The tanker carrying chlorine had ruptured during rush hour and the volatile, dangerous gas was whipping through the crowds as they were trying to evacuate the downtown area. While a lashing wind prevented a chlorine gas cloud from forming, it also increased the area that was affected, turning anyone with pre-existing respiratory difficulties into a probable patient, and creating new patients with respiratory damage and skin burns and a host of other problems.

  Already, Richland had reached capacity. Lexington, Baptist and Providence hospitals were close behind. Because CHC was on the northeast side of town, we weren’t getting chlorine-damaged disaster patients, but those who would ordinarily be sent to the closest trauma center were being diverted to us. The place was packed.

  I pulled on the wrinkled scrub uniform, keeping an eye on the TV in the corner of the lounge. A lot of EDs kept the television on when there was trouble, tuned to CNN, FOX or a local news channel. The media was often a better way to keep up with problems than the communication methods established by homeland security structures.

  I stepped out of the lounge and took a breath, centering myself in the melee of medical personnel. I spotted two surgeons who weren’t on rotation and didn’t have to be here, six respiratory therapists and techs, a lab girl, doctors Farley, Mathews and Benson, and four residents, who kept glancing at the TV with hopeful faces. They wanted to be where the most interesting patients were, which was at every hospital in town but this one. I picked a spot and dove in.

  For two hours, while the crew in the ED continued to grow as more employees checked messages or heard the news and showed up for work, I dumped meds and started respiratory treatments. At some point MacRoper clocked in, and twice, in his guise of Dr. Demerol, ordered meds at the wrong dosage, mistakes caught by assisting nurses. He was limping and complaining about a basketball injury, and he looked as if he had been drinking, though I didn’t detect the smell of alcohol on him. I saw Farley watching MacRoper. It looked as if the doctor’s poor medical practices were drawing the attention of not just the nursing staff, but of his peers. I hoped he wouldn’t be here much longer.

  An EMT arrived in the ED. He had mild burns on his face and one arm, and was so stinky with chlorine that we couldn’t treat him without a wash-down. Surrounded by residents with eager expressions, I doused him in the corner shower. Fully clothed.

  As water gushed over him and down the drain, he gasped, “We were carrying a patient from downtown when there was an accident on I-26. It backed up traffic for miles and sent me and my partner in the other direction.” His throat was raspy and strained with chlorine burns. “Straight back into a cloud of gas. We rerouted and came to you guys,” he said. The cold water brought on chills and his face paled.

  Both paramedics were having difficulty breathing, but their patient was none the worse for wear, having been breathing through an oxygen mask at the time. The fast-thinking paramedics had covered his skin with burn patches, which kept the fumes from damaging his skin, but they hadn’t had enough oxygen or equipment to protect themselves. I turned the EMT over to the residents, who descended on him like locusts.

  As they dragged him from his shower, the TV reporter broke in with news of a young girl’s body found at the foot of the Confederate Monument on the state capitol grounds. Unconfirmed reports said it was Sharon White, the dark-haired child abducted in the most recent Amber Alert. Every medical professional in the Majors went white-lipped at the words.

  On the 911 speakers, we heard ambulance number 718 dispatched to the scene. For a moment there was disbelief in the department, then a cautious optimism. Was a cop at the scene hurt? Had the gas cloud shifted? Or could the girl still be alive? Was it possible?

  Half an hour later, the call came in. 718 had been diverted from the closest hospital. A white female, victim of assault, was being transported to the CHC Emergency Department. A soft cheer went up.

  I looked at Lynnie Bee. Her eyes were angry, and when she saw me watching, her mouth turned down awkwardly. I shrugged in commiseration. Nurses weren’t supposed to react on an emotional level to anything and we were both breaking that cardinal rule. Lynnie took a breath and quickly scanned the cubicles, choosing a patient who was nearly ready to be sent home. Following her lead, I went back to my patient. Lynnie rushed through paperwork and cleared a private room for the arriving ambulance. Our eyes turned often to the TV, both of us silent, hopeful and fearful.

  Just before the ETA was up for the patient being shipped, I said, “I’ll take any patient.” I assumed I wouldn’t be allowed to help with the case, even though I was the only forensic nurse on duty.

