Kitabı oku: «One Kiss In Tokyo...»

CHAPTER ONE

THE NOISE HAD CHANGED. The steady drone of the engines had taken on a new pitch. Avery lifted his hat from over his eyes and sat up a little. Every bone in his body ached; muscles he hadn’t even known he had were protesting. Three plane journeys over twelve hours would do that to a man. It didn’t help that he’d been on duty for twenty-four hours before that.

He’d expected to have a few days’ rest before shipping out to Italy from Utah. But plans in the US Air Force often came unstuck.

His orders had changed overnight. A fellow physician who’d been scheduled to come to Japan had been struck down with a mystery illness. So, instead of flying over the boot-shaped coast of Italy, he found himself looking at the emerging coastline of Japan. The change of noise was due to the flaps moving and wheels coming down on the aircraft. His stomach growled loudly and the serviceman sitting next to him gave him a smile and passed over a packet of crisps. They weren’t flying on a commercial jet—there were no air hostesses, no bar and no food. They were flying on a military jet and it wasn’t exactly built for comfort. Avery couldn’t wait to find his accommodation and get his head down for a few hours. Sleep was all he cared about right now.

The plane landed with a bump. He pulled open the packet of crisps and started eating—the quicker he ate the sooner he would get to sleep. The jet took a few minutes to taxi to a halt. The rest of the servicemen were grabbing their packs, ready to disembark.

Avery kept looking outside, trying to get a better feel for the base. It housed nineteen thousand servicemen and servicewomen and contained one of the biggest military hospitals. Set in the outskirts of Tokyo, the base was a home away from home. Most of the staff stayed on-site. There were stores, cafés, schools for the kids, places of worship and even a golf course. The base had been here since the end of the Second World War.

He waited until the rest of the servicemen disembarked before finally grabbing his backpack and walking down the steps of the plane.

The warm air hit him straight away. The base was situated on the coast, and the air was muggy. He could see the metropolis of Tokyo stretching in front of him. He smiled. A whole world he’d never experienced.

He was kind of excited. He’d been stationed in a range of bases all around the world. Normally, he spent a little time finding about where he’d be stationed. Europe. The Middle East. And numerous places around the US. This time around he hadn’t had a chance. He’d no idea what he’d find at Okatu.

He followed the rest of the servicemen into the main hangar. Transfer between bases always took a little paperwork. A few were already heading towards the housing department.

Avery sighed and completed his obligatory paperwork and picked up the information sheet on the base. His stomach growled again. There was no way he could sleep until he’d eaten. It made more sense to find something to eat first, then come back and speak to the housing officer to find out where he’d be staying.

He walked out of the building, glanced at his sheet and turned left. He took things slowly, trying to shake off all the aches and pains of travel. The base was huge and during the stroll he passed an elementary school, a middle school, a gymnasium, the officers’ club, a travel centre, a few shops and a library. It was a fifteen-minute walk before the ten-year-old hospital appeared before him.

There it was. The buzz. The tickle. That crazy little sensation he felt whenever he saw somewhere new. The William Bates Memorial Hospital was named after an aviator hero from the First World War. It had one hundred and fifty beds, an ER, four theatres, an ICU, a mother-and-infant care centre, a neonatal intensive care unit, a medical ward, a surgical ward and a mental health inpatient facility. He loved hospitals like this. Most surgeons liked to specialise in one area. The military gave surgeons that opportunity too—there were a few specialists already here. But Avery had never just wanted to work in one area. He liked variety—and here he would get it.

He started to walk towards the main entrance to the hospital, then changed his mind, turning right and heading towards the ER. He may as well get a look around the place.

The glass doors slid open just as a siren started to sound. He looked around. The main reception area was empty. Where was everyone?

It didn’t take long to find out. Someone came running towards him, making the doors ahead slide open. He took a quick glance and kept walking down the corridor.

The ER was set up like many he’d worked in before. Cubicles with curtains, some side rooms, a treatment room and a room with around ten people standing outside. Resus, the most important room in the ER.

