"Bloodstream" - читать интересную книгу автора (Gerritsen Tess)

9

Carrot sticks and boiled potatoes and a microscopic sliver of chicken breast.

Louise Knowlton gazed down at the barren plate she’d just set before her son and she ached with maternal guilt. She was starving her own child. She saw it in his face, in those hungry eyes, the weak slump of his shoulders. Sixteen hundred calories a day! How could anyone survive on that! Barry had indeed lost weight, but at what price? He was but a shadow of his formerly robust 265-pound self, and even though she knew he needed to lose weight, it was clear to her, the one person in the world who knew him best, that her darling child was suffering.

She sat down at her own plate, on which she’d piled fried chicken and buttered biscuits. A solid, healthy meal for a cold night. Looking across the table, she met her husband’s gaze. Mel was silently shaking his head. He couldn’t stand it either, watching their son go hungry.

“Barry, sweetie, why don’t you have just one biscuit?” offered Louise.

“No, Mom.”

“It’s not so many calories. You can scrape off the gravy.”

“I don’t want any”

“Look how flaky they are! It’s that recipe from Barbara Perry’s mom. It’s the bacon fat that makes them so good. One little bite, Barry. Just try one bite!”

She held out a steaming biscuit to his lips. She could not stop herself, could not suppress the impulse, reinforced by fourteen years of motherhood, to feed that pink and needy mouth. This was more than food; this was love, in the shape of a crusty biscuit dripping butter onto her fingers. She waited for him to accept the offering.

“I told you, I don’t want any!” he yelled.

It was as shocking as a slap in the face. Louise sat back, stunned. The biscuit tumbled from her fingers and plopped into the lake of gravy glistening on her plate.

“Barry,” said his father.

“She’s always shoving food at me! No wonder I look like this! Look at both of you!”

“Your mother loves you. Look how you’ve hurt her feelings.”

Louise sat with trembling lips, trying not to cry. She gazed down at the bountiful dinner she had set on the table. It represented two hours of work in the kitchen, a labor of love, and oh how she loved her son! Now she saw the meal for what it was: the wasted efforts of a fat and stupid mother. She began to cry, her tears dribbling into the cream cheese mashed potatoes.

“Mom.” Barry groaned. “Ah geez. I’m sorry.”

“Never mind.” She held up a hand to ward off his pity. “I understand, Barry. I understand, and I won’t do it again. I swear I won’t.” She blotted away the tears with the napkin and for a few seconds managed to regain her dignity. “But I try so hard and-and-” She buried her face in the napkin, her whole body quaking with the effort not to cry. It took a moment for her to realize Barry was talking to her.

“Mom. Mom?”

She gulped in a breath and forced herself to look at him.

“Can I have a biscuit?”

Wordlessly she held out the platter. She watched him take a biscuit, split it open, and slather it with butter. She held her breath as he took the first bite, as the look of bliss rippled across his face. He had craved it all along, but had denied himself the pleasure. Now he gave himself up to it, eating a second. And a third. She watched him take every bite, and she felt a mother’s satisfaction, deep and primal.

Noah leaned against the side of the school building, smoking a cigarette. It had been months since he’d last lit up, and it made him cough, his lungs rebelling against the smoke. He imagined all those poisons swirling into his chest, the ones his mom was always lecturing him about, but in the general scheme of his life in this dreary town, he figured a little poison was hardly worth worrying about. He took another drag and coughed some more, not really enjoying the experience. But there wasn’t much else to do between classes, not since the skateboards were banned. At least out here, standing alone by the Dumpster, no one would hassle him.

He heard the soft growl of an engine, and he glanced toward the street. A dark green car was creeping by, so slowly it barely seemed to move. The windows were too darkly tinted to see through, and Noah couldn’t tell if it was a man or woman behind the wheel.

The car stopped right across the street. Somehow Noah knew the driver was staring at him, just as surely as Noah was staring back.

He dropped the cigarette and quickly crushed it under his shoe. No sense getting caught; the last thing he needed was another detention. The evidence now obliterated, he turned and brazenly faced the unseen driver. He felt a sense of victory when the car drove away.

