Page 2 of Duty Devoted
While waiting for Sophia, I explained to Miguel what needed to happen. “The object may have damaged your liver. We need to remove it carefully and repair any damage. I won’t lie to you—this is risky. But doing nothing is riskier.”
His hand found mine, surprisingly strong despite his weakened state. “I trust you, Doctor.”
Trust wasn’t necessarily going to be enough to keep him alive, but I squeezed his hand.
Sophia entered, her expression shifting from confusion to understanding as I outlined my plan. I waited for her to tell me all the reasons this was impossible.
“What do you need me to do?” she asked instead.
Relief flooded through me. This was why I respected Sophia. She saw the same impossible choice I did and chose to act.
“I know our limitations,” I said. “But he’ll die if we send him out untreated, and the company won’t pay for transport.”
“Then we work with what we have.” She was already mentally cataloging our supplies. “Let me call the hospital for guidance while you prep him. Maybe we can get through this time.”
“We’re racing against time here.”
“I know. But if we’re doing this, we’re doing it right.”
Surgery in our makeshift operating room was never ideal. The lighting was inconsistent, the equipment basic, and our anesthesia options limited. We had done difficult procedures before, but this would be the most challenging yet.
Once Miguel was sedated with our precious ketamine, I sterilized the area around the wound as best I could.
“Vital signs?” I asked Mariela, who had been trained to monitor patients during our improvised surgeries.
“Heart rate 110, BP 90/60. Dropping but still stable.”
I nodded, taking a deep breath. “I’m making the initial incision now.”
The first cut revealed what I’d feared—blood filling the abdominal cavity. Using suction and gauze, I worked to clear my visual field.
“More light,” I requested, and Sophia adjusted our surgical lamp—actually a modified construction light we’d rigged with a special bulb.
“There,” I said, finally locating the source of bleeding. “The foreign object has lacerated his liver. Clamps, please.”
For the next two hours, I worked methodically to repair the damage. Sophia anticipated my every need, handing me instruments before I could ask, monitoring vitals, adjusting lighting. We moved together with the kind of synchronization that came from months of working side by side in impossible conditions.
The liver laceration was serious but fixable. I removed the foreign object—a piece of metal roughly the size of my palm—and repaired the damaged tissue with careful sutures.
“BP’s dropping,” Mariela warned as I was placing the final sutures. “85/50.”
“Almost there,” I said, working faster. “Prepare another IV. We need to replace more volume.”
“That’s our last bag,” Sophia reminded me, but she was already moving to set it up.
“Then we’ll make it count.”
As I finished closing, Miguel’s blood pressure stabilized—low, but no longer falling. I stepped back, rolling my shoulders to release the tension that had built during the intense concentration.
“Good work, everyone,” I said, allowing myself a small smile. “He’s not out of the woods, but we’ve given him a fighting chance.”
“Beautiful suture work,” Sophia said quietly as we transferred Miguel to our recovery area. “I’ve seen trauma surgeons in fully equipped ORs do worse.”
While Mariela stayed with Miguel, I spoke with the other miners, now all treated for their less-severe injuries.
“He’ll need careful monitoring for the next forty-eight hours,” I explained. “If complications develop, we’ll have no choice but to transfer him to Ciudad del Este, regardless of cost.”
“The company will fire him if he causes trouble,” one man said, his eyes downcast.
