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  She and the nurse cut off the woman’s pink waitress uniform, slicing it away at the arms. The nurse was a young man, and his strength came in handy, shucking away the bunched cloth. He chucked the remnants into a yellow plastic box for police evidence, stooped to pick up a wallet that had fallen to the floor, and finished the cut-away.

  “Let’s go. Shock her,” Susan said.

  Six minutes had elapsed since she started massage. The nurse handed her the defibrillator paddles. She checked the EKG display nearby and saw that she was getting irregular beats from the woman’s heart, but nothing that settled into regularity. She fired the paddles. Chud. The body jerked, but the ‘scope showed flat line.

  Automatically she ran her hands down the woman’s sternum to the landmark called the angle of Louis. She probed. “Let’s ACD.”

  The nurse was there already with the molded gray cylinder, the hydraulic, power-assisted Active Compression and Decompression device. She positioned it, put her hand atop the mechanical diaphragm, and with a grunt started closed cardiac massage.

  The heart is packed tightly between the backbone and the breastbone. She had felt it, a lump of inert tissue that had somehow decided not to go on. She had to persuade that muscular knot to start pulsing anew, tug it back into the thumping arena of life. The woman didn’t seem to have lost a lot of blood, after all. Usually replacement of fluids and stimulation brought the heart back up. Usually. But behind the bland statistics lurked myriad special cases, patients with oddities of health or habit that all too often one only discovered too late.

  She practiced an old mental exercise, thinking down into the woman’s chest, through her hand, into the mass of unwilling muscle. Working through the ACD, a piston that amplified her effect, her hands pressed on the big breastbone. Susan thought of her working fingers, saw them sending into the woman’s flesh bright yellow arrows of stimulant, rays of hope, crisp vibrant lightning.

  She kept correct posture and concentrated on technique. All the mental focusing did no good if you goofed the essentials. Heel of the left hand coming down through the chuffing ACD, a third of the way up the breastbone. Take it easy on this old cartilage. Oh, and while you’re at it, don’t collapse her ribs.

  Without blood circulation, the patient would begin to suffer damage from lack of oxygen. Her brain cells would begin their little deaths, starved for air, long before the more durable heart muscle began to deteriorate.

  “Her name’s Patricia Olin,” the nurse said, jerking a thumb back over his shoulder. “See? Cops are waiting on this one.”

  Susan didn’t bother to look. “Epinephrine,” she ordered between strokes.

  Hands came into her field of view, inserting intravenous lines in both arms, attaching catheters, taking a blood sample, all under the hope that she would restart the heart. With IVs, a brachial patch for fresh blood, a breathing tube down her throat, and a ventilator working, Ms. Olin was being buried in technology.

  Susan felt her focus of attention narrow, the familiar falling away of all noise, sights, and smells that did not bear directly on the patient before her. The reeks and clangs and shouts faded. Every team leader wore a headset, which in theory was to help information flow faster, more quietly. She suspected they also doubled as earplugs.

  Her own headset belatedly recited Patricia Olin’s data, including an age of thirty-eight. Normally they came in already IDed. In a big crunch, niceties were set aside. A nurse had found Olin’s insurance card and taken it to a nearby optical reader, which would track down her records and risk factors. But that would probably be too late for Ms. Olin, she guessed.

  She puffed regularly, knowing that she had to keep her own oxygen level high or else lose a slight edge in her performance. Around her the ER was filling up. More bloody cases came in on swiftly rolling gurneys. It was a big smashup at high speeds. A resident shot questions at an injured woman at the next work station, only feet away, shouting over the noise.

  Susan gave herself over to a well-practiced rhythm: shock, massage, listen. Five times, ten. The monitor whispered that pH was dropping. “Sodium bicarb.”

  The nurse gave the injections into the heart’s right ventricle as Susan resumed massaging. Two more tries with the defibrillator paddles. Seconds ticked on.

  She ordered a dose of epinephrine given IV. Another try. She blinked back stinging sweat. Some premature contractions that faded as she caught them on the ‘scope.

