Thanks for all of the wonderful reviews. It seems this story is one that has intrigued quite a few readers and that, of course, makes me extremely happy!
Warning: Mild swearing, details of medical trauma, and accounts of war-centred violence.
CHAPTER 3: Aftermath
"War does not determine who is right - only who is left."
- Bertrand Russell
Al-Quds Hospital, Jami'a al-Zayraa district, Aleppo Governorate, Syria
"Oh my god!" Charlie's hoarse yell could be heard from across the street. The tall woman quickly shut down the engine of the diesel powered, four wheel drive loader and jumped out of the seat to kneel over the pile of rubble she had been trying to clear. She frantically tried to move more of the large bricks away with her hands, scraping them on the course cement, as 2 sets of legs were revealed, buried underneath the debris. She coughed from inhaling a small amount of fine dust, the chalky smell invading her nostrils. "Jesus! There's— Somebody get a doctor!"
More shouts were heard as others came to the aid of the discovered bodies. Several more hands began lifting the heavy blocks, not hopeful at all that they were a part of a rescue but rather a recovery.
"We need some help!"
"Nahn bihajat 'iilana musaeada!" (We need help!)
"Akhrujhum min hunakan!" (Get them out of there!)
"Oh merde!" (Oh shit!)
"Lacie! Can you help me lift this?!" Charlie practically begged. Her dirty, bleeding hands had started cramping up and she watched with relief as several medical personnel came running out of the hospital.
"Oui, you lift that way and I will pull to your right!" The tall, French woman responded anxiously, wiping her dripping brow, smudging grey dirt across it. It contrasted heavily with her jet black hair. She lowered herself next to Charlie and tried to shift the large block that was resting across one of the bodies.
Having only just entered the front entrance of the hospital, Rosie heard the shouting first, and ducked, thinking another airstrike was about to occur. After a few seconds that felt like minutes, she uncovered her head feeling a bit foolish and tried to settle her pounding heart.
A short, dark haired, Syrian nurse grabbed her arm as she was passing and the pair left the hospital building with footsteps sounding behind them.
As Rosie got closer, her bottom lip disappeared between her teeth with worry and her hands trembled. "Oh no, Aya, this is horrible!" Rosie exclaimed and reached for the head nurse's clammy hand. Any sort of physical connection was comforting to her right now.
"It's war, Rosie." Aya responded sadly.
In a war zone, it was almost impossible to maintain a level of homeostasis. The autonomic nervous system functioned constantly to regulate the body's unconscious actions. The sympathetic nervous system's fight-or-flight response was triggered multiple times a day. An increase in heart rate, breathing accelerated at the release of adrenaline into the bloodstream, it was all a part of the living conditions.
Maura noted the familiar, reactionary response that started in the amygdala and ended in the prefrontal cortex, resulting in her adrenal glands producing the right amount of norepinephrine for the task ahead and an invigorating amount of endorphins released in her system. She reacted quickly, as did other staff members. However, she did not have the same fear-filled rush that her colleagues experienced. They received an added cortisol hit to create a rocket of anxiety within them.
For Maura, there was nothing to be anxious about... It was the thrill of the job.
She sped up almost effortlessly into a run at the shout for a doctor, Jane and Kent matching her pace from right behind. They kept a balanced focus on the location of their feet and ahead to where they were trying to reach, only 10 metres away. In that short distance they had to carefully dodge road holes that could easily dislocate or even break a bone if the placement was just right.
Reaching the gathered group of people, a fraction of a second after Aya and Rosie, the trio pushed through the circle of onlookers with urgency.
Jane's face paled as they uncovered the faces of the victims.
"Oh no, it's Sami and Amena!" Charlie almost cried as she recognised the faces of the husband and wife. The couple worked at the school and lived just two houses from it. How had they not realised they were missing? It had been over 48 hours since the bombing and they thought everyone had been accounted for. Knowing that she had missed two people that she considered her friends, was beyond upsetting to the tall woman.
"Oh god." Kent whispered, a hand to his mouth, the other reached for Charlie's shoulder in sympathy. The scene, not unlike many others he had witnessed, still shook him to his core.
The Scotsman's time serving with the British Army in Afghanistan as a medic had been horrific. When UK troops began to pull out just a few years ago, Kent had begun his experience with Doctors Without Borders. It had been as equally horrific and it never got easier.