  Lynnie touched my hand, silently thanking me for understanding. “Can you take the broken femur?” she asked. I nodded and slipped into the ortho cubicle.

  I was right. The FBI blew in first, Emma Simmons in the lead, her face hard, shoulders bent beneath the weight of the investigation. She pointed at me and said, “That woman is to be kept out.”

  Understanding got squashed like a bug.

  Lynnie’s spine went ramrod straight and she looked from Emma to me and back. Her face was pale, and if anger could be worn, she would have been sheathed in it. “Lady,” she said softly, “you may be in charge in the FBI building and on crime scenes, but you ain’t in charge here. You can ask, but you can’t demand. Now, you want to start over?”

  I knew Lynnie would give in the moment the patient appeared on the scene, putting injuries before turf wars, but until that happened, she was ticked off. I turned back to the patient with the broken femur, hiding a smile.

  “Clearly, you don’t understand, Nurse,” Emma said. “This is a federal investigation. Where’s the doctor in charge?”

  “I’m the senior medical doctor,” Dr. Farley said, stepping out of a cubicle, rubbing his hands together so that the antibacterial wash he’d applied would dry more quickly. “And I’m with Lynnie. You want to start over?”

  Under most circumstances, I found Farley officious, intrusive and annoying. But right now, his supercilious attitude suited me just fine. Emma, however, didn’t like him much. The skin around her mouth went pale. “This is a—”

  “I got that. Which nurse do you want to toss out of here and why?”

  Emma pointed at me. “Her family is under investigation in the matter of the abductions of several underage females.”

  “The Ballerina Doll murders,” he said. “Is Ashlee charged with anything?” When Emma shook her head no, her mouth so tight I thought her lips might shatter and fall off, Farley said, “Then I guess it’s up to us, and Ashlee, whether she’ll be part of the girl’s case or not. Ashlee?”

  “I’m with the patients in four and seven. Lynnie and Claudia are available for the FBI.” I turned to Emma. “And that was decided before you barged in here and started throwing your weight around.” I turned on a heel and went into room seven to push some morphine into the IV line of the patient waiting for an orthopedic surgeon.

  As I worked, the doors blew in, paramedics running a stretcher between them. A patient lay beneath a white sheet. One medic was administering oxygen, holding a mask over the girl’s face. I got a glimpse of her, skin so pale it looked like parchment and purpled with bruises. She was strapped onto a backboard with a cervical collar around her neck. Two IVs were running, but slowly, which hinted that the paramedics feared a head wound. Oddly, I thought I saw blond hair hanging out of the protective padding sandbagged around her.

  Over the protests about physical evidence, Dr. Farley and the nurses pushed the feebs out of the way and went to work. Though I was kept busy, I saw the X-ray arm rocked down for head and chest shots, and caught sight of her stretcher as the girl was shipped to radiology for a CT scan, MRI and other X-rays. She might not be back. From radiology, she could be sent to a room, ending the ED’s participation in her care.

  As she disappeared down the hall, I saw a cop carrying evidence bags jog in the opposite direction. Someone had collected evidence for them. I kicked a gurney in passing. This was a huge thing, for the girl to be found and to be brought here. I wanted to know more. I wanted to be in on the action. I wanted to help, and here I was, stuck on the sidelines, not allowed to participate. Which really ticked me off.

  I was between patients when the girl’s mother raced in. I watched as the woman I recognized from the TV screen was instantly surrounded by law enforcement, both federal and local. Though she was distraught, she seemed the type to hold her own against pushy cops, and I heard her say, “Well, it looks to me like you have the wrong man in custody. Unless she drove herself to the monument.” Which made a lot of sense to me, but seemed to irritate Emma Simmons. I had to admit that pleased me immensely.

  At eight-forty, just as we got the last of the diverted patients admitted or sent home, a call came in about a gang shooting. There were three males down, all with multiple GSWs—gunshot wounds. And all three were coming here.

