One Kiss in Tokyo... (2 page)

He looked to be in his fifties and had a mid-Western accent. He was well over six feet tall with broad shoulders and what looked like thick dark hair under his hat. There was something about him. An aura. An air. And it wasn't all about the rank. What had brought him to the ER? He could understand any major general in charge of a base this size wanting to be informed about incidents. He just wouldn't have expected him to attend personally.

Blake glanced upwards but didn't stop what he was doing. ‘General Williams.'

The Major General was watching Blake carefully as he continued his resus attempts. ‘I heard there was an explosion. Does your team require assistance?'

Blake kept working steadily. He glanced in Avery's direction but the Major General didn't follow his glance. He was focused on Blake.

‘I have all the assistance I need. If anything changes, I'll let you know.'

‘I'll expect an update in a few hours.'

‘General.' Blake gave a nod in acknowledgement. He was attaching defibrillator pads to the young boy's chest. ‘All clear.'

There was a short ping.

Avery was holding his breath and bent to pick up an oxygen mask that had landed on the floor. Major General Williams turned to leave, his eyes lingering for a second on Avery.

Was he looking at him?

Two seconds later the major general disappeared down the corridor.

Avery straightened up, his gaze shifting around the people in the room. The noise level increased instantly. Katsuko was still bagging but her gaze was fixed on the door.

That
was who he'd been looking at. What was going on there?

The male nurse he'd met earlier shouted towards the door, ‘Two emergency theatres are open. The guy from the helipad is in the first one. We can take our kid to the other.'

There was a tiny second of silence, then it was broken with a little beep. Every head in the room turned. The monitor for the other patient. They finally had an output.

Avery paused as the doctor he hadn't even had a chance to meet yet raised his head from the bed. The look of pure relief on his face made him catch his breath. ‘Do you need the theatre?' Avery asked.

He had to. This was another doctor's ER. He might be treating a patient but this was the military. He had to follow the chain of command.

Blake shook his head. ‘No. I'm heading to paediatric ICU.' He frowned for a second. ‘Do you need assistance?'

Avery shook his head. ‘Is there a surgeon?'

Blake nodded.

‘Then I'm good.' He turned back to the team. ‘Right, get the IV fast-flowing, monitor his blood pressure.' He turned back at the nurse who'd threatened to break his hand. ‘Are you good to bag?' He could see the determined tic in her jaw. There was no way she was leaving this patient.

Another nurse appeared at the door. ‘We've another four trauma cases—two paediatric, two adult and about twelve walking wounded.'

Avery glanced down at his now blood-splattered shirt. At some point he should really change. The radiographer walked back in and stuck the X-ray straight up on the light box, flicking the switch.

It didn't take a genius to see what was wrong. Both of Mahito's lungs were deflated. Oxygen wasn't circulating properly because of the penetrating chest injury. If there was no other choice, he could try to insert chest drains but it was unlikely the lungs could reinflate with the spear still in place. It would be foolish to attempt anything like that now—particularly when he had a theatre and surgeon at his disposal. Avery shook his head. ‘Let's go, folks. We're never going to get these lungs to reinflate until we get this spear out of his chest. Someone point me in the direction of the theatre.'

‘Let's go, people!' shouted Katsuko. For someone small and perfectly formed her voice had a real air of command. Everyone moved. Monitors were detached from the wall, oxygen canisters pushed under the trolley, a space blanket placed over the patient. Avery kept his eyes on the patient but after a second he looked up. They were all watching him expectantly.

There was something so reassuring about this. And he'd experienced it time and time again in the military. These people didn't know him. He'd walked into an emergency situation with only a wave of his ID. That was all he'd needed.

From that point on—early or not—he'd been expected to do his job. At first he'd been a bit concerned about the chaos. Now he realised everyone had known what to do, but the rush of blood and age of the child had fazed them all.

‘Everyone ready?'

Eight heads nodded at him. ‘Then, let's go.'