Just like Barry, he was motivated and dedicated to help the vast amount of people in desperate need. How could he justify going home to his nice, upscale apartment in Edinburgh when there were people living amongst piles of rubble and dying every minute, every second in his world?
And it was his. He felt responsible for the state it was in, as did the others who were here. Those that could choose at any moment to be somewhere else, but they didn't. They knew how to own their part in the destruction of the world. No, none of them contributed directly or intentionally to the displacement of millions of people, but they felt indebted to give their everything to helping them.
Kent watched as his new boss quickly put her hair into a loose braid with the elastic at her wrist, and at the same time her intelligent hazel eyes searched the dirt encrusted faces for any sign of life.
The unconscious man and woman were partially covered by debris across their torsos and ashen white with chunks of mud caked to their bodies. The cement dust from the clearing of the bomb site had settled on them and they must have been close to where something had exploded in the ground, leaving the deep, dark earth splattered all over them. The man, Sami, looked like he had been impaled in his side by a piece of thick wire that had once been part of holding the flooring of the building together.
"Stop!" Maura commanded and scrambled forward to stop the hands that reached for the bodies. "You need to stop." Lacie stopped abruptly, her light blue eyes widening at the firm tone in which she was being spoken to. She looked over at the smaller woman with the commanding presence and put aside her offence to follow her instruction. It wasn't really possible to oppose the blonde doctor because she took over the whole scene with expertise.
Lacie had to admit, the woman wasn't difficult to watch. She was gorgeous and knew exactly what she was doing. It was a wonder to see.
Maura waved off the Red Cross workers and locals attempting to continue to move the heavy stones and bodies from the mess. "You could make it worse." She explained as she crawled closer again. Without any hesitation, she reached for Amena's neck, placing her fingers against a carotid artery and felt for a pulse. She wasn't hopeful considering the temperature of the woman. She frowned with disappointment before removing her hand and pulled at the skin underneath the woman's eyes. Nothing. Lifeless.
The doctor reached for Sami and repeated her actions.
It seemed like the small crowd surrounding her held their breath in anticipation.
Her eyes opened a little as she shifted her fingers slightly. "There's a faint pulse!" She claimed and held her hand there for another 10 seconds. Her eyes checked her expensive watch as she counted his heart's rate. Removing her fingers, she looked him over, assessing the scene in front of her. Behind the purposeful look, Maura was calculating exactly what the next best steps to take would be. It only took her 3 seconds. "Dr Drake, set up an OR. Get some nursing staff ready."
Kent got up and ran across the road and inside to do as he was instructed, grateful that he wasn't the one in charge. Rosie and Aya followed closely behind, intending to help him to prepare.
Jane had been watching the scene unfold in wonder. It had probably only been minutes since the initial yelling had taken place but so much had happened in the short time. She crouched down and placed her hand between the doctor's shoulder blades, her subtle perfume invaded Jane's senses and somehow caused her to feel comforted in the midst of the tragedy. "What can I do, Maura?" She asked as she looked over the unconscious man, tears threatening to spill as she looked over her friend.
The doctor seemed to not hear or feel the brunette as she focussed on running her hands expertly over various parts of the man's torso. After a few seconds she turned her head to face Jane. She heard her… and felt her. How could she miss the strong hand burning its impression onto her back? The expressive brown captivated her attention. They were a mix of worry, fear, and something else she couldn't quite place. Not now, Maura. She didn't give Jane's beautiful eyes another thought as she responded calmly. "We need a stretcher and blankets or sheets."
Jane removed her hand from the slightly damp back with a quick pat and got up from her crouched position. She jumped over a few larger blocks in her way and ran back to the hospital to get what was needed. Charlie followed, knowing she would require help.
"Maura! I got a call. What's going on?" An Australian accent sounded right next to her.
Too engrossed in what she was doing, she failed to express much emotion at seeing her long time friend. Instead she addressed him in a professional manner but there was a hint of recognition in the hazel gaze. "The female appears deceased and the male has a very weak pulse. As soon as that rubble is removed from his chest, we need to move quickly. Jane is retrieving a stretcher."
