The siren's wail wasn't a promise; it was a physical assault. It vibrated through the crumpled metal cage of the Nissan Sunny, drilling into Amara Okafor's fractured consciousness with each piercing oscillation. The red and blue lights strobed against her eyelids, painting the darkness behind them with jarring, urgent colour. Hands, impersonal yet firm, moved around her. Rough fabric scraped against her neck – a makeshift collar. Voices, sharp with practiced urgency, cut through the fog of pain and the relentless ringing in her ears.
"GCS 12! Possible C-spine, obvious left shoulder deformity, head lac, shallow resp!"
"Oya, move am gently-gently! Mind the neck! Abeg, hold the backboard!"
"IV access – find a vein! She's shocky!"
The world tilted violently as she was manoeuvred onto a rigid board. Agony, white-hot and blinding, exploded from her shoulder, radiating down her numb left arm and up her neck. A strangled cry escaped her lips, swallowed almost immediately by the metallic taste of blood and the suffocating press of the collar. Faces swam above her – paramedics in green LASAMBUS uniforms, their expressions focused, devoid of the earlier crowd's panic but etched with the weary competence of those who battled Lagos's chaos daily. One secured a plastic mask over her nose and mouth. Cool oxygen hissed, a stark contrast to the hot, dust-laden air of the bridge.
"Madam, you dey hear me?" A paramedic leaned close, his eyes scanning hers. "You go LUTH now. Just relax."
*Relax?* The absurdity almost sparked a laugh, but it died as another wave of pain from her ribs stole her breath. LUTH. Lagos University Teaching Hospital. The name conjured images of overcrowded wards, harried staff, and… bureaucracy. A fresh wave of anxiety, colder than the pain, washed over her. Her files. Her phone. Her car. Her *case*. The unfinished business against SARS felt like a physical weight crushing her chest alongside the broken ribs. She tried to form words, to demand information, to assert control, but the oxygen mask muffled her, and the paramedic was already turning away, shouting instructions.
The ambulance interior was a claustrophobic capsule of noise and movement. The siren screamed outside; inside, the rhythmic beep of a monitor joined the hiss of oxygen and the tense, clipped communication between the paramedics. Every bump in the road, and Lagos roads were *all* bumps, sent fresh jolts of agony through her body. The journey felt interminable, a descent into a personal hell paved with potholes and lit by flashing lights. She focused on the paramedic's face, on the sweat beading on his forehead, on the frayed edge of the oxygen mask strap – anything to anchor herself against the terrifying loss of control and the encroaching darkness she fought with gritted teeth.
***
Dr. Anayo Ifeanyi felt the familiar, unwelcome shudder vibrate through the soles of his worn loafers just as the fluorescent lights above the central nursing station in LUTH's ER flickered, dimmed dramatically, and then died. A collective groan, weary and resigned, rippled through the crowded space. The steady electronic symphony of monitors, the hum of air conditioning units, the fluorescent buzz – all cut off abruptly, plunging the large, open-plan Emergency Room into near-darkness punctuated only by the weak, greyish light filtering through high, grimy windows from the Lagos night.
"NEPA has finished us again!" Nurse Bimpe's voice cut through the sudden semi-darkness, sharp with frustration. She slammed a chart down on the counter.
Anayo didn't flinch. He simply closed the file he'd been reviewing – a complicated diabetic foot ulcer case complicated by obvious neglect – and reached for the heavy-duty torch clipped to his belt. Its powerful beam cut a swathe through the gloom, illuminating dust motes dancing in the air and the anxious faces of patients and relatives crowded onto benches lining the walls. The air, thick with the smell of antiseptic, sweat, blood, and underlying decay, instantly felt heavier, hotter, without the struggling AC.
"Generator go come on," he stated, his voice calm, low, and carrying an authority born of too many nights like this. It wasn't optimism; it was grim acceptance of the hospital's rhythm. "Bimpe, check Trauma Bay 2 is clear. We have that MVA incoming from Third Mainland Bridge. LASAMBUS just radioed, ETA two minutes. Female driver, conscious but injured, possible multi-trauma."
"Yes, Doctor," Bimpe replied, her tone shifting instantly to professional briskness. She grabbed another torch. "Oya, people!" she called to the junior nurses and orderlies. "Make una clear bay two! Bring the portable suction! Where that cervical collar dey?"
