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

5

Taylor Darnell sat handcuffed to a chair, swinging his foot, bam, bam, bam! against the principal’s desk. He didn’t look up when Claire and Lincoln walked into the room, didn’t even seem to notice they were there. Two Maine state cops were in the room with him. They looked at Lincoln and shook their heads, their thoughts transparent:

This one is totally bonkers.

“We just got a call from the hospital,” one of the state cops said to Lincoln.

“The teacher’s dead.”

No one spoke for a moment; both Claire and Lincoln absorbed the terrible news in silence.

Then Claire asked, softly: “Where is Taylor’s mother?”

“She’s still on her way back from Portland. She drove down there on business.”

“And Mr. Darnell?”

“I think he’s rounding up a lawyer. They’re going to need one.”

Taylor was kicking his foot against the desk again in a ceaseless, accelerating beat.

Claire set her medical bag down on a chair and approached the boy. “You remember me, Taylor, don’t you? I’m Dr. Elliot.” He didn’t answer, just kept up that angry banging. Something was very wrong. This was more than adolescent rage she was looking at. It appeared to be some sort of drug-induced psychosis.

Without warning, Taylor’s gaze rose and locked on hers, focusing with predatory intensity. His pupils dilated, irises darkening to ebony pools. His lips curled up, canines gleaming, and from his throat escaped an animal sound, half hiss, half growl.

It happened so fast she had no time to react. He sprang to his feet, dragging the chair up with him, and lunged at her.

The impact of his body slamming into hers sent her toppling backwards to the floor. His teeth sank into her jacket, ripping the fabric, sending goose down and feathers flying in a white cloud. She caught a glimpse of three frantic faces as the cops struggled to separate them. They wrenched Taylor away, dragging him backwards even as he continued to thrash.

Lincoln grasped her arm and lifted her back to her feet. “Claire- Jesus-”

“I’m okay,” she said, coughing on goose down. “Really, I’m fine.”

One of the state cops yelped. “He just bit me! Look, I’m bleeding!”

Even cuffed to the chair, the boy was fighting, bucking against his restraints.

“Let me go!” he shrieked. “I’ll kill you all if you don’t let me go!”

“He should be locked up in a freaking kennel!”

“No. No, there’s something seriously wrong here,” said Claire. “It looks like a drug psychosis to me. PCP or amphetamines.” She turned to Lincoln. “I want this boy moved to the hospital. Now.”

“Too much movement,” said Dr. Chapman, the radiologist. “We’re not going to get very clear definition here.”

Claire leaned forward, watching intently as the first cross-section of Taylor Darnell’s brain appeared on the computer screen. Each image Was a compilation of pixels formed by thousands of tiny X-ray beams. Aimed at different angles along one plane, the beams distinguished between fluid and solid and air, and the various densities were reproduced in the image on the screen.

“See that fuzziness there?” said Chapman, pointing to the movement artifact.

“We can’t make him hold still unless we put him under anesthesia.”

“Well, that’s an option.”

Claire shook her head. “His mentation’s cloudy enough. I don’t want to risk anesthesia right now. I’m just trying to rule out any mass shifts before I do the lumbar puncture.”

“You really think encephalitis could explain these symptoms?” Chapman looked at her, and she saw skepticism in his eyes. In Baltimore, she’d been a respected family practitioner. But here she still had to prove herself. How long would it take before her new colleagues stopped questioning her judgment and learned to trust her?

“At this point, I have no choice,” she said. “The initial screen for both methamphetamine and PCP came back negative. But Dr. Forrest thinks this is clearly an organic psychosis, not psychiatric.”

Chapman was obviously unimpressed by Dr. Forrest’s clinical skills. “Psychiatry is hardly an exact science.”

“But I agree with him. The boy’s shown alarming personality changes in just the last few days. We have to rule out infection.”

“What’s the white cell count?”

“Thirteen thousand.”

“A little high, but not all that impressive. What about the differential?”

“His eosinophil count is high. Way off the scale, in fact, at thirty percent.”

“But he has a history of asthma, right? That could account for it. It’s some sort of allergic response.”

