It rained the entire day. It rained with such force that the shrubs next to the emergency room parking lot lay flat to the ground and the new roof sprang a leak. One of the nurses set a bucket on the floor of the waiting room to catch the water, and within an hour the rain had filled it to the brim.
Olivia Simon watched the downpour through the broad windows of her office. The rain sapped her concentration, and the journal on her desk was still open to the article she’d started hours before. There was something unnatural about this rain. It sucked the oxygen from the air and made it hard to breathe, and it pounded above her head like marbles falling on a sheet of tin. Just when she thought she could no longer tolerate the noise, it stopped. In the silence, Olivia watched the sky turn light and shiny, like the inside of an eggshell. Then suddenly, it was snowing.
She walked into the reception area, where Kathy Brash and Lynn Wilkes had been playing pinochle for the last abysmally quiet two hours.
“It’s snowing,” Olivia said.
They lifted their rained-dazed eyes to hers, then turned their heads toward the windows.
“Unreal.” Lynn stood for a better look, her white coat scraping a few cards from the table.
“It’s beginning to be an annual tradition on the Outer Banks,” Kathy said. “Last Christmas we actually got snowed in.”
Olivia looked at her watch. Five-thirty. She couldn’t afford to get stuck here tonight.
Lynn took her seat again. “Want us to deal you in, Olivia?”
Olivia declined, and returned to her office. She couldn’t make herself join them tonight. She was too antsy, too preoccupied. She needed to get home.
She sat behind her desk and dialed her home number.
“It’s snowing,” she said when Paul answered.
“Yeah, I know.” He sounded irritated. She was getting accustomed to the curt tone he used with her these days. “When are you getting out of there?”
“Soon. Just a half hour more.” She’d had no choice but to work today. Of the four emergency room physicians, she had the least seniority. She wished she could tell Paul that it had been worth her while coming in today, worth their being apart when, God knows, they needed the time together. But all she had seen in eleven long hours was a scraped knee and a case of severe post-turkey indigestion. On days like this, she found herself missing the chaos of Washington General, where she’d worked for the past ten years, where her seniority had given her some control over her schedule. It scared her these days, being away from Paul. When she wasn’t close enough to touch him, she was afraid he might disappear.
They’d spent last Christmas with his family in Philadelphia. Paul had written a poem about her and stitched it into a sampler sometime during the long hours she was at work and he was not. The sampler hung in the study, and now each time she looked at it she wondered how the warmth Paul had felt for her one short year ago could have disintegrated so quickly.
“Turkey’s falling off the bone,” he said now. “Should I take it out?”
Olivia started to answer, but just then the police radio in the hall outside her office coughed to life.
“Hold on, Paul.” She held the receiver away from her ear and listened as Kathy sat down in front of the radio.
“Kill Devil Hills Emergency Room,” Kathy said.
“We’ve got a gunshot wound to the chest.” A male voice broke through the static. “Female. Mid to late thirties. Pulse one-fifty and thready. B.P. seventy-five over forty.”
“What’s your ETA?” Kathy asked.
“Fifteen minutes. Maybe twenty. It’s fucking snowing out here.”
Olivia stood up. “Paul, I’ve got to go.” She hung up the phone and raced to the treatment room.
“Call Jonathan,” she said as she passed Kathy. Jonathan Cramer was not Olivia’s favorite physician to work with, but he was the back-up physician tonight and he lived closest. He could be here in seconds.
She was soaping her hands and wrists at the treatment room sink when Jonathan arrived. “Gunshot, huh?” he said as he rolled his shirt sleeves over his beefy forearms. “We’ll stabilize her and fly her up to Emerson.”
Olivia turned on the EKG monitor. “We haven’t even seen her yet.”
“She’s going to need a trauma unit.”
Olivia began setting up the intubation tray. Jonathan had last worked in a sleepy Louisiana hospital. Gunshot wounds were probably not his area of greatest confidence. He had been here a little over a year, the first physician hired by the new freestanding emergency room, the only emergency facility serving North Carolina’s Outer Banks. She’d been told she’d be on an equal plane with him, with equal say in all decisions made. Yet she often wondered if someone had neglected to pass that information on to Jonathan.
