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The patient was heaving on the bed as the monitors screamed.

His details flicked through Caroline’s brain. Forty-two-year-old male. Stocky build. Non-smoker. No history of asthma or bronchial complications. Presented two days ago with a URTI. Became feverish overnight and was admitted to the sick bay for monitoring.

“No obstruction in the throat,” she told Kelebile on examination. “The narrowing is spasmodic in nature and very high up. Get the ventilator ready.”

She was pleased to see how quickly he responded. There was nothing worse than nurses who dragged their heels in an emergency. She turned to grab her instrument tray, but found he had already pushed it into place beside her.

Pulling on a pair of gloves, Caroline took a scalpel and felt in the patient’s neck for the indentation between the larynx and the cricoid cartilage. She made an 8 millimetre incision, swabbing the blood away herself. When she reached the cricothyroid membrane, she cut again. She held out her hand and Kelebile placed a soft tube into it.

“Ventilator?”

“Nearly ready.”

Caroline inserted the tube into the patient’s trachea with gentle hands. Then she attached a mouthpiece to the tube and blew into it – two rescue breaths. It was a relief to see the patient’s chest rise and fall twice in response.

“Okay, we got in below the spasm, but he’s still not breathing on his own. How’s that ventilator coming?”

“Ready.”

Together, they hooked the patient up to the ventilator, controlled the bleeding, and neatened up the tracheotomy incision. Caroline set the frequency and oxygen saturation levels, and instructed Kelebile to set up an IV line.

“I’m going next door to see what antibiotics, bronchodilators, and corticosteroids we’ve got.”

“Antibiotics, Doctor?” It was asked not as a criticism but in a spirit of inquiry. This illness was, after all, believed to be viral in origin.

“To control any infection that might result from the whacking great hole I just knocked into his trachea in unsterile conditions.”

Kelebile nodded, satisfied.

 

**

 

When Caroline had got the patient stabilised to her satisfaction, she put her hands on her hips and looked up at Kelebile. “What the hell?”

                Kelebile thought for a moment. “Could he have lied about his history of respiratory illness?”

Caroline picked up the file hanging at the foot of the patient’s bed. “You wouldn’t think so, would you? The man’s a scientist after all. And he has wintered over at SPIRE twice before without incident. That’s twice more than you or I have. It’s hard to believe he could be so stupid as to lie about his medical history.”

“Does it say where he’s been recently?”

“I’m checking now.” Caroline flipped through the file. “No trips to the Far East or West Africa. He’s from the Czech Republic, and that’s where he’s been for the past six months. There’s some cryogenic institute there that he’s attached to.”

Kelebile gave a frustrated sigh. “It doesn’t make any sense. Was this some kind of idiopathic reaction …?”

“How many other patients have presented with cold or flu symptoms?”

“Three besides Mr Abramovitch.”

“Okay.” Caroline began to pace. “I need you to round them all up and bring them in here for examination. I’m going to take another look at Mr Abramovitch too, and then I’m putting a call in to New York. How exactly do I do that, by the way? Do I just pick up a phone?”

Kelebile shrugged. “I think the satellite phones work pretty much like normal phones, but you could ask at the Communications Centre.”

 

**

 

For the second time that day, Caroline found herself sitting in front of a computer screen while grainy images bounced their way across three satellites to her. At least Johannesburg was in the same hemisphere as SPIRE. These images were coming from New York and were correspondingly grainier.

Caroline had tidied her hair and put on some lipstick. She was looking into the face of Director Ayesha King – the head of SPIRE. Caroline had met her once before and that was in New Zealand when she had come to wish the winter-overs well before their flight to McMurdo Station in Antarctica. She had come across as a composed woman with intimidatingly excellent grooming.

Right now she looked less than thrilled to be receiving an urgent call from SPIRE’s resident medical doctor and virologist.

“Dr Burchell.”

“Director King.”

“I presume this is urgent?”

“It is. At fourteen hundred hours, SPIRE time, today, I tracheotomised, intubated, and ventilated Mr Abramovitch who has been exhibiting cold and flu symptoms for the past 48 hours. He progressed within minutes from respiratory distress to full respiratory arrest.”

If Caroline had expected a reaction, she was disappointed. Not a muscle flickered on the other woman’s face.

“So, he’s not dead then?”

Caroline confirmed that he was indeed not dead.

Director King nodded slowly. “In that case, congratulations, Dr Burchell. Your response was clearly timeous and appropriate.”

This wasn’t why Caroline was calling, but she took the gap anyway. “I should also mention Nurse Kelebile Khumalo who assisted me. He responded coolly and with great skill under pressure.”

“Noted. Then if there’s nothing else …” Her hand crept towards the mouse to terminate the connection.

“No, wait! Director King.”

The director’s eyebrows rose.

“I’m not happy with Mr Abramovitch’s condition. Not at all.”

“But you got him stabilised?”

“That’s a very relative term, Ma’am. Mr Abramovitch is seriously ill. He’s not breathing on his own. His heartbeat is thready, his blood pressure dropping, and his whole system toxic. I suspect catastrophic organ shutdown. He needs to be evacuated immediately.”

“Impossible. Let me remind you what happened last winter …”

“I know about that, but I thought in this case …”

Director King rolled right over her. “One of the vehicle mechanics had a heart attack and needed to be medically evacuated. The weather was fine so I approved the evacuation. Two Twin Otter planes flew to McMurdo Station where the Americans were kind enough to accommodate us. Then one plane set off to SPIRE with three personnel on board. The other stayed behind as an emergency response plane. The first Twin Otter ran into unexpected bad weather and went down with all lives lost. The second plane was dispatched on a rescue mission but had to turn back when it too encountered bad weather. The bodies and wreckage were discovered this summer. I am never again trading three lives for the sake of one. The board has placed a moratorium on medical evacuations in all but the most exceptional of circumstances.”

“Yes, but…”

“Dr Burchell, you and Nurse Khumalo are the most highly qualified medical personnel we’ve ever had at SPIRE. We spent millions on outfitting the sick bay with all the latest medical equipment. The only item of any significance you don’t have is an MRI because they drain too much power. Between the two of you, you and Nurse Khumalo could take out an appendix, deliver a baby, perform a mastectomy – hell, you could probably manage some open-heart surgery if it came to it. So, what I want to know from you is this – will this man have a significantly higher chance of survival if we fly him sixteen hours to Chile than he would at SPIRE with you and Nurse Khumalo looking after him?”

Caroline closed her eyes. Terms like “significantly better chance” made her uneasy. A slim chance was usually a good enough reason for her to do something for a patient.

She opened her eyes. “No. I can’t honestly say that. The truth is, I think he’s going to die anyway.”

“Thank you for your honesty.”

The screen went blank.

 

**

 

Caroline had been back in the sick-bay just a few minutes when a new patient stumbled in through the door. He was bleeding from his eyes.

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