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“I can see that. OK, tell him he has a parasitic infestation by a tapeworm of the genus Echinococcus granulosus which is causing him a disease called cystic hydatidosis of the liver, the favorite target of the organism. At least one cyst now is over five centimeters in size and that’s why its pressure produced symptoms of obstructive jaundice and abdominal pain. I also suspect he has bile sac rupture, therefore his classical triad of biliary colic, jaundice and urticaria.”
She turned her back to the patient and shook with suppressed laughter. Dante widened his eyes in devilish innocence. “What? He should know all that!”
A splutter escaped. “I’m sure it would also interest him to know that the stuff he passed in vomit and stools was the hydatid membranes when the cyst ruptured!”
“Ah, so that is how you diagnosed it!”
“That, the triad and him living in a country in his childhood where it is endemic. He used to live in Greece.”
“Brilliant, bambola! So, shall you tell him all that?”
She gave him an affectionate nudge. “Just tell me what I can tell him about the surgery.”
“Tell him that’s it’s nothing serious now he’s diagnosed. We’ll take care of him, I’ll just go in, remove the ruptured gall bladder, remove the parasite and sterilize the cyst cavity by injection of a scolicidal agent. Hmm, we do have formalin here, don’t we?”
“Dante! You don’t tell patients you’re going to inject them with formalin!” She knew he was teasing her, knew how considerate he was with his patients.
He pretended bafflement. “It is what I’m going to do!”
“Well, I’ll stick with telling him it’s a solicidal agent—hell, a parasite killer. I’m not about to try to explain to him why we’re going to inject him with something used in preserving corpses!”
In twenty minutes, the surgical team was gathered around the sedated Mr. Khurdi and Dante was taking one more look at the X-ray and ultrasounds.
He snorted in disgust.
Gulnar raised her eyes from her final preparations of the surgical instruments. “We already knew X-rays aren’t well known for their reliability in detecting hydatids.”
He rotated his neck, working a crick out. “I do wonder why we bother with X-rays at all. And ultrasound results remain operator-dependent.”
Her eyes caressed him. “And since our operator is the best there is, we did find confirming signs—daughter cysts, sand…”
“But not an exact position. But, wonder of wonders, there is the barest shadow in the X-ray of a thin rim of calcification delineating the cyst.”
“Enough for you to go in with confidence?”
He gave the X-rays one last assessing look, then handed them to her. “I believe so.”
“OK, Dante, he’s under. You can go ahead.”
Dante looked at his anesthetist. Sam Hiller wasn’t looking at him. Not likely when he could barely take his eyes off Gulnar. Dante sympathized. And because he knew Gulnar was his alone, as long as their…arrangement lasted, he didn’t mind.
He still couldn’t believe what she’d done to him. She’d created new facets in him, new personas. The perpetually lusting male. The powerless, dependent creature. The devil-may-care rogue. The fearless fighter. And then there were the richness and tenderness and joy and freedom and constant surprises…
He knew he was heading fast for the fall of his life, the one he’d never recover from. He’d taken the leap into the chasm the day he’d come back, was now suspended in mid-air. Until he began his descent and crashed, it felt like soaring.
Helena’s guttural voice intruded into his contemplations as he marked the field of surgery on Khurdi’s abdomen. She was asking Gulnar something, her eyes as heavily on him as Sam’s were on Gulnar. But that he minded. He shouldn’t have agreed to make her his second assistant. Hell, he didn’t need a second assistant.
He shook his head and decided to give the staring Helena something to do to take her focus off him. “Gulnar, will you tell Helena to go find out if we have 0.5 per cent cetrimide solution in our pharmacy? It’s the agent of choice for cyst cavity sterilization. If we have it, I’d rather use it instead of formalin.”
Gulnar translated and the woman at last shifted her glassy blue eyes off him and went out to do his bidding. He breathed a sigh of relief. Then he began the procedure.
He made a mid-line incision at the same level as the cyst, then deepened it throughout the layers of the abdominal wall then pulled back as Gulnar placed self-retaining retractors, opening the operative field.
“We need to protect the surrounding tissues,” he informed her. “Once I begin removal of the daughter cysts, any spillage can seed the abdomen with the parasite and cause secondary infestation.”
“As I remember—packing by formalin soaked packs?”
“You remember right.”