  Minutes stretched amid the babble and shouts and clatter swirling around her. Heart muscles moved on finer and finer scales, the overall movements ceasing. Dying. She stood in the eye of the hurricane, totally transfixed, concentrated, sending lances of waning hope down through her tiring fingers.

  Wake up.

  With some jolts from the paddles, Olin’s arms flopped up and across her chest. It was as though for an instant the woman tried to seize control of herself and then her will wilted, helpless.

  Fifteen tries.

  Don’t go.

  She looked into Olin’s face as she worked, though she knew you could tell little or nothing about a patient that way. The eyes might be the windows of the soul, but they were of no help in reviving the body.

  Patricia Olin’s eyes fluttered for a moment, as delicately as the wavering of butterfly wings, as though she were struggling up from some shadowy quicksand that sucked her down into a black pit, away from the sweet sun and open air. The movement brought momentary life to her face. Despite what her hands told her, Susan felt a flicker of joy. If only—

  But a glance at the ‘scope showed no true, steady response in Olin’s chest. It was so easy to misread a passing tremor as a positive sign. She peered at the waxy skin with its sheen of perspiration and tried, as she worked, to see within the slack-jawed face the fragile, multisided person that was still somewhere in this phlegmatic body, these slabs of muscle and bone that resisted her probing fingers.

  Abruptly she thought of another body, of a muscular, big-boned, strong man. Her Roger. Always eagerly athletic, especially in bed, Roger had been massive, muscular, almost daunting to her at times, and he had fallen away from her just as suddenly as this, a coronary while jogging, of all the ridiculous—

  Seventeen. No! Come back! Don’t!

  Eighteen tries.

  Nineteen.

  “Blood pressure?” she prompted the diagnostics package. It reassured her that the pressure was not dropping much. So Ms. Olin had suffered few ruptured blood vessels from hydrostatic shock.

  “So why isn’t she responding?” Susan spat back.

  “There are no significant indicators at this time,” the bland, flat headset voice said.

  The voice was undoubtedly right and just as undoubtedly irritating. Sometimes patients simply did not fit the standard profile. Usually you never knew why until after the autopsy. If then.

  Last chance time. “Okay, let’s open her up.”

  Things moved in a blur then, as if she were under water.

  Closed-chest massage was moderately effective. She had considered using one of the “thumper” gadgets that sat on the patient’s chest and delivered an optimal pressure pulse. But something in her liked hands-on medicine, even through an ACD. And anyway, her research side reminded her, the latest data didn’t show them to be all that great.

  So Susan “zipped her open,” cutting swiftly through the left side of the chest with the big cutters. Patricia Olin’s heart was a sullen red lump. She narrowed her field of view to it and seized the slippery knot with one hand. For a silent, dreamlike time she labored at the inert ball of muscle. All her will bore down through her hands—and it all came to nothing.

  There came at last a moment when she wiped sweat away from her brow, panting, and glanced up. The attendants around her were looking at each other. Bottles of intravenous fluids clustered atop their poles, like ugly fruit on stripped trees.

  Slowly, unwillingly, Susan looked at the impersonal hands of the big white clock. It had been fifty-two minutes.


  Defeat flooded into her like a dark weight.

  “I… I guess that’s… all.”

  Her fingers numb, she automatically checked the other patients, each the focus of a buzzing cluster. Other faculty had arrived from the university and were handling matters well. A nineteen-car pileup, someone told her, caused by a jackknifed truck.

  When are they going to start regulating those damned trucks? Susan thought sharply. They do so much damage, so much—

  A wave of sudden, inexplicable grief burst over her. She made herself walk stonily out through the ER, checking to see if there was anything she could do, and at the same time trying to hold back the tide of emotion.

  She got herself out into the enameled light of the hallway, pushing the door open and leaning against it. The air out here seemed fresher. She longed to get outside, go for a quiet walk, feel the sting of the sun, gaze up into the pale, crystalline sky. She blew her nose, bringing swarming into her sinuses the astringent cleanser smell a hospital never lost. That seemed to clear her mind, to pull her up from the funnel of concentration, and the first thing she registered was a police officer asking her if Patricia Olin had said anything on the table.

