—
Sara Linton leaned back in her chair, mumbling a soft “Yes, Mama” into her cell phone. She wondered briefly if there would ever come a point in time when this felt normal again, when a phone call with her mother brought her happiness the way it used to instead of feeling like it was dragging a piece of her heart out of her chest.
“Baby,” Cathy soothed. “It’s all right. You’re taking care of yourself, and that’s all Daddy and I need to know.”
Sara felt tears sting her eyes. This would hardly be the first time she had cried in the doctor’s lounge at Grady Hospital, but she was sick of crying—sick of feeling, really. Wasn’t that the reason that, two years ago, she had left her family, left her life, in rural Georgia, and moved to Atlanta—so that she would no longer have the constant reminder of what had come before?
“Promise me you’ll try to go to church next week.”
Sara mumbled something that might sound like a promise. Her mother was no fool, and they both knew that the possibility of Sara ending up on a pew this Easter Sunday was highly unlikely, but Cathy didn’t press.
Sara looked at the stack of charts in front of her. She was at the end of her shift and needed to call in her dictation. “Mama, I’m sorry, but I need to go.”
Cathy exacted a promise of another phone call next week, then rang off. Sara kept her cell phone in her hand for a few minutes, looking at the faded numbers, her thumb tracing the seven and five, dialing out a familiar number but not sending through the call. She dropped the phone into her pocket and felt the letter brush against the back of her hand.
The Letter. She thought of it as its own entity.
Sara normally checked her mail after work so she didn’t have to drag it around with her, but one morning, for some unknown reason, she had checked her mail as she was heading out. A cold sweat had come over her as she recognized the return address on the plain white envelope. She had tucked the unopened envelope into the pocket of her lab coat as she left for work, thinking she would read it at lunch. Lunch had come and gone, and the letter had remained unopened, traveling back home, then out to work again the next day. Months passed, and the letter went everywhere with Sara, sometimes in her coat, sometimes in her purse to the grocery store or on errands. It became a talisman, and often, she would reach her hand in her pocket and touch it, just to remind herself that it was there.
Over time, the corners of the sealed envelope had become dog-eared and the Grant County postmark had started to fade. Every day pushed Sara further away from opening it and discovering what the woman who had killed her husband could possibly have to say.
“Dr. Linton?” Mary Schroder, one of the nurses, knocked on the door. She spoke in the practiced code of the ER. “We’ve got a P-O-P-T-A female, thirty-three, weak and thready.”
Sara glanced at the charts, then her watch. A thirty-three-year-old woman who had passed out prior to admission was a puzzle that would take time to solve. It was almost seven o’clock. Sara’s shift was over in ten minutes. “Can Krakauer take her?”
“Krakauer did take her,” Mary countered. “He ordered a CMP, then went to get coffee with the new bimbo.” She was obviously perturbed by this, and added, “The patient’s a cop.”
Mary was married to a cop; hardly shocking considering she had worked in the emergency room at Grady Hospital for almost twenty years. Even without that, it was understood at every hospital in the world that anyone in law enforcement got the best and quickest treatment. Apparently, Otto Krakauer hadn’t gotten the memo.
Sara relented. “How long did she lose consciousness?”
“She says about a minute.” Mary shook her head, because patients were hardly the most honest reporters when it came to their health. “She doesn’t look right.”
That last part was what got Sara out of her chair. Grady was the only Level One trauma center in the region, as well as one of the few remaining public hospitals in Georgia. The nurses at Grady saw car wrecks, shootings, stabbings, overdoses, and any number of crimes against humanity on an almost daily basis. They had a practiced eye for spotting serious problems. And, of course, cops usually didn’t admit themselves to the hospital unless they were at death’s door.
Sara skimmed the woman’s chart as she walked through the emergency department. Otto Krakauer hadn’t done more than take a medical history and order the usual bloodwork, which told Sara there was no obvious diagnosis. Faith Mitchell was an otherwise healthy thirty-three-year-old woman with no previous conditions and no recent trauma. Her test results would hopefully give them a better idea about what was going on.
Sara mumbled an apology as she bumped into a gurney in the hallway. As usual, the rooms were overflowing and patients were stacked in the halls, some in beds, some sitting in wheelchairs, all looking more miserable than they probably had when they’d first arrived for treatment. Most of them had probably come here right after work because they couldn’t afford to miss a day’s wages. They saw Sara’s white coat and called to her, but she ignored them as she read through the chart.