Hands remained pressed to a variety of areas on the little body. The move along the corridor was rapid. The theatre was on the same floor. The porter at the front of the procession swiped his card and held the doors open. A surgeon strode over and nodded at Avery, not even blinking that they didn't know each other.

Avery handed over the X-ray. ‘Explosion at a local factory. This is Mahito. I don't have an age. Penetrating wound to the chest, two collapsed lungs, intubated but sats are poor.' He nodded at the monitor. ‘Two IV lines, tachycardic at one-sixty and hypotensive. BP seventy over forty-five.'

He frowned. ‘Sorry, didn't have time to catheterise.'

The surgeon shook his head. ‘My staff will get to that. We'll take it from here.'

Theatre staff dressed in scrubs surrounded them, one set of hands replacing the others and a stern-looking woman taking over bagging duties from Katsuko. She moved away swiftly. It was the first time he'd actually seen her relinquish control to someone else.

The trolley moved forward, being pushed through another set of swing doors as the surgeon shouted orders.

Just like that.

Mahito was someone else's responsibility.

Avery looked down at his hands, smeared with blood. The rest of the staff turned and headed back out of the doors.

Katsuko folded her arms and glared at his hands.

‘If you ever come into my ER again and touch a patient without washing your hands and putting on gloves, I will make sure you live to regret it.'

Her accent was odd. It had a lilt. A twang. Part Japanese, part American. Her English was completely and utterly fluent.

‘And as for this...' She lifted her hand and picked his fedora off his head. He'd completely forgotten about it. ‘Who do you think you are, Indiana Jones?'

He let out a laugh. ‘It's a pleasure to meet you too. And who said this was your ER?' He glanced over his shoulder. ‘I was planning on making it mine.'

A spark flashed across her eyes. It was almost as if he'd issued a challenge.

There was a potent silence for a few seconds. Things had been chaotic before. Mahito had been the priority. Now the only noise around them was that of the swinging doors.

She was looking at him. Sizing him up. Did he meet the grade? His curiosity was sparked. What was the grade for the firecracker?

He couldn't help but start to smile. The air around them had a distinct sense of sizzle.

Despite the chaos of earlier her poker-straight hair had fallen back into place, framing her face perfectly. Those brown eyes could get him into a whole load of trouble. They hadn't even had a proper introduction yet, but Katsuko was one of the most gorgeous women he'd ever set eyes on. She might be small but she had curves in all the right places. One thing was for sure—if she was only six inches taller she would be on the catwalk.

It was odd. Avery had always gone for blondes—usually leggy. But all of a sudden leggy blondes had flown straight out of his mind.

She crossed her arms over her chest and met his inquisitive gaze. From the determined tilt of her chin it was clear she knew he'd been checking her out.

She plonked his hat back on his head, then turned and walked away, giving him a clear view of her tight, perfectly formed ass. The pale green scrubs looked good on her.

He couldn't help but laugh.

Shaking his head, he walked after her, stopping at the nearest sink to wash his hands. He didn't even have time to catch his breath. The siren sounded again and another trolley crashed through the doors from an ambulance outside. This time the patient was an adult. His colour was poor and he was rasping.

The ambulance crew spoke rapidly in Japanese. Katsuko didn't even blink, she just translated. ‘Thirty-five-year-old also injured in the factory explosion. Bruising across his torso already visible. No penetration wounds. They suspect broken ribs. Poor oxygen saturation. He's complained of chest pain and he's tachycardic. Probably tension pneumothorax.' She bit her lip. ‘First the kid, now the adult.'

She was mirroring his exact thoughts. Two cases of pneuomothorax, each requiring different management.

In their absence, someone had cleared the resus room. Both bays were empty again. Avery grabbed the pink stethoscope that was hanging around Katsuko's neck. ‘Hey!' she shouted.

‘Needs must. Haven't been able to find mine yet.'