Claire had to agree. Eosinophils were a type of white blood cell that proliferated most commonly in response to allergic reactions or asthma. High eosinophil counts could also be caused by a variety of other illnesses such as cancer, parasitic infections, and autoimmune diseases. In some patients, no discernible cause was ever found.

“So what happens now?” asked the Maine state trooper, who’d been watching the procedure with a look of growing impatience. “Can we move him to the Youth Center or not?”

“We have more tests to run,” said Claire. “The boy could be seriously ill."

“Or he could be faking it. That’s what it looks like to me.”

“And if he’s sick, you could find him dead in his cell. I wouldn’t want to make that mistake, would you?”

Without comment, the trooper turned and stared through the CT viewing window at his prisoner.

Taylor was lying on his back, wrists and ankles restrained. His head was hidden inside the CT cradle, but they could see the movement of his feet, twisting against the restraints. Now comes the hard part, she thought. How do we hold him in position long enough for the lumbar puncture?

“I can’t afford to miss a CNS infection,” said Claire. “With an elevated white blood count and changes in mental status, I have no choice but to do the spinal tap.”

Chapman at last seemed to agree. “From what I see here on the scan, it looks safe enough to proceed.”

They wheeled Taylor out of X-ray and into a private room. It took two nurses and a male orderly to transfer the struggling boy to the bed.

“Turn him on his side,” said Claire. “Fetal position.”

“He’s not going to lie still for this.”

“Then you’ll have to sit on him. We need this spinal tap.”

Together they rolled the boy on his side, his back to Claire. The orderly flexed Taylor’s hips, forcibly pushing the knees toward the chest. One nurse pulled the shoulders forward. Taylor snapped at her hand, almost catching her finger in his jaws.

“Watch his teeth!”

“I’m trying to!”

Claire had to work fast; they couldn’t keep the boy immobilized much longer. She lifted the hospital gown, exposing his back. With his body curled into a fetal position, the vertebral spines poked out clearly under the skin. In rapid order she identified the space between the fourth and fifth spinous processes in the lower back, and swabbed the skin with Betadine, then alcohol. She snapped on sterile gloves and picked up the syringe with local anesthetic.

“I’m putting in the Xylocaine now. He’s not going to like this.”

Claire pricked the skin with the twenty-five-gauge needle and gently injected the local anesthetic. At the first sting of the drug, Taylor shrieked with rage.

Claire saw one of the nurses glance up, fear in her eyes. None of them had ever dealt with anything like this, and the violence coursing through this boy’s body was frightening them all.

Claire reached for the spinal needle. It was three inches long, twenty-two-gauge gleaming steel, the hub end open to allow cerebrospinal fluid to drip out.

“Steady him. I’m doing the tap now.”

She pierced the skin. The Xylocaine had numbed the area, so he didn’t feel any pain-not yet. She kept pushing the needle deeper, aiming the tip between the spinous processes, toward the dura mater of the spinal cord. She felt a slight resistance, then a distinct pop as the needle penetrated the protective dura.

Taylor screamed again and began to thrash.

“Hold him! You have to hold him!”

“We’re trying! Can you hurry it up?”

“I’m already in. It’ll just be another minute now.” She held a test tube under the open hub of the needle and caught the first drop of CSF as it slid out. To her surprise, the fluid was crystal clear with no blood, no telltale cloudiness of infection. This was not an obvious case of meningitis. So what am I dealing with? she wondered as she carefully collected CSF in three different test tubes.

The fluid would be sent immediately to the lab, where it would be analyzed for cell count and bacteria, glucose and protein. Just by looking at the fluid in the tubes, she knew that the results would be normal.

She withdrew the needle and applied a bandage to the puncture site. Everyone in the room seemed to give a simultaneous sigh of relief; the procedure was over.

But the answer was no closer.

Later that evening, she found Taylor’s mother downstairs in the tiny hospital chapel, gazing numbly at the altar. They had spoken earlier, when Claire had requested the mother’s consent for the lumbar puncture. At the time, Wanda Darnell had been a bundle of nerves, all jittery hands and trembling lips. She had been on the road all day, first the two-hundred mile drive to Portland to visit her divorce attorney, and then the harrowing drive back, after the police had contacted her with the terrible news.