Unfazed by her aloof communication, Ian nodded and mentally prepared for what was to come. He knew Maura and wouldn't allow her outwardly cold persona to deter him. She had always been this way at work and it was effective. He had learned to appreciate it.
"What's the damage?" He smirked at his own question and took a second to internally acknowledge Maura's beauty. I didn't realise how much I missed her. His heart fluttered a little at the unexpected feelings stirring up and pushed them back down to dissect later. He gave a chuckle at her predictable reaction to his question.
Maura rolled her eyes. He knew she didn't like to guess. She didn't respond because Jane and Charlie came rushing back.
"Maura! Where do you want this?" The women carried the stretcher over and laid it down according to the petite doctor's instructions as best they could. Charlie remained near the man's head and Jane bent herself next to the doctor again, their arms brushing and distracting them both for a nanosecond.
"Don't move him yet." Maura instructed and grasped Jane's wrist lightly when it moved to act. She explained herself to the brunette quickly. "He's probably bleeding internally. If I can, I'll keep the metal in until we get him into the operating theatre. As soon as that debris is gone, we need to move fast."
Ian watched with intrigue at his friend's need to clarify. Dr Maura Isles didn't justify herself to anyone and to see her do so, so freely with Jane, caused him to take notice. He definitely noticed the contact that Maura had initiated. That was a big surprise.
Everyone surrounding, including Ian, watched in awe as the doctor expertly got the man ready to transport. "Ian, can you lift him so I can check if the wire is attached to anything?"
"Of course." The tall doctor crouched down next to her and carefully moved Sami enough for Maura to check his back.
Her hands probed cautiously. When she pulled them back out, her fingers were red. "It's unattached." She informed the Australian and reached for a blanket to place underneath the curve of the man's lower back and the newly bleeding wound. Ian lowered Sami back down and she quickly stabilised the wire. "Ok, ready to move." She stood, not caring about the filth that now covered her knees or the blood on her fingers.
"I'll support his neck." Ian stated and held the dark head in his large hands. He watched, amazed at Maura's ability to think and act so quickly and resourcefully in the emergency situation.
"Jane, can you and Charlie please grasp each side of the blanket here?" Maura pointed to either side of the unconscious body and the two women moved quickly. "As soon as I count to 3, we need to remove the rocks and lift him, but try not to jar his body. Straight onto the stretcher and into the operating room. Ok?" She looked at her helpers expectantly.
"Yeah, we got this." Jane nodded, ready to act.
"We need some help bringing Amena in too. She shouldn't be left here." Lacie's strong French accent sounded right next to Charlie.
"Of course." Jane instructed a few hospital staff and Red Cross workers on what to do once they removed Sami.
A little annoyed at the interruption to her course of action, Maura crouched down and readied herself for taking the man into surgery. She didn't bother looking around, expecting the hospital staff to follow her instructions. "Ok, let's get this debris off as quickly as possible… 1, 2 , 3!"
Jane picked up on her impatience and was a little startled by her unemotional attitude, but there was suddenly a flurry of activity and she focussed on what was happening.
The stones were removed rapidly, Sami was lifted carefully onto the stretcher, and Maura, Ian, Jane, and Charlie cautiously carried it to the rear entrance of the hospital.
The wheels were lowered when they reached the smooth flooring and Jane steered the bed down the hallway, Maura and Ian running after it. Charlie trailing behind anxiously.
They were met by Kent, Rosie, and Aya, ready to help.
The Scottish man tried introducing the pair but it wasn't the right time. "Dr Isles, this is—"
"Dr Drake, once we're inside, remove the metal and get the bleeding under control. The nurses can help. I'll check his head and chest." Maura grabbed a stethoscope and wrapped it around her neck. "Ian, I'll need your help."
"Doc- doctor Isles?" Kent's stammering sounded right next to her and she looked at him in irritation.
"Yes?" Her tone was clipped and she continued into the operating room to prepare herself.
"I'm- an orthopaedic surgeon! I- I don't—"
"Dr Drake, you have the training to handle what I've requested." She stated as she threw on a scrub top and washed her arms thoroughly.
"But, but I—"
"Move, Dr Drake!" Maura sternly ordered without looking up from rinsing the suds covering her arms. Every eye in the room zeroed in on the smaller woman and then looked away quickly.