Mary said, “I’ll catch up with you. She’s in three,” before letting herself get pulled away by an elderly woman on a stretcher.
Sara knocked on the open door of exam room 3—privacy: another perk afforded cops. A petite blonde woman was sitting on the edge of the bed, fully dressed and clearly irritated. Mary was good at her job, but a blind person could see that Faith Mitchell was unwell. She was as pale as the sheet on the bed; even from a distance, her skin looked clammy.
Her husband did not seem to be helping matters as he paced the room. He was an attractive man, well over six feet, with sandy blond hair cut close to his head. A jagged scar ran down the side of his face, probably from a childhood accident where his jaw slid across the asphalt under his bicycle or along the hard-packed dirt to home plate. He was thin and lean, probably a runner, and his three-piece suit showed the broad chest and shoulders of someone who spent a lot of time in the gym.
He stopped pacing, his gaze going from Sara to his wife and back again. “Where’s the other doctor?”
“He got called away on an emergency.” She walked to the sink and washed her hands, saying, “I’m Dr. Linton. Can you catch me up to speed here? What happened?”
“She passed out,” the man said, nervously twisting his wedding ring around his finger. He seemed to realize he was coming off as a bit frantic, and moderated his tone. “She’s never passed out before.”
Faith Mitchell seemed aggravated by his concern. “I’m fine,” she insisted, then told Sara, “It’s the same thing I said to the other doctor. I feel like I’ve been coming down with a cold. That’s all.”
Sara pressed her fingers to Faith’s wrist, checking her pulse. “How are you feeling now?”
She glanced at her husband. “Annoyed.”
Sara smiled, shining her penlight into Faith’s eyes, checking her throat, running through the usual physical exam and finding nothing alarming. She agreed with Krakauer’s initial evaluation: Faith was probably a little dehydrated. Her heart sounded good, though, and it didn’t seem like she’d suffered from a seizure. “Did you hit your head when you fell?”
She started to answer, but the man interjected, “It was in the parking lot. Her head hit the pavement.”
Sara asked the woman, “Any other problems?”
Faith answered, “Just a few headaches.” She seemed to be holding something back, even as she revealed, “I haven’t really eaten today. I was feeling a little sick to my stomach this morning. And yesterday morning.”
Sara opened one of the drawers for a neuro-hammer to check reflexes, only to find nothing there. “Have you had any recent weight loss or gain?”
Faith said “No” just as her husband said “Yes.”
The man looked contrite, but tried, “I think it looks good on you.”
Faith took a deep breath and let it out slowly. Sara studied the man again, thinking he was probably an accountant or lawyer. His head was turned toward his wife, and Sara noticed another, lighter scar lining his upper lip—obviously not a surgical incision. The skin had been sewn together crookedly, so that the scar running vertically between his lip and nose was slightly uneven. He had probably boxed in college, or maybe just been hit in the head one too many times, because he obviously didn’t seem to know that the only way out of a hole was to stop digging. “Faith, I think the extra weight looks great on you. You could stand to gain—”
She shut him up with a look.
“All right.” Sara flipped open the chart, writing down some orders. “We’ll need to do an X-ray of your skull and I’d like to do a few more tests. Don’t worry, we can use the blood samples from earlier, so there won’t be any more needles for now.” She scribbled a notation and checked some boxes before looking up at Faith. “I promise we’ll rush this as much as we can, but you can see we’ve got a pretty full house today. X-ray’s backed up at least an hour. I’ll do what I can to push it through, but you might want to get a book or magazine while you wait.”
Faith didn’t respond, but something in her demeanor changed. She glanced at her husband, then back at Sara. “Do you need me to sign that?” She indicated the chart.
There was nothing to sign, but Sara handed her the chart anyway. Faith wrote something on the bottom of the page and gave it back. Sara read the words I’m pregnant.
Sara nodded as she crossed through the X-ray order. Obviously, Faith hadn’t yet told her husband, but there was a different set of questions Sara needed to ask now, and she couldn’t do so without giving away the news. “When’s the last time you had a pap smear?”
Faith seemed to understand. “Last year.”
“Let’s take care of that while you’re here.” Sara told the man, “You can wait outside.”
“Oh.” He seemed surprised, even as he nodded. “All right.” He told his wife, “I’ll be in the waiting room if you need me.”
“Okay.” Faith watched him leave, her shoulders visibly slumping in relief as the door closed. She asked Sara, “Do you mind if I lie down?”