The ER, already operating at near-capacity before the power cut, descended into a new level of controlled pandemonium. Torch beams crisscrossed the space like searchlights. Relatives murmured louder, their anxiety amplified by the darkness. A child started wailing. Anayo moved with deliberate speed towards the ambulance bay entrance, his torch beam sweeping the floor ahead of him. His mind, usually a tightly ordered repository of symptoms, protocols, and differential diagnoses, compartmentalized the frustration. The power outage was an adversary, yes, but a familiar one. The patient coming in was the unknown, the immediate battle.
He heard the siren before he saw the flashing lights. It grew rapidly louder, a Doppler-shifted scream that cut through the background hum of the generator-less hospital and the city noise outside. Then the harsh white and red lights flooded the ambulance bay entrance as the LASAMBUS vehicle reversed in with practiced urgency.
The back doors flew open. The paramedics moved with efficient speed, sliding the stretcher out. Anayo's torch beam immediately found the patient.
A woman. Late twenties, perhaps. Her face was a mask of blood, dried and fresh, obscuring her features, matting her dark hair against her scalp. One eye was swollen shut. A crude cervical collar was in place. Her blouse was torn and stained. But it was her posture that struck him first – rigid with pain, yet radiating a fierce, almost defiant tension even in her battered state. Her one visible eye, a deep brown, was wide open, blinking rapidly against the sudden assault of torchlight. It wasn't the vacant stare of shock he often saw; it was alert, scanning, *assessing*. And filled with pain.
"Dr. Ifeanyi!" one paramedic called, recognising him. "Thirty-year-old female, RTC on Third Mainland Bridge. Car vs pillar. GCS dropped to 10 en route. LOC at scene, approx two minutes. Obvious left clavicular deformity, suspected # ribs left side, deep scalp laceration frontal region, approx five cm. BP 90/60, HR 120, RR shallow 28, SpO2 92% on O2. IV access left antecubital, normal saline running. No major external haemorrhage noted besides scalp."
Anayo nodded, his gaze never leaving the patient. "Okay. Into Bay 2. Now." His voice was clipped, all business. The torchlight caught the glint of a small silver pendant lying on her chest amidst the blood and torn fabric – a scale of justice. A detail noted, filed away.
The transfer from ambulance stretcher to the ER trolley in Bay 2 was a symphony of grunts, coordinated movements, and the clatter of equipment. The bay was illuminated by two portable examination lamps plugged into a heavy-duty extension cord snaking from a hallway outlet presumably on a different circuit. The main generator hadn't kicked in yet. The air was thick, stifling.
"Oya, log roll on three!" Anayo commanded, positioning himself at the head to maintain cervical spine control. "Bimpe, support the head! Tunde, Ade, ready? One… two… three!"
They rolled her with practiced care onto her side. Anayo's torch beam, now augmented by the portable lamps, swept down her back. No obvious spinal deformity, no major wounds. Good. They rolled her back.
"C-spine control maintained," Anayo confirmed. "Bimpe, get me shears. Let's get this blouse off, see what we're dealing with." He glanced at the patient. "Madam, I am Dr. Ifeanyi. You are in LUTH Emergency. We are going to help you. You were in a car accident. Do you understand?"
The one visible eye fixed on him. It was clouded with pain, but the intelligence, the awareness, was startling. She gave a tiny, almost imperceptible nod. Her lips moved behind the oxygen mask still in place. A faint sound emerged, muffled, unintelligible.
"What was that?" Anayo leaned closer, his ear near the mask.
She swallowed, a visible effort. Tried again, her voice a raspy whisper, thick with blood and effort, but laced with an undeniable sharpness. "…Sim… card…"
Anayo straightened, frowning slightly. Not a plea for water, not a cry of pain. *Sim card?* Priorities. "Your injuries are serious. We focus on that first." He took the trauma shears from Bimpe. The sound of the heavy blades cutting through the expensive-looking but now ruined silk-blend blouse was loud in the tense quiet of the bay. Underneath, the left clavicle was visibly deformed, a grotesque lump under the skin. Bruising was already blooming across her left chest wall like a dark, violent flower. He palpated gently, eliciting a sharp gasp and a flinch. Definitely fractured clavicle, likely multiple ribs too. Breath sounds were diminished on the left.
"Chest wall injury, probable pneumothorax developing," Anayo murmured to Bimpe. "Prep for chest tube, just in case. Portable X-ray STAT when power's back. Get bloods: FBC, U&E, GXM, coagulation." He turned back to the head laceration. It was deep, bleeding sluggishly now. "Suturing needed here too. Scalp bleeds like hell."