Now Wanda seemed exhausted, all her adrenaline depleted. She was a small woman, dressed in an ill-fitting skirt suit that made her look like a child playing grown-up in her mother’s clothes. She looked up as Claire came into the chapel and barely managed a nod of greeting.

Claire sat down and gently placed her hand on Wanda’s. “The lab results have come back on the spinal tap, and they’re completely normal. Taylor doesn’t have meningitis.”

Wanda Darnell released a deep sigh, her shoulders slumping forward in the oversize suit jacket. “That’s good, then?”

“Yes. And judging by the CT scan, he has no tumors or signs of hemorrhage in his brain. So that’s good, too.”

“Then what’s wrong with him? Why did he do it?”

“I don’t know, Wanda. Do you?”

She sat very still, as though struggling to come up with an answer. “He hasn’t been… right. For almost a week.”

“What do you mean?”

“He’s been out of control, angry at everyone. Cursing and slamming doors. I thought it was because of the divorce. He’s had such a hard time of it..

Claire was reluctant to bring up the next subject, but it had to be addressed.

“What about drugs, Wanda? That could change a child’s personality. Do you think he’s been experimenting with anything?”

Wanda hesitated. “No.”

“You don’t sound sure.”

“It’s just that She swallowed, tears flashing in her eyes. “I feel like I hardly know him anymore. He’s my son, and I don’t even recognize him.”

“Have you seen any warning signs?”

“He’s always been a little difficult. That’s why Dr. Pomeroy thought he might have attention deficit disorder. Lately, it seems he’s gotten Worse. Especially since he started hanging out with those awful boys.”

“Which boys?”

“They live up the road from us. J.D. and Eddie Reid. And then there’s that Scotty Braxton. All four of them got into trouble with the police back in March.

Last week, I told Taylor he had to stay away from the Reid brothers. That’s when we got into our first really big fight. That’s when he slapped me.”

“Taylor did?”

Wanda’s head drooped, the victim ashamed she’d been abused. “We’ve hardly spoken to each other since then. And when we do talk, it’s so obvious that Her voice slid to a whisper. “That we hate each other.”

Gently Claire touched Wanda’s arm. “Believe it or not, disliking your own teenager isn’t all that abnormal.”

“But I’m also afraid of him! That’s what makes it even worse. I dislike him and I’m scared of him. When he hit me, it was like having his father back in the house.” She touched her fingers to her mouth, as though remembering some long-faded bruise. “Paul and I are still in a custody fight. Two of us battling over a boy who doesn’t like either of us.”

Claire’s beeper went off. She glanced at the digital readout and saw the lab was paging her. “Excuse me,” she said, and left the chapel to make the call from the hospital lobby.

Anthony, the lab supervisor, answered the phone. “The Bangor lab just called with more of Taylor’s results, Dr. Elliot.”

“Did anything turn up positive on the specific screens?”

“I’m afraid not. There’s no alcohol, cannabis, opioids, or amphetamines in his blood. That’s a negative for every drug you wanted screened?’

“I was so sure,” she said in bewilderment. “I don’t know what else could cause this behavior. There must be some drug I’ve forgotten to test for.”

“There may be something. I ran his blood through our hospital gas chromatography machine, and an abnormal peak showed up at one minute, ten seconds’ retention time.”

“What does that mean?”

“It doesn’t pinpoint any particular drug. But there is a peak, which indicates something out of the ordinary is circulating in his blood. It could be completely innocuous-an herbal supplement, for instance.”

“How do we find out what it is?”

“We’d need more extensive analysis. The Bangor lab isn’t equipped to do that. We have to draw more blood and send it to our reference lab in Boston. They can simultaneously screen for hundreds of different drugs.”

“Then let’s do it.”

“Well, here’s the problem. It’s the other reason I paged you. I just got an order to cancel any and all remaining drug tests. It’s signed by Dr. DeIRay.”