  The night shift had come in and the day shift was still on duty. No one had gone home. The ED was more than double staffed and we needed every hand. The nurses and techs who had food ate it fast, and the rest of us raced to the nearest vending machine, taking a chance on the day-old sandwiches or making do with a candy bar. I was feeling righteous and went for the sandwich.

  I was finishing up the last bite of a slightly stale turkey-and-cheese when the first ambulance reported in. “This is unit 428,” the voice called over the loudspeaker, “transporting a male, approximate age nineteen, with four large-caliber GSWs, one mid-center chest, the others in limbs. CPR’s in progress. Patient is nonresponsive, BP seventy-five, palpated with chest compressions. Patient is intubated and has two IVs, running Ringer’s Lactate and O negative. Request a surgeon available upon arrival.” All the jargon meant that the patient was close to dead. It would be up to us to get him back among the living and to stabilize him for surgery.

  Dr. Farley called up to the OR for a surgeon. Dr. Christopher handled the EMT call. “O2 sat?” he asked, referring to the oxygen saturation as measured by a fingertip oxygen monitor.

  “O2 sat is eighty-eight and falling.”

  “What is patient’s heart rhythm without compressions?”

  “Patient is asystole without compressions,” the paramedic said.

  Which was bad. No rhythm at all. The teenager was flatlining.

  “Pupil contractions?” Christopher asked, his voice controlled and as sterile as an operating room. His questions were right on target, taking over for Farley who had been on duty for over fourteen hours.

  “Pupils are equal and reactive, but sluggish,” the paramedic said. Which meant that the patient still had some brain function, but it was vanishing.

  “Do we know what caliber of weapon was used?” Christopher asked.

  “Cops stated they have military-style, two-and-three-quarter-inch brass and shotgun-shell casings on the scene.”

  Someone cursed. Two nurses shook their heads. We all knew what that meant. He’d get the best medical care we could give, but the paramedic had just told us that the holes in the patient were too big to plug. The kid was a goner.

  Just before the gunshot victim arrived, I caught a glimpse of the monument girl, her head free of the sandbags and resting comfortably on the stretcher, eyes closed. Lynnie Bee slashed a final line on her paperwork and handed the young girl over to a transport crew. Pointing, she directed them to the hallway and the crew shuttled the cops and family out the door, just as the stretcher bearing the first GSW was brought in.

  17

  T he kid was stripped to his Skivvies and was so smeared with blood, it looked as if he’d been finger-painted in bright red by a dozen preschoolers. He was receiving chest compressions and being bagged with oxygen through a tube into his bronchial tubes. The paramedics wore PPEs—personal protective equipment—but large patches of bloody skin showed on both, where the blue and white plastic and cloth had been shoved aside in the heat of the moment.

  I sucked down the final swig of a Diet Coke, washed my hands with fast-drying alcohol and slid into a trauma gown and gloves. The kid was going to need more IVs and a lot of luck. I spotted what might have been a vein—if the kid had had any blood to fill it—on the left arm, proximal to the one in his hand, and reached for an IV kit.

  Dr. Christopher took one look at the patient and turned him over to a general surgeon standing nearby. “He’s all yours, Will.”

  “Gee, thanks,” the surgeon said. “Why didn’t I leave when my wife called me an hour ago? Let’s get a femoral line in, push some blood and get me a BP. And, Ash?” I looked up. “See which thoracic guy is on call.”

  “That guy would be me,” a tiny woman said, halting me as I reached for the phone. She was from India and barely five feet, making her even shorter than I. She was round all over, from her apple cheeks and cherry-shaped nose to her pregnant belly and swollen feet. Dr. Ishwandara, Dr. Ish to patients and medical personnel alike, took over. “Do we have an exit wound?”

  “Not in the torso,” the paramedic said, stripping out of gloves and a bloody trauma suit to reveal the uniform beneath. “Just the widespread pattern of the chest wound. The one on his arm took out a hunk of muscle and tendon. But he has two big mothers from the entrances and exits on his left leg. We got them all packed down but it’s gonna take a miracle to save it.”

  “Kit?” Dr. Ish demanded, the fingers of her left hand over the patient’s femoral artery.