Ian stood next to her, washing up with a smirk on his face. Oh buddy, don't fuck with her in the operating room, and don't show any sort of incompetence. She has no mercy for that.
Kent scrambled to do as he was commanded. His nerves took a backseat to fear of his new boss and not wanting to disappoint her. He put on a pair of latex gloves and a surgical mask, leaning over Sami and prodded carefully at the protruding wire. Ok, Kent, you know how to do this. It's been a few years, but you can do this. He went through the procedure in his head and waited patiently for the anaesthetist to arrive.
A little nervous about upsetting Maura, Jane moved to leave but was stopped by a hand on her arm. She looked at the calm and collected doctor. She wasn't sure how she hadn't noticed yet but she had the most stunning hazel eyes. They were full of excitement and confidence. She could tell that Maura thrived on this.
"Jane, can you please find me an operating kit, and get some gloves and scrub cap?!" Maura requested and continued on to speak with Ian. "Is the radiograph done?"
Ian stopped to observe again. Since when does she use manners in an emergency situation? He answered before she became impatient. "Yes, you were right." He pointed to the chest scan. He had tied his cap and put his gown on, and started prepping several IVs. There was no way he was going to appear lax in front of Maura on her first day… Or any day.
"Anterolateral flail chest with segmental fractures near the costovertebral junction. Pulmonary contusion on the right. We'll need to do an aortogram after surgery if he makes it." Maura stated impassively and waved Jane over to her with the items she had requested. "Thank you."
"Where the heck is the anaesthetist?!" Kent was stressing out.
"Relax… We can anaesthetise him." Maura commented with annoyance and Ian prepared a syringe. "You should have an oxygen mask on him already! Nurse, can you start antibiotics? Ian, as soon as this takes effect, I'm going to perform an anterolateral thoracotomy. I'll need to relieve the pressure around his heart. He has a high risk of aortic haemorrhage… Jane, can you please tie the cap on my head?"
Jane had never been so involved and up close to a surgery before. The limited help in the room was obviously making Kent panic but Maura was focussed and knew exactly what she needed to do. What confused her though is why Maura was asking for her to help with things the nurses could be doing but then she realised that she and Ian were the only ones the doctor knew.
The brunette put the material over Maura's golden head, reminiscing how just under an hour ago she had been standing behind the blonde in this position, unzipping her dress. Heaven help me! She held her breath to avoid the doctor's distracting scent and tied the cap tightly. She stood back as gloved hands reached up to settle the surgical mask into place. Maura's operating kit was opened quickly and she retrieved her preferred sized scalpel.
She leaned over the man's chest and counted. Third, fourth, fifth intercostal. She placed the scalpel slightly to the left and made an incision. Apex, midclavicular line. Maura continued her internal instruction and performed the surgery by the textbook, like she wasn't cutting into a human being that depended on it for survival.
"Blood pressure is dropping. He's tachycardic! Oxygen is low, Dr Isles." Kent exclaimed, slightly worried.
Jane's heart leapt in her throat as the room filled with beeping. The rest of her body, frozen in anticipation.
She watched in awe as Maura continued, unfazed, commanding the situation. The doctors and nurses assisting, followed her orders promptly as she helped them to get the man's vitals stable.
The blonde head bent back over the body and she continued her operation, unperturbed by the whole disruption.
Jane joined Charlie off to the side of the room and stared unmoving for the next 3 hours as the doctors literally saved the man's life.
"Fractured segments are bridged. It'd be nice if we had some plates here, huh?" Ian chuckled as he finished his part of the surgery.
"Is osteosynthesis not conducted here?" Maura asked without looking up. She was almost finished.
"Kinda." The Australian shrugged indifferently and stared at the focussed hazel eyes that took a second to roll at his comment. He laughed affectionately and kept staring at the blonde. "You look good, Maur."
The comment made her glance around the room and frown at him in warning.
Ian smirked and backed off from making any more comments.
They all breathed a sigh of relief once everything that could be done, was done, and Sami continued to breathe with ease. Time would tell more about his recovery.
"Well, that was relatively uncomplicated considering the circumstances." Maura stated as she finished tying the sutures closed on the man's chest.
Kent's eyes went wide at the comment. There was no way that was relatively easy in his mind.