Noah looked down at the crushed cigarette, only half smoked. What a waste. He was weighing the chances of salvaging what remained when he heard the school bell ring, signaling the end of break.

Then he heard the shouting. It came from the front of the school. He rounded the corner of the building and saw a crowd of kids milling on the lawn, chanting:

“Cat fight! Cat fight!”

This should be something to see.

He pushed forward, trying to get a peek at the action before the teachers broke it up, and the two battling girls practically flew right into him. Noah stumbled backwards to a safer distance, shocked by the viciousness of the fight. This was worse than any brawl between two boys; this really was a cat fight, the girls clawing at each others’ faces, yanking at hair. The shouts of the crowd rang in his ears. He looked around at the circle of spectators, and saw their frenzied faces, smelled the blood lust, strong as musk.

A strange excitement coiled inside him. He felt his hand close into a fist, felt heat rush to his face. Both the girls were bloodied now, and the sight of it enthralled him. Provoked him. He pushed forward, jostling with the crowd for a better view, and was angry when he could not get closer.

“Cat fight! Cat fight!”

He began to chant too, his excitement building with every glimpse of a bloodied face.

Then his gaze froze on Amelia, standing at the far edge of the lawn, and instantly he fell silent. She was staring at the crowd in disbelief and horror.

Shamefaced, he turned before she could see him, and he fled into the building.

In the boys’ restroom, he stared at himself in the mirror. What happened to everyone out there? he thought. What happened to me?

He splashed icy water on his face, and scarcely felt its sting.

“They were fighting over a boy,” said Fern. “At least, that’s the story I got.

It started off with a few insults, and the next thing you know, they were clawing each other’s faces.” She shook her head. “After Mrs. Horatio’s funeral, I was hoping the kids would support each other. Stand by each other. But this is the fourth fight we’ve had in two days, Lincoln. I can’t control them. I need a policeman to stand watch in this school.”

“Well, it seems like overkill,” he responded doubtfully, “but I can have Floyd Spear drop in a few times during the school day, if you want.”

“No, you don’t understand. We need someone here all day. I don’t know what else is going to work.”

Lincoln sighed and ran his hand through his hair. It seemed to Fern that he was getting grayer every day, just as she was. This morning, she had noticed the telltale hairs sprouting among her blond ones, had realized that the face she saw in the mirror was that of a middle-aged woman. Seeing the changes in Lincoln’s face, though, was somehow more painful than confronting her own aging image, because she carried such vivid memories of the man he’d been at twenty-five: dark-haired, dark-eyed, already a face of strength and character. The days before Doreen caught his eye.

She regarded the deepening lines in his face and thought, as she so often did: I could have made you so much happier than Doreen has.

Together they walked to her office. Fourth period classes had started, and their footsteps echoed in the empty hallway. A banner sagged overhead: Harvest Dance November 20! From Mr. Rubio’s classroom came the sound of bored voices raised in unison: Me ilamo Pablo. Te llamas Pablo. Se llama Pablo…

Her office was her private territory, and it reflected the way she lived her life, everything neat and in its place. Books lined up, spines out, no stray papers on the desk. Controlled. Children thrived on order, and Fern believed that only through absolute order could a school function properly.

“I know it’s asking for a manpower commitment,” she said, “but I want you to consider assigning a full-time officer to this school.”

“It means pulling a man off patrol, Fern, and I’m not convinced it’s necessary.”

“And what are you patrolling out there? Empty roads! The trouble in this town is right here, in this building. This is where we need a policeman.”

At last he nodded. “I’ll do what I can,” he said, and stood up. His shoulders seemed to sag with the burdens they carried. All day he wrestles with the problems of this town, she thought guiltily, and he gets no praise, only demands and criticism. Then he has no one to go home to, no one to comfort him. A man who makes the mistake of marrying the wrong woman should not have to suffer for the rest of his life. Not a man as decent as Lincoln.