“What?” She shook her head in disbelief. “I’m Taylor’s doctor.”

“But DelRay’s writing orders, and his are contradictory to yours. So I’m not sure what to do.”

“Look, let me talk to the mother and I’ll clear this up right now” She hung up and returned to the chapel.

Even before she opened the door, she could hear a man’s voice, raised in anger. never exerted any control! Completely useless, that’s what you are. No wonder he’s so screwed up!”

Claire pushed into the chapel. “Is there a problem here, Wanda?”

The man turned to her. “I’m Taylor’s father.”

Personal crises bring out the worst in people, but Paul Darnell was probably not likable even at his best. A partner in the largest accounting firm in Two Hills, he was far more stylishly garbed than his wife, who seemed to shrink to inconsequential size in her ill-fitting suit. The brief interaction Claire had witnessed between these two ex-spouses told her what this marriage must have been like: Paul the aggressor, full of demands and complaints. Wanda always appeasing, retreating.

“What is this about my son taking illegal drugs?” he asked.

“I’m trying to find a reason for what happened today, Mr. Darnell. I was just asking your wife-”

“Taylor hasn’t been taking any drugs. Not since you stopped the Ritalin.” He paused. “And he was fine on the Ritalin. I never understood why you took him off it.”

“It’s been two months since I discontinued it. This personality change is more recent.”

“Two months ago, he was fine.”

“No he wasn’t. He was tired and listless. And that diagnosis of ADD was never really established. it’s not the same as diagnosing hypertension, where there are definite parameters to go by.”

“Dr. Pomeroy was certain of the diagnosis.”

“ADD has turned into a catchall for all childhood misbehavior. When a student’s failing in class, or he gets into mischief, parents want to find a reason. I didn’t agree with Pomeroy’s diagnosis. When in doubt, I prefer not to push pills on children.”

“And look what’s happened. He’s out of control. He’s been out of control for weeks?’

“How would you know, Paul?” said Wanda. “How long has it been since you actually spent time with your own son?”

Paul turned to his ex-wife with such a look of hatred, Wanda shrank back.

“You’re the one who’s supposed to be in charge,” he said. “I knew you couldn’t handle him. You screwed it up as usual, and now our son’s going to end up in jail!”

“At least I didn’t provide him with the gun,” she said softly.

“What?”

“It was your gun he brought to school. Did you ever notice it was missing?”

He stared at her. “The little shit! How did he get-”

“This isn’t helping!” Claire cut in. “We need to focus on Taylor. On how to explain his behavior.”

Paul turned to his wife. “I’ve asked Adam DelRay to take over. He’s upstairs looking at Taylor now.”

Paul’s blunt announcement left Claire speechless. So this was why DelRay had written orders; he was the new attending. She’d just been fired from the case.

“But Dr. Elliot’s his doctor!” Wanda protested.

“I know Adam, and I trust his judgment.”

Meaning he doesn’t trust mine?

“I don’t even like Adam DelRay,” said Wanda. “He’s your friend, not mine.”

“You don’t have to like him.”

“If he’s taking care of my son, I do.”

Paul’s laughter was grating. “Is that how you choose a doctor, Wanda? Pick whoever gives you the most warm fuzzies?”

“I’m doing what’s best for Taylor!”

“And that’s exactly why he ended up here.”

Claire’s temper at last burst through. “Mr. Darnell,” she said, “this is not the time to be attacking your wife!”

He turned to Claire, and his contempt was clearly meant for her as well.

“Ex-wife,” he corrected. And he turned and walked out of the chapel.

She found Adam DelRay sitting at the nurses’ station, writing in Taylor's chart.

Although it was late in the evening, his white coat was starched and fresh, and Claire felt rumpled by comparison. Whatever embarrassment he’d suffered earlier that day during the crisis with Katie Youmans had been conveniently forgotten, and he regarded Claire with his usual irritating self-confidence.

“I was about to page you,” he said. “Paul Darnell just decided-”

“I’ve already spoken to him.”

“Oh. So you know.” He gave an apologetic shrug. “I hope you don’t take it personally.”