“Let’s see her first,” she said.
They had the treatment room ready by the time the two paramedics wheeled the woman into the ER. Her shirt and bra had been cut off. The bullet hole in her left breast was deceptively small and bloodless. That could mean only one thing- the bullet had penetrated the heart. Olivia felt a rush of adrenaline. Surgery was the only possible course of action and they had no time to waste.
“Get the surgical tray,” she said to Kathy.
“What?” Jonathan was helping one of the paramedics fit the inflatable MAST trousers on the woman’s legs. “Forget it, Olivia. Let’s get her out of here and up to Emerson.”
“Get me two units of O-negative packed cells,” she said to Lynn as she checked the woman’s vital signs. It would take the helicopter forty minutes to fly her to Emerson, probably longer in the snow, and at least another fifteen minutes before she could get into surgery.
“She won’t make it,” she said.
Kathy produced the surgical tray. The instruments rattled against one another in her trembling hands. She had pinned her dark hair up, and Olivia wished she’d thought to do the same. Her fine brown hair was a little longer than chin-length, and each time she lowered her head it slipped forward, like blinders.
“You can’t be serious,” Jonathan said. “We’re not set up for anything like this.”
“Fifty over thirty,” Lynn said. “I can’t get a radial pulse.”
“Hang normal saline wide open. And do a cutdown, please, Jonathan,” Olivia said. This woman needed blood fast.
“Olivia, this isn’t the goddamned District of Columbia. She needs a trauma unit.”
“Start a bicarb bolus,” she said to Lynn. “And epinephrine. And get that blood hung.” Then she turned to Jonathan. “Look. We can ship her up to Emerson and you and I both know she’ll die on the way. Working on her here might not be ideal, but it’s the only chance she has.” She turned back to the table and did the cut-down herself, slipping the scalpel into the blue vein in the woman’s groin. She picked up the large bore needle.
“I can do it.” Kathy took the needle from her and fit it into the vein. Her hands no longer trembled and Olivia admired her for getting her fear under control so quickly.
Jonathan glowered at her. “I won’t be a part of this. I’m calling the helicopter.” He turned on his heel and walked out of the room.
Olivia stared after him, dumbfounded. “I don’t believe it.” She turned to one of the paramedics. “Call Dr. Shelley,” she said. “Tell him to get over here stat.” She began swabbing Betadine on the woman’s chest and side. Then she slipped her hands into the sterile gloves Lynn held out to her.
“Maybe we should send her up,” Lynn said quietly. Perspiration glowed on her forehead.
“We’re going to do our best for her, Lynn.” Olivia picked up a second scalpel from the tray and noticed the tremor in her own hand. She was suddenly aware of being the only physician in the room. Steady, come on, steady. She set the scalpel between the woman’s ribs and felt all her concentration flow into the task ahead of her. She bore down. No blood at all. She cut deeper, through the layers of muscle, until she reached the heart cavity. Blood suddenly gushed from the wound she’d created. It poured down the front of her scrubs and onto the floor, and the paramedic standing nearest her let out a moan.
“No BP,” Lynn said. “And no pulse.”
Olivia looked up at the flat green line on the monitor behind the patient’s head. She felt a film of sweat break out across her own forehead. They were losing her. She had to widen the incision. She looked at the tray of instruments. “No rib spreader?”
Kathy shook her head.
Of course they had no rib spreader. Olivia set the scalpel again and forced it through the woman’s fifth rib. Once the wound was wide enough, she slipped her hand inside. She cautiously curved her fingers around the woman’s heart, then slid her thumb over the surface, hunting for the bullet hole. She found it quickly-a little dimple in the heart’s smooth surface-and held her thumb over it to block the flow of blood. Then she found the exit wound in the back of the heart. She covered it with her middle finger and felt the heart contract in her palm. She looked at the monitor as a cheer went up in the room.
