Jihad

CHAPTER 8

Lia saw Dr. Ramil freeze as the bodyguard demanded that he save Asad. His face paled and his eyes seemed to push back in their sockets. He was the perfect picture of fear.

“Brother,” she whispered in her Egyptian Arabic, tugging at the bodyguard’s shoulder. “The gun may not be a good idea here. The doctors are not used to being threatened. If they are nervous, they may not be able to do their job.”

The man turned and glared down at her.

“And someone who sees it might call the police,” added Lia.

Something flickered in the bodyguard’s eyes — hate, she thought, though she wasn’t sure whether it was toward her or the police.

“I will be nearby,” the bodyguard told her. Lia needed the translator’s help to untangle his quick Syrian tongue. “If they do the slightest harm to him, scream, and I will run and send them to hell where they belong.”

Dean nudged Ramil into the curtained cubicle. The emergency room physician gave Dean and Ramil a quick read of the patient’s vital signs and condition: shallow head wound, unconscious, low blood pressure.

“There are other patients arriving,” said the doctor. “Can you take him?”

“Of course,” said Ramil smoothly.

Dean took a small penlight from a nearby tray and checked for a concussion. The pupils were nonreactive; Dean gave a loud “hmmmm.”

“Mr. Dean, there appears to be a problem with the patient’s blood pressure,” said the specialist back in the Art Room. “There’s a chance it may be a reaction to the drugs. His heart beat also seems irregular. You’ll want to make sure Dr. Ramil makes a note of it.”

Dean glanced up at Ramil, who was just checking Asad’s eyes with a borrowed penlight.

“Can we have skull films?” Dean asked. “We should get them right away. If there’s a hematoma—”

“I would strongly recommend a CT scan,” said Ramil. “As a precaution.”

“Yes, by all means,” said Dr. Ozdilick.

“Blood pressure is low,” said Dean.

“Is it?” said Ramil, bending over Asad.

Ramil had already seen the blood pressure, but he pretended now to notice it for the first time. He was not a neurologist, but he had extensive experience with trauma patients, and he knew that this was not only unexpected but a bad sign. It might mean not only that Asad had really been injured in the accident, contrary to expectations, but that the injury was life threatening.

On the other hand, there were no obvious signs of cranial swelling. There was no obstruction to his airways and he was breathing normally. His temperature was fine.

If anything, the drugs that Asad had been given should have raised his blood pressure slightly. So was this a reaction to them?

They had planned to check for a hematoma. It was part of the standard medical procedure for a potentially serious head injury. And since the bug could be spotted on a scan, the films taken before the implant could be substituted in the hospital’s high-tech system later on if Asad was kept overnight for observation. Now, though, they had to take the scan to really rule out a head injury.

In layman’s terms, a hematoma was a pool of blood that leaked into a place where it shouldn’t be; it had to be removed or a patient might die from the injury. If this was the case, the low blood pressure would cause the brain to receive less oxygen. At the same time, the arteries in the brain would attempt to overcome the flow restriction and dilate, increasing blood flow and amplifying the injury. The result would be fatal unless Ramil operated immediately to relieve the pressure.

He could do that. He hadn’t expected to, but he could.

Then again, the patient didn’t have any of the other symptoms Ramil would expect to accompany that sort of head injury. This might be a reaction to the drugs he’d been given.

Something which also could be fatal.

“We need to insure positive ventilation,” said Ramil. “Is there an anesthesiologist?”

“He’s been paged,” said the nurse.

“We can’t wait. We need an intravenous, and we’ll want to ventilate,” Ramil told the nurse, adding that she should prepare doses of morphine and fentanyl, and to have ephedrine on hand.

Ephedrine especially, he thought, but he had to play it as someone who didn’t know what was going on would.

“Pressure dropped a little,” said Dean. He wasn’t looking at the instruments, and Ramil realized he had probably been prompted by the medical expert back in the Art Room.

“Six milligrams of ephedrine,” said Ramil.

He caught Dean looking at him as he waited for the hypo.

“He’ll be all right,” said Ramil.