She walked him to the door. They were close enough to touch each other, and the temptation to reach out, to throw her arms around him, was so overwhelming she had to close her hands into fists to resist it.

“I look at what’s happening," she said, “and I can’t help but wonder what I’m doing wrong.”

“You haven’t done anything wrong?’

“Six years as principal, and suddenly Fm fighting to keep order in my school.

Fighting to keep my job.”

“Fern, I really think it’s just a temporary reaction to the shooting. The kids need time to recover.” He gave her shoulder a reassuring pat and he turned to the door. “It'll pass.”

Once again Claire was staring into Mairead Temple’s mouth. It seemed like familiar territory to her now, the furry tongue, the tonsillar pillars, the uvula hanging down in a quivering flap of pink flesh. And that smell, like an old ashtray, the same smell that permeated Mairead’s kitchen, where they were now sitting. It was Tuesday, the day Claire made house calls, and Mairead was the next to last patient on her schedule. When one’s medical practice is failing, when patients are switching to other doctors, desperate measures are called for. A home visit to Mairead Temple’s smoky kitchen qualified as a desperate measure. Anything to keep a patient happy.

Claire turned off her pen light. “Your throat looks about the same to me. It’s just a little red.”

“Still hurts wicked bad.”

“The culture came back negative.”

“You mean I don’t get any more penicillin?”

“I’m sorry, but I can’t justify it.”

Mairead clacked her dentures together and glared at Claire with pale eyes. “What kinda treatment is that?”

“Well, I’ll tell you, Mairead, the best treatment is prevention.” “So?”

“So Claire eyed the pack of menthol cigarettes lying on the kitchen table. In the advertisements, it was a brand usually associated with slim sophisticates, women in slinky gowns trailing furs and men. “I think it’s time for you to quit smoking.”

“What’s wrong with penicillin?”

Claire ignored the question, turning her attention instead to the wood-burning stove in the center of the overheated kitchen. “That’s not good for your throat, either. It dries out the air and fills it with smoke and irritants. You do have an oil furnace, don’t you?”

“Wood’s cheaper.”

“You’d feel better.”

“I get the wood free, from my nephew.”

“All right,” sighed Claire. “So how about just quitting the cigarettes?” “How about the penicillin?”

They looked at each other, budding enemies over a handful of three-buck pills.

In the end, Claire surrendered. She didn’t have the stamina for an argument this late in the afternoon, not with someone as mulish as Mairead Temple. Just this once was what she told herself as she rummaged for the appropriate antibiotic samples.

Mairead crossed to the woodstove and threw in another log. Smoke puffed out, adding to the general haze hanging over the room.

Even Claire’s throat was beginning to feel sore.

Mairead picked up a pair of tongs and poked at the logs on the fire. “I heard more talk about those bones,” she said.

Claire was still counting out sample tablets. Only when she looked up did she see Mairead was studying her, eyes strangely alert. Feral.

Mairead turned and slapped the stove’s cast-iron door shut. “Old bones, that’s what I heard.”

“Yes, they are.”

“How old?” The pale eyes were once again locked on hers.

“A hundred years, maybe more.”

“They sure about that?”

“I believe they’re quite sure. Why?”

The unsettling gaze slid away from hers again. “You never know what goes on around these parts. No big surprise they found the bones on her property. You know what she is, don’t you? She’s not the only one around here, either. Last Halloween, they lit themselves a big bonfire, over in Warren Emerson’s cornfield. That Emerson, he’s another one.”

“Another what?”

“What do you call ‘em when they’re men? A warlock.”

Claire burst out laughing. It was the wrong thing to do.

“You go ask around town,” insisted Mairead, now angry “They’ll all tell you there was a bonfire up in Emerson’s field that night. And right afterwards, those kids caused all that trouble in town.”

“It happens everywhere. Kids always get rowdy on Halloween.”

“It’s their holy night. Their black Christmas.”

Looking into the other woman’s eyes, Claire realized she didn’t like Mairead Temple. “Everyone is entitled to their beliefs. As long as no one gets hurt.”