“We’ve got a pulse!” Kathy said.
Olivia smiled and let out her breath. There was little they could do now except wait for Mike Shelley, the director of the ER, to get over here. She wasn’t sure how long she could hold her position. It was painfully awkward. She was nearly crouching, her spine twisted to keep her hand in the right position on the heart. If she moved her fingers, the woman would die. It was that simple. The muscles in her thighs began to quiver, and her shoulder ached.
She could hear the helicopter making its approach, the familiar thud as it landed on the roof. She hoped they would need it, hoped they could repair the damage to this woman’s heart and stabilize her well enough to make the trip.
For the first time she looked at the woman’s face. Her skin was white and lightly freckled. She wore no makeup. Her hair was cherry-wood red, long and full. It fell over the edge of the table in a mass of corkscrew curls. She looked like an advertisement for Ivory soap.
“Who shot her?” She raised her eyes to the younger of the two paramedics, trying to get her mind off her own discomfort.
The paramedic’s face was as white as the patient’s, his brown eyes wide. “She was a volunteer at the Battered Women’s Shelter in Manteo,” he said. “Some guy came in, threatening his wife and kid, and this lady got in the way.”
The Battered Women’s Shelter. Olivia felt a spasm of pain in her own chest. She had to force herself to ask the next question. “Does anyone know her name?”
“Annie somebody,” said the paramedic. “O’Brien. O’Something.”
“O’Neill,” Olivia whispered, so quietly none of them heard her. She let her eyes run over the body in front of her, over the creamy white, freckled breasts, the softly sloping waistline. She closed her eyes. Her shoulder burned; the tips of her fingers were numb. She was no longer certain they were in exactly the right place. She lifted her eyes back to the monitor. She would be able to tell by any change in the heartbeat if her fingers were slipping.
Had it only been a month since Paul had written that article for Seascape Magazine? She remembered the pictures of the stained glass in Annie Chase O’Neill’s studio. The women in silk, the sleek blue heron, the sunset on the sound. Paul had changed after that story. Everything had changed.
Mike Shelley arrived and she saw in his dark eyes his shock at the scene. But he scrubbed quickly and was at her side in seconds. “Where’s Jonathan?” he asked.
“He thought she should go up and I thought she should stay. So he left to call the helicopter and he hasn’t come back.”
Mike threaded the curved needle with his gloved hands. “Maybe she should have gone up.” He spoke very quietly, very softly, his lips close to her ear. “This way her blood’s on your hands.”
Olivia’s eyes stung. Had she made the wrong decision? No, this woman would never have survived the trip. Never.
Mike had to work around her fingers. If she moved just a fraction of an inch, the blood poured from the bullet holes. The pain in Olivia’s shoulder became a steady fire and the shaking in her legs spread to the rest of her body. Still she held her position while Mike slipped a tiny piece of felt beneath her thumb and stitched it into place. But the exit hole was not so easy to close. It was large and nearly impossible to reach without damaging the heart in the process.
She watched the lines deepen in Mike’s forehead as he struggled with the needle.
“Please, Mike,” she whispered.
He finally shook his head. The felt refused to hold, and the blood seeped, then poured from the back of the heart. Olivia felt the heat of it on her fingers as the green line of the monitor shivered and flattened, and the room grew hushed with failure.
For a moment on one moved. No one spoke. Olivia could hear Mike’s breathing, rapid and deep, keeping time with her own. She straightened up slowly, gritting her teeth against the pain in her back, and looked at Kathy. “Is any of her family here?”
Kathy nodded. “Yes, and we called Kevin in. He’s with them in the little waiting room.”
“I’ll tell them,” Mike said.
Olivia shook her head. “I should do it. I was with her from the start.” She turned and started walking toward the door.
“Whoa.” Mike caught her arm. “Better change first.”
She looked down at her blood-soaked scrubs and felt a ripple of doubt. She was not thinking clearly.