“Of course not.” Sara helped her get comfortable on the bed, thinking Faith looked younger than her thirty-three years. She still had the bearing of a cop, though—that no-nonsense, don’t-bullshit-me squareness to her shoulders. Her lawyer husband seemed like an odd match, but Sara had seen stranger combinations.
She asked the woman, “How far along are you?”
“About nine weeks.”
Sara put this in her notes as she asked, “Is that a guess or have you seen a doctor?”
“I took an over-the-counter test.” She changed that. “Actually, I took three over-the-counter tests. I’m never late.”
Sara added a pregnancy test to the orders. “What about this weight gain?”
“Ten pounds,” Faith admitted. “I’ve kind of gone a little crazy with the eating since I found out.”
In Sara’s experience, ten pounds usually meant fifteen. “Do you have any other children?”
“One—Jeremy—eighteen.”
Sara made the notation in the chart, mumbling, “Lucky you. Heading into the terrible twos.”
“More like terrible twenties. My son is eighteen years old.”
Sara did a double take, flipping back through Faith’s history.
“Let me do the math for you,” Faith offered. “I got pregnant when I was fourteen. I had Jeremy when I was fifteen.”
Not much surprised Sara anymore, but Faith Mitchell had managed to do it. “Were there any complications with your first pregnancy?”
“Other than being fodder for a Lifetime movie?” She shook her head. “No problems at all.”
“Okay,” Sara answered, putting down the chart, giving Faith her full attention. “Let’s talk about what happened tonight.”
“I was walking to the car, I felt a little dizzy, and the next thing I know, Will’s driving me here.”
“Dizzy like the room spinning or dizzy as in light-headed?”
She thought about the question before replying. “Light-headed.”
“Any flashes of light or unusual tastes in your mouth?”
“No.”
“Will’s your husband?”
She actually guffawed. “God, no.” She choked on an incredulous laugh. “Will’s my partner—Will Trent.”
“Is Detective Trent here so I can talk to him?”
“Special Agent. You already did. He just left.”
Sara was sure she was missing something. “The man who was just in here is a cop?”
She laughed. “It’s the suit. You’re not the first person to think he’s an undertaker.”
“I thought lawyer,” Sara admitted, thinking she had never met anyone who looked less like a police officer in her life.
“I’ll have to tell him you thought he was a lawyer. He’ll be pleased you took him for an educated man.”
For the first time, Sara noticed the woman was not wearing a wedding ring. “So, the father is …”
“In and out of the picture.” Faith didn’t seem embarrassed by the information, though Sara supposed that there wasn’t much that could embarrass you after having a child at fifteen. “I’d prefer Will didn’t know,” Faith said. “He’s very—” She stopped mid-sentence. She closed her eyes, pressed her lips together. A sheen of sweat had broken out on her forehead.
Sara pressed her fingers to Faith’s wrist again. “What’s happening here?”
Faith clenched her jaw, not answering.
Sara had been vomited on enough to know the warning signs. She went to the sink to wet a paper towel, telling Faith, “Take a deep breath and let it out slowly.”
Faith did as she was told, her lips trembling.
“Have you been irritable lately?”
Despite her condition, Faith tried for levity. “More than usual?” She put her hand to her stomach, suddenly serious. “Yes. Nervous. Annoyed.” She swallowed. “I get a buzzing in my head, like there are bees in my brain.”
Sara pressed the cold paper towel to the woman’s forehead. “Any nausea?”
“In the mornings,” Faith managed. “I thought it was morning sickness, but …”
“What about the headaches?”
“They’re pretty bad, mostly in the afternoon.”
“Have you been unusually thirsty? Urinating a lot?”
“Yes. No. I don’t know.” She managed to open her eyes, asking, “So, what is it—the flu or brain cancer or what?”
Sara sat on the edge of the bed and took the woman’s hand.
“Oh, God, is it that bad?” Before Sara could answer, she said, “Doctors and cops only sit down when it’s bad news.”
Sara wondered how she had missed this revelation. In all her years with Jeffrey Tolliver, she’d thought she had figured out every one of his tics, but this one had passed her by. She told Faith, “I was married to a cop for fifteen years. I never noticed, but you’re right—my husband always sat down when there was bad news.”
“I’ve been a cop for fifteen years,” Faith responded. “Did he cheat on you or turn into an alcoholic?”
Sara felt a lump in her throat. “He was killed three and a half years ago.”
“Oh, no,” Faith gasped, putting her hand to her chest. “I’m so sorry.”