“Well, that’s the question, isn’t it? We just don’t know. Look what’s happened around here since then.”

Abruptly Claire shut her medical bag and stood up. “Rachel Sorkin minds her own business, Mairead. I think everyone else in this town should do likewise.”

The bones again, thought Claire as she drove to her last house call of the day.

Everyone wants to know about the bones. Whom they belonged to, when they were buried. And today a new question, one that had taken her by surprise: why were they found in Rachel Sorkin’s yard.

It’s their holy night, their black Christmas.

In Mairead’s kitchen, Claire had laughed. Now, driving through the deepening gloom, she found nothing humorous about the conversation. Rachel Sorkin was the outsider, the black-haired woman from away who lived alone by the lake. That’s how it had always been through the ages; the young woman alone was an object of suspicion, the subject of gossip. In a small town she is the anomaly that requires explanation. She is the town siren, the irresistible temptation for otherwise virtuous husbands. Or she is the shrew no man wants to marry or the twisted female with unnatural desires. And if one is also attractive, like Rachel, or exotic, or peculiar of taste and whim, then suspicion is mixed with fascination. Fascination which could turn to obsession for someone like Mairead Temple, who brooded all day in her grim kitchen, smoking cigarettes that promised glamour but delivered bronchitis and yellow teeth. Rachel did not have yellow teeth. Rachel was beautiful and unencumbered and a little eccentric.

Rachel must therefore be a witch.

Since Warren Emerson had lit a bonfire in his cornfield on Halloween night, he must be a witch as well.

Though dusk had not yet fallen, Claire turned on her headlights and drew some measure of reassurance from the glow of her dashboard. This time of year, she thought, brings out irrational fears in all of us. And the season hasn’t yet reached its darkest point. As the nights grow longer and the first heavy snows begin to fall, cutting off all access to the outside world, this bleak and lonely landscape becomes our universe. And it’s an unforgiving one, where a patch of black ice, and a night’s bitter cold, can act as both judge and executioner.

She arrived at a rural mailbox labeled “Braxton” and turned onto the dirt road.

Her patient’s house stood surrounded by neglected fields. The clapboards were stripped bare, the wood weathered to silver. On the front porch, half a cord of firewood was stacked up precariously against the crooked railing. It would all come tumbling down one of these days-the railing, the porch, the house itself.

Divorced, forty-one-year-old Faye Braxton, who lived here with her two children, was as structurally unsound as her dwelling. Both her hips had been destroyed by rheumatoid arthritis, and she could not even step out of this dismal home without assistance.

Carrying her medical bag, Claire climbed the steps to the front porch. Only then did she realize something was not right.

It was thirty-five degrees outside, and the front door was open.

She poked her head inside the house and called into the gloom:

“Mrs. Braxton?” She heard a shutter banging in the wind. And she heard something else-the faint patter of footsteps, running in an upstairs room. One of the children?

Claire stepped into the house and closed the door against the cold. No lamps were on, and the fading daylight glowed dimly through thin living room curtains.

She felt her way down the hail, searching for the light switch. At last she found it and flicked it on.

At her feet, a naked Barbie doll lay on the threadbare runner. Claire reached down for it. “Mrs. Braxton? It’s Dr. Elliot.”

Her announcement was met with silence.

She looked down at the Barbie doll and saw that half of its blond hair had been cut away. When she had last visited this house, three weeks ago, she had seen Faye Braxton’s seven-year-old daughter Kitty clutching a Barbie doll like this one. It had been dressed in a pink prom gown and the long blond hair had been tied back with a scrap of green rickrack.

A chill slithered up her spine.

She heard it again: the rapid thump-thump-thump of footsteps moving across the ceiling. She looked up toward the stairs, toward the second floor. Someone was home, yet the heat was off, the house was freezing, and none of the lights were on.

Slowly she backed away, then turned and fled the house.

Sitting in her car, she used her cell phone to call the police.

Officer Mark Dolan answered.

“This is Dr. Effiot. I’m at the Braxton residence. Something’s wrong here.“

“What do you mean, Dr. Elliot?”