He reached for a gauze pad soaked in saline to clean the area around the wound, trying to get a better look. As he gently dabbed, his fingers brushing sticky blood from her forehead, her visible eye snapped open wider. She flinched violently, a full-body jerk despite the pain it must have caused.
"Get… your hands… off me!" The words were stronger now, fueled by adrenaline and indignation, cutting through the oxygen mask's hiss. Her eye blazed with a fury that seemed incongruous with her battered state. "Who… are you? What are you… doing?"
"I am Dr. Ifeanyi," he repeated, his voice deliberately calm, though a flicker of irritation sparked. He'd seen combative patients before, usually drunk or high. This felt different. This felt like… accusation. "I am trying to assess your injuries. You have a serious head wound and possible internal injuries."
"You look… like a butcher… in scrubs," she rasped, her gaze fixed on his face with unnerving intensity. The torchlight caught the defiance in her eye, the pain receding momentarily behind a wall of sheer will. "Where's… my phone? My SIM card?"
The sheer irrelevance of the question, the misplaced focus amidst her obvious trauma, struck Anayo. It wasn't confusion; it was a demand. A lawyer's demand, perhaps? The scale pendant… "Madam," he said, his tone hardening slightly, the professional mask slipping just enough to reveal the bone-deep fatigue beneath. "Your phone is irrelevant right now. You are bleeding. You are potentially bleeding inside. You cannot breathe properly. That," he gestured towards her deformed shoulder, "needs attention. Your *SIM card*," he infused the words with deliberate, cool disdain, "can wait."
Her visible eye narrowed. She tried to lift her right hand, perhaps to push him away, but pain shot through her shoulder and ribs, forcing a choked gasp. She sank back, panting, the oxygen mask fogging rapidly. But the fire in her eye didn't dim. "You have… no right… to touch my things… or me… without…" She winced, struggling for breath. "…consent."
Anayo felt a muscle twitch in his jaw. Consent. In the chaotic, resource-starved pit of LUTH's ER at night, with NEPA playing its usual games, consent was often implied by the act of arriving broken and bleeding. He had a duty of care that superseded demands about SIM cards. "Your consent is implied by your medical emergency," he stated flatly, picking up the gauze again. "Now, hold still. This needs cleaning."
He reached for her forehead again. This time, she managed to turn her head slightly away, a feeble but unmistakable act of defiance. "Don't… touch me," she whispered, the words laced with pain but also a core of steel. "I want… another doctor."
A low murmur ran through the small team in the bay. Nurse Bimpe exchanged a glance with an orderly. Anayo froze, the damp gauze hovering inches from her bloodied skin. The request, delivered with such wounded pride, hit him unexpectedly. It wasn't just combative; it was a rejection. A personal dismissal. In the dim, flickering light, surrounded by the groans from other bays and the oppressive heat, her refusal felt like a physical blow. He saw the tremor in her hand resting on the trolley, the rapid rise and fall of her injured chest beneath the sheet they'd draped over her, the sheen of sweat mixing with the blood on her brow. She was terrified. And she was channelling that terror into anger, directed squarely at him.
He took a slow, deliberate breath, forcing down the flare of professional pride and the deeper, older ache that her rejection inadvertently prodded. *Not again. Not another life lost to distrust, to fear of the white coat.* The image of his younger brother, Emeka, pale and still in a poorly lit rural clinic bed, flashed unbidden – a wound that never truly healed. Emeka had trusted, and the system had failed him. This woman didn't trust at all.
"There *is* no other doctor for you right now," Anayo said, his voice lower, stripped of its earlier coolness, revealing a thread of something harder, almost weary. "I am the consultant on duty. You need urgent care. Your bravado is admirable, but misplaced. That head wound could hide a skull fracture. Every minute you waste fighting me increases the risk of permanent damage or worse." He held her gaze, his own dark eyes unflinching in the torchlight. "I understand you are scared. I understand you feel violated. But right here, right now, in this darkness, with your body broken, I am your best chance. So, you can waste energy fighting the hand trying to help you, or you can let me do my job. Choose."
The silence that followed was thick, charged. The only sounds were her ragged breathing amplified by the mask, the distant wail of another siren approaching, and the frustrated clatter of instruments as Bimpe prepped the suture tray under the portable lamp. The portable lights flickered ominously.
The woman stared at him. The fury in her visible eye warred with the dawning, terrifying comprehension of her vulnerability. The pain was relentless. The darkness was disorienting. The sheer, overwhelming reality of her situation – trapped, broken, at the mercy of this stern-faced stranger in a failing hospital – pressed down on her. The fight leaked out of her posture, replaced by a tremor she couldn't control. Her eye flickered, losing focus for a second before snapping back to his face. The defiance was still there, but it was fractured, overlaid with primal fear.