“It’s all right,” Sara answered, wondering why she’d even told the woman such a personal detail. Her life over the last few years had been dedicated to not talking about Jeffrey, and here she was sharing him with a stranger. She tried to ease the tension by adding, “You’re right. He cheated on me, too.” At least he had the first time Sara married him.
“I’m so sorry,” Faith repeated. “Was he on duty?”
Sara didn’t want to answer her. She felt nauseated and overwhelmed, probably a lot like Faith had felt before she’d passed out in the parking lot.
Faith picked up on this. “You don’t have to—”
“Thanks.”
“I hope they got the bastard.”
Sara put her hand into her pocket, her fingers wrapping around the edge of the letter. That was the question everyone wanted answered: Did they get him? Did they catch the bastard who killed your husband? As if it mattered. As if the disposition of Jeffrey’s killer would somehow alleviate the pain of his death.
Mercifully, Mary came into the room. “Sorry,” the nurse apologized. “The old lady’s kids just dropped her here. I had to call social services.” She handed Sara a piece of paper. “CMP’s back.”
Sara frowned as she read the numbers on the metabolic profile. “Do you have your monitor?”
Mary reached into her pocket and handed over her blood glucose monitor.
Sara swabbed some alcohol on the tip of Faith’s finger. The CMP was incredibly accurate, but Grady was a large hospital and it wasn’t unheard-of for the lab to get samples mixed up. “When was the last time you had a meal?” she asked Faith.
“We were in court all day.” Faith hissed “Shit” as the lancet pierced her finger, then continued, “Around noon, I ate part of a sticky bun Will got out of the vending machine.”
Sara tried again. “The last real meal.”
“Around eight o’clock last night.”
Sara guessed from the guilty look on Faith’s face that it had probably come out of a takeout bag. “Did you have coffee this morning?”
“Maybe half a cup. The smell was a bit too much.”
“Cream and sugar?”
“Black. I usually eat a good breakfast—yogurt, fruit. Right after my run.” Faith asked, “Is something wrong with my blood sugar?”
“We’ll see,” Sara told her, squeezing some blood onto the test strip. Mary raised an eyebrow, as if to ask if Sara wanted to place a wager on the number. Sara shook her head: no bet. Mary persisted, using her fingers to indicate one-five-zero.
“I thought the test came later,” Faith said, sounding unsure of herself. “When they make you drink the sugary stuff.”
“Have you ever had any problems with your blood sugar? Is there a history in your family?”
“No. None.”
The monitor beeped and the number 152 flashed on the screen.
Mary gave a low whistle, impressed by her own guess. Sara had once asked the woman why she didn’t go to medical school, only to be told that nurses were the ones who practiced the real medicine.
Sara told Faith, “You have diabetes.”
Faith’s mouth worked before she managed a faint, “What?”
“My guess is that you’ve been pre-diabetic for a while. Your cholesterol and triglycerides are extremely elevated. Your blood pressure is a little high. The pregnancy and the rapid weight gain—ten pounds is a lot for nine weeks—plus your bad eating habits, pushed you over the edge.”
“My first pregnancy was fine.”
“You’re older now.” Sara gave her some tissue to press against her finger so the bleeding would stop. “I want you to follow up with your regular doctor first thing in the morning. We need to make sure there’s not something else going on here. Meanwhile, you have to keep your blood sugar under control. If you don’t, passing out in the parking lot will be the least of your worries.”
“Maybe it’s just—I haven’t been eating right, and—”
Sara cut her off mid-denial. “Anything over one-forty is a positive diagnosis for diabetes. Your number has actually inched up since the first blood test was taken.”
Faith took her time absorbing this. “Will it last?”
The question was one for an endocrinologist to answer. “You’ll need to talk to your doctor and have him run some more tests,” Sara advised, though, if she had to make an educated guess, she would say that Faith was in a precarious situation. Except for the pregnancy, she would be presenting as a full-blown diabetic.
Sara glanced at her watch. “I would admit you tonight for observation, but by the time we processed you and found you a room, your doctor’s office would be open, and something tells me you wouldn’t stay here anyway.” She had spent enough time around police officers to know that Faith would bolt the minute she got the chance.
She continued, “You have to promise me that you’ll call your doctor first thing—and I mean that, first thing. We’ll get a nurse educator in here to teach you how to test your blood and how and when to inject yourself, but you’ve got to follow up with him immediately.”
“I have to give myself shots?” Faith’s voice went up in alarm.