“It’s the parents’ decision. They have a right to make it,” she acknowledged grudgingly. “But since you’re taking over, I thought you should know the boy has an abnormal peak on gas chromatography. I suggest you order a comprehensive drug screen.”

“I don’t think that’s necessary.” He set the chart down and stood up. “The most likely drugs have been ruled out.”

“That peak needs to be identified.”

“Paul doesn’t want any more drug tests.”

She shook her head, puzzled. “I don’t understand his objections.”

“I believe he reached that decision after speaking with his attorney.” She waited for him to walk away before picking up the chart. She flipped to the progress notes and with growing dismay read DeiRay’s entry.

History and physical dictated.

Assessment.

1. Acute psychosis secondary to abrupt Ritalin withdrawal.

2. Attention Deficit Disorder.

Claire dropped into the nearest chair, her legs suddenly unsteady, her stomach queasy. So this was their criminal defense strategy. That the boy was not responsible for his actions. That Claire should be blamed, because she took him off the Ritalin, triggering a psychotic break. That she was the one who should be blamed. I’m going to end up in court.

This was why Paul didn’t want to find any drug in the boy’s bloodstream. It would shift the blame away from Claire.

Agitated, she flipped to the front of the chart and read DelRay’s orders.

Cancel comprehensive drug/tox screen.

Refer all future questions and lab reports to me. Dr. Elliot is no longer the attending physician.

She slapped the chart shut and felt her nausea intensify. Now it was no longer just Taylor’s life on the line; it was her practice, and her reputation as well.

She thought of the first rule of defensive medicine: cover your ass. You can’t get sued if you can prove you didn’t make a mistake. if you can back up your diagnosis with lab tests.

She had to get a sample of Taylor’s blood. This was her last chance to draw the specimen; by tomorrow, any drug would be cleared from his system, and there’d be nothing left to detect.

She crossed the nurses’ station to the supply room, pulled open a drawer, and collected a Vacutainer syringe, alcohol swabs, and three red-top blood tubes.

Her heart was racing as she walked up the hall to Taylor’s room. The boy was no longer her patient, and she had no right to be doing this, but she needed to know what drug, if any, was circulating in his bloodstream.

The state trooper gave her a nod of greeting as she approached.

“I need to draw blood,” she said. “Would you mind holding down his arm for me?”

He didn’t look happy about it, but he followed her into the room.

Draw it quick and get out of here. With shaking hands she snapped on the tourniquet and twisted off the needle cap. Get out of here before someone finds out what you’re doing. She swabbed Taylor’s arm with alcohol and he gave a shout of rage, twisting against the trooper’s restraining grip. Claire’s pulse accelerated as she pierced the skin and felt that subtle and satisfying pop as the needle penetrated the vein. Hurry. Hurry. She filled one tube, slipped it into her lab coat pocket, then squeezed another into the Vacutainer. Dark blood streamed out.

“I can’t hold him still,” said the trooper, wrestling for control as the boy bucked and cursed.

“I’m almost done.”

“He’s trying to bite me!”

“Just keep him still!” she snapped, her ears ringing with the boy’s shrieks. She slipped the third tube into place and watched as a fresh stream of blood shot out. Just one more. Come on, come on.

“What the hell is going on in here?”

Claire looked up, so startled she let the needle slip out of the vein. Blood dribbled from the puncture wound and dripped onto the sheets. Quickly she snapped off the tourniquet and applied gauze to the boy’s arm. Cheeks burning with shame, she turned to face Paul Darnell and Adam DeIRay, who were staring at her incredulously from the doorway. Two nurses peered over their shoulders.

The trooper said, “She was just drawing some blood. The boy got a little noisy.”

“Dr. Elliot isn’t supposed to be in here,” said Paul. “Didn’t you hear about the new orders?”

“What orders?”

“I’m the boy’s physician now,” snapped DelRay. “Dr. Elliot has no authority. She shouldn’t even be in here.”

The trooper stared at Claire, and his anger was unmistakable. You used me.

Paul thrust out his hand. “Give me the blood tubes, Dr. Elliot.”