“I found the front door open, and there’s no heat on, no lights. But I heard someone moving around upstairs.”

“Is the family home? Have you checked?”

“I’d rather not go upstairs.”

“All you’d have to do is take a look. We’re already swamped with calls, and I don’t know when I can get a man over there.”

“Look, could you just send someone? I’m telling you, it doesn’t feel right.”

Officer Dolan gave a loud sigh. She could almost see him at his desk, rolling his eyes in derision. Now that she had actually voiced her fears, they did not seem significant. Perhaps she hadn’t heard footsteps at all, but merely that loose shutter swinging in the wind. Perhaps the family was away. The police will arrive and find nothing, she thought, and tomorrow the whole town will be laughing at the cowardly doctor. Her reputation had already suffered enough blows this week.

“Lincoln’s somewhere over that way,” Dolan finally said. “I’ll ask him to swing by when he gets the chance.”

She hung up, already regretting the call. Stepping out of the car again, she looked up at the house. Dusk had thickened to night. I’ll cancel the dispatch and save myself the embarrassment, she thought. She went back into the house.

Standing at the foot of the stairs, she gazed up toward the second floor landing, but heard no sound from above. She grasped the banister. It was oak, solid and reassuring. She began to climb, driven upward by pride, by grim determination not to be the butt of the latest town joke.

On the second floor, she turned on the light switch and confronted a narrow hallway, the walls dingy from little hands trailing smudges. She poked her head into the first room on the right.

It was Kitty’s bedroom. Ballerinas danced across the curtains. Scattered on the bed were girl things: plastic barrettes, a red sweater embroidered with snowflakes, a child’s backpack in pink and purple. On the floor was Kitty’s beloved Barbie doll collection. But these were not pampered recipients of a young girl’s love. These dolls had been viciously abused, their clothes ripped to shreds, their limbs splayed out as though in horror. A single doll’s head, torn from its body, stared up at her with bright blue eyes.

The chill was back in her spine.

She backed into the hail, and her gaze suddenly shifted to another doorway, to the unlit room beyond. Something shimmered in the darkness, a strange luminescence, like the green glow of a watch face. She stepped into the room and turned on the light. The green glow vanished. She was in a boy’s room, untidy, with books and dirty socks scattered on the bed and floor. A rubbish can overflowed with crumpled papers and Coke cans. It was the typical disarray left by a thirteen-year-old. She turned off the light.

And saw it again-the green glow. It came from the bed.

She stared down at the pillow, splashed with a bright luminescence, and touched the linen; it was cool, but not damp. Now she noticed the faint streaks of luminescence on the wall as well, just above the bed, and one brilliant emerald splash on the sheet.

Thump, thump, thump. Her gaze shot upward, and she heard a whimper, a child’s soft cry The attic. The children were in the attic.

She left the boy’s room, stumbling over a tennis shoe as she reemerged in the hallway. The attic stairs were steep and narrow; she had to grasp the flimsy handrail as she climbed. When she reached the top, she was standing in impenetrable darkness.

She took a step forward, and brushed past a hanging light chain. One tug, and the bare lightbulb came on, its dim glow illuminating only a small circle of the attic. In the shadowy periphery she could make out a jumble of old furniture and cardboard boxes. A coat rack, its prongs wide as elk’s antlers, cast a threatening shadow across the floor.

Next to one of the boxes, something moved.

Quickly she shoved aside the box. Behind it, curled up on a bundle of old coats, was seven-year-old Kitty The girl’s skin felt icy, but she was still alive, her throat issuing soft little moans with every breath. Claire reached down to pick her up, and realized the girl’s clothes were saturated. In horror she lifted her glistening hand to the light.

Blood.

The only warning she had was the creak of the floorboard. Someone is standing behind me.

Claire turned just as the shadow exploded toward her. The impact slammed hard against her chest and she flew backwards, pinned under the weight of her attacker. Claws grappled at her throat. She tried to tear them away, frantically thrashing left, then right, a dozen shadowy images swirling before her eyes. The coat rack slammed to the floor. Under the swaying light, she caught sight of her attacker’s face.