“Oral meds aren’t approved for use in pregnant women. This is why you need to talk to your doctor. There’s a lot of trial and error here. Your weight and hormone levels will change as the pregnancy progresses. Your doctor’s going to be your best friend for the next eight months, at least.”
Faith seemed embarrassed. “I don’t have a regular doctor.”
Sara took out her prescription pad and wrote down the name of a woman she’d interned with years ago. “Delia Wallace works out of Emory. She has a dual specialty in gynecology and endocrinology. I’ll call her tonight so her office knows to work you in.”
Faith still seemed unconvinced. “How can I suddenly have this? I know I’ve put on weight, but I’m not fat.”
“You don’t have to be fat,” Sara told her. “You’re older now. The baby affects your hormones, your ability to produce insulin. You haven’t been eating well. The stars lined up and it triggered you.”
“It’s Will’s fault,” Faith mumbled. “He eats like a twelve-year-old. Doughnuts, pizza, hamburgers. He can’t go into a gas station without buying nachos and a hot dog.”
Sara sat down on the edge of the bed again. “Faith, this isn’t the end of the world. You’re in good shape. You’ve got great insurance. You can manage this.”
“What if I …” She blanched, breaking eye contact with Sara. “What if I wasn’t pregnant?”
“We’re not talking about gestational diabetes here. This is full-blown, type two. A termination won’t suddenly make the problem go away,” Sara answered. “Look, this is probably something you’ve been building up to for a while. Being pregnant brought it on faster. It will make things more complicated in the beginning, but not impossible.”
“I just …” She didn’t seem capable of finishing a sentence.
Sara patted her hand, standing. “Dr. Wallace is an excellent diagnostician. I know for a fact that she takes the city insurance plan.”
“State,” Faith corrected. “I’m with the GBI.”
Sara assumed the Georgia Bureau of Investigation’s plan was similar, but she didn’t quibble. Faith was obviously having difficulty absorbing the news, and Sara had not exactly eased her into it. You couldn’t unring a bell, though. Sara patted her arm. “Mary will give you an injection. You’ll be feeling better in no time.” She started to leave. “I mean it about calling Dr. Wallace,” she added firmly. “I want you on the phone with her office first thing in the morning, and you need to be eating more than sticky buns. Low-carb, low-fat, regular healthy meals and snacks, okay?”
Faith nodded, still dumbstruck, and Sara left the room feeling like an absolute heel. Her bedside manner had certainly deteriorated over the years, but this represented a new low. Wasn’t that anonymity why she had come to Grady in the first place? But for a handful of homeless men and some prostitutes, she seldom saw a patient more than once. That had been the real pull for Sara—the absolute detachment. She wasn’t at a stage in her life where she wanted to make connections with people. Every new chart was an opportunity to start all over. If Sara was lucky—and if Faith Mitchell was careful—they would probably never see each other again.
Instead of going back into the doctors’ lounge to finish her charts, Sara walked past the nurses’ station, through the double doors, into the overfilled waiting room and finally found herself outside. There were a couple of respiratory therapists by the exit smoking cigarettes, so Sara kept walking toward the back of the building. Guilt about Faith Mitchell still hung heavy on her shoulders, and she looked up Delia Wallace’s number in her cell phone before she forgot to follow up. The service took her message about Faith, and Sara felt slightly better as she ended the call.
She had run into Delia Wallace a couple of months ago, when the woman had come in to see one of her wealthy patients who had been airlifted to Grady after a bad car accident. Delia and Sara had been the only women in the top five percent of their graduating class at Emory University Medical School. At the time, it was an unwritten rule that there were two options for female doctors: gynecology or pediatrics. Delia had chosen the first, Sara the latter. They would both turn forty next year. Delia seemed to have everything. Sara felt like she had nothing.
Most doctors—Sara included—were arrogant to one degree or another, but Delia had always been an avid self-promoter. While they drank their coffees in the doctors’ lounge, Delia quickly offered the highlights of her life: a thriving practice with two offices, a stockbroker husband and three overachieving kids. She’d shown Sara pictures of them all, this perfect family of hers who looked as if they had walked out of a Ralph Lauren advertisement.
Sara hadn’t told Delia about her own life after medical school, that she had gone back to Grant County, her home, to tend to children in rural areas. She didn’t tell Delia about Jeffrey or why she moved back to Atlanta or why she was working at Grady when she could open her own practice and have some semblance of a normal life. Sara had just shrugged, saying, “I ended up back here,” and Delia had looked at her with both disappointment and vindication, both emotions conjured by the fact that Sara had been ahead of Delia their entire time at Emory.