"I can finish dressing his wounds, Dr Isles." Aya informed the doctor nervously.
Hazel eyes searched the woman's half-covered face and nodded, moving away from the body and pulling off her gloves and gown.
As the medical staff wrapped up the surgery, Jane and Charlie slipped outside and waited for the others to exit.
"That was fucking brilliant!" Charlie exclaimed, on a high from watching the doctors perform so efficiently and skilfully. "Did you see Dr Isles in there? When was the last time you had such a competent doctor under your supervision?!" The Red Cross representative had never been so close to the action inside the hospital. Sure, she had seen her fair share of the devastation here but it was rare that they got insight into the hopeful outcomes like what she had just witnessed.
Jane was in a daze. It really had been an incredible experience. She simply gave a laugh at the situation and shook her head at Charlie, unable to find words to express how she was feeling.
They made it a few metres down the hallway when Ian, Maura, and Kent exited the OR.
Ian's Australian accent sounded loudly in the quiet corridor as he addressed his friend and colleague with a beaming grin. "I gotta hand it to you, Maur, you really are the best!"
Kent, right behind the duo, nodded vigorously. "I'll say!"
Maura ignored them both and untied her hair, shaking it out in a move that shouldn't have been sexy at all after their recent event, but she had those present mesmerised for a moment. She roughly ran a hand through her golden locks and ruffled it to fall naturally to one side of her head, just wanting it free and out of her face.
Charlie recovered promptly and stuck her hand out to the smaller woman. "Dr Isles, I'm Charlie. ICRC Representative here in Aleppo." The tall woman gave her the most charming grin she could muster, her blue eyes twinkling. She was pretty sure she was already in love.
Professional mask still in place, Maura held her hand out and grasped it firmly. "Nice to meet you, Charlie." Her tired eyes communicated a kind interest but she wasn't capable of making small talk right at this time. She turned her attention to Jane and spoke softly. "Could you please take me to see the Chief of Medicine? I'd like to check in and report the operation while it's still fresh in my mind."
Jane almost jumped to attention, even at the gentle request. "Yeah, yeah, of course! His office is on the second level." The brunette noticed how tired the blonde was but she didn't want to oppose her request at this time. I think she might be a cyborg. She just got off a 12 hour flight, spent 2 hours touring the house with me, and then another 4 hours in an intense emergency situation. Now she wants to go and talk with the Chief… She's either a cyborg or Wonder Woman.
"Excuse us, Charlie. I look forward to chatting more another day." Maura stated and turned to the other two doctors. "Dr Drake, Dr Faulkner, thank you for your assistance today." She smiled politely once more at the three of them before beginning down the hallway to the stairs. Jane waved at them and caught up to Maura, walking side -by-side quietly to the Chief of Medicine's office.
"Bye Dr Isles." The short-haired woman responded and watched the doctor as she walked away, unable to keep her eyes off the firm backside encased in tight khaki.
"You wont get into her pants." Ian declared as he sidled up next to Charlie with mirth twinkling in his light brown eyes.
She raised an eyebrow at him sceptically. "Why, because you want to?"
He scoffed at her.
"Challenge accepted." The tall woman crossed her muscular arms over her chest and smirked at him.
The Australian shook his head and raised his hands as if surrendering. "No, no, Charlie. I wasn't challenging. It was more of a 'don't waste your time' warning."
Charlie contemplated his words. "Why? Coz she's straight?"
He simply rolled his eyes at her and turned back to meet up with Kent to check up on their other patients.
"Alright. I'll take that into consideration." The Red Cross representative mumbled to herself before leaving.
Jane knocked on the door and heard a quiet 'come in'. She smiled as she opened the door and the short, balding, Syrian man stood, grinning happily. "Jane! Come in, come in." His eyes landed on Maura and his grin broadened.
Jane turned to the smaller woman and almost placed her hand on her back again. She used it to move one of the visitor's chairs back slightly and leaned on it while making introductions. "Dr Abu Wassim please meet our new Medical Coordinator and trauma surgeon, Dr Maura Isles."
"Dr Wassim, it's a pleasure to meet you." They shook hands and Maura continued with enthusiasm. "I read the research paper you wrote with the American University of Beirut on the treatment of diabetes mellitus in the Middle East. The statistics for Syria were astounding."