  Despite herself, she laughed. The thin cackle came out with unnerving force. Susan gulped and made herself say slowly, soberly, “She never regained consciousness. The heart stopped on her way in.”

  “I see, ma’am,” the patrol officer said, making a note. “We’ll be getting in touch with you about this after—”

  “Wait a minute. What happened to that woman?”

  The officer blinked, his respect for physicians battling visibly in his face with reflexive caution. “It’s an active case, and I can’t—”

  “No, damn it, why was she in a dumpster?”

  The officer’s lips pursed, and he relented. “We don’t know. Just got a feedback, sayin’ she worked in a Denny’s up in the middle of the county. Walked out the back early this mornin’.”

  “And right into some bad luck,” Susan said.

  “Guess so, doctor. That’s all I know.”

  She thanked him and pressed her back flat against the cool wall again. Aches seeped out of her. Slowly she noticed a hospital administrator nearby speaking in low, soft, sympathetic words.

  But not to her. The target of this professional solace was a stocky woman in a honey blouse and brown skirt one size too small for her. The administrator was a thin, soft-spoken man gently trying to steer the woman into one of the small waiting rooms. The woman would have none of this.

  “I want to see my daughter immediately!” she cried, snatching her arm away from the man’s grasp. She turned abruptly to Susan. “Where is she?”

  “Who?” Susan asked automatically. She felt for a door handle, preparing to retreat into the ER. She did not feel like dealing with relatives just now.

  “Olin. Patricia Olin,” the woman said adamantly. “I got a call from you people, I’m Donna Olin, I live just down the road, got here as soon as—”

  “Please, just step in here,” the administrator beseeched.

  “No, I have a right to know, I’ve been waiting and I want—”

  The woman stopped, mouth open, eyes widening, her irises like brown islands floating in lakes of white. Susan realized that the woman could see through the doorway behind her, to where the team had already drawn a sheet over the patient’s face.

  Or had they? Susan turned and saw that the team was still tending to the body, its face uncovered.

  When she looked back, the woman seemed to wilt, swaying like a willow in a savage, silent wind. She babbled, crying between bursts of incoherent words. Susan put a hand out to comfort her and was brushed aside. The administrator was speaking slowly in low, calm tones, but the woman heard nothing, her eyes rolling in their sockets, lungs laboring, pale lips pulled back in a crooked grimace. Suddenly she snapped to attention, turned, and struck the wall with open hands. Furiously she beat the hard plaster in a sudden tornado of emotion, as if trying to drive the ER itself away. She shouted, cursed, kicked at the wall—and then collapsed, knees splaying outward, arms limp, making no attempt to cushion her fall.

  Susan stood frozen, her mind whirling in an empty, frictionless void. The Olin woman struggled to get back up, her face closed in upon her own misery.

  “No, no, I won’t have that.” Her mouth sagged as she argued emphatically with the air, focusing on nobody. “You can’t say that.”

  “Say what, Mrs. Olin?” the administrator asked calmly.

  “That she’s—that she’s just—” She gulped, blinked. With visible effort she pulled herself up, took a deep breath, her mouth firming. “Gone.”

  “If you’ll kindly step this way… a little privacy…” Smoothly the thin man led her into a small waiting room.

  No matter what you did, Susan thought, there was always some detail. No matter how efficient and sanitized and crisply run, in a hospital each death had some cruel, nasty detail. It might be minor, trivial, but it snagged in the mind and left a scar on the memory. And sometimes it was something sudden and awful, like this, as vivid as spurting crimson blood. This mother would carry this scene to her own grave. Such things happened. They had to. They arose from the noise and hurry and crowding of a place where daily, hourly, people died among strangers.

  Susan made herself go back into the ER. She would be no good at comforting Mrs. Olin. That was what the buffer of assistants around so many doctors was for, though no one ever said so explicitly.