Sara tucked her hands into her pockets, pulling her thin coat closed to fight the chill. She felt the letter against the back of her hand as she walked past the loading dock. She had volunteered to cover an extra shift that morning, working straight through for nearly sixteen hours so that she could have all of tomorrow off. Exhaustion hit her just as the night air did, and she stood with her hands fisted in her pockets, relishing the relatively clean air in her lungs. She caught the scent of rain under the smell of car exhaust and whatever was coming off the Dumpster. Maybe she would sleep tonight. She always slept better when it rained.
She looked down at the cars on the interstate. Rush hour was at its tail end—men and women going home to their families, their lives. Sara was standing at what was called the Grady Curve, an arc in the highway that traffic reporters used as a landmark when reporting trouble on the downtown connector. All the taillights were bright red tonight as a tow truck pulled a stalled SUV from the left-hand shoulder. Police cruisers blocked the scene, blue lights spinning, casting their eerie light into the darkness. They reminded her of the night Jeffrey had died—the police swarming, the state taking over, the scene combed through by dozens of men in their white suits and booties.
“Sara?”
She turned around. Mary stood with the door open, waving her back into the building. “Hurry!”
Sara jogged toward the door, Mary calling out stats as she got closer. “Single car MVA with pedestrian on foot. Krakauer took the driver and passenger, possible MI on the driver. You’ve got the woman who was hit by the car. Open frac on right arm and leg, L-O-C at the scene. Possible sexual assault and torture. Bystander happened to be an EMT. He did what he could, but it’s bad.”
Sara was sure she’d misunderstood. “She was raped and hit by a car?”
Mary didn’t explain. Her hand was like a vise on Sara’s arm as they jogged down the hallway. The door was open to the emergency triage room. Sara saw the gurney, three medics surrounding the patient. Everyone in the room was a man, including Will Trent, who was leaning over the woman, trying to question her.
“Can you tell me your name?” he asked.
Sara stopped short at the foot of the bed, Mary’s hand still on her arm. The patient was lying curled on her side in a fetal position. Surgical tape held her tightly to the frame of the stretcher, pneumatic splints binding her right arm and leg. She was awake, her teeth chattering, murmuring unintelligibly. A folded jacket was under her head, a cervical collar keeping her neck in line. The side of her face was caked in dirt and blood; electrical tape hung from her cheek, sticking to her dark hair. Her mouth was open, lips cut and bleeding. The sheet they had covered her with was pulled down and the side of her breast gaped open in a wound so deep that bright yellow fat was showing.
“Ma’am?” Will asked. “Are you aware of your condition?”
“Move away,” Sara ordered, pushing him back harder than she intended. He flailed, momentarily losing his balance. Sara did not care. She had seen the small digital recorder he had in his hand and did not like what he was doing.
Sara put on a pair of gloves as she knelt down, telling the woman, “I’m Dr. Linton. You’re at Grady Hospital. We’re going to take care of you.”
“Help … help … help …” the woman chanted, her body shivering so hard the metal gurney rattled. Her eyes stared blankly ahead, unfocused. She was painfully thin, her skin flaky and dry. “Help …”
Sara stroked back her hair as gently as she could. “We’ve got a lot of people here and we’re all going to help you. You just hang on for me, okay? You’re safe now.” Sara stood, lightly resting her hand on the woman’s shoulder to let her know she was not alone. Two more nurses were in the room, awaiting orders. “Somebody give me the rundown.”
She had directed her request toward the uniformed emergency medical techs, but the man across from her started talking, delivering in rapid staccato the woman’s vitals and the triage performed en route. He was dressed in street clothes that were covered in blood. Probably the bystander who had given aid at the scene. “Penetrating wound between eleventh and twelfth ribs. Open fractures right arm and leg. Blunt force trauma to the head. She was unconscious when we arrived, but she gained consciousness when I started working on her. We couldn’t get her flat on her back,” he explained, his voice filling with panic. “She kept screaming. We had to get her in the bus, so we just strapped her down. I don’t know what’s wrong with … I don’t know what—”
He gulped back a sob. His anguish was contagious. The air felt charged with adrenaline; understandably so, considering the state of the victim. Sara felt a moment of panic herself, unable to take in the damage inflicted on the body, the multiple wounds, the obvious signs of torture. More than one person in the room had tears in their eyes.
