“I’ll take care of it,” Laurel assured him.
Would she have said that with as much confidence a few weeks ago? She was different. Coming to Zentar had changed her.
Their patient let out a moan. Hopefully she was regaining consciousness. “What’s her name?”
“Melina.”
Laurel spoke in a soft reassuring voice. “Melina, I’m going to have to move you. I’m sorry if it hurts. I promise I’ll try to make this as painless as possible. I also have to remove your clothes.”
Tariq stepped away. Laurel lifted the woman as much as she could and removed an arm from the sleeve of a full cotton dress, then did the same with the other.
The husband sat candles around the area. It helped some but the light was still poor.
With an amount of work that made Laurel break out in a sweat, she removed the woman’s garment, always speaking to Melina as she worked. When she had Melina in nothing but her underclothes, Laurel proceeded to examine her. “I don’t see any obvious problems on her head, arms or legs.”
“Good.” Tariq’s voice came from close by.
Laurel rolled Melina to one side and checked her back, pulling the underclothing as far from the skin as the material would allow. Nothing. If she didn’t find something obvious soon, it must be an internal problem. In these primitive conditions that would make the situation more difficult.
She eased Melina down on the bed again. Reaching across her, Laurel rolled the woman toward her. Melina moaned.
“I’m almost done,” Laurel comforted her. Shifting the woman’s underclothes as much as possible again, Laurel checked her back for anything suspicious. Just under the woman’s shoulder blade was a large angry-looking area. In the center the skin was raised, with an advanced infection. No wonder the woman was sick.
“I found the problem. She has an abscess. It’s on her back.” Laurel covered Melina’s lower body with a blanket.
Tariq spoke to the man, who responded. Seconds later Tariq joined her, with the old man hovering nearby.
“Let me see,” Tariq said.
Together they rolled Melina toward them. “That is ugly. It must be lanced and drained right away.” He met her gaze. “You up for a little surgery?”
“I don’t think we have a choice.” Laurel helped him roll the woman back to the bed.
“We don’t.”
“We need to get her on her stomach and the rest of her clothing removed.” Tariq picked up his bag and started going through it. “We will have to improvise. We cannot wait. It will take too long to get an ambulance to this remote area. This needs to be done now.”
Tariq spoke to the man, who joined them. Tariq then said to her, “It will take all three of us to turn her. Her husband has agreed to help you remove her underclothing. Cover her with the blanket again.”
They all did as instructed and soon had Melina in the necessary position.
Tariq spoke to the man and he left by the front door. “I told him to heat some water.” He looked down at the woman. “Do you want to handle the surgery or shall I?”
“I’ll be glad to assist. I haven’t done anything like this in a long time.”
“We are thin on supplies but we will make do. See if you can find some clean cloths while I assemble what we need.”
Laurel hurried to the kitchen. After a short search she located where Melina kept her dish towels. Grabbing the stack, she hurried back to Tariq. She placed them on the bed and then removed one off the top and spread it over the bed.
“Thanks,” Tariq murmured his attention on the job at hand.
* * *
Tariq was impressed by Laurel’s anticipation of what would be required She was thinking through the problem, not depending on him to make all the decisions. Laurel was far more capable than she let on. Or that he thought she would admit to herself. That guy in college had really messed with her mind.
It had been a long time since he had performed surgery, and he had never done it under such primitive conditions. Working in a small dark house in the middle of nowhere and with nothing but his medical bag contents for supplies was a stretch. What he feared was that the patient’s condition would get worse if they did not do something immediately.
If only he could call an ambulance. But that would take over two hours to arrive. The road up the mountain it would have to travel was little more than a cart track.
As he assembled instruments Laurel redid vitals. “Her temperature is up.”
The man returned with a bucket of water and was busy heating it on the wood stove.
“I only have a few alcohol and iodine wipes. We will use those only when absolutely necessary. What I cannot work out is what to use for the drain tubing.”
“It’s a little large but how about the hose on the blood-pressure cuff?” Laurel looked at him for a response. “We can always do BP by touch.”
Tariq nodded. “That would work.” He picked up the blood-pressure cuff and cut as long a length of tube as he could then set it on the towel beside his other instruments. “We need to sterilize everything in the hot water. We also need to wash Melina’s back.” He was talking to himself as much as to Laurel.
The man brought a pot of steaming water to the bedside and set it on the floor. Tariq asked for soap. The man returned with it. Laurel took it from him. Picking up a cloth, she bathed the surgical field. Tariq asked for a bowl and began sterilizing instruments as Laurel scrubbed Melina’s back for the second time then wiped it with an iodine swab.
He met Laurel’s gaze. “I have one set of plastic gloves. We each get one. That means we will have to think and act as one.” Tariq handed her a glove.
“I understand.”
“Are you ready?”
“As I’m going to be.” She pulled on the glove with an unwavering look on her face.
“It is time. I will make the incision. You will need to mop up as we go. As soon as we can see, we will check for tissue damage then place the tube.”
Laurel nodded. “I understand.”
“Then we will begin.” Tariq poised the disposable scalpel over the swollen skin. Tariq nicked it. Melina groaned and Laurel dabbed as the infection flowed. Tariq enlarged the incision as Laurel grabbed another cloth. The smell of contamination filled the air. With the incision open, he placed the scalpel in the hot water.
“I’m going to press around the wound. We have to remove all the infection or we are doing no good.” Tariq applied pressure with his glove-covered fingers. Melina let out a sob of pain.
Laurel mopped the exudate. Tariq continued until finally more blood than infected material covered the cloth. “I am going to open the site and see if the infection has affected the tissue. You hold one side and I will pull from the other. That should make it wide enough for us to see.”
The old man brought another pot of water.
They did as Tariq had mapped out.
“It looks clean.” Tariq glanced at Laurel to see if she agreed. She nodded. “Now we need to flush it and insert the drain.” To the man he said, “We need a clean cup.”
Seconds later the man had placed one in his hand. Tariq filled it with clean water. He checked the heat against his cheek. It should be close to room temperature before using it in the wound.
“Let’s roll her on her side so it will drain well,” Laurel suggested.
“Good idea. Roll her toward us, that way we can see better.”
Happy with the temperature, he gently poured the water into the wound to irrigate it. The excess Laurel mopped up with a cloth. They continued the process for another five minutes.
Laurel dropped a wet cloth on the floor and picked up a clean one. “We shouldn’t close it. Just pack it and they can close it after she has been started on an antibiotic at the hospital.”
They settled the woman on her stomach again.
/> “I agree.” Tariq removed his glove and pulled out packages of gauze squares. “Will you take care of packing while I reassure the husband?”
“I can do that.” Laurel wiped her glove on the cloth then started opening a package.
A few minutes later Tariq returned to find the drain in place and the wound packed. “One of us is going to need to go for the ambulance while the other stays with our patient.”
“That’ll have to be you. I don’t know the way back to the city and I don’t speak the language.” Laurel checked Melina’s pulse at her neck.