  She stood silently and felt the hubbub ebbing in the ER, tension trickling away into rivulets of talk and cleanup jobs. To her relief, she was no longer needed. She told the operations chief that she was leaving, ignoring his puzzled glance. Her face must be giving away a lot.

  A clerk stopped her as she left, guiding her to a small cubicle. She punched in on her phone, and her mind went on automatic, making the case report. The story tumbled out, data and treatment and impersonal slabs of facts. Robo-Doc. Strangely, it helped.

  She climbed the external stairs slowly back to her office. The Saddleback Valley stretched like a jumbled-up board game, buildings jutting up through a white haze. The Indians had called this the Valley of Smokes, she recalled, because of the dry dust stirred incessantly by winds from the deserts to the east. Smog tinted this a ruddy brown and brought a prickling to her nose. Three stories below, palm trees lined the sweeping emergency driveway. A gust set their fronds to clattering, a sound both natural and strangely alien, like the clicking, impatient language of giant insects.

  Only when Susan closed the door to her office did she notice that she still wore her bloody rubber gloves. She pulled them off and collapsed into her chair, a Norwegian leather tilt-back with a footrest that popped out. She needed the comfort. Her back muscles tensed up while standing at the operating table, storing her knotted frustrations, and then they protested hours later with stabbing spikes of pain.

  Things had been going a bit too fast for her. The revival of Sparkle, the emergency in ER, the terrible way she had slipped up and let Mrs. Olin get the news… She knew she would relive those awful moments in dreams for weeks.

  She needed a break. No company just now, thanks, no quick coffee in the cafeteria. Something to take her out of herself.

  The pleasure of working at a teaching hospital lay in the students and the research. An ordinary, workaday hospital dealt with the steady, awesome responsibilities of medicine. A university hospital did, too—but it also had in its bones the brimming promise of the unknown. Future ERs would see the same tragedies, pain, and grief, unless medical research found better ways of dealing with trauma.

  With a beep her printer started sliding forth the typescript of her case report on Patricia Olin. Machine-translated from her voice code groups, it would probably be ninety-eight percent accurate, requiring only a quick scan. At the moment she did not feel like facing even that.

  Time for a little fun. With a distinct tingle of anticipation, Susan plucked her working n
otebook from its slot in the bookshelf. She used a notebook-style computer that allowed her to write on the screen with a stylus. In an age of marvels, she still liked methods that echoed the jottings she had made as a schoolgirl.

  She “refreshed” her notebook’s memory from the big desktop computer where she kept her permanent records. Disks hummed to each other in their insect drone. Just as the transfer ended, something caught her eye. The systems log-in table, which kept track of her additions and editings, had an entry from two hours ago.

  She had been with patients then, as scheduled.

  Which meant that somehow, somebody had gotten into her files. When they knew she would be doing her rounds with the interns, not running any programs herself.

  She tapped in commands, but there was no trace of what the intruder had done. No files missing. None even edited.

  She sighed in relief. No damage, then. An accident, maybe? Her general directory was open to official additions, as per policy. Some misdirected inquiry from the hospital’s main computer?

  Or maybe not.

  A chilly shiver ran through her. Sour, nauseated anger licked in her belly, a blood-deep, visceral revulsion at the violation of her private records. She gritted her teeth, whispered swear words. With leaden certainty she knew what had happened here. Some cunning snoop had broken in, looked around, and left.

  Who? Why? Not a malicious vandal, or else her data would be scrambled, notes deleted, texts chopped and confused.

  But her files could have been copied, of course. If the intruder wanted to steal her research. Or simply to know what it was.

  Susan felt a gray, sinking dread. Yes—to know what it was.

  She had heard the distant whispers of scuttlebutt about her work. Most of it came because she worked by herself, a woman alone, and didn’t talk shop. There was no one here in her field, after all. But that didn’t stop nasty rumors.

  All the snooper had left was this single footprint in her log-in table. Which meant he was pretty good. Not expert, but good. Any competent technician or physician could have done it. In and out—for reasons she would never know.