This book represented a significant challenge to me because I had never before written a book in which children figured so prominently. Children mystify me on many levels, and I wasn't at all certain that I could write one believably. I'm very fortunate that one of my beta readers and her partner have two children who served as consultants for this work. Emma, their daughter, provided inside information on the pivotal role of soccer for many families (as well as invaluable information on the general nature of life as viewed by a teenager). Wally, their son, is slightly closer to Arly's age, and by the time I finished writing this book, I was convinced that my character was channeling him. Thank you, Eva, Jenny, Wally, and Emma, for providing a wonderful model of today's family, and for answering my endless questions regarding "how do children think?"
As always, I wish to thank my other beta readers, Athos, Denise, Diane, JB, Paula, and Tomboy, for taking time out of their busy lives to read, comment upon, and encourage my work. Laney Roberts and Stacia Seaman once again provided expert editorial assistance and guidance, making this a better book as a result.
The cover is a compilation of several photographs that once again Sheri, with her unique artistry and skill, has crafted into a seamless whole that speaks eloquently to the heart of the story.
This cover is also special in that the wedding rings are mine and Lee's.
RADCLY f FE
Q uinn Maguire stopped just inside the sliding double glass doors of the emergency room. It was only the second time she'd been there, but it already felt like home. Hospitals everywhere were very much the same—the same drab tiled floors, the same muted color schemes in bland institutional shades, the same stark undercurrent of loss and despair, perceptible beneath the thin veneer of hospitality and welcome. With a brief glance, she swept the admissions area to her left, noting the solitary clerk with her head bent over a computer screen and two patients, both of whom looked to be half asleep, waiting in the unadorned area beyond. A television, perched high in one corner with the volume turned down low, was tuned to CNN.
Hitching up her leather backpack and mentally squaring her shoulders, Quinn walked down a corridor that was just wide enough for two stretchers to pass. She nodded to a lone man in khaki work clothes who was buffing the floor with an electric polisher and turned into the nurses' station that occupied the center of the emergency room proper. Despite the fact that PMC, the Philadelphia Medical College, was one of five major university hospitals in the metropolitan area and the only one in the Germantown-Mount Airy section, the emergency room had an abandoned air at just after six on that Monday morning.
The few hours on the cusp between the end of the weekend and the beginning of the workweek tended to be the quietest time of all in the ER. The night nurses were finishing their paperwork and getting ready for the change of shift, the residents were running down lab and x-ray results before turning over their patients to the incoming teams, and the attending physicians were catching a couple hours' sleep in their on-call rooms.
Quinn scanned the area to orient herself in the unfamiliar space. The patient cubicles were arranged in a U-formation around three sides of the central workstation, a large open area enclosed by waist-high counters. Inside were computers, fax machines, racks of patient charts, drawers containing all manner of forms, and nooks for the staff to complete paperwork. At the moment, the curtains were closed on several of the adjacent examining rooms, suggesting that there were patients inside awaiting final treatment determinations, and the faint beep of an EKG monitor marked time somewhere in the background. A lone resident-—or possibly an older-than-average medical student—sat behind the counter making notes in a chart.
Quinn approached and leaned her hip against the edge of the long narrow countertop. The woman looked up, a question in her eyes.
For just an instant, Quinn hesitated. The nearly ubiquitous emergency room uniform of scrub shirt and pants tended to reduce everyone to gender-neutrality, but not this woman. Nothing could diminish her singular presence. Her almost carelessly layered collar-length hair, a lustrous mixture of golds and browns and a whisper of red, framed a face remarkable for sun-kissed skin, deep brown eyes, and perfectly balanced features. Despite the attractive picture of delicately arched brows, finely etched cheekbones, and full, ripe lips, it was the sharp intelligence in the inquisitive gaze that captured Quinn's attention and drew her in.
"Can I help you?" Honor Blake asked again, her eyes quickly scanning the woman's open-collared pale blue cotton shirt and jeans as she attempted to place her. Not a patient—she would have remembered. Certainly the chiseled features, blazing blue eyes, and jet-black hair formed a visage not easily forgotten, but Honor drew a blank. She suddenly found herself being boldly appraised, and that not only surprised but annoyed her. "I'm sorry. This is a restri—"
"I'm Quinn Maguire," Quinn said quickly, extending her hand with a grin. "A new ER attending. Maybe you can show me the locker—"
Before she could finish her sentence, a shout from the hall caught the attention of both women. They turned as two EMTs careened into the ER pushing a gurney.