A Japanese orderly rushed past, pushing a wheelchair. He threw Avery a second glance, looking him up and down. ‘You work here?’

He nodded and waved his ID. ‘From tomorrow. Captain Avery Flynn. I’m a doctor.’ He was relieved the man had spoken to him in English. He didn’t know a word of Japanese and he wasn’t sure if it was going to be a problem. Most military bases didn’t just serve their own personnel. Often they took cases from the surrounding areas. Having no grasp of the language could prove a problem.

The man gave him a nod. ‘No time for introductions. We’re expecting seven.’

He disappeared quicker than a cartoon character. Seven what? wondered Avery. ‘Oof!’

A force hit him from behind, knocking him clean off his feet and onto the floor. He barely had time to put out his hands to break his fall.

‘Get out of the way’ came the sharp voice.

All he could see was feet. Lots of feet, crammed into the resus room. He pushed himself up and shrugged off his backpack. If he was needed, he was needed.

A hand grabbed him from behind and a male nurse grinned at him. ‘Hey, you must be new. Falling for the nurses already?’

Avery blinked as he dumped his jacket next to his backpack and flashed his ID. ‘What...? Who was that?’

The guy hadn’t stopped smiling. ‘Faiyakuraka.’

‘What?’ Avery couldn’t quite make sense of the word.

The guy tapped him on the shoulder. ‘It’s Japanese for firecracker. But you can only call her that once you know her well. For you, it’ll be Katsuko.’ Then he shook his head. ‘Actually, let’s try to keep you safe. Just call her First Lieutenant Williams.’ He moved forward. ‘Now, let’s see if you’re any good or not.’ And with that, he disappeared into the scrum in front of them.

It was difficult to tell who was who. These people weren’t in regular military uniforms. The majority of them wore the usual garb for an ER—pale green scrubs. He had no idea who was a nurse, a doctor or an aerospace medical technician.

‘I need an airway. I need an airway now!’ came the shout.

Avery shouldered his way in.

It brought everything into focus. That, he could do.

He put up his hand. ‘I’ll do it.’ A few heads turned at the unfamiliar voice and a little space appeared in the crowd.

The woman who had sent him flying had her short dark hair leaning over the patient. Her head shot up and her eyes narrowed. She had the darkest brown eyes he’d ever seen.

‘Who are you?’

Blood. Everywhere. All over the chest of a young child. His reactions were instant. Now he understood the clamour around the bed. Hands were everywhere, pressing on the little chest, trying to stem the flow.

The woman was right. This young patient needed an airway now.

The large penetrating wound—a spear of some kind through the chest—told him everything he needed to know.

He moved to the top of the bed and nudged her out of his way. Or, at least, he tried to.

Her hips stayed firmly in place. ‘Who are you?’ She was practically growling at him.

He glanced at the nearby trolley, opening the first few drawers until he found what he needed. ‘Do we have IV access?’ he asked a nurse to his left.

‘Just,’ she said promptly.

A small, firm hand closed over his. He turned around. The woman who’d sent him flying was just about in his face. Her dark brown eyes could have swallowed him up. She spoke so quietly he was sure no one else could hear. ‘I’m not going to ask you again.’ She gave a squeeze over his hand—and this time her grip was like iron. ‘I’m just going to break your hand.’

He lifted his ID and slid it between both their faces. ‘Let me do my job. We’ve got six months to fight with each other.’

She was small, obviously of Japanese descent but her skin was slightly darker than he would have expected. Her hair was poker straight, cut very short at the nape of her neck but becoming longer down past her ears. From straight on it looked like a bob. A smart cut for a nurse, short enough to be off her collar but not long enough to need tying up every day.

There seemed to be something about her. A presence. She was like a cannonball. People paid attention to her even though she couldn’t be the highest-ranking person in the room. Far from it, in fact. She only looked in her mid-twenties.

Firecracker? He couldn’t remember what the Japanese word was but somehow the nickname suited her. It seemed to sum her up perfectly.

It was obvious that in this room people respected her. He liked that. He liked that she was direct and efficient at her job.