She shook her head. “I’m following up an abnormal test. It could affect your son’s treatment.”

“You’re no longer his doctor! Give me the tubes.”

She swallowed hard. “I’m sorry, Mr. Darnell. But I can’t.”

“This is assault!” Paul turned to the others in the room, and his face was florid with outrage. “That’s what this is, you know! She assaulted my son with that needle, and she knows she has no authority!” He looked at Claire. “You’ll be hearing from my attorney.”

“Paul,” interjected DelRay, playing the role of diplomat to the hilt. “I’m sure Dr. Elliot doesn’t want this kind of complication in her life?’ He turned to her and spoke with the smug voice of reason. “Come on, Claire. This is turning into a circus. Just give me the tubes.”

She looked down at the two tubes she was holding, weighing their value against a charge of assault. Against the probable loss of her hospital privileges. She felt the gaze of everyone in the room watching, even enjoying, her humiliation.

In silence she handed over the blood tubes.

DelRay took them with a look of triumph. Then he turned to the Maine state trooper. “The boy is my patient. Is that clear?”

“Perfectly clear, Dr. DelRay.”

No one said a word to Claire as she walked out of the ward, but she knew they were staring at her. She kept her gaze focused straight ahead as she turned the corner and punched the down button. Only when she’d stepped into the elevator and the door slid shut did she finally allow her hand to slip into her coat pocket.

The third blood tube was still there.

She rode the elevator to the basement lab and found Anthony sitting at his lab bench, surrounded by racks of test tubes.

“I’ve got a sample of the boy’s blood,” she told him.

“For the drug screen?”

“Yes. I’ll fill out the requisition myself.”

“The forms are on that shelf over there She took one off the stack and frowned at the letterhead, Anson Biologicals.

“Are we using a new reference lab? I’ve never seen one of these forms before.”

He glanced up from a whirring centrifuge. “We just switched over to Anson a few weeks ago. The hospital signed a new contract with them for our complex chem and radioimmunoassay work.”

“Why?”

“I think it was a cost issue.”

She scanned the form, then checked off the box for gas chromatography/mass spectrometry; comprehensive drug and tox screen. in the space for comments at the bottom of the page, she wrote: “Fourteen-year-old boy with apparent drug-induced psychosis and aggression. This lab test is for my personal research only. Report results directly to me.” And she signed her name.

Noah answered the knock on his front door and found Amelia standing outside in the dark. She was wearing a bandage, a bright slash of white across her temple, and he could tell it hurt her to smile. In her discomfort, the best she could muster was a crooked lifting of one side of her mouth.

He was so surprised by her unexpected visit, he couldn’t think of a single intelligent thing to say, so he just gaped at her, as dazzled as a peasant who suddenly finds himself in the presence of royalty “This is for you,” she said, and she held out a small brown package. “I’m sorry I couldn’t find anything nice to wrap it in.”

He took the package, but his gaze remained on her face. “Are you all right?”

“I’m okay. I guess you heard that Mrs. Horatio She paused, swallowing back tears.

He nodded. “My mom told me.”

Amelia touched the bandage on her face. Again he saw a flash of tears in her eyes. “I met your mom. In the emergency room. She was really nice to me…“

She turned and glanced over her shoulder at the darkness, as though expecting to see someone watching her. “I’ve got to go now-”

“Did someone drive you here?”

“I walked.”

“You walked? In the dark?”

“It’s not so far. I live just the other side of the lake, right past the boat ramp.” She backed away from the door, blond hair swaying. “I’ll see you in school.”

“Wait. Amelia!” He held up the gift. “What’s this for?”

“To thank you. For what you did today.” She took another retreating step, and was almost swallowed up in darkness.

“Amelia!”

“Yes?”

Noah paused, not knowing what to say. The silence was broken only by the rustle of dead leaves scattering across the lawn. Amelia stood on the farthest edge of the light spilling from the open doorway, her face a pale oval eclipsing into night.

“You want to come inside?” he asked.

To his surprise she seemed to consider the invitation. For a moment she lingered between darkness and light, advance and retreat. She looked over her shoulder again, as though seeking permission. Then she nodded.