The boy He tightened his grip around her throat, and as her vision began to blacken, she saw his lips curl back, his eyes narrow to angry slits.

She clawed at his eye. Shrieking, the boy released her, stumbling away. She scrambled to her feet just as the boy lunged at her again. She dodged sideways and he flew past her and landed among the cardboard boxes, scattering books and tools across the floor.

They both spotted the screwdriver at the same time.

Simultaneously they sprang toward it, but he was closer. He snatched it up and brought it high over his head. As it came stabbing down, she raised both hands to catch the boy’s wrist. His strength shocked her. She was forced down to her knees. The blade of the screwdriver wavered closer, even as she fought to keep it at bay.

Then, through the roar of her own pulse, she heard a voice calling her name. She screamed out: “Help me!”

Footsteps thudded up the stairs. Suddenly the weapon was no longer stabbing toward her. The boy pivoted, his weapon redirected as Lincoln flew toward him.

She saw the boy fall backwards, sprawling to the floor. Saw the boy and Lincoln rolling over and over in a blur of thrashing limbs, furniture and boxes scattering around them. The screwdriver skittered off into the shadows. Lincoln pinned the boy facedown on the floorboards and Claire heard the metallic click of handcuffs snapping shut. Even then, the boy continued to struggle, kicking out blindly. Lincoln dragged him over to an attic support post and tightly lashed him there with his belt.

When at last he turned to Claire, he was breathing hard, and a bruise was swelling up on one cheek. For the first time he noticed the girl, lying among the boxes.

“She’s bleeding!” said Claire. “Help me get her downstairs, where there’s light!”

He scooped the girl into his arms.

By the time he lay her on the kitchen table, she had stopped breathing. Claire gave her three quick breaths, then felt for a carotid pulse, but could not detect one. “Get an ambulance here now!” she said to Lincoln. Positioning her hands over the girl’s sternum, Claire began chest compressions. The blouse was soaked, and her hands kept slipping as she pumped. Fresh blood seeped through the fabric. She is only seven years old. How much blood can a child lose? How much longer can I keep her brain cells alive?

“Ambulance is on the way!” said Lincoln.

“Okay, I need you to cut off her blouse. We have to see where she’s bleeding.”

Claire paused to give the girl three more breaths. She heard fabric ripping and saw that Lincoln had already bared the girl’s chest.

“Jesus,” he murmured.

Blood dribbled from half a dozen stab wounds.

She placed her hands back on the sternum and resumed cardiac compressions, but with every pump, more blood spilled out of the girl’s body.

A siren wailed closer, and through the kitchen window they saw strobelike flashes of light as the ambulance pulled into the front yard. Two EMTs swept into the house, took one look at the child on the table, and threw open their emergency kit. Claire continued pumping on the chest as the EMTs intubated, inserted an IV, slapped on EKG leads.

“Have we got a rhythm?” Claire asked, holding compressions.

“Rapid sinus tach.”

She heard the whiff, whiff of the blood pressure cuff, then the answer: “Barely palpable at fifty. Ringer’s lacate going wide open in this IV Having trouble getting this second line started.

Another siren screamed into the yard, and more footsteps banged into the house.

Officers Mark Dolan and Pete Sparks crowded into the kitchen. Dolan met Claire’s gaze, and he quickly looked away, sensing her reproach. I told you something was wrong!

“There’s a boy upstairs in the attic,” said Lincoln. “I’ve already got him cuffed. Now we have to find the mother.”

“I’ll check the barn,” said Dolan.

Claire protested, “Faye’s in a wheelchair! She couldn’t get out to the barn.

She’s got to be somewhere in this house.”

Ignoring her, Dolan turned and headed straight out the door.

She focused her attention back on the girl. Now that they were getting a pulse, she could stop pumping on the chest, and she was acutely aware that her hands were sticky with blood. She heard Lincoln and Pete running from room to room in search of Faye, heard the EMT’s radio crackle with questions from the Knox Hospital ER.