She didn't speak. She didn't nod. But she stopped trying to turn away. Her gaze remained locked on his, a silent, furious capitulation.
Anayo saw it. The slight sag of her uninjured shoulder, the minute relaxation of the rigid tension in her neck muscles against the collar. It was enough. He didn't wait for verbal confirmation. Time was critical.
"Okay," he said, the single word devoid of triumph, only grim necessity. He resumed cleaning the wound with swift, efficient strokes. The blood was stubborn, sticky. "Bimpe, get that suture tray ready. And where is that portable suction? We need a better view." He glanced down at the patient. "This will sting."
It did. She hissed, a sharp intake of breath, her good hand clenching the sheet beneath her. But she didn't pull away. Her eye remained fixed on the ceiling, or perhaps on the shadows dancing there cast by the flickering lamps. Anayo worked quickly, his movements precise despite the challenging conditions. He irrigated the laceration, revealing its full extent – deep, down to the bone, but clean-edged. No obvious fracture palpable. Good news, relatively.
"Scalp lac, deep but no fracture evident," he dictated softly to Bimpe, who was threading a needle. "Prepping for closure. Give me 2% lignocaine with adrenaline. Small wheal." He took the syringe Bimpe handed him. "Local anaesthetic," he informed the patient, his voice clinical again. "Going in now. Small pinch."
He injected swiftly, expertly. She barely flinched. Her focus seemed turned inward, wrestling with pain and humiliation. As the anaesthetic took effect, Anayo began suturing. The rhythmic motion – needle piercing skin, suture pulling through, knot tied – was almost meditative in the tense atmosphere. He worked meticulously, ensuring the edges aligned perfectly to minimize scarring. His concentration was absolute, a shield against the heat, the gloom, and the unsettling intensity of the woman's silent presence.
Halfway through closing the wound, the overhead lights flickered violently, buzzed loudly, and then flooded the ER with a sudden, harsh, unforgiving fluorescence. The main generator had finally roared to life somewhere deep within the hospital's bowels. The air conditioning units sputtered back on, blasting out a wave of blessedly cool, though stale, air. The electronic monitors around the bay sprang back to life, displaying their glowing numbers and waveforms. The background hum of the hospital machinery returned, a familiar, if unwelcome, soundtrack.
The sudden brightness made the woman blink rapidly. It also illuminated the ER bay in stark detail – the chipped paint on the walls, the stains on the floor, the worn equipment, the exhausted faces of the staff, and the full extent of the blood smeared on the trolley and on Anayo's gloved hands. She saw the deformed lump of her shoulder clearly now under the thin sheet. She saw the deep bruising spreading across her chest. The reality seemed to hit her anew. A small, choked sound escaped her, quickly stifled.
Anayo finished the final suture, tied it off, and cut the thread. "Sutures done. Head wound closed." He peeled off his bloodied gloves. "Bimpe, clean and dress it. Now, let's look at that shoulder properly." He reached for a fresh pair of gloves.
As he moved to the side of the trolley, his gaze swept over her properly in the bright light for the first time. Beyond the blood and swelling, beyond the defiance and the pain, he saw the fine bone structure of her face, the determined set of her jaw even in defeat. He saw the expensive, now ruined, clothes. He saw the intelligence still burning in that one dark eye, watching his every move. And he saw the small silver scale pendant, glinting against her skin. Recognition clicked, finally, slotting into place like a missing puzzle piece.
The fiery human rights lawyer. The one who'd just won the high-profile SARS case. He'd seen her face briefly on the NTA news bulletin playing silently in the doctors' lounge earlier that evening. Amara Okafor.
A complication. Not just a trauma patient. A public figure. A woman used to being in control, now utterly dependent. A woman whose fight against systemic injustice mirrored his own private battles within the crumbling healthcare system, albeit on a different battlefield. The potential for… difficulty… skyrocketed.
He met her gaze again. She was watching him, a new kind of awareness dawning in her eye. Had she recognised him? Unlikely. But she saw his pause, his momentary assessment.
"Problem, Doctor?" Her voice was still weak, still raspy, but the edge was back. It was a challenge. A demand for information. The lawyer reasserting herself, even broken.
Anayo snapped the fresh gloves onto his hands, the sound sharp in the now brightly lit bay. "No problem, madam," he replied, his tone carefully