Noah found himself panicking over the disorder in the front parlor. His mom had been home for only a few hours that afternoon, to comfort him and cook dinner.

Then she’d driven back to the hospital to see Taylor. No one had tidied up the parlor, and everything was still lying where Noah had dropped it that afternoon-backpack on the couch, sweatshirt on the coffee table, dirty tennis shoes in front of the fireplace. He decided to bypass the parlor and led Amelia into the kitchen instead.

They sat down, not looking at each other, two foreign species struggling to find a common language.

She glanced up as the phone rang. “Aren’t you going to answer that?”

“Naw. It’s another one of those reporters. They’ve been calling all afternoon, ever since I got home.”

The answering machine picked up, and as he’d predicted, a woman’s voice came on:

“This is Damaris Home of the Weekly Informer. I’d really, really like to talk to Noah Elliot, if I could, about that amazing act of heroism today in the classroom. The whole country wants to hear about it, Noah. I’ll be staying at the Lakeside B and B, and I could offer some financial compensation for your time, if that would make it more worth your while..

“She’s offering to pay you just to talk?” asked Amelia.

“Crazy, isn’t it? My mom says it’s a sure sign I shouldn’t talk to that lady.”

“But people do want to hear about it. About what you did.”

What I did.

He gave a shrug, feeling unworthy of all the praise, of Amelia’s praise, most of all. He sat listening as the call ended. The silence returned, interrupted only by the soft beep of the message reminder.

“You can open it now. If you want,” said Amelia.

He looked down at the gift. Though the wrapping was plain brown paper, he took great effort not to tear it, because it seemed uncouth to go ripping it open in front of her. Gingerly he peeled off the tape and folded back the wrapping.

The pocket knife was neither large nor impressive. He saw scratches on the handle, and realized it was not even new. She’d given him a used knife.

“Wow,” he managed to say with some measure of enthusiasm. “This is a nice one.”

“It belonged to my dad.” She added, quietly: “My real dad.” He looked up as the implication of those words sank in. “Jack is my stepfather.” She uttered that last word as though it were an object of disgust.

“Then J.D. and Eddie..

“They’re not my real brothers. They’re Jack’s boys.”

“I guess I wondered about it. They don’t look like you.”

“Thank god.”

Noah laughed. “Yeah, that’s not a family resemblance I’d want to have, either.”

“I’m not even allowed to talk about my real dad, because it makes Jack mad. He hates to be reminded there was someone else before him. But I want people to know. I want them to know Jack has nothing to do with who I am.”

Gently he placed the knife back in her hand. “I can’t take this, Amelia.”

“I want you to.”

“But it’s got to mean a lot to you, if it belonged to him.”

“That’s why I want you to have it.” She touched the bandage on her temple, as though pointing to the evidence of her debt to him. “You were the only one who did anything. The only one who didn’t run.”

He didn’t confess the humiliating truth: I wanted to run, but I was so terrified I couldn’t move my legs.

She looked up at the kitchen clock. With a start of panic, she abruptly stood up. “I didn’t know it was so late.”

He followed her to the front door. Amelia had just stepped out when headlights suddenly cut through the trees. She spun around to face them, and then seemed to freeze as the pickup truck roared up the driveway.

The door swung open and Jack Reid stepped out, whippet thin and scowling. “Get in the truck, Amelia,” he said.

“Jack, how did you-”

“Eddie told me you’d be here.”

“I was just about to walk home.”

“Get in the truck now.”

Instantly she clammed up and obediently slid into the passenger seat. Her stepfather was about to climb back behind the wheel when he met Noah’s gaze.

“She doesn’t hang out with boys,” he said. “I want you to know that.”

“She only came by to say hello,” said Noah angrily. “What’s the big deal?”

“The deal, boy, is that my daughter’s off limits.” He climbed in and slammed the door.

“She’s not even your daughter!” Noah yelled, but he knew the man couldn’t hear him over the revving engine.

As the truck swung around in the driveway, Noah caught one last glimpse of Amelia’s profile, framed by the passenger window, her terrified gaze focused straight ahead.