“How much blood loss?” It was McNally’s voice on the radio.

“Her clothes are saturated,” answered the EMT “At least six stab wounds to the chest. We’ve got sinus tach at one-sixty BP palpable at fifty. One IV in. We can’t get a second line started.”

“Breathing?”

“No. She’s tubed and we’re bagging her. Dr. Effiot’s here with us.”

“Gordon,” Claire called out. “She needs immediate thoracotomy! Get a surgeon there, and let’s just move her!”

“We’ll be waiting for you.”

Though it took only seconds to transfer the girl into the ambulance, Claire felt as if everything were moving in excruciatingly slow motion. She saw it all through a cloud of panic: the heartbreakingly small body being strapped into the stretcher, the tangle of EKG wires and IV line, the tense faces of the EMTs as they ran the girl down the porch steps and slid her into the ambulance.

Claire and one of the EMTs climbed in beside the girl and the door slammed shut.

She knelt beside the stretcher, bagging the lungs and fighting to keep her balance as they bumped down the Braxton driveway, then swung onto the main road.

On the cardiac monitor, the girl’s heart rhythm stumbled. Two premature ventricular beats. Then three more.

“PVCs,” said the EMT

“Go ahead with the lidocaine.”

The EMT had just started to inject the drug when the ambulance hit a pothole. He sprawled backwards, his arm snagging the IV line. The catheter slid out of the girl’s vein, sending a spray of Ringer’s lactate into Claire’s face.

“Shit, I’ve lost the line!” he said.

An alarm beeped on the monitor. Claire glanced up to see a string of PVCs skipping across the screen. At once she began cardiac compressions. “Hurry with that second line!”

Already he was ripping open a package, pulling out a fresh catheter. He tied a tourniquet on Kitty’s arm and slapped the flesh a few times, trying to get a vein to plump up. “I can’t find one! She’s lost too much blood.”

The girl was in shock. Her veins had collapsed.

The alarm squealed. Ventricular tachycardia was racing across the screen.

In panic, Claire gave Kitty’s chest a sharp thump. Nothing changed. She heard the whine of the defibrillator. The EMT had already punched the charge button and was slapping contact pads on Kitty’s chest. Claire pulled away as he positioned the paddles and discharged the current.

On the monitor, the tracing shot up, then slid back to a rapid sinus tachycardia. Both Claire and the EMT released loud sighs of relief.

“That rhythm’s not going to hold,” said Claire. “We need the IV.”

Fighting to keep his balance in the swaying ambulance, he wound the tourniquet around the opposite arm and again searched for a vein. “I can’t find one.”

“Not even the antecubital?”

“It’s already blown. We lost it trying to get the IV started earlier.”

She glanced up at the monitor. PVCs were beginning to march across the screen again. They were still miles away from the ER, and the girl’s rhythm was deteriorating. They had to get an IV in her now.

“Take over CPR,” she said. “I’ll start a subclavian line.” They scrambled to switch positions.

Claire’s heart was hammering as she crouched beside Kitty’s chest and stared down at the collarbone. It had been years since she’d inserted a child’s central venous line. She would have to insert a needle under the clavicle, angling the tip toward the large subclavian vein, while running the danger of puncturing the lung. Her hands were already trembling; in the swaying ambulance, they would be even less steady The girl is in shock, and dying. I have no choice.

She opened the central venous line kit, swabbed the skin with Beta-dine, and snapped on sterile gloves. Then she took a shaky breath. “Hold compressions,” she said. She placed the tip of the needle beneath the collarbone and pierced the skin. With steady pressure she advanced the needle, the whole time gently applying suction to the attached syringe.

Dark blood suddenly flashed back.

“I’m in the vein.”

The alarm squealed. “Hurry! She’s in V. tach!” said the EMT

Lord, don’t send us over a pothole. Not now.