Her eyes shifted and focused on the ID. She turned without a word and started shouting orders at others in the room. ‘Get an IV run through.’ She glanced at the endotracheal tube in the hand of her colleague. ‘I think we’ll need something smaller.’

Perfect. A nurse he could work with. All air force and military nurses and personnel were efficient and well trained. But he always worked best with those who could think ahead and weren’t afraid to voice their opinion. He had a sneaky suspicion that Katsuko—was that her name?—would never be afraid to voice her opinion.

Avery tried to ignore the bedlam around him. He tried to cut out the noise. There were two trolleys in the resus room and another team was working on another patient. They were moving like clockwork, performing cardiac massage.

He moved swiftly. ‘Any other doctors in here?’

‘Two are up on the helipad. They haven’t even managed to get the patient down yet.’ She pressed her lips together. ‘Blake won’t give up on the other kid. Not until he’s tried everything.’

The doctor attending to the little boy on the other trolley. Blake Anderson. The guy he was supposed to report to tomorrow. The scene on the other trolley was disheartening and he didn’t feel the urge to introduce himself right now. If he didn’t pay attention to the kid directly in front of him, he might end up resuscitating him too.

Avery took a breath and held out his hand. The area around this little boy’s neck and chest was swelling, a reaction to the severe injury that could compromise his airway. His sallow skin was losing its natural colour rapidly. A nurse was poised next to the IV meds, awaiting his instructions. He gave them quickly. Something for pain control. Something to sedate the boy and steroids to reduce the swelling and allow him to intubate. Airway first. Everything else later.

The nurse nodded and inserted the drugs into the IV cannula on the inside of the kid’s elbow.

‘ET tube.’ Avery held out his hand, bending down at the top of the trolley and tilting the little boy’s head. ‘Do we have his name?’

‘Mahito. His name is Mahito.’ The firecracker nurse was watching his every move.

‘Mahito, I’ve given you something for the pain and something to relax you. I’m going to have to slide a tube down your throat. Don’t panic. We’ll take good care of you.’ It didn’t matter that the little Japanese boy might not understand a word of English, or his Ohio accent.

He’d done this a hundred times before and he’d do it a hundred times again.

He gave Katsuko a few seconds as she translated his words rapidly. The little boy was barely conscious. He probably had no awareness of what was going on right now and that wasn’t a bad thing.

He tilted the little boy’s head back, lifting his jaw and sliding the silver laryngoscope into place. He could barely visualise the cords—if he waited any longer he’d probably have to do an emergency tracheotomy—but thankfully he had time to slide the thin blue ET tube into place and inflate the cuff. It took less than four seconds to secure the airway. He attached the bag to the end of the tube and let the nurse take over.

With the airway secure he could now take a few minutes to assess the situation properly. ‘We’re going to need to take him to Theatre. Can I get a portable chest X-ray?’

A woman in a blue tunic stepped forward, pushing the machine towards them. She’d been waiting for his signal. Like in most military hospitals, radiographers were always available in the ER.

A heavy lead-lined apron was dropped over his head. He didn’t even question where it had come from. A few people stepped from the room for a second.

‘Done,’ said the radiographer.

She glanced back at Avery. He could see the question on her face. ‘Avery Flynn. I officially start tomorrow.’

Satisfied with his answer, she gave a nod. ‘Dr Flynn, I’ll have your X-ray in a few minutes.’

Avery nodded. ‘Can anyone tell me what actually happened?’ He could see his counterparts still working on the kid on the other trolley, the flat line on the monitor almost mocking them.

‘Some kind of explosion. Lots of penetrating injuries. It was outside a local factory. The kids were playing, waiting for their parents to finish their shifts.’

‘Major Anderson,’ a voice boomed through the resus room doors. Everyone froze for a second then immediately resumed what they’d been doing. Eyes glanced at each other and the noise level in the room plummeted.

Avery frowned at the uniformed figure in the doorway. He had three people standing nervously behind him. The rank was instantly recognisable—as was the glint of the two silver stars—and he could hardly hide his surprise. He’d never seen a major general in an ER before.

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.