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“If antibiotics aren’t working, he could die of a cavernous sinus thrombosis.”
Dante’s eyes widened. A leap of admiration lit his eyes—he was impressed. This shouldn’t be a time for such pleasure, but she couldn’t help it. She craved his approval. And by tomorrow there would be no more of it.
“That’s one of many things that could happen if his facial fractures are left untreated for any length of time. Which brings us to our catch-22 situation. We can’t operate because he can’t withstand the lengthy anesthesia and the multiple reconstructive procedures. We can’t not operate because waiting would also kill him.”
A feeling of impotence shuddered through her. What would they do now?
“So, Gulnar, where are those mini-plates?”
She blinked at his change of subject. “I ordered them the minute we arrived.” He’d asked for the mini-plate and screw systems, the latest techniques to hold together small bone fragments. She’d thought he just wanted to have them handy, in case he decided to proceed with the reconstruction. “They didn’t have any left, so they sent for them from Srajna’s other main hospital.”
“I just hope they make it by the time I need them to start stabilizing the bone splinters.”
Her heart lurched. “You mean you will go ahead with the procedure?”
The corner of those lips lifted. “Let’s scrub.”
“Let’s end this!”
Emilio’s note of urgency rang in Dante’s ears.
Dante knew he was pushing it, that Dimitri could stand no more. He still didn’t know how the guy had held on that long—four hours of surgery and some of the most intricate and extensive reconstructive work he’d ever done. But there had been no way around it. On exposure, Dimitri’s fractures had turned out to be far more catastrophic than even he and Gulnar had thought.
“Guerriero, just close him up. Finish this later!”
He couldn’t. Dimitri was dead anyway if he didn’t complete reconstruction. If not on the table now, then a week from now—maximum. There would be no other secondary surgery at a later date. It was now or never. He’d rather have Dimitri die in his hands as he fought for his life than die because he’d given up the fight.
But he could sympathize with Emilio’s distress. It must have been too much for even him—a man who lived on the razor edge of violence and desperati
on, and by choice, seeing his buddy’s face a dissected nightmare with Dante’s hands and scalpels deep inside it. Emilio had reached his limit after Dimitri had flat-lined. What about Gulnar?
She was holding in her distress better than Emilio, murmuring encouragement to Dimitri.
Emilio was silent for a dozen heartbeats then hissed again, “Pulse 185, BP 70 over 40. We’re losing him—again!” Emilio still didn’t miss a beat of the flawless surgical routine they’d fallen into, handing Gulnar the cautery probe and preparing the next set of mini-plates.
“No, we’re not.” Gulnar’s voice trembled as she cauterized and swabbed for Dante. Then it was time for the most important step, the frontal sinus ablation.
All through the first step of the procedure, Gulnar continued her murmurings to Dimitri between Dante’s hushed requests for instruments and assistance. Then Dante sighed as he moved away from the surgical microscope. “Gulnar, I’ve removed all sinus mucosa. Sort through the removed bone slivers and fat pads, form me squares of one centimeter each. I will need them to obliterate the naso-frontal duct.” It was where the infection was finding its way into the brain.
That took another ten minutes and Emilio announced again. “60 over 20. You’ve done the most important things. Anything else isn’t life-threatening and we’ve already shocked him once. How many times does his heart need to stop before you end this?”
“Emilio!” Gulnar’s warning mutter was almost inaudible. “Dimitri doesn’t need to hear your doom-mongering!” Louder, she resumed talking to Dimitri, bolstering, tender—teasing. “You don’t, do you, Dimitri? You’re fed up with all that doom-and-gloom stuff, huh? You’ve held up all through this when everyone kept saying you wouldn’t. You’ll do this, won’t you? You’ll get through this so we can finish our chess game. I want to beat you and get one of your fabulous caricatures.”
Dante’s eyes darted from Gulnar’s hands, as she helped him gain exposure of the central nasal bone fragments, to the monitors. Dimitri’s pulse was slowing down, his blood pressure inching its way up.
It had to be Gulnar. The man had been hanging on all that time to please her. He just knew it. And he knew the feeling. He’d done it before.
“Good man. We’re almost there,” Dante murmured.
“Hear that, Dimitri?” Gulnar helped Dante as he reduced and stabilized the superior and inferior orbital rim fragments with mini-plates. “If—and that’s a very long shot—you beat me, I’ll set you up with Magdalene. Yes, I know, and the good news is she feels the same. Now, all you have to do is get back on your feet…”
Dante ended up by reconstructing the nasal bone with a cantilever bone graft secured with a mini-plate. He finally tightened the last screw then sat back.
It was done. They’d put Dimitri’s face back together. And not only was he still alive, he was stabilizing. And Gulnar was still murmuring to him, congratulating him, praising his effort.
Dante suddenly felt the need to communicate with him, too. He took the needle holder from the relaxing Emilio, picked up the threaded needle from Gulnar and smiled beneath his mask down at his patient. Dimitri would hear—feel his pleasure, his confidence. He hoped. “Thanks Dimitri. It’s been an honor fighting through this with you. We’re closing you up now. And don’t worry, I promise you the best esthetic result possible. Once the swelling and bruises disappear, the fair Magdalene won’t even notice any scars.”
He felt Gulnar’s eyes swinging up to him, hotter than a cautery probe. He wondered if they would leave scars.