Holding the needle absolutely still, she removed the syringe and threaded the J wire through the hollow needle, into the subclavian vein. Her guide wire was in position; the most delicate part of the procedure was over. Moving swiftly now, she slid the catheter into place, withdrew the wire, and connected the IV tubing.

“Good show, doc!”

“Lidocaine’s going in. Ringer’s at wide open.” Claire glanced at the monitor.

Still in V. tach. She reached for the paddles, and was just placing them on Kitty’s chest when the EMT said, “Wait.”

She looked at the monitor. The lidocaine was taking effect; the V. tach had stopped.

The abrupt lurch of the braking ambulance alerted them to their arrival. Claire braced herself as the vehicle swung around and backed up into the ER bay.

The door swung open and suddenly McNally and his staff were there, half a dozen pairs of hands reaching to pull the stretcher out of the vehicle.

They had only a bare-bones surgical team waiting in the trauma room, but it was the best McNally could round up on such short notice: an anesthetist, two obstetrical nurses, and Dr. Byrne, a general surgeon.

At once Byrne moved into action. With a scalpel, he slashed the skin above Kitty’s rib and with almost savage force shoved in a plastic chest tube. Blood gushed through the tube and poured into the glass reservoir. He took one look at the rapidly accumulating blood and said, “We have to crack the chest.”

They had no time for the ritual hand scrub. While McNally performed a cutdown on the girl’s arm for another IV line, and a unit of O-neg blood pumped in, Claire slipped into a surgical gown, thrust her hands into sterile gloves, and took her place across from Byrne. She could see from his white face that he was scared.

He was not a thoracic surgeon, and clearly he knew he was in over his head. But Kitty was dying, and there was no one else to turn to.

“Hail Mary, full of grace,” he muttered, and started up the sternal saw.

Wincing at the whine of the saw, Claire squinted against the spray of bone dust, into the widening gap of Kitty’s chest cavity. All she could see was blood, glistening like red satin under the lights. A massive hemothorax. As Byrne positioned the retractors, widening the gap, Claire suctioned, temporarily clearing the cavity “Where’s it coming from?” muttered Byrne. “The heart looks undamaged.”

And so small, thought Claire with sudden anguish. This child is so very small…

“We’ve got to clear away this blood.”

As Claire suctioned deeper, a tiny spurt suddenly appeared from the lacerated lung, pumping out an arc of blood.

“I see it,” he said, and snapped on a clamp.

Another spurt appeared, fresh blood swirling bright red into the darker pool.

“That’s two,” he said with a tense note of triumph, clamping off the second bleeder.

“I’m hearing a BP!” said a nurse. “Systolic’s seventy!” “Hanging the second unit of 0-neg.”

“There,” said Claire, and Byrne clamped off the third telltale spurt. Claire suctioned again. For a moment they watched the open chest, waiting in dread for the blood to reaccumulate. Everyone in the room fell silent. The seconds ticked by.

Then Byrne glanced across at her. “You know that Hail Mary I just said?”

“Yes?”

“It seems to be working.”

Pete Sparks was waiting for her when Claire finally emerged from the trauma room. Her clothes were splattered with blood, but he didn’t seem to notice it; they had seen so much violence that night, perhaps they could no longer be shocked by the sight of gore. “How’s the girl?” he asked.

“She made it through surgery As soon as her blood pressure’s stabilized, they’ll be transferring her to Bangor.” Claire gave him a tired smile. “I think she’ll be fine, Pete.”

“We brought the boy here,” he said.

“Scotty?”

He nodded. “The nurses put him in that exam room over there. Lincoln thought you’d better take a look at him. There’s something wrong.”

With growing apprehension, she crossed the ER and came to an abrupt halt in the exam room doorway. There she stood staring into the room, saying nothing, a chill rising up her spine.

She almost jumped when Pete said, quietly, “You see what I mean?” “What about his mother?” she asked. “Did you find Faye?” “Yes, we found her.”

“Where?”

“In the cellar. She was still in her wheelchair.” Pete looked into the exam room, and as if repelled by what he saw, he took a fearful step backwards. “Her neck was broken. He pushed her down the stairs.”