She changed in the lounge and then walked to the small, private waiting room. Through the high window in the hallway she caught a glimpse of snowflakes dancing in the darkness. She wished she could step outside for a second. Her muscles still burned. And she hated what lay ahead of her. She hoped Kevin Rickert, the social worker, had prepared them for what she had to say.
Kevin looked relieved to see her. “This is Dr. Simon,” he said.
There were three of them-a girl about thirteen who looked strikingly like the woman she had just left on the table, a boy a few years older. And a man. Annie’s husband, Alec O’Neill. He was dark-haired, tall and thin, with an athletic tightness to his body. He wore jeans and a blue sweater, and he held his hand toward her, tentatively, his pale blue eyes asking her what his future held.
She shook his hand quickly. “Mr. O’Neill.” She would make the words come out very slowly. “I’m so sorry. The bullet went straight through her heart. The damage was too extensive.”
There was still hope in his eyes. It was always that way. Until you said it clearly, until you stopped mincing words, that hope would be there. The son understood, though. He looked like a younger version of his father-the same black hair, striking pale blue eyes beneath dark brows. He turned to face the wall, his shoulders heaving, although he made no sound.
“Do you understand what Dr. Simon is saying?” Kevin asked.
The man stared at her. “Are you saying Annie’s dead?”
Olivia nodded. “I’m sorry. We worked on her for over an hour but there was…”
“No!” The girl threw herself at Olivia, knocking her into the wooden arm of one of the chairs. She flailed at her with closed fists, but Kevin wrapped his arms around her from behind before she could cause any real harm. “She can’t be dead!” the girl screamed. “There wasn’t any blood.”
Alec O’Neill extracted the girl from Kevin’s grip and pulled her into a hug. “Shh, Lacey.”
Olivia regained her balance and set a hand on the girl’s back. How did she know about the blood? “She was bleeding inside, honey,” Olivia said.
The girl pushed Olivia’s arm away. “Don’t call me honey.”
Alec O’Neill pulled Lacey closer to him and she began to weep against his chest. Olivia looked at Kevin. She felt helpless.
“I’ll stay with them,” Kevin said.
Olivia walked to the door but turned back to face the family once more. “If you have any questions, please call me.”
Alec O’Neill looked across the room at her and Olivia stood fast, forcing herself to face the hurt in his eyes. She’d taken something from him. She needed to give him something back.
“She was very beautiful,” she said.
Jonathan and the helicopter pilot were standing in the hallway, and she had to pass them to get to her office.
“Nice job,” Jonathan said, his tone mocking.
She ignored him and walked into her office, where she cranked open her windows to let in the cold air. The snow was still falling, so silently that when she held her breath she could hear the thunder of the ocean two blocks away.
After a while, Kevin poked his head in her door. “You okay, Olivia?”
She turned away from the window, sat down behind her desk. “Yes. How’s her family?”
Kevin stepped into the room. “Dad and the son went in to see her,” he said as he sat down across the desk from her. “Daughter didn’t want to. I think they’ll be okay. Pretty solid family. Mom was the hub, though, you know, so it’s hard to say.” He shook his head. “Life sucks sometimes, doesn’t it?”
“Looks like this one was pretty rough on you.”
She felt a tear hit her cheek and Kevin plucked a tissue from the box on her desk and handed it to her.
“Cramer’s an asshole,” he said.
“I’m all right.” She sat up straight, blew her nose. “So, do you ever have to comfort Jonathan or Mike? Hand them tissues?”
Kevin smiled. “You think women have exclusive rights on feeling like shit?”
She thought of Alec O’Neill’s eyes when she’d left the waiting room. Those eyes were going to haunt her for a long time. “No, I guess not,” she said. “Thanks for stopping in, Kevin.”
It was after seven. Her shift was long over. She could leave now, any time she wanted. She would drive to her house on the sound where she would have to tell Paul what had happened tonight, and for the second time that night she would watch a man crumble. What was it about Annie O’Neill?
Olivia looked down at her hand where it rested in her lap. She turned it palm side up and thought she could still feel it-the life, the warmth of Annie’s heart.