As the trolley eased to a halt he listened carefully to both sides of the man's chest. He waved his hand. ‘Sit him forward so I can check his back.' Two nursing assistants responded instantly, helping to sit the man forward. The back was clear. No sign of any wounds. The patient was eased back. The shift in the trachea was evident. There was no need for anything else. A pneumothorax was air in the chest cavity. This had probably resulted from a fractured rib puncturing his lung and releasing air into the pleural space. A pneumothorax wasn't usually life-threatening unless it progressed to a tension pneumothorax, causing compression of the vena cava, reducing cardiac blood flow to the heart and decreasing cardiac output—and that was exactly what had happened here.

A tension pneumothorax could be life-threatening and needed prompt action. The military had collected vast amounts of data regarding tension pneumothorax and subsequent treatment. In a combat setting, tension pneumothorax was the second leading cause of death, and was often preventable. Today Avery was going to make sure it was preventable.

‘Tension pneumothorax.'

Two words were all it took. Packs opened around him. Surgical gloves appeared. He pulled them on and swabbed the skin. Katsuko was speaking into the man's ear in a low voice. She waved Avery on with a nod of her head.

‘Let's get some oxygen on the patient.'

The staff responded instantly.

‘Do we have a name?'

His body was already starved of oxygen. They had to supplement as much as possible.

One of the physician's assistants put his hand in the man's pocket and pulled out a wallet. ‘Akio Yamada.' He frowned as he calculated in his head. ‘I make him forty-four.'

Avery leaned over the man. His eyes were tightly closed and he was wincing, obviously in pain. He put his hand gently on his shoulder. ‘Akio, I'm a doctor. I'm going to do something that will help your breathing. It might be a little uncomfortable.'

This wasn't a pleasant procedure but the effect would be almost instant relief. Air was trapped and had caused the man's lung to collapse. As soon as the pressure was relieved and the lung reinflated he'd be able to breathe more easily again. Katsuko gave a nod that she'd finished translating.

There were specially manufactured needles designed just for a tension pneumothorax. Avery held out his hand. ‘Fourteen-gauge needle and catheter.' He'd done this on numerous occasions in the past. It only took a few seconds to feel with his fingers for the second intercostal space, at the midclavicular line. It was vital that the needle be inserted at a ninety-degree angle to the chest wall so it would be positioned directly into the pleural space. Any mistake could result in a chance of hitting other structures—even the heart. But Avery was experienced.

The room was silent during the procedure. In a few seconds there was an audible release as the trapped air rushed out and the tension was released from his chest. Avery removed the needle and disposed of it, leaving the catheter in place. He secured it with some tape as he watched the man's chest. Sometimes the lung inflated again immediately, sometimes it took a little time. The patient would need to be monitored.

He pulled off his gloves. ‘Can we keep an eye on his sats for the next few hours and get a portable chest X-ray?' The man's eyes flickered open.

Avery put a hand on his shoulder. It didn't matter that the patient couldn't understand him. ‘You should feel easier now. Just relax. We'll keep a close eye on you.'

Katsuko's gaze met his and she translated again. At least, he hoped she was translating. The truth was she could be saying anything at all and he'd never know. In a way it frustrated him. When he'd thought he was being shipped out to Portugal and Italy he'd learned a few words and phrases that he could use in clinical situations to reassure patients. He'd need to try and learn some basic Japanese.

‘Doctor?'

A clerk was standing at the door. ‘Yes?'

She waved an electronic tablet at him. ‘I'll need you to write some notes on the two patients you've seen and fill some orders.' She hesitated for a second. ‘Because you're not officially on duty yet I'll need to get another doctor to sign off on your cases.'

He met her worried gaze with a smile. ‘No problem.' He could almost hear her inaudible sigh. Was she really worried he'd be offended? Of course he wasn't.

He turned back to the patient. The male African-American nurse he'd met earlier had appeared back in the room. This time he held out his large hand towards Avery. ‘Frank Kelly, pleased to meet you.' Avery had thought he was big at six feet two, but this guy was a giant. With his regular runs and gym workouts he normally felt pretty fit, but Frank would make a professional wrestler shrink away.

‘I'll take over, Katsuko,' Frank said confidently. ‘The other two majors are fractures, one a femur, the other a humerus and shoulder displacement. Do you want to check them over? Katia is triaging the walking wounded.'