Dr Wassim gave Jane an impressed look and sat down, motioning for the women to sit too.
Jane and Maura settled themselves quickly. The brunette felt a little out of place, not having known that the Chief of Medicine had published anything noteworthy. She sat upright, not feeling comfortable enough in front of Maura to slump in her chair in a relaxed state as she usually would when speaking with Abu. She had spent many hours in this office, venting her frustrations to the understanding and compassionate man. They had formed an odd bond and cared greatly for one another.
"Please call me Abu, Dr Isles. I am grateful you have read some of my work. I am very passionate about the health needs of the Syrian people but I feel the government is not providing us with what we need."
Maura relaxed into a conversation that was well within her comfort zone. "What do you believe is the greatest need?" She crossed one leg over the other, her booted foot coming in contact with Jane's knee. "Sorry." She whispered to the taller woman and got a slight, amused, raising of a lip in response. Jane didn't mind at all.
Maura focussed back on Dr Wassim as he gave her a well thought out answer.
"Besides the obvious immediate trauma cases from air raids, we need help with immunisations and noncommunicable diseases, and also obstetrics. Women will always continue to have babies, even in the midst of war, and children are dying from sicknesses that can be prevented. The problem is getting the medication."
Jane could contribute to this part of the conversation. "We had a load of meds come in yesterday afternoon. Insulin among them."
"Oh, this is great news! Why didn't you tell me?" Abu chuckled, not upset at all with the brunette. He knew how busy she got and that she would have told him as soon as possible.
It reminded Jane about why she had brought Maura to him in the first place. "Actually, I was on my way in this morning to show Kent and tell you about it but we found another couple under the rubble at the school."
Abu's eyes widened. "Ya alqarf!" He realised that neither of them spoke Arabic. "Um, I said shit. Sorry, Dr Isles." He apologised for his slip.
"It's nothing I haven't heard before, Dr Wassim." Maura offered with understanding.
"No, please, it's just Abu. May I call you Maura?"
"If that puts you at ease, then sure." Maura submitted to his authoritative position, obviously uncomfortable with the informality but unwilling to object.
The older doctor smiled in victory but Jane observed the blonde's body language. She wasn't happy about it. Maura had a warmth about her but her tone was still clipped and professional. Too many years on the field perhaps? Or maybe she's just not used to interacting with many people? She's certainly passionate about architecture and literature and she's damn good at her job. I just need to get her to talk more about stuff she likes. She got lost in her thoughts about her new roommate again, not hearing her name spoken until the third time.
"Jane?" Maura's hand reached over and rubbed her knee briefly.
"Oh, sorry! Long day already." The brunette snapped back to attention, trying to recall what they had been talking about. She looked at her watch. It was only 1:30pm.
"Jane, you were telling me something about the bodies found this morning." Abu prompted and Jane couldn't believe she had zoned out on that conversation.
"Shit, yes. Um, Amena and Sami." She stated sadly.
"Oh dear. I suppose the outcome was not good?"
Jane cleared her throat to hide the emotion she felt. "Uh, Amena didn't make it but um, Dr Is— Maura handled the situation and performed emergency surgery. Sami's stable but she can fill you in on the details. I just wanted you to know that's where we just came from."
The Chief of Medicine was beyond elated at the news. MSF had competent doctors but there weren't enough present and only one of them were confident enough for trauma responses. "Wow, Maura. You certainly know how to make an impression! We are very happy to have you. You can tell me about it tomorrow. Please go home and rest. You must be exhausted."
"Thank you. I will, if Jane doesn't mind escorting me?" The honey blonde turned to the tall woman, hoping that she didn't have to stay any longer. The doctor's eyes were bordering on bloodshot and would close involuntarily if she didn't sleep soon.
Jane thought she still looked beyond lovely. "Of course." She stood and shook the Chief's hand. "See ya, Abu."
Maura did the same. "See you tomorrow, Dr Wassim— Abu." She smiled sheepishly. It would take some time to adjust to informalities within the hospital but she knew she would adapt soon enough.
"Goodbye ladies." The Syrian man smiled broadly and watched the pair retreat, feeling more hopeful for their patients and district residents than he had in a long time.
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