"GSW to the chest, pressure's 40 palp," the first EMT yelled.
Rising quickly, Honor pointed. "Put him in trauma one."
"Where's your attending?" Quinn demanded sharply as they sprinted behind the stretcher.
"He just lost his pulse," the second EMT announced breathlessly, "Shit. He's flatline."
"Never mind," Quinn snapped to the resident as she grabbed sterile gloves and a mask from a cart just inside the procedure room. She tied on the mask, ripped open the package of gloves, and pulled them on. "Just find me a thoracotomy set and open it."
Two nurses and a wild-eyed medical student ran into the room, pulling on gloves, and instantly began the choreographed trauma routine without need of instruction. One nurse immediately cut off the patient's clothing, the other hung a fresh bag of normal saline and ran it wide open, and the student collected blood specimens in multicolor, rubber-topped vials.
"Can you handle tubing this guy?" Quinn asked, sparing the other doctor a quick glance as she poured Betadine directly from the bottle onto the patient's chest. "Or do you want me to? You need to be quick."
"I've got it," Honor replied evenly. She picked up the curved laryngoscope, which resembled a thin flashlight with a right-angle extension, from a cart beside the stretcher, slid it deftly into the unconscious man's throat, and followed with a plastic endotracheal tube that she passed between the vocal cords and into the trachea. It took her less than ten seconds to complete the maneuver and attach the breathing tube to a ventilator.
"Nice," Quinn grunted.
"Linda," Honor said to the nurse beside her, "get me some morphine and succinylcholine, will you?"
"Sure." The nurse, a small trim blond, cast a curious look in Quinn's direction and raised an eyebrow.
Honor muttered, "New attending."
"Ah," was all the nurse said as she drew up the drugs and passed the syringes to Honor, who then injected them into the IV line.
"Pressure?" Quinn asked as she reached for the number-ten scalpel.
"Nothing," one of the other nurses replied.
"Okay, then. Somebody call and get some blood down here stat." As she spoke, Quinn placed her left hand on the chest with her fingers palpating the fourth and fifth ribs just below the man's nipple and cut a long incision in the space between them directly into the chest cavity. She was about to ask for the rib spreaders when they appeared in her field of vision. "Thanks."
"No problem," Honor murmured as she peered over Quinn's shoulder. "Linda, hand me the suction, please."
Honor cleared the clots from around the heart and watched as Quinn used scissors to open the pericardium, the dense fibrous covering around the heart. She'd seen a lot of surgeons do the same maneuver and had done it herself, but she couldn't remember ever seeing anyone's hands move so quickly or so well. "Tamponade?"
Cardiac tamponade was a condition in which the heart was unable to pump effectively because it was being compressed by a collection of blood or fluid inside its own containing cover.
"Looks like it," Quinn replied, gratified to see the heart start to beat. She slid her fingers underneath the left ventricle and carefully turned the heart. "And a big mother of a hole back here, too."
"Pressure's coming up," a voice announced.
"Not for long, not unless we get this bullet hole closed up." Quinn never took her eyes off the beating organ in her hand. She never looked away from the field when she was operating, because it broke her concentration and cost her several seconds of precious time to refocus on the wound. She held out her right hand and hoped to hell that someone there knew something about surgery. "I need a three-0 silk on a taper needle. That's a—"
Miraculously, it appeared in her hand.
Very smart resident.
As she placed a purse-string suture in the muscle around the hole in the left ventricle, she heard the mellifluous alto voice behind her tell the nurses to call the OR and alert the chest surgeons that there was a patient coming up who might need bypass.
"Did it hit the hilum?" Honor asked, referring to the vessels behind the heart that supplied blood to the lungs. She noted the perfect placement of the sutures and the slick, economical way that Quinn handled the instruments.
She's an incredible surgeon.
"Don't think so." Carefully, Quinn tied down the suture, hoping as she always did at this point that the muscle would hold and not shred as the knot was tightened. "Can you get a chest tube in and hooked up to suction?"
"It's ready to go as soon as you get that bleeding stopped."
Quinn straightened and met the appraising brown eyes. Behind her mask, she grinned, flushed with success. "My part's all taken care of, Doctor. Now let's see how you do."