Sara made her voice as calm as possible, trying to bring the hysteria down to a manageable level. She dismissed the EMTs and the bystander by saying, “Thank you, gentlemen. You did everything you could just to get her here. Let’s clear the room now so that we have space to keep helping her.” She told Mary, “Start an IV and prep a central line just in case.” She told another nurse, “Get portable X-ray in here, call CT and get the surgical on-call.” And said to another, “Blood gas, tox screen, CMP, CBC, and a coag panel.”
Carefully, Sara pressed the stethoscope to the woman’s back, trying not to concentrate on the burn marks and crisscrossed slices in the flesh. She listened to the woman’s lungs, feeling the sharp outline of ribs against her fingers. Breath sounds were equal, but not as strong as Sara would’ve liked, probably because of the massive amount of morphine they had given her in the ambulance. Panic often blurred the line between helping and hindering.
Sara knelt down again. The woman’s eyes were still open, her teeth still chattering. Sara told her, “If you have any trouble breathing, let me know, and I’ll help you immediately. All right? Can you do that?” There was no response, but Sara kept talking to her anyway, announcing every step of the way what she was doing and why. “I’m checking your airway to make sure you can keep breathing,” she said, gently pressing into the jaw. The woman’s teeth were reddish pink, indicating blood in her mouth, but Sara guessed that was from biting her tongue. Deep scratches marked her face, as if someone had clawed her. Sara thought she might have to intubate her, paralyze her, but this might be the last opportunity the woman had to speak.
That was why Will Trent would not leave. He had been asking the victim about her condition in order to set up the framework for a dying declaration. The victim would have to know she was dying before her last words could be admitted in court as anything other than hearsay. Even now, Trent kept his back to the wall, listening to every word being spoken in the room, bearing witness in case he was needed to testify.
Sara asked, “Ma’am? Can you tell me your name?” Sara paused as the woman’s mouth moved, but no words came out. “Just a first name, all right? Let’s start with something easy.”
“Anne?”
“Nah … nah …”
“Anna?”
The woman closed her eyes, gave a slight nod. Her breath had turned more shallow from the effort.
Sara tried, “How about a last name?”
The woman did not respond.
“All right, Anna. That’s fine. Just stay with me.” Sara glanced at Will Trent. He nodded his thanks. She returned to the patient, checking her pupils, pressing her fingers into the skull to check for fractures. “You’ve got some blood in your ears, Anna. You took a hard knock to your head.” Sara took a wet swab and brushed it across the woman’s face to remove some of the dried blood. “I know you’re still in there, Anna. Just hang on for me.”
With care, Sara traced her fingers down the neck and shoulder, feeling the clavicle move. She continued down gently, checking the shoulders front and back, then the vertebrae. The woman was painfully undernourished, the bones starkly outlined, her skeleton on display. There were tears in the skin, as if barbs or hooks had been imbedded under the flesh, then ripped out. Superficial cuts sliced their way up and down the body, and the long incision on the breast already smelled septic; she had been like this for days.
Mary said, “IV’s in, saline wide open.”
Sara asked Will Trent, “See the doctors’ directory by the phone?” He nodded. “Page Phil Sanderson. Tell him we need him down here immediately.”
He hesitated. “I’ll go find him.”
Mary supplied, “It’s faster to page him. Extension 392.” She taped a loop from the IV to the back of the woman’s hand, asking Sara, “You want more morphine on board?”
“Let’s figure out what’s going on with her first.” Sara tried to examine the woman’s torso, not wanting to move the body until she knew exactly what she was dealing with. There was a gaping hole in her left side between the eleventh and twelfth ribs, which would explain why the woman had screamed when they tried to straighten her out. The stretching and grinding of torn muscle and cartilage would have been excruciating.
The EMT had put a compression pack on her right leg and arm along with two pneumatic splints to keep the limbs stabilized. Sara lifted the sterile dressing on the leg, seeing bright bone. The pelvis felt unstable beneath her hands. These were recent wounds. The car must have hit Anna from the right side, folding her in two.
Sara took a pair of scissors out of her pocket and cut through the tape that kept the woman immobile on the gurney, explaining, “Anna, I’m going to roll you onto your back.” She braced the woman’s neck and shoulders while Mary took care of the pelvis and legs. “We’ll keep your legs bent, but we need to—”
“No-no-no!” the woman pleaded. “Please don’t! Please don’t!” They kept moving and her mouth opened wide, her screams sending a chill up Sara’s spine. She had never heard anything more horrific in her life. “No!” the woman yelled, her voice catching. “No! Please! Noooo!”