  “You sure you up to this?” the general surgeon asked, staring at her belly

  “You can assist, if you will,” she said. “Put in this line?”

  “Sure.” He held out a hand for the kit and Ish stepped aside.

  “Got another line started, right jugular,” Lynnie said, dropping a long needle into the sharps container and sweeping trash to the floor, clearing the bed.

  I had started another line in the antecubital site, at the left elbow vein, and got a flashback of blood in the Jelco. I inserted the plastic sheath and said, “Here, too. Want blood started?”

  “Yes,” Ish said, taking a glance at the general surgeon working at the femoral site. She placed her stethoscope on the kid’s chest. “Stop compressions,” she said, listening. Everything stopped, even the steady hands of the surgeon.

  Someone dropped a chilled bag of blood into my hand as I tore tape to hold the line in place, ready to hook up a unit of blood. Someone else took the bag and slid it into a special sleeve that pumped blood through the line and into the kid’s arm faster than normal.

  “Begin compressions. Let’s get him upstairs, stat,” Ish said, sliding a stool over. “Can you give me a boost?” Every eye in the cubicle went to her. “I can’t see what I need to see. Boost me up there.” She pointed at the kid and placed one foot on the stool. The paramedic who had stripped down to his uniform picked her up and set her atop the patient on the stretcher. She was straddling his abdomen, her weight on her knees, her lower legs and feet close to his body, resting in his blood. The paramedic’s face turned bright red, but Dr. Ish was too busy to notice. She was palpating the boy’s chest and abdomen.

  She paused a moment to look up. “Why are we still here, please? Go!”

  Lynnie slammed the brake off with her foot and four of the gathered crew pushed the stretcher toward the bank of elevators, Dr. Ish atop the patient for the ride. They passed the next two stretchers on the way in.

  “I got this one,” a voice said. Olivia, an RN I had worked with several times and who knew her stuff, grabbed the one spurting the most blood and I got ready to take the other. The teams split, with Livy’s group applying pressure, starting additional IVs and beginning basic life support, and mine starting neuro checks and assessments.

  My PPEs were soiled, so before I could do anything, I stripped and redressed, tossing the bloody gown into a corner, washing and re-gloving as I looked over my five-man crew. I’d be team leader over Amy, an RN, Fred, an LPN, Sheldon, a tech, Willie Mae, the patient rep, plus Dr. Christopher and me. We were all well trained and no newbies. Good. They were already giving overlapping reports, voices colliding and sharing.

  “BP’s one-forty over ninety-seven,” Fred said.

  “Pulse ninety. Hey, kid, you been running a marathon?” Sheldon asked. “What day is it?”

  “Tuesday. I’m hurting,” the kid said.

  “O2 is ninety-nine,” Fred said.

  “No kidding. I’d be hurt, too, if I got shot with a military round.” Sheldon continued with the banter. “What’s your name, marathon man?”

  “We got two wounds, in and out, midline, right side, but the exit is a doozy,” one of the paramedics who had stabilized and transported the patient said. He was letting us know that the wound was worse than it appeared from the front.

  “Elroy Littlejohn,” the patient said. “Can I have something for pain?”

  “Elroy Littlejohn?” I leaned in. He had pasty skin and pale hair, glasses, khakis cut half away, brown lace-up shoes still on his feet and a laptop clutched under one arm. If it hadn’t been for the kid’s blood-smeared chest, he’d have been a poster boy for geek. I knew him. He’d gone to classes with Jasmine last year. “Hi, El. It’s Ashlee. Miz Davenport. Jas’s mom.”

  “Oh. Mamash. Right?” Tears started to fall as he recognized me, and his skin went a shade paler. He reached out and I caught his hand. “Help me,” he begged, panic in his eyes.

  “We’re helping you, kiddo,” I said. To the patient representative, Willie Mae, I said, “USC student.” She nodded, understanding that we might have a patient who was legally a minor. To El, I said, “Let me put your laptop over here, where it’ll be safe.”

  He hesitated. Bloody fingers tightened with spastic reflex, relaxed and slid away. I put the laptop on the counter. “Take care of it, okay?” he said, his eyes acquiring the glassy stare of shock.