flowed through it from Katie’s arm into the girl’s.
“How much have you given her?” he snapped.
“I’ve only been at it for about three minutes. I’ll give it another five minutes, and that should be around a pint of blood. I’m O negative, by the way. A universal blood donor.”
“That’s noble of you. But we’ll see dozens of patients the next few months. You can’t give them all blood. Next time, have a family member donate it.”
Katie managed to look both chagrined and defiant at the same time. He couldn’t fault her, though. It was a generous act. Even if it was impulsive and risky. She would need all her blood to carry oxygen at these high altitudes.
Katie’s transfusion did wonders to stabilize the girl’s vitals. He removed the IV from Katie’s arm, sterilized the needle prick, and bandaged it carefully. Then he settled down to the slow, meticulous business of stitching up the girl’s class four tear.
Although it took longer to do, he made sure all the stitches were internal and hidden. There mustn’t be any evidence of modern medicine, no sirree.
As he was finishing up and had just asked Katie to give the girl a massive shot of antibiotics to help ward off an infection, Grandma piped up. “How much longer? I must have her home by dawn.”
“She can’t move!” he exclaimed. “I just sewed her back together. I don’t need her running around, or walking for that matter, and tearing out all her stitches.”
Grandma looked alarmed but stubborn. “We must leave.”
Katie murmured in English, “We have to find a way to get her home.”
Sonofabitch . “Where do you live?” he asked Grandma in resignation.
The woman answered, “At the edge of Karshan village.”
“I’ll carry the girl to the Land Rover and drive as close as I can without being spotted. I’ll carry her on foot as far as I can,” he announced.
Katie replied, “None of it is safe.”
He rolled his eyes and scooped the girl up off the cot. The trip down the hill was an exercise in precarious balance, but he made it to the Land Rover without dropping the exhausted girl. He set her gently in the front seat and hastily took enough boxes out of the back for Grandma and Katie to have a spot to sit.
The drive didn’t take long. Thankfully, the family’s home was far enough outside the village that he was able to drive within a few hundred feet of it and find a stand of dead brush to park behind.
Grandma led the way and he followed behind, carrying the girl, who was still more asleep than awake from the painkiller. Katie brought up the rear, carrying the baby.
The grandmother veered off the road and followed a narrow path that took them around the stone-walled compound silhouetted against the rapidly lightening sky.
The ground was slippery with frost as they approached a narrow wooden gate in the back wall of the mini-fortress.
“I’ll take my granddaughter from here.”
He eyed the short woman. “How?”
“I will help her and my granddaughter will find the strength to walk.”
Katie said quietly, “It’s what we women do, is it not?”
The older woman nodded, her eyes sad and wise. “It has always been so.”
Although he felt himself an outsider to the women’s moment of mutual understanding, profound respect for all women’s ability to persevere swept through him.
He set the girl on her feet and draped her arm over her grandmother’s shoulders. Grandma looped her right arm around the girl’s waist, and Katie handed the bundled infant into the grandmother’s left arm.
Alex pushed open the heavy gate for them. The old woman nodded her thanks and trudged inside. The girl sagged, barely able to shuffle along. But she did, indeed, find a way, step by agonized step.
Madness. Utter madness for that girl to be conscious, let alone walking . But his hands were tied. He could only render medical aid his patients were willing to receive. Frustrated, he pulled the gate shut and left the women to their uncertain fate.
He muttered tersely to Katie, “It’ll be light any minute. We need to get away from here and under cover by then.”
He gestured for Katie to lead the way back while he took the rear-guard position that put his body between her and the most likely direction gunfire would come from.
The hike back to their Land Rover seemed to take forever. Maybe it was because his shoulder blades kept tensing in anticipation of a bullet between them. Or maybe it was because he’d gotten no sleep last night. Or maybe it was because he was more than half convinced the two of them weren’t going to make it out of this hostile country alive.
* * *
Glancing furtively around the mobile command post to make sure no one was close enough to overhear him, Ian McCloud picked up the satellite phone and dialed an encrypted number he’d memorized and never written down.
“Hey. It’s me.” He reeled off a quick set of latitude and longitude coordinates where the target was currently hunkered down on a mountainside delivering babies.
As the voice at the other end of the phone drew breath to speak, he interrupted quickly. “I don’t want to know why you need the coordinates.”
At the grunt of assent at the other end of the phone, Ian disconnected the call quickly. He checked his watch. The entire call had taken under fifteen seconds. He was in the clear.
Now all he could do was pray that Katie was safe. The man he’d just called promised on a stack of bibles that she wouldn’t be hurt. The bastard had better keep his word. He’d hate to have to kill his own brother.