She started to violently convulse. Instantly, Sara leaned over the stretcher, pinning Anna’s body to the table so she wouldn’t fall onto the floor. She could hear the woman grunt with each convulsion, as every movement brought a knife of pain to her side. “Five milligrams of Ativan,” she ordered, hoping to control the seizures. “Stay with me, Anna,” she urged the woman. “Just stay with me.”
Sara’s words did not matter. The woman had lost consciousness, either from the seizure or the pain. Long after the drug should have taken effect, the muscles still spasmed through the body, legs jerking, head shaking.
“Portable’s here,” Mary announced, motioning the X-ray technician into the room. She told Sara, “I’ll check on Sanderson and the OR.”
The X-ray technician put his hand to his chest. “Macon.”
“Sara,” she returned. “I’ll help.”
He handed her the extra lead apron, then went about preparing the machine. Sara kept her hand on Anna’s forehead, stroking back her dark hair. The woman’s muscles were still twitching when Sara and Macon managed to roll her onto her back, legs bent to help control the pain. Sara noticed that Will Trent was still in the room and told him, “You need to clear out while we do this.”
Sara helped Macon take the X-rays, both of them moving as fast as they could. She prayed that the patient would not wake up and start screaming again. She could still hear the sound of Anna’s screams, almost like an animal caught in a trap. The noise alone would set up the belief that the woman knew she was going to die. You did not scream like that unless you had given up all hope on life.
Macon helped Sara turn the woman back on her side, then went off to develop the films. Sara took off her gloves and knelt beside the gurney again. She touched her hand to Anna’s face, stroking her cheek. “I’m sorry I pushed you,” she said—not to Anna, but to Will Trent. She turned to find him standing at the foot of the bed, staring down at the woman’s legs, the soles of her feet. His jaw was clenched, but she didn’t know if that was from anger or horror or both.
He said, “We’ve both got jobs to do.”
“Still.”
Gently, he reached down and stroked the sole of Anna’s right foot, probably thinking there was nowhere else to touch her that wouldn’t cause pain. Sara was surprised by the gesture. It seemed almost tender.
“Sara?” Phil Sanderson was in the doorway, his surgical scrubs neatly clean and pressed.
She stood up, lightly resting her fingertips on Anna’s shoulder as she told Phil, “We’ve got two open fractures and a crushed pelvis. There’s a deep incision on the right breast and a penetrating wound on the left side. I’m not sure about the neurologic; her pupils are nonresponsive, but she was talking, making sense.”
Phil walked over to the body and started his examination. He didn’t comment on the state of the victim, the obvious abuse. His focus was on the things he could fix: the open fractures, the shattered pelvis. “You didn’t intubate her?”
“Airways are clear.”
Phil obviously disagreed with her decision, but then, orthopedic surgeons didn’t generally care whether or not their patients could speak. “How’s the heart?”
“Strong. BP is good. She’s stable.” Phil’s surgical team came in to prep the body for transfer. Mary returned with the X-rays and handed them to Sara.
Phil pointed out, “Just putting her under could kill her.”
Sara snapped the films into the lightbox. “I don’t think she’d be here if she wasn’t a fighter.”
“The breast is septic. It looks like—”
“I know,” Sara interrupted, putting on her glasses so she could read the X-rays.
“This wound in her side is pretty clean.” He stopped his team for a moment and leaned down, checking the long tear in her skin. “Was she dragged by the car? Did something metal slice her open?”
Will Trent answered, “As far as I know, she was hit straight-on. She was standing in the roadway.”
Phil asked, “Was there anything around that might have made this wound? It’s pretty clean.”
Will hesitated, probably wondering if the man realized what the woman had been through before the car had struck her. “The area was pretty wooded, mostly rural. I haven’t talked to the witnesses yet. The driver had some chest complaints at the scene.”
Sara turned her attention to the X-ray of the torso. Either something was wrong or she was more exhausted than she’d realized. She counted the ribs, not quite trusting what she was seeing.
Will seemed to sense her confusion. “What is it?”
“Her eleventh rib,” Sara told him. “It’s been removed.”
Will asked, “Removed how?”
“Not surgically.”
Phil barked, “Don’t be ridiculous.” He strode over, leaning close to the film. “It’s probably …” He put up the second film of the chest, the anterior-posterior, then the lateral. He leaned closer, narrowing his eyes as if that would help. “The damn thing can’t just drop out of the body. Where is it?”
“Look.” Sara traced her finger along the jagged shadow where cartilage had once held bone. “It’s not missing,” she said. “It was taken.”